04 November 2018

Inclusive Family Planning Takes More Than Words On Paper

Family planning is the basic human right of all individuals to freely and responsibly determine when they want to have children, and how many they want to have. It is important to ensure that family planning is inclusive, meaning it includes all citizens regardless of gender, marital status, age, sexual orientation or religion. Family planning is one aspect of reproductive health, which is also comprised of:
  • HIV/AIDS prevention;
  • Prevention and treatment of sexually transmitted diseases and infections;
  • Pre and post-natal care;
  • Sexual education and counselling especially for youths.
Some policy-makers view family planning from the perspective of economics, and conclude that better family planning slows population growth and increases wage and GDP. However, our own history of imposed ‘family planning’ as a measure of control under the Indonesian occupation, illuminates the dangers of framing family planning policies solely around economics and population control without viewing it as a human right. Today, Timor-Leste is an independent nation whose Constitution, article 57, guarantees universal, free health services to every citizen. To keep this promise, Timor-Leste must give our women and men the tools and resources we need to decide wisely about our own bodies and health.

La’o Hamutuk believes that family planning should be discussed openly and freely. If we frame the discussion solely around economics, we may forget that family planning is fundamentally about each woman’s right to make choices about her own body.

This article will discuss the importance of family planning in Timor-Leste, current policy, barriers to implementation and recommendations for the future.

Is Family Planning Important in Timor-Leste?

Family planning has recently been discussed more openly in Timor-Leste. It was a main policy recommendation of the United Nations Development Program’s 2018 National Human Development Report, which anticipates that wider use of family planning will decrease unemployment, and increase investment per capita, GDP and women’s life expectancy. The 2016 Demographic and Health Survey (DHS) reports on how many people use family planning, what methods are being used, and how many people want access to family planning. Additionally, in June 2018, First Lady Cidalia Lopes Nobre Mouzinho Guterres discussed the importance of family planning on an international scale.

Family planning is a prerequisite for sustainable and inclusive development. Inclusive family planning will greatly improve maternal and infant health, empower women, increase levels of education, protect the environment, and reduce the spread of HIV/AIDS. There will, of course, also be economic benefits such as increases to household income. Timor-Leste is a young country – 35% of our people are between 15-35 – and family planning will make their futures brighter based on their own choices.

The government of Timor-Leste is obliged by the Constitution to protect and care for all its citizens, regardless of gender, marital status, or religion. However, the implementation of the current Family Planning Policy has not included everyone, often leaves out young, rural and/or unmarried women. Family planning must be progressive and inclusive in practice, not just on paper.

Current Family Planning Policy and Implementation in Timor-Leste

In 2004, Timor-Leste adopted a National Family Planning Policy, which La’o Hamutuk considers both inclusive and progressive. This policy was developed after broad consultation and public debate, and has been embraced by many leaders in health, other sectors of government, and civil society, including religious leaders. The policy, which is still in place, states that reproductive health services should be “universally accessible, acceptable, convenient and available in an effective way at every health facility.” The policy states that all health facilities must provide reproductive services and counselling, including “an appropriate range of [contraceptive] methods” and “complete and accurate information about all methods” to all citizens, regardless of age, marital status, or gender.

Although the policy is better implemented today than it was 14 years ago, significant gaps and challenges remain. According to the 2016 DHS only 16.1% of women between 15-49 use some form of family planning, however this report is based on what women told the interviewers, and some may be embarrassed to share such information with a stranger. The graph below shows that injectables and implants are used much more than other methods.

No single method of family planning works best for everyone, since each method has its own benefits and drawbacks; therefore, La’o Hamutuk believes that everyone should have information and a full range of choices. The present dominance of injectables and implants suggests that many people are unaware of or unable to access other methods and options. The DHS reports that only approximately half of women using injectables (by far the most common family planning method), say that they decided to use them after being informed about potential side effects, what to do if they experience side effects, and what other methods are available.

According to the DHS, condom use remains low, with only 0.6% of respondents reporting using this method. This is not surprising when the public dialogue on condom use is stigmatizing and non-supportive. Family planning requires shared responsibility and decision making from both  men and women.

Further, it appears that vasectomy services are not available in Timor-Leste, due to a lack of equipment and skilled providers. This is a safe, simple and effective method of family planning.  Ignoring actions that men can take and their responsibilities in planning their families, places an unfair burden on women and allows men (including male politicians) to disregard family planning as a ‘women’s issue’.

Although the policy claims to be inclusive, young, unmarried and/or rural women often cannot access reproductive health services. According to the DHS, more than one-third of sexually active unmarried women say they want to use family planning, but only about half of these women have access to it. The 2016 DHS key findings, in line with global DHS reports, only present statistics on married women and their need for family planning, however it is important for influential reports, such as the DHS, to value and present unmarried women’s demand equally to help combat the stigma against them. Other important reports and surveys, such as the Census, should also add family planning components to their surveys so we can obtain a more complete picture of family planning in Timor-Leste.

Barriers to family planning in Timor-Leste

Every Timorese person has the right to decide which of the many family planning methods is best for them. Therefore, they must be informed about different family planning methods, including their benefits and risks. However cultural beliefs, which give more power to men in relationships, can restrict women’s ability to make these decisions themselves. Two recent studies, one on male attitudes to gender and the other on understanding violence against women, confirm that there is a continuing strong belief among both men and women that men should be the main decision makers in relationships. We must embrace and promote the cultural beliefs that empower women, and challenge those that disempower women, as an important step in providing family planning across the country.

Prominent educational campaigns led by the Catholic Church and other institutions have focused exclusively on traditional family planning methods. However, these campaigns have not persuaded many women to use these methods (see graph). This is not surprising considering that their effective use requires women and their partners to be able to read and do arithmetic, and to deeply understand their body and reproductive system; their sexual partners must also be open, communicative and supportive, which unfortunately is not the reality in most families.

Unfortunately, most young people have little information about reproductive health issues, and therefore cannot fully understand sexual health or make informed decisions about their bodies. For example, according to the DHS, only 23% of young women and 20% of young men say they have received information on reproductive health. Additionally, only 47% of women and 66% of men between 15-49 have heard of HIV or AIDS. Unfortunately, many teachers and parents avoid discussing topics which may feel embarrassing to them. Even though sex education is in the school curriculum, it is often skipped over. Therefore, many young people do not know how to avoid becoming pregnant or how to avoid, recognize, or treat sexually transmitted diseases.

Specific recommendations to the VIII Government

Next year, our Government will submit its fourth periodic report to the Committee on the Elimination of Discrimination Against Women (CEDAW). The most recent CEDAW report, published in 2015, made the following recommendation to the Timor-Leste’s Government:
“Strengthen measures to ensure that all young women, adolescent girls and rural women have access to sexual and reproductive health services and emergency health care, and improve the quality of family planning services… irrespective of marital status.”

Drawing from and expanding on this recommendation, we urge the government to:
  • Continue and strengthen implementation of the 2004 National Family Planning Policy, so that what is good on paper can also be good in practice. Family planning is not mentioned in the VIII Government’s program, but it is a necessary condition for achieving the goals of the Health Sector Strategic Development Plan 2011-2030, which aims to “increase access to and demand for high-quality ante-natal care, childbirth, postnatal care and family planning, including difficult access.”

  • The 2018 State Budget allocated $43,000 to the Ministry of Health’s “maternal and reproductive health services including family planning”, which was reduced by nearly half from the 2017 Budget. La’o Hamutuk encourages the government to increase this allocation in the 2019 budget.
        Include specific and detailed programs for family planning in the Ministry of Health Action Plans, the Government Program, and the 2019 State Budget, the Government must ensure that there is adequate leadership, planning and budget to ensure proper implementation of this important policy.

  • The Ministry of Health should invest more in providing health officials with the information, skills and resources they need to provide genuine and informed options to all Timorese, both men and women, married and unmarried, young and old, urban and rural. There should be special attention to promoting men’s shared responsibility for contraception (including condoms and vasectomies), and to sensitizing and educating men about their obligations related to family planning. The Ministry must ensure that implementation of policy does not discriminate against anyone.

  • The Ministry of Health, Ministry of Education and the National Commission to Combat HIV/AIDS should ensure their public messages and discussions about family planning are inclusive, positive, supportive and rights-based. The goal is to empower all people to make appropriate and responsible decisions about their individual and family health, based on accurate and clear information.

  • The Ministry of Education and Ministry of Health should continue the important collaboration they have started to ensure that reproductive health and sex education are taught in schools and teachers are mandated, capable, and confident to discuss this topic with students.

Conclusion

Timorese women and men do not yet have adequate information or choices about reproductive health, which violates their rights as outlined by the Constitution and by government policy. Past governments have not implemented the 2004 National Family Planning Policy effectively, and La’o Hamutuk calls on the Eighth Constitutional Government to do better. 

On 25 July, Timor-Leste’s Prime Minister, Taur Matan Ruak, in his speech to the newly sworn-in members of Parliament, emphasized that the youth of Timor-Leste are our greatest asset, and we must address their needs with regards to health, education, and employment. Providing family planning information and opportunities to every Timorese person – regardless of age, gender, religion, or region – is an essential condition for, sustainable, equitable development in Timor-Leste.

No comments:

Post a Comment