Fernanda told us how she travelled to a medical centre in a remote village many hours out of Dili. Travel in Timor-Leste is treacherous and difficult, sometimes there are no roads and huge mountain ranges to cross. These conditions get between health services and isolated communities that need them the most. At the medical centre Fernanda found a woman bleeding and unconscious. Her husband had pushed her for hours in a wooden cart but there was no one at the centre who could help her. The woman was four months pregnant with her 13th child which she had miscarried.
 Fernanda Serra, a "Mobile Midwife" talks to women about Family Planning at a rural outreach session |
Fernanda helped her and stopped the haemorrhaging. When the woman awoke, Fernanda talked to her and her husband about family planning, asking them if they wanted to have any more children. They did not and wanted to use contraception which Fernanda provided, giving them five years of contraceptive protection with an intrauterine device (IUD).
Fernanda doesn’t need to wonder what would have happened if she had not arrived at the medical centre when she did. She knows this woman would have lost her life. Fernanda also knows that if this woman had access to family planning she would not have been pregnant for the 13th time - a pregnancy that carried an extremely high risk of death and which she would not have chosen if she had the choice.
At the core of Melinda and Fernanda’s work in Timor-Leste is a commitment to the United Nations Millennium Development Goal Five: “Improve maternal health” which is the most ‘off-target’ of all eight Millennium Development Goals. This commitment is their driving force given that in Timor-Leste for every 100,000 births there are 380 mothers who will lose their lives. This rate is a staggering 42 times higher than developed countries. Maternal deaths have a number of causes, most are from complications brought on by many consecutive pregnancies – the result of lack of access to family planning. Women in Timor-Leste die because they live in isolation and poverty where often they literally miss out on family planning education and services that we take for granted. We also know that women in Timor-Leste are often dying from pregnancies that they do not want to have.
 Mother and baby at Marie Stopes Timor-Leste family planning outreach session |
In the past seven years there have been major changes in the attitudes held by the women of Timor-Leste. A national health survey in 2003 showed that only 35% of women didn’t want to have any more children or wanted to delay their next child by two years. This figure is now at 70% showing us that women increasingly want to plan their families. They want to space their children and they want to live and be a part of their communities. They want and need access to family planning without which women will continue to due from pregnancies.
So far this year alone in Timor-Leste we have increased the number of women and families we have helped by 230%. As the demand for family planning increases so does the demand for support for programs like Marie Stopes’ outreach services in Timor-Leste. Women want to control their fertility, they clearly want contraceptive choices and they want every pregnancy to be a wanted one. If we are in the position to help these women and are serious about achieving the Millennium Development Goals, especially Millennium Development Goal Five: “Improving maternal health” then we have to get serious about contraception and family planning.
Family planning and contraceptive access is a fundamental prevention strategy to combat maternal deaths along side basic interventions, such as safe motherhood and emergency obstetrics. I encourage all those involved in policy and funding decisions to add family planning and contraception to the list of basic interventions and see the real impact that we can all have on Millennium Development Goal Five.
