Findings from the research Timor Leste 2009-2011 University of New South Wales and Alola Foundation

Acknowledgements
y The women of Timor Leste, particularly those who contributed to this study y The agencies and services that support women and their families y The Minister Dr Martins and the Ministry of Health y Alola Foundation, Teresa Verdial, Angelina Fernandez, Elisa Savio, Natalino Tam, Zulmira Fonseca, Veronica Correia, Antonio Pinto, Lazaro Lelan Sila. y UNSW and Australian Research Council (ARC) team: y Derrick Silove, Susan Rees, Rosamund Thorpe and Anthony Zwi, Kuowei Tay

y The Harmonia Iha Famalia project was

developed by the Psychiatry Research and Teaching Unit (PRTU), University of New South Wales, and the Alola Foundation, Timor Leste, to explore the causes and manifestations of a high level of anger identified amongst women (Silove et al., 2009).

Objectives
y A key objective of the study was to identify

and document the social and psychological factors that placed women at risk of anger, and the effects of anger on the wellbeing of women and their families. y The study was guided by a theory in which the effects of trauma and injustice can be made worse by contemporary hardships.

Traumas affecting women

y Women were targeted by the Indonesian

army in order to undermine and destabilise the resistance movement, as well as to damage family relationships and the Timorese society.
y Since independence domestic violence has

continued to be a widespread form of trauma and violence.

Methodology
y A mixed method approach (predominantly

qualitative) was used. We recruited women from the existing epidemiological data base from our 2004 survey (the East Timor Mental Health Epidemiological Needs Survey - ETMHENS). y We used in-depth qualitative interviews y A measure for anger y A measure for depression

Sample
yFrom the database of 664 women

participants, 177 were identified as having explosive anger at baseline (Silove et al 2009). We interviewed 63 women with anger and 13 women without anger at baseline.

Sample
y 76 participants y 42 women from rural Hera y 34 from urban Becora. y The age ranges were: 21-30 years (31.2%), 31-40

years (22.1%), 41-50 years (22.1%) and 51 years and over (24.7%). y Over 80% were married, and 15% were widowed. 85% of the women did not receive an income and/or were involved in subsistence farming. The remaining 15% were involved in small business or farming for income to support the family.

Representativeness
y The study is undertaken in Hera and Becora. y Representativeness is most important for studies

reporting on prevalence and not so relevant for qualitative studies exploring contextual factors and their relationships. y The key factors identified by women are common and universal, that is, they are found throughout Timor Leste. y As a qualitative study this indicates that we have attained a transferable study, and the findings are relevant toTimor Leste.

Participants had an average of 5.6 children

Our data show that of those who were angry in 2004, around 60% remained angry and 40% recovered by 2010.

Anger
y Of those who were angry in 2004, around

60% remained angry and 40% recovered. y Anger was seen as a significant problem by the majority of women who identified experiencing this problem. y Anger affects women on a spectrum, with a small number 4-6% having very severe anger.

Frustration and resentment causing no significant harm or disability

Pervasive feelings of anger causing significant personal and/or family problems

Severe pathological Anger attacks, including violence against others and damage to property.

Connected meta-themes
y Poverty and adversity. y Domestic violence, spousal relationship y y y y

problems, alcohol and patriarchy. Persecution, trauma, loss of family members and feelings of injustice Socio-economic development, education and employment for women. Children, parenting problems and coping with the burden of too many children. Problems accessing health services

Employment
y We identified the factors that helped women who had

recovered from experiencing anger. y One of the central factors helping women recover was income generation. y In this presentation we are focusing on the relationship between work and mental wellbeing, a strong theme from our study.

Employment
y Unemployment was a major issue that women identified as a cause for anger. y Many husbands were unemployed and more pressure was on women to find income. y Without adequate income women could not provide for the family . y There was not enough food or the means to send children to school

Income, anger and violence

y Women were at risk of conflict and violence as a result

of household income pressure that is, not enough money for food.
y This contributes to the risks of living in patriarchal

societies where women are blamed if the household is not managed in a way the husband and family think it should be.

Poverty and raising a family

y A dominant theme related to women's

experience of anger was the hardship associated with managing the burden of raising a family and maintaining their marriage in conditions of extreme poverty.

Food, clothing and unemployment

y An important factor leading to anger was

the general burden of work that fell on women in a context where there was inadequate income, including insufficient access to food and clothing.

A participant explained:
y "Generally women are angry because we have a lot of house work. We have a lot of children but we don t have enough to support them. My youngest son stopped his study since last year because no money to buy shoes and uniform. He was very angry at me and my husband including all my brothers. I don t know when he can go to school again. What I know about anger in families in East Timor is that fighting between husband and wife is because of dealing with many children and daily needs."

Lia
y Lia was commonly cited as a problem

because financial and resource stress meant that Lia was unaffordable. In some cases families were borrowing to give Lia, providing an additional pressure to pay back the loan.

Domestic violence
y Domestic violence and relationship problems were identified as causes for women's anger. Poverty was widely reported as exacerbating relationship stress. y A risk factor is traditional patriarchal attitudes in society where women are expected to meet the needs of men, including providing food under severely restrictive economic conditions. y A combination of traditional values and poverty is placing women at risk of domestic violence.

Traditional views and violence against women

y A participant highlighted the connection between men's anger and the role expectations of women, resulting in domestic violence. y "Men are sometimes angry because before or after work there is not enough food or drinks like coffee prepared for them. When he comes back home from work he feels tired and sees a lot of mess at home and this makes him angry, talking a lot and treating the wife badly".

Education
y Most of the women involved in our study were

unemployed, illiterate or semi-literate and had not attended secondary school. A participant emphasised the limitations for women if they are illiterate, and the connection with feelings of anger: y "I feel angry and thinking too much because life is very hard here. I am getting bored staying at home all the time, nothing to do but in my heart I have to accept this condition as a result of an illiterate person."

Unemployment and Anger

y "I think anger problem mostly happens to

men and women who do not have a job. But in this village there is no existing program to make people reduce their anger."

The reality for women

y Many women felt that the daily demands on them to support the family prevented their participation in education, employment or development. y A participant said "A lot of women now are in parliament, but I myself didn t feel like involving in the development of this country because I have no job. We know nothing about the process of development in East Timor because we are busy finding ways to survive our family."

Employment and poverty

y If women have access to income they can reduce

poverty, care adequately for their children and can improve their capacity to engage in the development of the country . y Our study indicates that income for women is central to women s empowerment, to their safety and psychological wellbeing. y Women in our study identified the problems or challenges with them gaining education and employment

Barriers to income generation for women

y Not being able to pay back small loans for business y No programs available to assist women into work y Not being able to access existing programs because of

lack of child care y Not being able to access programs because of lack of support from husbands y Not being able to access programs because of the need to focus exclusively on the household and particularly being able to feed the family.

Social and economic factors in mental health context

y The study indicated that anger amongst the

majority of affected women could be alleviated by addressing important social and economic factors. y Attention by policy makers and relevant agencies to alleviate poverty-related pressures at the household level is required to address the problem of anger amongst women in Timor Leste.

In summary:
y Poverty, the burden of the household and

the risk of anger disorder can be reduced for women by supporting women s role in the labour market, and men s role in household chores and childcare. Programmes for changing gender roles to facilitate gender equality are essential to improving the lives of women and children (Bedford and Jakobsen 2008).

We have identified some projects relevant to women, income and development

Literacy programs

Women s Working Centre

Women s rights with respect to property ownership, labour code, traditions and customs

Community Learning Centres