1 World Population Review http://worldpopulationreview.com/countries/timor-leste-population/
2 Maternal mortality in 1990-2015 - Timor Leste https://www.who.int/gho/maternal_health/countries/tls.pdf?ua=1 3 Timor-Leste Demographic and Health Survey 2016 https://dhsprogram.com/pubs/pdf/FR329/FR329.pdf 4 National Health Sector Strategic Plan 2011-2030. Ministry of Health. Dili, Timor Leste 2011
https://abortion-policies.srhr.org/documents/countries/06-Timor-Leste-National-Health-Sector-Strategic-Plan- Ministry-of-Health-2011.pdf
5 National Strategy on Reproductive, Maternal, Newborn, Child and Adolescent health 2015-2019. January 2015 https://abortion-policies.srhr.org/documents/countries/04-T mor-Leste-National-Strategy-on-Reproductive- Maternal-New born-Child-and- Adolescent-Health-Ministry-of-Health-2015.pdf
6 Attitudes towards the legal context of unsafe abortion in Timor-Leste
https://www.researchgate.net/publication/40449618_Attitudes_towards_the_legal_context_of_unsafe_abortion_
in_Timor-Leste
REFERENCES
POLICY PROGRESS AND GAPS
1
The country has drafted guidelines for post-abortion care including post-abortion family planning.2
The legal requirement of gaining agreement from three doctors (in addition to the one performing the abortion) is highly restricting, given the number of doctors available in the country.3
No strategy to tackle unsafe abortion though it is recognized as a direct cause of maternal mortality.Not defined
ABORTION
POLICY LANDSCAPE
Timor Leste
In 2009, Timor-Leste adopted a penal code that permitted abortion to save a woman’s life and health.
However, just over a month after ratification, Decree Law 19/2009 was passed, with 13 amendments to Article 141 (Termination of Pregnancy), which are highly restrictive. They lay down several pre-conditions and allow termination of pregnancy only when it is the only means to save the pregnant woman’s life.
Abortion to save the life of the pregnant woman needs to be conducted by a medical doctor or other health professional under his/her supervision in a public health facility or other officially recognized facility.
ABORTION LAWS AND POLICIES
Figure 1: Conditions and gestation limit for which abortion is permitted in Timor-Leste (based on amendments to Article 141)
The law requires the consent to be given in writing in a document signed by the pregnant woman or by someone else she requests, if possible two days before the abortion. The consent of spouse or partner is taken when possible. In case of minors, consent is given by legal representative. In cases of an emancipated pregnant woman who is physically incapable the consent can be taken from a range of third-party stakeholders.
CONSENT
For PAC, all the hospitals and community health centres (CHC) are to be equipped to handle and provide these services6. According to RMNCAH Strategy, PAC services and contraception are a part of this plan to reduce MMR remarkably and a budget line is also tagged to it.
In terms of medical abortion (MA), combi kit of misoprostol and mifepristone is unavailable.
Specifically, misoprostol (22 mcg bag) is part of Timor-Leste EML (under oxytocin) but the use is not.
PROVISION OF POST-ABORTION CARE (PAC)
The law stipulates prison sentence (ranging from 2 years to 8 years) for the woman herself and whoever else who causes or helps her with an abortion with or without her consent.
PUNISHMENTS
Medical doctors and other health professionals have the right to conscientious objection about any procedure related to abortion – it is required to be expressed and communicated by a written and signed document to the facility manager. Also, medical doctors and other health professionals who claim for conscientious objection should ensure that another health professional immediately intervenes and attends to the pregnant woman.
CONSCIENTIOUS OBJECTION
Save woman’s life
Physical health
Mental health
Rape/
Incest
Fetal
impairment
Economic/
social reasons
request On
Conditions
permitted (no limit)
Con ditions not permitted
BACKGROUND
Timor-Leste is one of the youngest nations in the world, gaining independence in 2002. It has a population of about 1.29 million (mid-year 2019)1 (almost half of them are females).
ABORTION-RELATED INDICATORS
Unsafe abortion is listed as one of the direct causes of MMR4.The Maternal Death Surveillance and Response (MDSR) annual report 2016 – 2017 states that maternal mortality due to abortion is 4%.
Complication of abortion is estimated to contribute to 13% of maternal deaths, which might be categorized under haemorrhage or sepsis. The Ministry of Health reported only 765 complicated abortion cases in health facilities in 2018 – 2019. However, illegal abortions may happen throughout the year and have been conducted in clandestine ways using traditional or modern methods5. As a post-conflict state, the maternal mortality ratio (MMR) in Timor-Leste was one of the highest in the world in 2005 at 506 maternal deaths per 100 000 live births. The MMR among adolescents ages 15 – 19 was even higher at 1 037 deaths per 100 000 live births. In 2010, the MMR decreased to 317 deaths per 100 000 live births, and by 2015, it was even lower at 215 deaths per 100 000 live births.
25% of currently married women have an unmet need for family planning services, while 26″ % of currently married women are using a contraceptive method.
215/100 000 live births
294
221.7 years
323 years
34.2
326%
325%
3Maternal mortality ratio (2015)
Number of maternal deaths (2015)
Median age at first marriage
Median age at first child birth
Unmet need for family planning Total fertility rate
Contraceptive prevalence rate (all methods)
CONSENT
The law requires the consent to be given in writing in a document signed by the pregnant woman or by someone else she requests, if possible two days before the abortion. The consent of spouse or partner is taken when possible. In case of minors, consent is given by legal representative. In cases of an emancipated pregnant woman who is physically incapable the consent can be taken from a range of third-party stakeholders.
