Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111868

Mary Anne Mercer, MPH, DrPH and Susan Thompson, MPH. Health Alliance International, 1107 NE 45th St, Ste 427, Seattle, WA 98105, 206-543-8382, mamercer@u.washington.edu

Introduction: In May 2002, following 24 years of brutal and violent Indonesian occupation, Timor Leste (formerly East Timor) became the world's newest independent nation. This paper addresses the unique challenges for the provision of maternal and newborn care (MNC) services in this post-conflict setting, and suggests strategies to address these challenges.

Methods: Data sources are 1) quantitative data from the 2003 Timor Leste DHS, 2002 Multiple Indicator Cluster Survey, and 2004 health facility assessment; 2) qualitative assessments exploring knowledge, beliefs, home care and care-seeking behaviors related to MNC, and community influences regarding these practices; and 3) literature review of women's narratives since independence.

Results: Current challenges for maternal and newborn care in Timor Leste include: dispersion of the population post-independence that limits access to health facilities; low utilization and mistrust of government health services due in part to human rights violations during the Indonesian occupation; widespread prevalence of emotional disorders and domestic violence; extremely high fertility as peace becomes established; and inadequately trained and limited numbers of health staff who also lack experience in health systems management. In addition, a number of culturally-based traditional practices such as ‘sitting fire' further limit access to postpartum and newborn services.

Recommendations: Effective strategies will require re-thinking the current structure of services and investigating options for 1) providing improved services closer to the home, possibly via institutionalizing home visits; 2) enlisting active community support in notification of vital events; 3) strengthening health worker skills and motivation; and 4) creative rural health promotion approaches that incorporate an understanding of traditional practices and will improve home care regarding MNC and also rebuild trust in the official health system.

Learning Objectives:

• Describe several key challenges to providing maternal and newborn care in post-conflict settings
• Describe approaches to addressing each of the challenges presented.

Keywords: International MCH, International Public Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.