"We want to have another baby," says Casilda, a mother of one living in the small nation of Timor-Leste. "If God gives them to us, I'd love two more."
Sitting in Saint Anthony's clinic in Dili, the country's capital, 40-year-old Casilda talks about the natural family planning information she just received. Sister Isabel de Orleans, a Carmelite nun on staff at the clinic, shows Casilda and her husband a calendar and "cycle beads"—a bracelet-like chain with beads of different colors representing different stages in a woman's monthly fertility cycle. White beads represent days when a woman can get pregnant; brown beads represent days when pregnancy is unlikely. Though a lab technician, Casilda was unfamiliar with the concept: "Before this, I didn't know about the fertility cycle."
She is not alone. In Timor-Leste, an impoverished country near Australia, few couples understand how to work with natural cycles to increase their chances of conceiving or to delay pregnancy. While women like Casilda want more children, many Timorese mothers—who have, on average, six children—want to space births. Timor-Leste has some of the highest infant mortality and maternal mortality rates in Asia, and delaying the time between births can keep mothers and children alive.
Dilva, 27, and her husband Joseda, 29, are talking to Sister Isabel about delaying pregnancy. "At first we thought we wanted three girls and three boys," Dilva says. "It didn't turn out like we expected. Now we have seven children."
With many childbearing years ahead of her, Dilva is worried that her husband's salary as an auto mechanic will be stretched if they have more children soon. She's tired, too. "I have so much to do—washing clothes, cooking, cleaning… ."
Saving Lives by Spacing Births
Dilva and Joseda are receiving the beads, calendar and counseling free thanks to a Catholic Relief Services program called Planning for Responsible Parenthood. The program reaches out to Timorese couples, with a special focus on those in the poorest villages. Working through the ministry of health and the local church, CRS staff and partners tell communities about the cycle beads, holding sessions at health clinics and village centers. They train midwives and volunteers who can access families in remote areas. Posters, pamphlets, and short informational movies help spread the word.
Timorese couples are interested in natural methods not only because of their faith—97 percent of the country is Catholic—but also because other methods can be difficult to access, especially in poor rural areas. Some are also afraid to use artificial means like injections. "Natural family planning gives people an option," says Soetarmi Soerono, CRS health program manager. "When you speak to them, they just have no idea there's a way to delay pregnancy."
Most Timorese families want to have large families. "It's good luck to have more children—and ensures that while some can go to school, there will still be some children to help their parents with daily chores and the family farm," says Soerono. Parents want both boys and girls because traditionally boys continue the lineage, and the custom of bride price (dowry) continues. "Men say, 'Look how virile I am, I have ten kids,' " says Soerono, "but women often say they'd like to have stopped at five children."
Spacing births helps prevent mothers from dying in labor, and babies from dying soon after they are born. "My neighbor's wife died giving birth to their seventh child this year," says Juliao dos Reis, health manager for CRS. "When we talk to couples, we say 'NFP is important for your family's health.' " Benvinda dias Ximenes, a midwife in a village outside the town of Baucau, agrees. Standing in her rural clinic near a natural family planning poster, she says she's delivered "too many babies to count."
"In Timor-Leste, mothers work very hard in the fields during pregnancy and have the baby early," she says. "They lose a lot of blood during the delivery. They have a child each year, and don't have time to take a rest." Now, when women give birth, she and other midwives give them the calendars, cycle beads, and breastfeeding advice. Exclusive breastfeeding for up to six months, with no bottle formula, can delay pregnancies—information 27-year-old Dilva didn't have earlier. "I didn't breastfeed properly—the babies ate other food," she says.
Preparing for Parenthood
CRS staffers also discuss financial issues with couples. "We say, 'If you earn $100 a month and you have six kids who all want to go to school, and transportation to school costs this much, let's think about that,' " says dos Reis. " 'If you plan ahead, your wife has time to help support the family in between births.' "
Women like that the cycle bead system has no side effects—and is free. "The most common question is whether it will cost anything," says Sister Isabel.
The staff face challenges—everything from trying to help illiterate couples use the calendar to counseling husbands who don't want to abstain from sex during fertile times.
"The majority of clients already have many children," says Sister Isabel. "Those who come are in a desperate state. The husband has agreed." The beads are helpful only for women who have a regular 26- to 32-day cycle, and thus won't work for everyone.
Despite this, the program has educated hundreds of Timorese villagers and individually counseled more than 580 couples so far. Collaborating with Carmelite sisters and other Catholic groups enabled CRS to reach people in isolated areas where there are few hospitals or health centers. Recently on television, the country's minister of health noted that because the program is supported by the Church, it has a better chance of success.
"I think NFP is great," says Casilda. "If you want to have a child, you can use it. If you don't, you can use the method to delay pregnancy."
"If you can space your children and earn money, you may be able to send them to get higher education," she continues. "You're building a solid foundation for your family."
Laura Sheahen is CRS' regional information officer for Asia.