How a policy scare galvanized a small island's family planning sector

A pregnant woman in Timor-Leste. Photo by: Martine Perret / United Nations / CC BY-NC-ND

BANGKOK — A restrictive family planning policy first presented to the public in July met strong opposition in Timor-Leste, where local and international nongovernmental organizations and youth groups rose up to quash it in the months following. The show of activism is welcome in a country with a historically weak family planning NGO network, where it remains largely taboo to speak about contraceptive methods. It is perhaps a sign of more change to come, several groups tell Devex.

In a country where 98 percent of the population practices Catholicism, the government proposal promoted the “Billings method”— a natural technique that encourages women to identify their fertility patterns by examining the appearance of vaginal discharge — as the leading form of contraception.

Access to other forms of contraception would be granted only to those who are already married, the reformed version of the country’s 2004 family planning policy stated.

The proposal, presented by the minister of health at the time, has not been approved and is unlikely to move forward now that a new minority government has taken office under Prime Minister Mari Alkatiri. Former Prime Minister Dr. Rui Maria de Araújo — who was minister of health when Timor-Leste created its progressive 2004 family planning policy — is once again the minister of health.

The shift in administration, however, is not the only reason the policy may never leave draft form. A growing group of young activists has become far more vocal in asking their government to stand for their reproductive health and rights in the wake of the damaging policy proposal.

“One part of the policy suggested that if you are going to a health center and you don’t bring your husband, you will not be given access to any contraceptive method you wish,” said Berta Antonieta, a 26-year-old Timorese activist working on gender research. “That is why we as a group came together and wrote a letter to the prime minister.”

Teenage pregnancy is all too common in Timor-Leste, where nearly one in four girls and young women have had a child before the age of 20, according to research from Plan International, UNFPA, and the Timorese government. Of that group aged 15-19 years old, 50 percent already have more than one child. These factors contribute to a high rate of child marriage in the country. One in five girls are married before 18.

Antonieta formed Grupu Feminista in February as a way to talk about these issues, as well as broader topics around feminism and gender equality. What began as a cohort of her and her “progressive-minded” friends has grown to a Facebook group of nearly 400 young people, including female members of parliament and advisors from the prime minister’s office.

Soon, Grupu Feminista was leading meetings to discuss issues around the proposed policy, and signed a letter to the prime minister articulating their concerns for leaving vulnerable women and youth behind, including those who are illiterate and those who have no agency in negotiating their sexual relationships — a major concern when promoting only natural family planning methods.

Despite a lack of consultative period during the creation of the proposed policy, the Ministry of Health received concerns from a diversity of organizations, ranging from youth groups, advocacy groups, academia, and women’s movements focused on preventing violence against women and children, according to John Pile, UNFPA representative in Timor-Leste.

“One positive of the draft policy being developed was that it sort of united and got a lot of people that were concerned about the restrictions in the policy together,” Pile said.

Grupu Feminista in particular “presented fresh and diverse opinions to the Ministry of Health, who were more accustomed to delivering to an entirely health audience,” he said. “These were new actors, who were successful in halting the process and gave time for reflection and consideration.”

Grupu Feminista’s mobilization was welcomed not only from UNFPA, “but a range of partners who recognize access to family planning is a human right,” he added.

Many group participants now meet once a month to discuss certain issues and decide who in the government they may need to reach out to, Antonieta said. In the meantime, the family planning policy of 2004 will remain in effect until the new minister of health takes steps to revise it. But there are only “minor revisions required in order to align the policy with the 2030 sustainable development agenda's aspiration to 'leave no-one behind,’” Pile told Devex.

There is concern about several sections in the 2004 policy, where “if you wanted to adhere to the policy, it could become restrictive,” Pile said — such as a section that references where services can be provided, limiting what can be performed at rural health posts. Long acting, reversible contraceptives, for example, should be available wherever there is a trained provider, Pile said.

It is policy versus practice that most concerns Antonieta, she told Devex, saying of the 2004 policy: “It all sounds generally good, it’s highly progressive. But in practice it’s not. If you go to a rural clinic, they don’t have condoms or a reproductive health actor to explain to a woman her contraceptive choices, and there are still women going to clinics being asked where their husbands are before they are helped.”

And while Pile sees the Billings method as a technique that can be presented to women alongside other methods of birth control, he does not see it becoming the method of choice in Timor-Leste, considering it is used by a mainly urban, educated 1 percent of the population. Timor-Leste’s total population, by contrast, is nearly 70 percent rural.

The right to choose is tantamount for any new policy, and all men and women need to know their right to access a wide range of contraceptive methods appropriate for their individual circumstances, both Pile and Antonieta stressed.  

For now, nearly 400 young people have come together to halt a policy that threatened rights of the young and unmarried, and Antonieta plans to continue to capitalize on the collective power of the group to “transform mindsets” in the country.

“I was surprised at how many young people care about these issues,” Antonieta said. “This is a patriarchal society where we have conservative mindsets … things like menstruation are not even mentioned.”

She is optimistic to have the medically trained Dr. Rui Maria de Araújo back in the position of health minister, and looks forward to pushing the government to invest in young people, starting with stronger education in reproductive health and contraception.

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About the author

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    Kelli Rogers

    Kelli Rogers is a global development reporter for Devex. Based in Bangkok, she covers disaster and crisis response, innovation, women’s rights, and development trends throughout Asia. Prior to her current post, she covered leadership, careers, and the USAID implementer community from Washington, D.C. Previously, she reported on social and environmental issues from Nairobi, Kenya. Kelli holds a bachelor’s degree in journalism from the University of Missouri, and has since reported from more than 20 countries.