By Alison Walkley
27 June 2009 [MEDIAGLOBAL]: Due to the illegality of the practice, women in Timor-Leste are dying as a result of unsafe abortions, according to “Maternal Mortality, Unplanned Pregnancy and Unsafe Abortion in Timor-Leste: A Situation Analysis,” performed by the Charles Darwin University in Australia.
Supported by the United Nations Population Fund (UNFPA) and Alola Foundation, a Timor-Leste-based non-governmental organization, the report determined the following: “induced abortion occurs in Timor-Leste and is performed in clandestine ways which increases the health risks and compromises safety; traditional and modern methods are used to terminate unwanted pregnancies; 40% of all emergency obstetric care involved managing and treating complications from early pregnancy losses; access to family planning information, education and supplies was limited (particularly for young people) and opportunities to promote family planning were missed; in three of the four health facilities investigated, evidence-based protocols in the provision of post-abortion care were not used; and policies and protocols reviewed did not give enough emphasis to the termination of pregnancy and unsafe abortion as a public health issue.”
Timor-Leste has a total fertility rate of seven children per woman, which is the third highest in the world. It is hypothesized that the reason behind the high fertility rate is related to conflicts in the country that have caused a loss of life in the recent past. Despite this post-war baby boom, however, 660 women die for every 100,000 births—the highest maternal mortality rate in Asia after Afghanistan.
Hernando Agudelo, UNFPA Country Representative to Timor-Leste, stated in the report and informed MediaGlobal, “In countries such as Timor-Leste, where low use of contraceptive methods leads to many unwanted pregnancies, the practice of unsafe abortion is an increasing health risk…The low knowledge about contraception by both sexes is likely to lead to many unwanted pregnancies, a catalyst for unsafe abortion. This calls for concerted efforts to promote family planning methods not only to reduce unsafe abortion, but more importantly to improve the lives of women and to reduce the very high maternal mortality ratio.”
Since the practice of abortion is illegal, data on the number of induced abortions was not able to be collected. The report stipulates, “The Indonesian Penal Code criminalizes all terminations of pregnancy for any reason. Some Timorese entered the judicial system for the crime of abortion and some have been imprisoned for infanticide.”
To MediaGlobal, William Ryan, UNFPA Regional Communications Adviser for Asia and the Pacific, quoted from the report, “Unsafe abortion is the third most common reason for pregnant women to die,” the first two reasons being excessive bleeding and infection. Despite the moral quandary behind the practice, abortion is common worldwide. Ryan reported, “Globally 46 million abortions are performed annually and about 19 million are outside the legal and formal health systems. The Guttmacher Institute notes that globally almost a quarter of all pregnancies are terminated.”
Surveys of Timorese women deduced that most want to learn about family planning and contraception methods in order to avoid unwanted pregnancies. The report also recommends that husbands be included in choices regarding the health of their wives in order to facilitate successful family planning decisions.
“In order to achieve the Millennium Development Goals, specifically Goal 5 on improving maternal health, the Ministry of Health is scaling up its efforts to advance the health care system and thus reduce the number of diseases, deaths, and disabilities,” Agudelo stated. “Well targeted plans and strategies for achieving goal 5 require comprehensive, accurate, and current data on issues related to maternal health and maternal health care services. Due to social, cultural and religious issues in Timor-Leste however, there is limited information about abortion practice—the need for up-to-date and reliable data is particularly salient given abortion’s direct association with maternal death.”
Better information services provided by the government are required in order for change to come to these women, even if abortion remains illegal. By providing the Timorese with the knowledge necessary to plan their families, it is possible to lower the incidence of unsafe abortions.
