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

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about three children more than women in the highest quintile (4.2 births). Unplanned Fertility. Despite a marked increase in the level of contraceptive use over the past eight years, the 2009-10 TLDHS data indicate that unplanned pregnancies are not uncommon. Overall, 86 percent of births are wanted, 12 percent of births in the country are mistimed (wanted later), and 2 percent are unwanted. Data from the 2003 DHS show that there has been little change in the status of planning for children, with 86 percent of births in the five years preceding the survey planned and 11 percent mistimed. Unwanted births declined from 4 percent in 2003 to 2 percent in 2009-10. Fertility Preferences. There is considerable desire among currently married Timorese to control the timing and number of births. Thirtyfive percent of currently married women would like to wait two or more years before the next birth, and 36 percent do not want to have another child, or are sterilized. About one in ten (9 percent) of currently married women would like to have a child soon (within two years). In addition, 17 percent are undecided about whether to have a child or not. The proportion of currently married women who want no more children more than doubled in the last seven years, from 17 percent as reported in the 2003 DHS to 36 percent in the 2009-10 TLDHS. Currently married women and men prefer about six children. Data from the 2003 DHS show that the ideal number of children preferred by currently married women has changed little over the last seven years. FAMILY PLANNING Knowledge of Contraception. Findings from the 2009-10 TLDHS show that 78 percent of currently married women and 66 percent of currently married men in Timor-Leste know of at least one modern method of family planning. The most widely known modern contraceptive methods among currently married women are injectables (70 percent) and the pill (58 percent). Currently, married men are most likely to know of the male condom (54 percent) and injectables (46 percent). Twenty-seven percent of currently married men mentioned knowledge of a traditional method compared with 22 percent of currently married women. xxiv | Summary of Findings Over the past seven years there has been a considerable increase in the overall knowledge of contraceptive methods in the country. Use of Contraception. More than one in five currently married women (22 percent) is using a method of family planning, with 21 percent using a modern contraceptive method. This indicates that modern contraceptive methods are highly favored over either natural family planning methods or other traditional methods. One percent of women report currently using a traditional method. The rhythm method is slightly more popular than withdrawal. Injectables are by far the most popular modern method, and they are used by 16 percent of currently married women. Two percent of women use the pill, and about 1 percent of women each use the IUD or implants, or they are sterilized. Most women who are sterilized are over age 30. Injectables are popular among women age 20-44. Trends in Contraceptive Use. There has been a marked increase in the use of contraception by currently married women since 2002. Use of modern methods doubled in the five years between 2002 and 2007 and rose by nearly 50 percent in the three years between 2007 and the 2010. The increase in use of modern methods contributed to a three-fold increase in overall contraceptive use, from 7 percent to 21 percent, in a matter of 7 to 8 years. Differentials in Contraceptive Use. Women in urban areas (30 percent) are more likely to use a family planning method than rural women (20 percent), reflecting wider availability and easier access to methods in urban than in rural areas. 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). Current use varies markedly between women who have some education and those who have none, however, there is little variation among educated women by specific level of education. 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.
Source of Modern Methods. Forty-five percent of all users are served by community health centers, 20 percent by health posts, 17 percent by government and referral hospitals, 3 percent by integrated community health services (SISCa), and 2 percent by mobile clinics. In the private medical sector, most users are served by private hospitals/clinics (8 percent of all users). Most contraceptives sold in private hospitals/ clinics are provided through the Timor-Leste Contraceptive Retail Sales Company. Unmet Need for Family Planning. About one in three currently married women has an unmet need for family planning, with 21 percent having an unmet need for spacing and 10 percent having an unmet need for limiting. Twenty-two percent of women have a met need for family planning. If all currently married women who say they want to space or limit their children were to use a family planning method, the contraceptive prevalence rate would increase to 53 percent from the current 22 percent. Currently, only 42 percent of the family planning needs of currently married women are being met. MATERNAL HEALTH Antenatal Care. Antenatal care from a skilled birth attendant, that is, from a doctor, nurse, midwife, or assistant nurse, is very common in Timor-Leste, with 86 percent of women reporting receipt of such care. The majority of women received care from a nurse or midwife (80 percent). Four percent of women received care from a doctor, and less than 2 percent received care from an assistant nurse. One percent of women received care from a traditional birth attendant. Thirteen percent of women did not receive care from a health provider for their last birth in the five years preceding the survey. Antenatal care from a skilled provider is lowest in Ermera (71 percent) and highest in Dili (96 percent). There has been a significant improvement in the proportion of women receiving antenatal care from a skilled provider—an increase of 41 percent, from 61 percent in the 2003 DHS to 86 percent in the 2009-10 TLDHS. Neonatal tetanus is a leading cause of neonatal death in developing countries where a high proportion of deliveries occur at home or in places where hygienic conditions may be poor. Tetanus toxoid (TT) vaccinations are given to pregnant women to prevent neonatal tetanus. The survey results show that three-quarters of mothers with a live birth in the five years preceding the survey received two or more tetanus toxoid injections during their last pregnancy, and four-fifths were protected for their last birth. Mothers in Manatuto are most likely to have received two or more tetanus toxoid injections (92 percent) and to have had their last birth protected against neonatal tetanus (95 percent) compared with mothers in all other districts; tetanus toxoid coverage is lowest among mothers in Ermera and Ainaro. With regard to antimalarial indicators, the results show that overall, 39 percent of all women and 45 percent of pregnant women slept under some sort of net the night before the interview. Thirty-seven percent of all women and 43 percent of pregnant women slept under an ever-treated net, and 34 percent and 41 percent, respectively, slept under an ITN. In households that own at least one ITN, a substantially larger proportion of women slept under an ITN the night before the survey (77 percent of all women and 84 percent of pregnant women). Delivery Care. Just over one in five births are delivered in a health facility, with the vast majority delivered in a public (21 percent) rather than in a private (1 percent) facility. The majority of births (78 percent) are delivered at home. Delivery in a health facility is most common among young mothers (25 percent), mothers of first-order births (31 percent), and mothers who have had at least four antenatal visits (31 percent). Half (53 percent) of the children in urban areas are born in a health facility, compared with only 12 percent in rural areas. Delivery in a health facility also varies by district, with facility delivery in Dili being much more likely than in any other district (63 percent). Less than 10 percent of births in Ermera, Oecussi, and Ainaro are delivered in a health facility. Thirty percent of births are delivered by a skilled provider (doctor, nurse, assistant nurse, or midwife), with a nurse or midwife being the most common skilled provider. Three percent of deliveries are performed by a doctor, and less than 1 percent are performed by an assistant nurse. Nearly one-fifth of deliveries are carried out by traditional birth attendants (18 percent). Women receive assistance from a relative or some other person for nearly one in two births (49 percent), while 3 percent of births take place without any type of assistance at all. Summary of Findings | xxv
Page 1 and 2: Timor-Leste Demographic and Health
Page 3 and 4: CONTENTS TABLES AND FIGURES .......
Page 5 and 6: CHAPTER 7 FERTILITY PREFERENCES 7.1
Page 7: 14.8 HIV/AIDS-related Knowledge and
Page 10 and 11: x | Tables and Figures CHAPTER 4 FE
Page 12 and 13: xii | Tables and Figures Table 11.4
Page 14 and 15: xiv | Tables and Figures Table 16.4
Page 17: FOREWORD The 2009-10 Timor-Leste De
Page 21: CONTRIBUTORS TO THE REPORT Elias do
Page 26 and 27: Postnatal Care. The majority of wom
Page 28 and 29: However, the level of chronic energ
Page 31 and 32: MILLENNIUM DEVELOPMENT GOAL INDICAT
Page 33 and 34: INTRODUCTION 1 1.1 HISTORY, GEOGRAP
Page 35 and 36: The government of Timor-Leste has l
Page 37 and 38: 1.5 ORGANIZATION OF THE SURVEY The
Page 39 and 40: 1.8 HEMOGLOBIN TESTING In one-third
Page 41: In these households, 13,796 women w
Page 44 and 45: Table 2.1 Household population by a
Page 46 and 47: The percentage of children not livi
Page 48 and 49: The Early Childhood Care and Educat
Page 50 and 51: Table 2.4.2 Educational attainment
Page 52 and 53: The GAR at the primary school level
Page 54 and 55: ate (2 percent) than their rural co
Page 56 and 57: water. Thirty-six percent of househ
Page 58 and 59: The type of flooring material used
Page 60 and 61: Table 2.11 Wealth quintiles Percent
Page 63 and 64: CHARACTERISTICS OF RESPONDENTS 3 Th
Page 65 and 66: Table 3.2.1 Educational attainment:
Page 67 and 68: Table 3.3.1 Literacy: Women Percent
Page 69 and 70: Table 3.4.1 Exposure to mass media:
Page 71 and 72: Table 3.5.1 Employment status: Wome
Page 73 and 74: 3.4.2 Occupation Respondents who we
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3.4.3 Earnings, Employers, and Cont
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Tables 3.8.1 and 3.8.2 show the per
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Table 3.9.1 Use of tobacco: Women P
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FERTILITY 4 One of the major object
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Table 4.2 Fertility by background c
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calculated in the 2003 DHS follows
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of primary sterility. In Timor-Lest
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Table 4.8 Median age at first birth
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FAMILY PLANNING 5 In 2002, the Coun
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According to the 2003 DHS, knowledg
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Table 5.3.1 Ever use of contracepti
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Table 5.4 Current use of contracept
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Table 5.5 Current use of contracept
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Use increases with parity but with
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Female and male sterilizations are
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Table 5.10 Future use of contracept
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Table 5.13 Exposure to family plann
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Table 5.15 Husband/partner’s know
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6.2 POLYGYNY Polygyny (the practice
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20.9 years. Although the proportion
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84 | Other Proximate Determinants o
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Table 6.7.1 Recent sexual activity:
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There is little difference in the p
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2 percent among women age 30-34 to
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92 | Fertility Preferences Table 7.
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94 | Fertility Preferences 7.3 NEED
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96 | Fertility Preferences an idea
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98 | Fertility Preferences The perc
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with their death, or they may live
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100 80 60 40 20 102 | Infant and Ch
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104 | Infant and Child Mortality Ta
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8.7 HIGH-RISK FERTILITY BEHAVIOR Th
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ADULT AND MATERNAL MORTALITY 9 The
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9.2 ADULT MORTALITY Table 9.3 Sibsh
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MATERNAL HEALTH 10 Making Pregnancy
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among women in the lowest wealth qu
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A much lower percentage of Timorese
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Table 10.5 Knowledge of danger sign
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10.6.2 Assistance during Delivery O
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Table 10.8 Knowledge of danger sign
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Table 10.10 Application of material
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Table 10.12 Timing of first postnat
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Where health services are present,
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CHILD HEALTH 11 This chapter presen
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In the TLDHS, information on vaccin
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Boys (54 percent) are somewhat more
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The data indicate that two percent
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11.6 DIARRHEAL DISEASE Dehydration
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Table 11.8 Diarrhea treatment Among
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Ten percent of children with diarrh
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There are marked differences in the
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international reference population
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80 Percent 70 60 50 40 30 20 10 150
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60 50 40 30 20 10 152 | Nutrition o
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Table 12.2 shows the percentages of
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100 Percent 90 80 70 60 50 40 30 20
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Table 12.5 Foods and liquids consum
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Table 12.6 Infant and young child f
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Table 12.7 shows the percentage of
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the most recent distribution preced
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Table 12.10 Nutritional status of w
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Table 12.12 shows data on micronutr
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12.12 PREVALENCE OF ANEMIA IN WOMEN
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MALARIA 13 Malaria remains a leadin
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13.1.2 Use of Mosquito Nets by Chil
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Tables 13.3 and 13.4 show the perce
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The highest prevalence of fever is
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HIV/AIDS-RELATED KNOWLEDGE, ATTITUD
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percent of women and 61 percent of
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person who has AIDS or by sharing c
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Comprehensive knowledge about AIDS
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HIV or AIDS on all four indicators
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Table 14.6 Payment for sexual inter
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14.5 MALE CIRCUMCISION Male circumc
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In the 2009-10 TLDHS, women and men
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100 Percent 80 60 40 20 0 64 Total
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14.8.2 Age at First Sex and Condom
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To assess the extent of condom use
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WOMEN’S EMPOWERMENT AND DEMOGRAPH
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Table 15.2.1 Control over women’s
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Table 15.2.2 Control over men's cas
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Table 15.4.1 Women’s participatio
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Table 15.5.1 Women’s participatio
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15.5 ATTITUDES TOWARD WIFE BEATING
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Table 15.6.2 Attitude toward wife b
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Table 15.7.1 Attitude toward refusi
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Women’s empowerment is closely as
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Table 15.8 Indicators of women’s
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pathways: its negative association
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DOMESTIC VIOLENCE 16 In the words o
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partner] hit, slapped, kicked, or d
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Table 16.1 Experience of physical v
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Among women who have never been mar
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who experienced sexual violence fir
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Domestic violence is not limited to
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Table 16.8 Forms of spousal violenc
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Table 16.9—Continued Emotional vi
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Table 16.10 Spousal violence by hus
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16.14 Physical Violence by Women ag
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16.15 HELP-SEEKING BEHAVIOR OF WOME
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16.17 SOCIAL NORMS AND VALUES The f
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REFERENCES Acharya, M. 2010. Effort
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Ministry of Health (MOH) [Timor-Les
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World Health Organization (WHO), Wo
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256 | Appendix A during the populat
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A.5 SURVEY RESULTS 258 | Appendix A
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ESTIMATES OF SAMPLING ERRORS Append
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Table B.1 List of selected variable
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Table B.3 Sampling errors for Urban
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Table B.5 Sampling errors for Aileu
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Table B.7 Sampling errors for Bauca
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Table B.9 Sampling errors for Coval
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Table B.11 Sampling errors for Erme
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Table B.13 Sampling errors for Liqu
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Table B.15 Sampling errors for Manu
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Table B.17 Sampling errors for Viqu
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282 | Appendix C Table C.2.1 Age di
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284 | Appendix C Table C.5 Reportin
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286 | Appendix C Table C.7 Nutritio
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PERSONS INVOLVED IN THE 2009-10 TIM
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Martinho da Costa Cesaltina Falcao
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QUESTIONNAIRES Appendix E Appendix
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296 | Appendix E Introduction and C
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IF AGE 15 IF AGE 0-17 YEARS IF AGE
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300 | Appendix E HOUSEHOLD CHARACTE
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302 | Appendix E NO. QUESTIONS AND
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306 | Appendix E WEIGHT, HEIGHT AND
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308 | Appendix E WEIGHT, HEIGHT, AN
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310 | Appendix E
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312 | Appendix E INTRODUCTION AND C
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314 | Appendix E SECTION 2. REPRODU
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212 316 | Appendix E 213 214 215 21
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326 | Appendix E LAST BIRTH NEXT-TO
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350 | Appendix E LAST SEXUAL PARTNE
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352 | Appendix E SECTION 7. FERTILI
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356 | Appendix E SECTION 8. HUSBAND
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362 | Appendix E SECTION 10. OTHER
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364 | Appendix E SECTION 11. MATERN
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366 | Appendix E SECTION 12. DOMEST
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372 | Appendix E INSTRUCTIONS: 2 04
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374 | Appendix E INTRODUCTION AND C
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376 | Appendix E SECTION 2. REPRODU
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378 | Appendix E SECTION 3. CONTRAC
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380 | Appendix E 311 Where is that?
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386 | Appendix E SECTION 5. FERTILI
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388 | Appendix E SECTION 6. EMPLOYM
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390 | Appendix E SECTION 7. HIV/AID
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