Using film for culturally-relevant child-spacing promotion in Timor-Leste

Timor-Leste had the highest fertility in the world in 2003 after it emerged from the ashes of a violent break from 24 years of Indonesian occupation. In 2005 Health Alliance International (HAI) initiated a program supported by the USAID to increase community demand for child spacing in Timor-Leste. The program's primary partner is the Ministry of Health, aiming to integrate program approaches into the newly-developing health system and assure sustainability. Qualitative information on traditional beliefs and practices revealed limited understanding of the possibility of spacing births aside from traditional Timorese methods, and very limited knowledge of modern contraceptive methods. A mistrust of the family planning program implemented during Indonesian occupation and the strong influence of the Catholic Church further limited acceptance of contraception. The program contracted a local filmmaker to produce two short films that acknowledge traditional methods of child spacing and present messages to educate and motivate families and communities about modern contraceptive methods, including natural methods. The term we use is ‘Espacu Oan' (child spacing) rather than the Indonesian term for family planning. The film includes interviews with satisfied users and with church leaders including a bishop who discuss the importance of responsible parenthood, including birth spacing to ensure healthy families. Health workers discuss methods available at MOH clinics. The film is shown at community venues by MOH staff with focused discussions afterwards to reinforce key messages. Early evaluation results indicate the film is effective in increasing motivation and knowledge regarding child spacing and sources of methods; monitoring of behavior change is ongoing