The DHS, the first comprehensive assessment of the demographic, health and nutrition status of the population after independence, was carried out under the country's Second Health Sector Rehabilitation and Development Program. The US$ 12.6 million Program is funded by the multi-donor Trust Fund for Timor-Leste which is administered by the World Bank. This Survey aims to provide the data needed to develop critical health services including reproductive, maternal and child health, child spacing and nutrition programs.
The good news in the Survey was the 50% decrease in mortality rates for children under five from 165 deaths per 1000 live births in the period 1989-1993, to 83 per 1000 in the period 1999-2003. Overall, most deaths continue to occur in the first year of life with children living in the highlands having a 28% higher probability of dying before their fifth birthday than those in the lowlands. One reason for the improved survival rates of infants: the steadily rising immunization rates. According to the Survey, 18% of children aged 12-23 months had not received immunisations against any of the diseases, while the same percentage of the children had been immunised against all the diseases. The highest coverage was for polio 0 (77%) and BCG (75%), followed by polio 1 (69%) and DPT 1 (68%).
There has also been steady progress in the number of women receiving ante natal care. Of the mothers who had given birth in the five years preceding the Survey, 61% had received antenatal care from a medical professional: 56% from a nurse or midwife, 2% from an obstetrician and 2% from a general practitioner. The figures reflect overall general improved access to health care facilities in the districts. Currently, 25% of families have to travel two hours or more to reach nurses or paramedics in government health care facilities, mostly from the remote mountain areas.
The DHS is however, notable for the very high level of childbearing for women between the ages of 20 to 35 years: at least one- third of women have a baby in any given year. Birth rates are the lowest in urban areas at 8% and extremely high in the rural east, at 14%. While education, wealth and access to health facilities account for lower birth rates in urban areas, there was remarkably little difference in the fact that the majority of Timorese women want a high numbers of children - half the women who had reached the end of their reproductive years in 2003 having given birth to 5.9 children, of whom 4.9 were still alive, wanted more children
Compared to other countries in the region, there is little knowledge and practice of contraception: 70% of the men interviewed in the Survey failed to recognize any of the contraceptive methods listed while the women were a little more aware of the use of contraceptive pills and injections. The findings also raise concern among aid workers and officials who are spearheading the campaign to prevent the deadly HIV/AIDS virus from taking hold in Timor-Leste. Some 70% of men and 80% of women had no knowledge of the lethal disease and, with only 0.5% of men ever having used a condom, the need to spread AIDS prevention awareness is important.
In sum, the picture presented by the DHS is of a post-war baby boom where the high desire for marriage and children has not yet been affected by falling infant mortality rates, low family incomes or improving access to health care.
For more information please visit www.worldbank.org/tl.
Contacts: in Dili, Luis Sequeira
(670) 723 0554
in Sydney, Elisabeth Mealey