In 2005, a woman was taken to hospital in Maliana District, Timor-Leste, after experiencing labour pains for three days at home. She delivered a stillbirth and was referred to the national hospital in the capital Dili with complications that needed eight operations. Her husband left her and her family did not visit, but she made a full recovery after five months and now she wants to have another baby.
"This woman is a survivor," trainer and consultant Amita Thapa told her class of midwives at the national hospital in Dili.
The Maliana case study - gruesome slideshow and all - is just one of many Thapa's class will learn about as they go through 15 weeks of emergency obstetric care (EMOC) training based on World Health Organization (WHO) guidelines and supported by the UN Population Fund (UNFPA).
EMOC, which refers to lifesaving services provided by a trained health professional in a well-equipped facility, is vital to Timor-Leste, where maternal deaths number about 380 per 100,000 live births, according to the latest UN and World Bank estimates.
Timor-Leste also has one of the highest fertility rates in the world - an average of 7.8 children per woman and a population of about 1.1 million - and yet according to government statistics, only 37.3 percent of births in 2007 were attended by skilled midwives. Furthermore, about 80 percent of women deliver at home.
Angela Bismark, UNFPA family planning adviser, told IRIN: "Right now the Ministry of Health has SISCa [Servisu Integradu Saude Communitaria, or Integrated Health Service to the Community], which is a community-based initiative to enable maternal health services, integrated management of childhood illness and child services to reach the village level.
"Services include ante-natal and post-natal care, family planning, nutrition, child health services, immunization, hygiene, adult health services and health promotion," she added.
Most maternal deaths are a result of delays in seeking, reaching and receiving medical care, caused by a lack of transport and skilled staff, sub-par health equipment and reliance on traditional practices, with some women favouring a dukun - traditional birthing attendant - over a midwife.
Boosting the numbers
According to the EMOC Needs Assessment Report 2008, the government last year had 231 women listed as midwives. Bismark estimates there are some 400 now, 110 trained for EMOC.
But Timor-Leste needs at least double that number to work in the country's 430 health facilities if it is going to reach its target of reducing maternal mortality by 75 percent by 2015.
"One solution that the Ministry of Health has done is to establish a midwifery school in Dili," said Bismark.
The government aims to have 50 midwives enrolled on the school's three-year course every year, but although training began in 2008, facilities, equipment and the standard of teaching need to be fine-tuned to deliver effective results, she added.
Spreading the word
Thapa's training covers theoretical and practical learning and in a year she educates about seven batches of 15 midwives, most completing one-year courses in basic midwifery.
"After the 15 weeks we have a final assessment and if they are competent enough, we certify them as EMOC service providers," she said.
At the same time, the Ministry of Health is working with NGOs around the country to disseminate information about the importance of maternal health.
One is Health Alliance International (HAI), which has produced two films, one focusing on the benefits of consulting midwives for pre-natal care, deliveries and post-natal services, and another focusing on family planning.
The videos form the basis of educational programmes presented to rural communities in six districts. Between 2003 and 2008, use of skilled birth attendants increased about 15 percent in those districts, while the number of women making at least one ante-natal care visit increased more than 30 percent.
Dominique Freire, HAI country director, said: "With vulnerable populations in rural areas, you have to come up with creative ways of reaching them, especially as the literacy rate is so low [about 50 percent, according to the UN Development Programme]. We used our staff and local people as actors so the communities can connect with what they see in the videos."
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"This woman is a survivor," trainer and consultant Amita Thapa told her class of midwives at the national hospital in Dili.
The Maliana case study - gruesome slideshow and all - is just one of many Thapa's class will learn about as they go through 15 weeks of emergency obstetric care (EMOC) training based on World Health Organization (WHO) guidelines and supported by the UN Population Fund (UNFPA).
EMOC, which refers to lifesaving services provided by a trained health professional in a well-equipped facility, is vital to Timor-Leste, where maternal deaths number about 380 per 100,000 live births, according to the latest UN and World Bank estimates.
Timor-Leste also has one of the highest fertility rates in the world - an average of 7.8 children per woman and a population of about 1.1 million - and yet according to government statistics, only 37.3 percent of births in 2007 were attended by skilled midwives. Furthermore, about 80 percent of women deliver at home.
Angela Bismark, UNFPA family planning adviser, told IRIN: "Right now the Ministry of Health has SISCa [Servisu Integradu Saude Communitaria, or Integrated Health Service to the Community], which is a community-based initiative to enable maternal health services, integrated management of childhood illness and child services to reach the village level.
"Services include ante-natal and post-natal care, family planning, nutrition, child health services, immunization, hygiene, adult health services and health promotion," she added.
Most maternal deaths are a result of delays in seeking, reaching and receiving medical care, caused by a lack of transport and skilled staff, sub-par health equipment and reliance on traditional practices, with some women favouring a dukun - traditional birthing attendant - over a midwife.
Photo: Matt Crook  |
| About 80 percent of women in Timor-Leste deliver their babies at home |
According to the EMOC Needs Assessment Report 2008, the government last year had 231 women listed as midwives. Bismark estimates there are some 400 now, 110 trained for EMOC.
But Timor-Leste needs at least double that number to work in the country's 430 health facilities if it is going to reach its target of reducing maternal mortality by 75 percent by 2015.
"One solution that the Ministry of Health has done is to establish a midwifery school in Dili," said Bismark.
The government aims to have 50 midwives enrolled on the school's three-year course every year, but although training began in 2008, facilities, equipment and the standard of teaching need to be fine-tuned to deliver effective results, she added.
Spreading the word
Thapa's training covers theoretical and practical learning and in a year she educates about seven batches of 15 midwives, most completing one-year courses in basic midwifery.
"After the 15 weeks we have a final assessment and if they are competent enough, we certify them as EMOC service providers," she said.
At the same time, the Ministry of Health is working with NGOs around the country to disseminate information about the importance of maternal health.
One is Health Alliance International (HAI), which has produced two films, one focusing on the benefits of consulting midwives for pre-natal care, deliveries and post-natal services, and another focusing on family planning.
The videos form the basis of educational programmes presented to rural communities in six districts. Between 2003 and 2008, use of skilled birth attendants increased about 15 percent in those districts, while the number of women making at least one ante-natal care visit increased more than 30 percent.
Dominique Freire, HAI country director, said: "With vulnerable populations in rural areas, you have to come up with creative ways of reaching them, especially as the literacy rate is so low [about 50 percent, according to the UN Development Programme]. We used our staff and local people as actors so the communities can connect with what they see in the videos."
mc/ds/mw
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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