Op-Ed By Dr Arvind Mathur, WHO Representative in Timor-Leste
DILI, 07 April 2025 (TATOLI) – Every seven seconds, a mother or newborn dies from preventable causes in the world! That means by the time it takes to read this article, lives are lost that could have been saved.
Maternal and newborn health is not just a health issue—it is a fundamental pillar of a thriving society. The survival of mothers and children is at the heart of the well-being of families, communities, and the future of any nation. Timor-Leste has recorded a continued decline in maternal deaths in the Southeast Asia region, but it still has the highest maternal mortality ratio (204 per 100,000 live births). While there has been an impressive decline in under-five mortality, newborn mortality rates (21 per 1000 live births) are still unacceptably high compared to other countries in the region.
Behind these numbers are faces- mothers, daughters, sons and futures cut short. For every mother who does not survive childbirth, entire families bear the loss. Ironically, most of these deaths are preventable. The key lies in providing timely, quality, and accessible healthcare to every woman and child.
The common biomedical causes for maternal deaths are well-known. The leading killers remain hemorrhage, infections, and untreated chronic conditions. Birth asphyxia, sepsis and prematurity contribute to more than 60% of deaths in the neonatal period. However, it’s not only the medical condition—delays are a major reason these deaths occur.
Many women, especially in rural and remote areas, face significant barriers in accessing health services (First Delay). The distance and lack of transport in reaching the health facility (Second Delay); and insufficient healthcare infrastructure often with poorly skilled health worker, result in delayed or no care (Third Delay). Too many mothers are forced to give birth without skilled support, and many newborns miss the vital care they need in their early days.
However, it’s not all doom and gloom. There’s hope and a strong one. A multifaceted approach, backed by strong political will to improve access to health services, especially through the flagship initiative Programa Integrado Saude (PIS), which aims to bring care closer to communities. Community Health Volunteers (CHVs) play a key role as the link between homes and health facilities for effective and efficient referral services.
At the World Health Organization, we are actively engaged in these efforts, including strengthening maternal and newborn health services. Together with UNICEF and UNFPA, the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Strategy is being finalized. The pre-service training curriculum (midwifery, nursing and medical) are being reviewed and updated based on the latest evidence and WHO guidelines. In-service trainings for healthcare professionals’ under the Life Course Approach is being expanded.
Every maternal and neonatal death is an avoidable tragedy— it’s imperative to learn from each one to prevent the next. The Maternal and Perinatal Death Surveillance and Response System (MPDSR), implemented by Ministry of Health with support from WHO, UNICEF and UNFPA, aims to collect better data and analyze, especially around delays in care and develop action plan to prevent future deaths. While we note incremental progress in death registrations across municipalities, I would urge that “Every Maternal and Perinatal Death” be made mandatorily “notifiable” by each facility. Health workers and facilities should be encouraged to report even when there are no maternal deaths—this ‘zero reporting’ helps confirm that data is complete and that no cases are being missed. WHO-TLS supported the Ministry Of Health in disseminating the MPDSR bulletins for 2022 and 2023 to ensure key learning and actions for improvements are shared across the health sector.
Furthermore, WHO’s Essential Newborn Care Course has trained over 100 healthcare providers across neonatal and pediatric units, improving care during the critical “golden hour” after birth. This training has significantly improved newborn survival rates by equipping providers with updated WHO protocols. I am pleased to note that the Maternal and Newborn Accelerator Plan of Action–developed with technical assistance of WHO and in collaboration with UNICEF, UNFPA and other partners through national and local consultations –is launched on 77th World Health Day, 7th April 2025. This action plan lays the foundation to further strengthen the health systems and ensure maternal and newborn health services are accessible and effective for all women and children, no matter where they live.
It’s noteworthy that Ministry of Health together with Ministry of Social Solidarity and Ministry of Education has undertaken initiatives to address social determinants of health while continuing to focus on promoting breastfeeding, supplementary nutrition for pregnant women, early childhood development and school meal programs.
While progress has been made, there is much work to be done. The challenges are complex, but we must remain committed to overcoming them. By continuing to invest in healthcare, training skilled professionals, and ensuring essential health services reach every corner of Timor-Leste, we can save lives and build a stronger, healthier future for all.
On this 77th World Health Day, let us unite to ensure that every woman has the chance to give birth safely and every newborn has the chance to survive, thrive and reach their full potential. Let us remember: the health of our mothers and children is a direct reflection of the health of our society. Investing in them is not just a moral imperative but a critical investment in our future. Every dollar spent on maternal care saves $16 in long-term economic costs. The question is not about the cost. It’s about courage.
By investing in maternal and newborn health, we are not only protecting lives today—we are securing a brighter, hopeful and more resilient future for Timor-Leste.
TATOLI
