Imagining life: Using film to improve the health of mothers and newborns in Timor-Leste

Purpose: Timor-Leste (formerly East Timor) is the newest and poorest country in Asia with very high rates of maternal and newborn mortality, and a rural population that has not been exposed to modern media. Less than 20% of Timorese women have a skilled birth attendant (SBA) at delivery. The untimely deaths of mothers and their newborns a major problem in resource-poor settings such as Timor-Leste, yet to date efforts to reduce maternal and newborn mortality have fallen far short of their goals. This presentation describes an innovative effort to develop locally-produced film as tool to improve maternal and neonatal outcomes in that country. Methods: A baseline qualitative assessment for a maternal and newborn care program in program districts provided evidence of widespread ignorance of basic maternity care practices, including the belief that skilled birth attendance was unnecessary because birth was a ‘normal process.' These findings prompted the development and production of an audiovisual film on maternal and newborn health designed to show the realities of birth outcomes in rural Timor-Leste, as an effort to improve the use of skilled birth attendants. Results: Directed by an internationally-known filmmaker, the filming was carried out by Timorese film students who spent time in rural areas with women who were near the time of delivery. The film portrays powerful scenes of pregnancy, birth, and the postpartum period, including actual scenes of serious neonatal complications that were resolved because of the attendance of a midwife as well as others that were not successfully resolved. The film is being shown in remote rural areas to provide women and their families with visual evidence of the dangers of delivery without an SBA, along with other community-based strategies including locally-developed educational picture cards and community discussions. Policy implications: Where tradition and difficult access to services seriously limit women's understanding of the need for skilled birth attendance, it is important to provide credible evidence of its importance to women and their families. Modern film technologies can make that feasible even in very resource-poor settings.