(Editor’s note: The article was originally published by IRIN on 15 April 2009, with the following URL:http://www.irinnews.org/report.aspx?ReportID=83929)

Infant and maternal mortality rates in Timor-Leste are being adversely affected by harmful traditions and practices, according to experts. But fighting them is a sensitive issue. Nadine Hoekman, country director and programme manager for Health Alliance International (HAI), a Washington-based NGO working with the Health Ministry, told IRIN it was difficult to quantify the problem.

“There are no stats available regarding mortality or morbidity specifically related to these practices,” she said, adding that even accurate information on exactly how many mothers and newborns are dying is difficult to ascertain since the deaths often go unreported.

“It happens quite a lot that when a mother gives birth, they stay by a fire for three months,” said Macu Guterres, the coordinator of the National Breastfeeding Association for the Alola Foundation, an NGO that supports women and children in Timor-Leste.

“They make a small bed beside the fire and sleep there while the fire burns 24 hours a day,” she said, explaining that the heat from the fire is believed to help dispel “dirty” blood from the body after birth.

“This can affect the baby’s health as well as the mum. The baby can develop asthma or may find it hard to breathe because of the smoke. It happens a lot in Oecussi,” she said, referring to the Timorese enclave deep inside Indonesian territory.

According to figures published by the UN Children’s Fund (UNICEF), the infant mortality rate in Timor-Leste in 2007 was 77 per 1,000 live births, which is “relatively high” for the region.

Timor-Leste has one of the fastest-growing populations in the world, with women having an average of 6.5 children each, according to the UN World Population Prospects.

Several NGOs are working to raise awareness of the potential danger of such customs for mothers and babies, but this is not easy given that the adult literacy rate is just over 50 percent (UN Human Development Index).

Traditional birth attendants

Traditional birth attendants (‘dukuns’), using traditional medicines and sometimes harmful practices, are common, especially in rural areas. The Alola Foundation estimates that only 10 percent of women in Timor-Leste give birth with the assistance of a skilled birth attendant.

According to HAI, harmful practices by ‘dukuns’ include encouraging the mother to push before she is ready, and placing rice or other substances in the birth canal to “lure the baby out”.

“Sometimes this choice [of birth attendant] is related to a stronger belief in the skill and practices of a traditional birth attendant in the community as compared to a trained health person,” Hoekman said.

Another common belief is that colostrum, the nutrient-rich milk mothers produce in the late stages of pregnancy and immediately after birth, is bad for the baby.

“They believe using water and honey instead of colostrum will wash the baby’s stomach and intestines and remove dirty blood,” Alola Foundation’s Guterres said, adding that the Foundation has 436 volunteers in nine districts working in “mother support groups”.

Rogerio Pedro Sam, an obstetrician and gynecologist at the Mother of Perpetual Help Pharmacy and Clinic in Bidau (part of Dili), said another harmful custom was the taking of a really hot bath, and drinking really hot water, after delivery. “Sometimes they burn their skin,” he said, explaining that the hot water is believed to flush out “dirty” blood after childbirth.

Sam said harmful practices were most prevalent in rural areas, where 70 percent of the country’s one million people live.

“Behaviour change is a long process. We try for a multi-pronged approach in our work - using different strategies to address issues, keeping messages simple and consistent, but delivering them in a variety of ways,” HAI’s Hoekman said.

“Rather than operating under the assumption that anything traditional is bad, and modern is good, we have chosen to look at how non-harmful traditional practices can be supported.”