Timor-Leste has one of Asia’s highest child mortality rates, but skilled birth attendants provide an answer. Find out how UNICEF is training birth attendants to prevent tragedies in some of Timor-Leste’s most rural and under-resourced villages.
GLENO, TIMOR-LESTE : In the small maternity room at the back of the Gleno Community Health Centre, rural Timor-Leste, 23-year-old Deolinda de Deus Maia sits with her newborn baby bundled on her lap. The baby sleeps peacefully, with closed eyes barely visible under a soft woollen beanie.
“How old is he?”
“Born last night,” she replies, with a tired smile.
It’s the first child for Deolinda and her husband, who stands proudly by his wife’s side at her hospital bed. They’re clearly thrilled with the healthy boy, and Deolinda is recovering well from the birth. Looking at the family, you wouldn’t believe how close they could have come to something else.
“Two days ago, I got suddenly sick,” Deolinda explains. “So, I called the midwife to help me.”
On the midwife’s advice Deolinda went to the health clinic at Railaco, a semi-rural town approximately halfway between Gleno and the country’s capital city, Dili, but the electricity at the clinic was out and they sent her to Gleno Community Health Centre instead, where she safely delivered the baby boy.
“I wanted to deliver my baby here because sometimes it is difficult at home, and they can help me in the hospital,” Deolinda says, referring to the common practice in Timor-Leste of delivering babies at home. It’s estimated that 52 per cent of Timorese women give birth at home, and each woman can expect to birth on average seven or eight children.
When you ask a mother in Timor-Leste how many children she has, she’ll tell you the number, and then explain how many of them have passed away. Timor-Leste’s infant mortality rate is among the worst in Asia – one in 46 children dies during the first 28 days of life. Many mothers in the largely rural country are disadvantaged by service concentration in municipality capitals.
A skilled solution
Access to skilled birth attendants is essential for eliminating preventable maternal and child death. UNICEF is supporting the Ministry of Health by providing training to the birth attendants in rural areas of Timor-Leste required to help mothers like Deolinda. The training includes training on newborn care, antenatal care and family planning, so that birth attendants can skilfully and safely deliver babies in some of Timor-Leste’s most remote and under-resourced areas.
“The training is good,” says Paulina Fernandes da Costa (48), a cheery midwife who has been working in Gleno since she finished nursing school in 1994. She’s one of eight midwives at the clinic, and estimates the staff assist with three births every day.
“The training increases our capacity and knowledge, and make it more comfortable for the patients who come to the clinic,” she says. “When they come in for a consultation, we do counselling, five times in the nine months, and give explanations of what’s happening when. We tell them what can affect their pregnancy, and suggest they get help in clinics close to their homes.”
Delolinda confirms she received counselling support from a midwife and had check-ups at four and seven months of pregnancy. She will return to the clinic next month for the baby’s immunisations.
Challenges in accessing medical services
Jose de Carvalho, 65, is the director of Gleno clinic, and had worked in health care and education in the region since 1977. He says the distances expecting mothers must travel is a huge challenge for women in accessing the services of skilled birth attendants.
“Now, we have the women’s contact numbers, and can call them,” he says. “But in the past, they just had to walk to the Health Centre.”
He says the Health Centre’s catchment area stretches to include two villages very far from Gleno, but confirms that after receiving UNICEF-supported skilled birth attendant training, the two sites can receive patients for consultations, ensuring women from these areas don’t have to make the long journey to Gleno.
But it’s not just distances preventing women from accessing skilled birth services.
“We see in the communities that people just use their own consciences, their own thoughts, and they just guide themselves,” says Jose, explaining how clinic staff use counselling sessions to explain the importance of attending the clinic to women.
“And culture also sometimes has an impact. For example, if a woman lives far from the hospital, her mother may say, ‘don’t go to the clinic, it’s too far away.’ But there’s an enormous risk in the home.”
Young mothers taking the lead
Twenty-five year old Elsa dos Santos is determined not to have this happen to her. She lives down the road from the Gleno Health Centre, and says all three of her children, including her week-old baby, were born in the clinic.
Did anyone in her house suggest that she should give birth at home?
“I don’t want to!” she exclaims, immediately. ‘They’re not preoccupied with this. I don’t want them to stop me if I feel like I want to go.”
No one in the house challenged Elsa’s decision, and you’d now wonder if another baby will ever be born in this house down the hill from the health centre ever again thanks to her conviction.
Elsa’s neighbour, 37-year-old Jacinta da Costa Brites, agrees that the Health Centre is safer, but says she’s chosen to give birth to three of her five children at home when she knows someone’s around and she has support. Two of her children were born in the Health Centre up the hill.
“Don’t do it alone,” she cautions, quickly. “It’s not safe alone.”
With the support of UNICEF and the commitment of skilled attendants like Paulina and her colleagues, Timor-Leste is working towards a future where new mothers across the country will never be alone or unsupported in delivering healthy babies.