Using film for culturally-relevant reproductive health promotion in Timor-Leste

Introduction: Timor-Leste had high maternal and infant mortality and the highest fertility in the world in 2003 after it emerged from the ashes of a violent break from 24 years of Indonesian occupation. Health Alliance International (HAI) initiated programs supported by USAID to work with the MOH to strengthen the country’s maternal and newborn care (MNC) programs and increase community demand for both maternal/newborn care and child spacing. Qualitative baseline information revealed strong traditional beliefs around childbearing and a limited understanding of the value of maternal/newborn care and birth spacing. MOH staff lacked effective tools to reach out to communities.

Methods: The program contracted a well-known local filmmaker to produce films that acknowledge traditional beliefs and present messages to educate and motivate families and communities about antenatal, postpartum and newborn care and modern contraception. The MNC film showed scenes of births in homes and clinics, including a midwife’s resuscitation of a newborn. The child spacing film includes interviews with satisfied users and with church leaders including a bishop who discuss the importance of birth spacing for healthy families.

Results: Modern digital technology has made it possible to show the films even in remote rural areas without electricity. The films have been shown to over 9000 community members by MOH/HAI staff with focused discussions that reinforce key messages. Both films have stimulated enthusiastic discussion among community leaders, men and women. A recent survey of the program area showed significantly higher use of skilled birth attendants among women who had viewed the MNC film. Dissemination of the child spacing film is in early stages.

Conclusions: Modern digital technology makes the use of locally produced, culturally-specific film a feasible approach for MOH staff to use in educating and motivating communities to improve their reproductive health knowledge and behaviors.