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

FAMILY PLANNING 5
In 2002, the Council of Ministers for Timor-Leste developed and approved the first family
planning policy for the country (MOH, 2004a). Despite the presence of this policy, reproductive
choice remains a relatively new concept for families in Timor-Leste. Findings from the 2009-10
TLDHS suggest that the total fertility ratio (TFR) of 5.7 children per women in Timor-Leste is the
highest in South East Asia and also in Asia, where the rank is shared with Afghanistan (PRB, 2010).
This high total fertility rate has immediate and serious implications for childbearing women and the
health care system. The ability to provide quality reproductive health services will be severely
compromised because existing resources are scarce, and high fertility will only increase these
demands on the system.
According to the International Conference on Population and Development (ICPD) Program
of Action, family planning programs must enable couples and individuals to decide freely and
responsibly the number and spacing of their children; to provide individuals and couples with the
information and means to make these decisions; to ensure informed choices; and to make available a
full range of safe and effective family planning methods (MOH, 2004a).
Family planning continues to be a priority of the National Reproductive Health Strategy
2004–2015. The objectives of the National Family Planning Program are (1) to reduce the population
growth rate gradually by promoting the concept of a small family norm to the population in general
and to the rural population in particular; (2) to increase the availability of and the demand for family
planning services; (3) to provide quality services; and (4) to reduce unmet need for services (MOH,
2004b).
The National Family Planning Program also aims to expand and sustain adequate family
planning services at the community level utilizing all health facilities. To achieve this, family
planning services are being offered at integrated community health service (SISCa) posts. These are
mobile outreach services that provide integrated care, including health promotion, on a monthly basis,
in almost every suco in the country. Health facilities have been encouraged to play a more effective
role in the national family planning program. The Ministry of Health (MOH) plans to train health care
providers in not only the technical and managerial aspects of contraception but also in appropriate
interpersonal communication and counseling skills. Contraceptive services will be provided as part of
primary health care. Advice on natural methods (standard days method and lactational amenorrhea
method) as well as the provision of condoms, pills, and injectables will be provided at the health post
level; implants and IUDs will be available at level two community health centers with beds (CHC-2);
and sterilization will be available at referral hospitals and higher level health centers that have
appropriate equipment and trained staff. Specific strategies will be developed to cover areas of unmet
demand for family planning, particularly for older mothers still of childbearing age.
This chapter evaluates the level of knowledge of various contraceptive methods and discusses
past and current prevalence of use. For users of periodic abstinence (rhythm method), knowledge of
the ovulatory cycle is examined, and for those relying on sterilization, the timing of the method of
adoption is reviewed. Special attention is focused on the source of contraception, informed choice,
non-use, and intention to use contraceptive methods in the future. The chapter also contains
information on exposure to family planning messages through the media, contact with family
planning providers, and a husband’s knowledge of his wife’s use of contraception. These topics are of
practical use to policy and program administrators to formulate effective family planning strategies.
Although the chapter focus is on women, results from the survey of men are also presented because
men play an important role in the realization of reproductive goals. Wherever possible, comparisons
are made with findings from previous surveys in order to evaluate progress in family planning in
Timor-Leste over time.
Family Planning | 59