The decision to seek care antenatally and during labour and birth - Who and what influences this in Timor-Leste? A qualitative project exploring the perceptions of Timorese women and men.

BACKGROUND: While global maternal deaths have decreased significantly, hundreds of thousands of women still die from pregnancy and birth complications. Interventions such as skilled birth attendants, emergency transportation to health facilities and birth preparedness have been successful at reducing such deaths, however barriers to seeking, reaching, and receiving respectful care persist. OBJECTIVE: This study aimed to identify what influences people's decisions to seek antenatal care and care during labour and birth in Timor-Leste, a low-middle income newly independent nation in South East Asia with a high maternal death rate. The study aimed to provide emic/local insights to help midwives and maternal health providers tailor care and resources appropriately, thus improving maternal health. DESIGN: This qualitative study with a decolonising methodology, was designed to explore the perceptions of reproductive aged Timorese women and men, situating Timorese worldviews in the centre of the research process. Data collection occurred in four municipalities of Timor-Leste in October 2015 and included 9 focus group discussions with 80 men, and 17 individual reproductive history interviews with women. FINDINGS: An expanded 'Three Delays' model was used to frame the findings. The study found multiple factors impacting on decisions to seek antenatal care and care during labour and birth. Husbands, history, minimal birth preparedness, ethno-physiological beliefs (personal perceptions of how the body works), infrastructure limitations, geographical location, hospital policies and staff attitudes influenced and potentially delayed the decision to seek or reach care. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE AND POLICY: Policies and programs that increase accessibility of midwives and encourage birth preparedness are vital. Given the current locus of power in families in Timor-Leste, it is imperative that men are educated regarding the importance of care from skilled providers, and supported to access such care with their partners. Culturally respectful, inclusive and quality care needs to be emphasised so that trust is established between health providers and communities.

Identifying national health research priorities in Timor-Leste through a scoping review of existing health data.

Health research is crucial to understand a country's needs and to improve health outcomes. We conducted a scoping review and analysis of existing health data in Timor-Leste to identify the health research priorities of the country. Published and unpublished health research in Timor-Leste from 2001 to 2011 that reported objectives, methods and results were identified. Key findings were triangulated with data from national surveys and the Health Management Information System; 114 eligible articles were included in the analysis, the leading topics of which were communicable (malaria, tuberculosis, HIV and sexually transmitted diseases and dengue) and non-communicable (eye and mental health) diseases. There were 28 papers (25%) on safe motherhood, child health and nutrition, of which 20 (71%) were unpublished. The review of national indicators showed high infant, under-five and maternal mortality rates. Burden of disease is greatest in young children, with respiratory infections, febrile illnesses and diarrheal disease predominating. There is poor access to and utilization of health care. Childhood malnutrition is an important unresolved national health issue. There are several obstacles leading to under-utilization of health services. The following topics for future health research are suggested from the review: nutrition, safe motherhood, childhood illness (in particular identifying the causes and cause-specific burden of severe respiratory, febrile and diarrheal diseases) and access to and use of health services.