What influences a woman’s decision to access contraception in Timor-Leste? Perceptions from Timorese women and men

Abstract

Timor-Leste's Maternal Mortality Ratio remains one of the highest in Asia. There is ample evidence that maternal deaths may be reduced substantially through the provision of good-quality modern methods of contraception. Many Timorese women wish to stop or delay having children. However, even when health services make contraception available, it does not mean that people will use it. Collaborating with Marie Stopes Timor-Leste, this qualitative research project used decolonising methodology to explore perceived influences contributing to contraceptive choices, and gain insight into how women's decisions to access contraception in Timor-Leste occur. Over two fieldwork periods (2013 and 2015), we used focus group discussions and structured interviews to speak with 68 women and 80 men, aged 18-49 years, across four districts of Timor-Leste. Findings demonstrate that the decision to access contraception is often contentious and complicated. These tensions echo concerns and ambiguities contained within global and national reproductive health policy. Overwhelmingly, participants emphasised that despite her wishes, a woman can only rarely exercise her right to access contraception freely and independently. She is most often constrained by family, cultural, traditional and educational influences.

Key factors deterring women's engagement with skilled birth attendants in three districts of Timor—Leste. A qualitative descriptive study

“…The general lack of privacy and other culturally congruent care provided to women in the health care facilities in Timor Leste is a barrier to women's access. This issue is recognised in previous research in Timor-Leste (HAI, 2015;Wallace et al, 2018;Wild, 2009;Zwi et al, 2015). In addition, there are other international studies which similarly identify the lack of privacy as a relatively widespread problem for women accessing SBA services in many low and middle income countries (Rosen et al, 2015;Srivastava et al, 2015).…”

“…This means the woman does not have access to a SBA. The issue is also identified in other research recently conducted in Timor-Leste (Wallace et al, 2018). Cultural practices and women's perceived lack of social power can impact upon choices of SBA care in other low and middle income countries (Kamblijambi, 2015;Tesfaye et al, 2019).…”

“…The lack of Access to health care facilities are reiterated in a number of previous reports from Timor-Leste (Price et al, 2016;Wallace et al, 2018;Zwi et al, 2009). These are particularly relevant in regional areas where 70% of people are living (NDS, 2010).…”

“…Women's reduced access to family planning information and services is another important manifestation from Timor-Leste's unique cultural contexts. Timorese law and policy environment is supportive of reproductive health education (Cummins, 2017), however, widespread conservative family values and a church-government alliance restricts young Timorese access to sexual and reproductive health information and services including in school curriculum and health service provision (Cummins, 2017;Richards, 2017;UNFPA, 2017;Wallace et al, 2018;Wallace, 2014). This stance ignores the internationally recognised role of reproductive health education in reducing STIs, unwanted pregnancy and delaying sexual debut (Pappa et al, 2013;UNFPA, 2017).…”

An analysis on choices of contraception

“…influences from social media and friends, their partners and religious belief, educational status etc. 2,3 In the TRIO study at Kenya and South Africa uses of daily OCP, monthly injections and monthly vaginal ring were compared and it was found that mean choices for monthly injections were significantly higher [4.3 (SD=1.0)] in compare to the OCP [3.0 (SD=1.3)] and vaginal rings [3.3 (SD=1.4)] (p<0.001); mean choices for vaginal rings were significantly higher than for OCP (p=0.013). 4 Present study is conducted to know what the couples attending our hospital prefer these days.…”