Let’s go someplace warm and beachy this week. Somewhere in the South Pacific, with palm trees, gorgeous caves, and sparkling blue waters. Somewhere with a 400-year history of colonial oppression, a brutal quarter century of war in recent history, and, until recently, one of the highest fertility rates in the world, perhaps?
Yes, that too. Today’s country and topic is the fertility rate in East Timor, a country barely a decade old. East Timor, or Timor-Leste, has had a complicated history, and has a bright future. But, like all nations, East Timor must make sure that its women have equal rights and opportunities to ensure that bright future. And when, as of two years ago, the average woman has seven children in her lifetime, that’s quite the challenge ““ though we’ll get to that in a minute.
Timor-Leste’s recent history is an essential part of the current situation, and must be explained before we can go further into the fertility issue. Okay, so where in the world are we? Timor-Leste is the eastern half of Timor Island, and several other smaller surrounding islands, about 400 miles northwest of Darwin, Australia. Indonesia pretty much surrounds Timor-Leste. For over 400 years, up until 1975, Timor-Leste was a Portuguese colony, except when it was occupied by Japan during World War II. In 1975, Portugal went through a rapid decolonization, freeing the colony, but after only a few days of independence, Indonesia invaded the country. What followed was twenty-five years of occupation, frequently including brutal crackdowns on populist uprisings. In the two and a half decades, there were over 100,000 conflict-related deaths (the vast majority from hunger and illness, directly due to the war. Some statistics put the number of deaths closer to 250,000) Multiple sources have called this a genocide, and for a country with a current population of just over 1 million, this is a huge percentage of people to lose to conflict. East Timor, with strong backing from the United Nations, declared independence from Indonesia in May of 2002, after an international peacekeeping force ended the violence in the country in September of 1999. Since then, the United Nations has been heavily involved with the country ““ running a provisional government from 1999 to 2002, and after independence was declared and elections were held, supported the new government until 2005. After barely a year’s absence, the UN again sent in peacekeeping troops, this time by request of the government, which nearly collapsed after protests sparked violence and a massive increase in internally displaced persons, fleeing the violence. Currently, there is a standing UN mission in East Timor.
And therein lies my own personal issue with the UN. There are some things that the massive organization is quite good at ““ distributing emergency aid, pretty much everything UNICEF and UNESCO do, improving the lives of women and children, creating and supporting refugee camps ““ the UN, while far from perfect, is experienced and qualified to do these things. Their peacekeeping missions, however, are more of a mixed bag. Timor-Leste was supposed to be the shining example for the UN’s push for self-determination, but it’s been a decade and the country is still unequipped to maintain peace and stability on its own. With such a massive UN presence, however, there has been massive attention paid to the quality of life issues within the country ““ especially the fertility rate. (See how I made that come full circle?!)
So, high fertility rates – it’s not the number of children per se that is the issue. It’s what such a high fertility rate indicates that is much more problematic. At its highest, Timor-Leste’s fertility rate was 7.8 births per woman. Even in 2009 (which is considered a current statistic), their total fertility rate was about 6.5, the fourth highest fertility rate in the world. Fantastically, demographic data from 2012 shows that the rate has fallen to 3.06, a huge change in just a few years. To understand the impact of this decreased rate, let’s first look at what caused Timor-Leste’s fertility rate to be so high in the first place. Obviously, there was a lack of access to – and unbiased information about – contraception and family planning, but there’s more to it than that. The earlier a woman (girl, really) becomes pregnant for the first time, the higher the chances she’ll have more children. At the other end of things, the longer a mother breastfeeds, the longer she has postpartum amenorrhea ““ the natural infertility that occurs while breastfeeding. Now, we know that breastfeeding, whenever possible, is very important for infant health. We also know that having children earlier leads to girls dropping out of school, and that a lack of girls education really slows down the advancement of a country.
In addition to these factors, Timor-Leste’s culture and recent history contributed to the high birth rate. The country is heavily Catholic ““ 96% (a remnant of its colonial past) and strict Catholic rules against birth control have permeated the culture. There is also a more complicated element. The entire country is recovering from losing between a tenth and a quarter of its population just over a decade ago. This act of war touched everyone. On an individual level, there is a strong urge to “replace” lost family by having a large number of children. So while the high fertility rate is most definitely a symptom of poverty, there are also cultural elements, and having a large number of children was seen as a desirable thing. Why try to change it? Because high fertility rates cause an increase in poverty, maternal and fetal malnutrition, a decrease in female education and literacy, and overburden the education and social welfare systems. Additionally, disproportionately young populations in impoverished countries are quite literally a recipe for instability and violence, an especial concern in this new, unstable country.
So, how did this massive decrease occur? There’s been a massive push from joint initiatives between various UN organizations and the government, and, as always, local women working hard to improve their lives and the lives of people they care about.
First, there’s something that I need to make very clear – this decrease is RECENT. My rule of thumb when researching is that data from the past five years or so can essentially be counted as current. Between the time it takes to gather statistics, break them down, and then publish them, there’s usually a lag of several months to a year, and in the more remote parts of the world, statistics are usually only measured every few years or so. I also tend to forget what year it is. So in my initial research, statistics from 2009 and 2010 were showing up as the most-recent-available stats, and they put Timor-Leste’s birthrate at around 6.5 children per woman, keeping the country on the top 10 list of highest birthrates. Timor-Leste’s page on UNFPA’s website, the UN’s Population Fund, is from 2010 and focuses extensively on the high birthrate. There are a ton of reports and research from around the same time period, explaining the severity of the problem and the long-term impacts. So when I finally found a site with current statistics, and saw that the birth rate had fallen SO dramatically, I must admit I was shocked. This is all happening so quickly – too quickly, perhaps, for people to write about and make public reports on how this decrease occurred, but let’s see what we can find out, shall we?
The government of Timor-Leste established a National Family Planning Policy in 2004, when the country was barely two years old. Because this was done so recently, and with significant international imput from a variety of stakeholders, the focus is human rights – maternal health and reproductive health, rather than simple population control. Further evidence they’re going about things the right way: the program is highly decentralized, with local leaders, who are committed to the cause, directing how these programs will be implemented. The focus is on community health, so the most effective methods for that community will be used. There are four aspects of the Policy: young people’s sexual and reproductive health, reproductive choice/family planning, safe motherhood, and general reproductive health. Improving these elements will be done via trainings, education, and making the necessary supplies – from clinics and doctors to condoms and other contraception – easily accessible throughout the country. The main goal, at this point, is for people of reproductive age to space their children by at least three years. Experts posit, however, that the incredibly high birthrate of almost a decade ago was a direct reaction to the recent violence and genocide in the country, and as the nation moves forward, the overall fertility rate will decrease on its own. While the plan laid out above is still in the early stages, its obvious that it’s had a measurable positive impact on the fertility rate. In 2003, 32.4 percent of married women said they wanted another child soon, and initial reports from a 2009/2010 survey say that only 8.5 percent want another child within two years. The percent of women saying they don’t want any more children rose from 17.1 percent to 34.7 percent over the same time period. Good signs!
So who is actually out there, educating women on the necessity of family planning? Why, local NGOs, partnering with the government and big NGOs, of course! If you’re going to do something right, involve the local population!
The Alola Foundation is a perfect example of this. First founded in 2001 by Kristy Sword Gusmao, then-First Lady of Timor-Leste, the organization’s initial goal was to increase awareness about sexual violence during the conflict, and to help sexual violence survivors. A decade later, the Alola Foundation supports women and children on many levels, including maternal and infant health. They have established nine Maternal Support Groups throughout the country, where over 200 local women volunteer to educate their fellow community members about the importance of breastfeeding (breastfeeding, as mentioned above, decreases fertility to a certain degree) and overall infant nutrition. There is also a Maternal and Child Health team, which partners with Marie Stopes International, a major international family planning organization, to provide healthcare to women and children.
Rede Feto is an umbrella organization that unites 24 different local women’s NGOS in Timor-Leste. These 24 organizations have a variety of different goals, from women’s political participation to domestic abuse prevention, but the one essential thing that they have in common – and, indeed, what may be the key to the success of the family planning policy – is their firm grounding in women’s rights. The rights-based approach, which puts women and their needs and rights at the center of all programming, enables projects to be successful at previously-unheard of levels. Rede Feto conducts programs that train their member NGOs on this rights-based approach, guiding them to be the best partners possible as they carry out their mission. While not all of Rede Feto’s NGOs are focused on reducing the overall fertility rate, they do all have women’s rights at their center, and the improvement of women’s lives as their paramount goal. As women’s lives improve, they tend to be able to have fewer children, so indirectly, all of these NGOs are working on reducing the fertility rate.
In five or ten years from now, there will be books on the rapid change in Timor-Leste’s fertility rate – on how this happened, what exactly about the policies and actions of the government, UN, and local communities made this successful. In my opinion, there are two key factors: 1) the rights-based approach, which is clear at every step of the process and 2) the role that women played in educating each other and supporting each other. The decrease in the total fertility rate in Timor-Leste is going to lead to healthier children, healthier mothers, and more freedom and equality for women. The change in statistics over the past few years is phenomenal, and bodes well for this tiny new country.
Background Note: Timor-Leste
CIA Factbook: Timor-Leste
Marie Stopes International – Where We Work
The Status of Family Planning and Reproductive Health in Timor-Leste
The world’s highest fertility in Asia’s newest nation: an investigation into reproductive behaviour of women in Timor-Leste
Timor-Leste: Spectacular Reduction in Child Mortality Rates