Making Facilities Birth-Friendly in Timor-Leste

Susan Thompson, MPH• Health Alliance International • University of Washington, Seattle, WA

2005 Baseline Assessment

• Common understanding that a MW should only be called if there is a problem

• Strong preference for home delivery

• Husbands/family play an active role in birth preparation & delivery

• Traditional birthing practices important

Negative Associations with Facility-based Births

• Lack of privacy

• No hot water

• No traditional wooden bed

• No rope hanging from ceiling

• Family members not always welcome

Concept Development: Birth-Friendly Facilities

Create a comfortable space that respects desired traditional practices where women and families

can delivery their babies

• Involvement with key stakeholders Partnership with the MOH Strong community socialization process Connected health staff with communities

• Local investment Rebuilt a destroyed building Used local labor and materials

• Complete integration into MOH system

Birth-Friendly Facility: Program Objectives

• Increase # of women delivering with SBA

• Increase knowledge of benefits of SBA

• Improve linkages between community & health facility

• Improve health staff understanding of desired traditional birthing practices

Birth-Friendly Facilities

Inauguration of Birth-Friendly Facilities

Formative Evaluation

Methods• Qualitative

–Semi-structured interviews–Key informant interviews–Focus group discussions–Observations

• Quantitative –Analysis of utilization trends

Evaluation Questions

• Who is the BFF serving?• Are BFF users & providers

satisfied?• What factors influence

use of the BFF?• What are the barriers to

utilization?• Has knowledge changed

in the community?• Is SBA increasing?

Respondent Demographics

BFF UsersBFF Non-

users

Mean age 26.4 years 25.9 years

No formal education 33% 56%

Primary school education

27% 22%

Mean # of children 3.13 4.22

Mean # of pregnancies 3.73 4.89

Findings

Non Users UsersNone had experience of a facility-based birth

50% of women had a previous facility-based birth

Little experience of SBA Had more experience with SBA in the past

Lack of family support Family supported decision

Labor progressed quickly and/or at night

What influences the use of BFF?

• Knowing midwife is available

• Perception of safety/fear of complications

• BFF is “complete” with MW, medicines, equipment

• Traditional practices possible

• Family support• Respect• Families welcomed

“I thought the BFF would be the same as the clinic, but when I saw inside and realized that there was a wooden bed and

rope, I was really happy.”

Barriers to Using the BFF

• Lack of transportation• Fear• Unaware of benefit of

SBA• No birth plan

“I thought about using the BFF, but I went into labor at night, and I was

scared to walk to the clinic…I worried that I would deliver my

baby while traveling to the facility.”

Skilled Birth Attendance: Maubara

Skilled Birth Attendance: Remexio

Brainstorming

We would like you to think about how you would approach expanding the use of the Birth-Friendly Facilities.

What programmatic adaptations could be implemented at the community or facility level?

What did we learn?

• Achieving change of deeply entrenched practices is a process which requires time

• Engaging communities throughout the entire process of a community-based program is the key to success

• Formative evaluation of the implementation phase can identify adaptation needs at an early stage

What did we learn? (cont)

• Birth planning needs more focused promotion

• Need outreach health promotion to remote areas with less access to health system

• MOH ownership key to sustainability• Work with MOH & communities to expand

the use of the BFF space