Maternal Health Progress in Post-Conflict Timor-Leste
Timor-Leste has a history fraught with political instability and war. After overcoming Portuguese colonization, it gained independence from Indonesia and was declared a new nation in 2002. In 2006, further violence and uprising in the country led to military and humanitarian assistance from overseas. The war destroyed much of the country’s health infrastructure, systems and services, and poverty levels increased dramatically.
Maternal health then and now
The latest Demographic and Health Survey (DHS) for Timor-Leste published in 2017 gives reason for optimism. As a post-conflict state, the maternal mortality ratio (MMR) in Timor-Leste was one of the highest in the world in 2005 at 506 maternal deaths per 100,000 live births in 2005. The MMR among adolescents ages 15-19 was even higher at 1,037 deaths per 100,000 live births. In 2010, the MMR decreased to 317 deaths per 100,000 live births, and by 2015, the MMR was even lower at 215 deaths per 100,000 live births.
Timor-Leste also achieved remarkable progress across several other maternal health indicators between 2010 and 2016 including skilled birth attendance, postnatal care utilization and facility-based delivery.
| Maternal health indicators in Timor-Leste | 2010 | 2016 |
| Percentage of women receiving at least one antenatal care (ANC) visit | 86% | 84% |
| Percentage of women receiving four or more ANC visits | 55% | 77% |
| Percentage of urban vs. rural women receiving four or more ANC visits | 63% vs. 53% | 87% vs. 72% |
| Percentage of deliveries by a skilled birth attendant | 30% | 57% |
| Percentage of deliveries in a health facility | 22% | 49% |
| Percentage of women reporting postnatal check-up within two days | 3% | 35% |
Drivers of progress
In 2010, poor maternal health in Timor-Leste was compounded by high fertility rates, inadequate birth spacing, early onset of childbearing and low contraceptive use and knowledge. These issues were further exacerbated by poor access to health services—particularly antenatal care. Inefficiencies in the health system included a poorly distributed and depleted workforce, a lack of essential medicines and geographical barriers in health service delivery. Conservative cultural and religious beliefs in the devoutly Catholic country also contributed to a slower pace of change, particularly with respect to family planning.
The Ministry of Health in Timor-Leste has since worked diligently to encourage institutional delivery, guaranteeing free health care for all and improving access to health care at referral hospitals, community health centers and, in particular, at rural health posts. The government has actively promoted policies to enhance community engagement, raise awareness of maternal health issues, improve maternal nutrition and streamline family planning services. A recent United Nations study announced Timor-Leste as the world’s ‘most improved’ in the health-related Sustainable Development Goals (SDGs) index.
The government has also effectively engaged with key partners from the World Health Organization, United Nations Population Fund and UNICEF to develop innovative maternal health strategies. Improving the clinical skills of health workers is an active priority, in addition to ensuring that primary health care facilities are well-equipped to provide high quality maternal health care.
Timor-Leste should celebrate its progress in maternal health over the last decade-and-a-half, serving as an inspiring model for other low-income, post-conflict countries to follow. A substantial amount of work remains for Timor-Leste to achieve the maternal mortality targets under the Sustainable Development Goals, but with sustained effort, the country will remain on its path to success.
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Learn more about maternal mortality under the SDGs.
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