1999 Belize Family Health Survey Females

Publication date: 2001

1999 - - , - - Prepared by the Central Statistical Office a es November 2001 Tables of Contents ACKNOWLEDGEMENTS .1 Executive Summary.3 CHAPTER I .8 GENERAL BACKGROUND. 8 1.1 Historical, Geographical, Demographic, and Social Background. 8 1.2 Population Policies and Programmes. 10 1.3 Objectives of the 1999 Family Health Survey of Belize. 10 1.4 Coverage of the 1999 Survey. 10 1.5 Administration of the Survey . 11 1.6 The Sample Design. 11 1.7 The Questionnaire Design . 12 1.8 Recruitment and Training . 12 1.9 Fieldwork. 13 1.10 Summary. 13 CHAPTER 2 . 15 CHARACTERISTICS OF THE SURVEY POPULATION. 15 2.1 Introduction . 15 2.2 General Housing Characteristics . 15 2.3 General Characteristics. 17 2.4 Summary. 19 CHAPTER 3. 20 SEXUAL ACTIVITY. 20 3.1 Introduction .20 3.2 Age at first sexual intercourse.20 3.3 Level of education at first sexual intercourse .20 3.4 Relationship to first male.21 3.5 Contraceptive use at first sexual intercourse .21 3.6 Sexual intercourse in the last 30 days and last 3 months .22 3.7 Summary .22 CHAPTER 4.23 FERTILITY, RELATIONSHIP AND REPRODUCTIVE HISTORY . 23 4.1 Introduction .23 4.2 Levels and Differentials.23 4.3 Retrospective Fertility .25 4.4 Nuptiality.26 4.5 Fertility Preferences .27 4.6 Current Pregnancy Intentions .28 4.7 Summary.29 CHAPTER 5.32 ATTITIDES TOWARDS CHILDBEARING AND CONTRACEPTION .32 5.1 Introduction.32 5.2 Family Planning Messages . 32 5.3 Meaning of Family Planning . 32 5.4 Reasons to limit the number of children. 33 5.5 Right to decide about pregnancy and reasons to terminate pregnancy . 33 5.6 Age at First Sexual Intercourse and First Child. 33 5.7 Breastfeeding. . 34 i 5.8 Ideal Family Size. 35 5.9 Opinions About Childbearing. 35 5.10 Contraception. 36 5.11 Summary. 37 CHAPTER 6 . . 38 KNOWLEDGE, USE AND SOURCE OF CONTRACEPTION . 38 6.1 Introduction . 38 6.2 Knowledge of Contraceptive Methods. 38 6.3 Knowledge of the Fertile Period . 40 6.4 Current Contraceptive Use . 40 6.5 Reasons for Currently Using Contraception. 43 6.6 Characteristic at First Contraceptive Use. 44 6.7 Source of Contraception. 45 6.8 Reasons for Non-Use of Contraception.46 6.9 Reasons for Discontinued Use of Contraception .47 6.10 Desire to Use Contraception in the Future. 47 6.11 Summary.48 CHAPTER 7.50 WOMEN IN NEED OF FAMILY PLANNING SERVICES.50 7.1 Introduction .50 7.2 Characteristics of Women in Need of Family Planning Services .50 7.3 Summary.51 CHAPTER 8.52 FAMILY LIFE EDUCATION.52 8.1 Introduction.52 8.2 Findings.52 8.3 Summary.53 CHAPTER 9.55 USE AND POTENTIAL DEMAND FOR SURGICAL CONTRACEPTION .55 9.1 Introduction .55 9.2 Profile of Sterilized Women .55 9.3 Satisfaction with Surgical Contraception.56 9.4 Demand for Sterilization .56 9.5 Summary.57 CHAPTER 10. 58 ACCESS AND USE OF MATERNAL AND CHILD HEALTH SERVICES .58 10.1 Introduction. 58 10.2 Prenatal Care . . 58 10.3 Location and Type of Last Delivery. 59 10.4 Postpartum Care and Newborn Check-up. 60 10.5 Use of MCH Services. 61 10.6 Summary'. 62 CHAPTER 11. . 64 BREASTFEEDING AND WEANING PRACTICES. . 64 11.1 Introduction. . 64 11.2 Initiation of Breastfeeding . 64 11.3 Mean Duration and Frequency of Breastfeeding . 65 11.4 Reasons for Never Breastfeeding and for Stopping Breastfeeding. . 65 11.5 Supplementation and Weaning Practices . 66 11.6 Summary. 68 ii CHAPTER 12 . 69 IMMUNIZATION LEVELS. 69 12.1 Introduction . 69 12.2 Immunization Levels. 69 12.3 Summary . 70 CHAPTER 13. 71 CHILD MORBIDITY AND MORTALITY . 71 13.1 Introduction . 71 13.2 Prevalence and Treatment of Diarrhea. 71 13.3 The Treatment of Diarrhea. 73 13.4 The Prevalence and Treatment of Acute Respiratory Infection (ARI) Prevalence. 75 13.5 The Treatment of ARI . 75 13.6 Infant and Child Mortality. 77 13.7 Summary . 77 CHAPTER 14. 78 KNOWLEDGE OF HIV/AIDS. 78 14.1 Introduction. 78 14.2 Women Who Have Heard of AIDS.79 14.3 Sources of Information on HIV/AIDS .80 14.4 Correct Knowledge of How AIDS May be Transmitted.80 14.5 Incorrect Knowledge of How AIDS May be Transmitted .81 14.6 Perceived Risk of Getting AIDS Among Women.82 14.7 Perceived Risk and Condom Use.83 14.8 Summary.84 CHAPTER 15.85 CONDOM USE .85 15.1 Introduction.85 15.2 Condom Use.85 15.3 Summary.87 Appendix I.88 Appendix II .89 BIBLIOGRAPHY.90 iii ACKNOWLEDGEMENTS Both surveys of Males' and Females' Family Health were conducted in December 1999. Even though there were some unforeseen setbacks, I am now happy to report that the final reports have been prepared by the following personnel, two of whom were intimately involved with the project from its inception. Mrs. Jewell Quallo Rosberg, Director of the Belize Family Life Association (BFLA), prepared chapters 6, 7, 8 and 9 of the female survey, and chapters 6 and 7 of the male survey. Mr. Jose Orlando Puga, private consultant, assisted in preparing chapters 14 and 9 of the female and male survey respectively. Mrs. Elizabeth Talbert, Deputy Chief Statistician was responsible for chapters 3, 4, 5 and 15 of the female survey and chapters 3 and 4 of the male survey. Mrs. Leticia Vega prepared chapters 10, 11 and 12 of the female survey and chapters 5, 8 and 11 of the male survey. I prepared chapters 1, 2 and 13 and chapters 1,2 and 10 of the female and male surveys respectively. Formal acknowledgements must also be made of the funding and technical assistance agencies whose inputs were essential in realizing the final products. The Caribbean Development Bank (CDB) funded most of the cost related to the female Family Health Survey. UNICEF and the Government of Belize also assisted with funding for this study, and together met all costs related to the male survey. The Centers For Disease Control (CDC) provided very essential and timely technical assistance in helping to train four (4) key members of the staff of the Central Statistical Office (CSO), and also in the review of the final databases. Most importantly, this is to formally acknowledge the co-operation of the many households who were in the sample for both surveys, who so generously gave of their time and patience in answering the questions. No matter how much funding or expertise were available, if the respondents had not co-operated with the field-staff, these final reports would not have been possible. Let it be reiterated here that the CSO greatly appreciates this co-operation and will always do all that is possible to ensure the confidentiality of all information provided, and the usefulness of it in improving the quality of life of the entire population. CHIEF ST A TISTIC1AN 1 Executive Summary This report on the Belize Family Health Survey of Females 1999 represents another milestone for the Central Statistical Office and the Government of Belize. The report provides valuable information, which would assist in the development of some of the necessary programmes that can improve the quality of lives of the citizens of Belize as they continue along the road of sustainable development. The survey followed along the lines of the 1991 survey, which provided benchmark data and thus allows for comparison as well as a measure of change over the intervening years. A total of 3613 women between the ages of 15 and 49 years were interviewed during the course of the survey. The survey results show that 61% of women live in dwelling units whose floors are made of "cement", with another 32% living in dwelling units with wooden floors. For the majority of dwellings, the main source of lighting is electricity from BEL (86%), while 83% use Butane Gas for cooking. However, some still use kerosene lamps, 5% for lighting and 14% still use fire from wood for cooking. Only 45% of the households can be said to have a properly treated potable water supply, 33% of which came from a public source. Another 48% had their own source of water supply, but 7% used water from a river, which certainly was not treated. The critical situation of a proper water supply is further evidenced, since only 49% of the households have flush toilets. The fact that 47% use pit latrine is cause for concern, since this could very well pollute the underground water supply. There was a marked improvement in living space available over 1991, with 65% of households having access to 2 or more bedrooms. However, 22% still have just one or no bedroom. It is worth noting that just about two thirds of all households have access to a radio and/or a television. Overall, there is still a fair amount of disparity in living conditions between urban and rural households. While the mean age at first sexual intercourse is 18 years, for women aged 15 to 19 years it is 16 years, while for women 40 to 44 years it is 18 years. The age at first sexual intercourse varies by ethnic group, with Mestizo women having the highest mean age, 18 years. Overall, 18% of women 3 had their first sexual intercourse while still in school, the rate being higher among rural women. However, for most (96%) their first sexual intercourse was on a consensual basis, as well as to use a contraceptive, 61%. Only 17% had used a contraceptive during their first intercourse, and of these, 63% of their partners used a condom. What is noteworthy, though, is the fact that, while 77% used a contraceptive to avoid pregnancy, only 2% used it as a measure against HIV infection and 21% used it for both reasons. Contraceptive use is high among married fecund women, whether or not they do not desire to be pregnant now (59%) or do not want any more children (53%). The methods of choice are orals, injectables, condoms and Rhythm/Billing method in that order. In addition, 15% of all women interviewed are in need of family planning services, particularly with 4 or more children and with little education. The teaching of human reproduction, contraception and STIs, including HIV/AIDS in school, is acceptable by almost all women between the ages of 13 to 34 years. The feeling of most of them is that it should be taught to children between the ages of 10 to 14 years, 75%. Most of these women's information about pregnancy came from their parents/guardian, but only about one third received information about birth control methods from this source. Generally speaking, less than half of these women were exposed to family life or sex education while in school, and an even smaller proportion while outside of school. Information was provided mainly by teachers, a physician/nurse or someone from BFLA. Preferred sources were parent/guardian, teachers, someone from BFLA or health personnel. In addition, they knew where to go for information on reproductive health. The total fertility rate (TFR) calculated from the survey is 3.7, which is much lower than that of 4.5 in 1991. The TFR is the average number of births a woman is likely to have during her lifetime. The TFR for urban women is much lower (3.1) than that of rural women (4.2). The difference of 1 child is half of what it was in 1991. The TFR is highest in Toledo (5.6) and Stann Creek Districts (5.2) and lowest in Belize (3.0). As expected, TFR decreases with education, being 2.73 for women with 9+ years of education. A low rate of fertility was experienced by Catholics (3.85). 4 There was a significant decline in the age specific fertility rate among teenagers from 135 to 97, which may be due to increased participation in tertiary level education, as well as increased awareness of contraception. While 42% of the women had at least one pregnancy during the 5 years prior to the survey, 72% had no current desire to become pregnant. In addition, most of those who had become pregnant, had planned their last pregnancy (72%). The survey results indicate a low volume of family planning messages reaching women. Only 41% hears messages on the radio, 36% sees them on the television and 16% in the newspaper, with the Belize Family Life Association (BFLA) leading the way in providing these messages. To the majority, family planning means "planning the number of children" (56%). Seventy two percent feel that a woman's "financial situation" is the main reason for limiting the number of children she should have. While 69% of all women feel the woman has the right to decide about her pregnancy, only 45% of Maya women feel so. A high proportion (44%) of women agree with abortion for "health reasons of the mother" or "because of rape" (37%). While many women (41%) feel that the earliest age for sexual intercourse should be 18 years, a large proportion feel that a woman should not have a child until she is 20 years of age. In addition, the woman must be "mature" if she wants to have a child. The ideal number of children a woman should have is 3.8 which is close to the TFR (3.7). However, the ideal size increased from that of 1991. The decision making process can be of significant importance in a relationship, and it is worth to note the 80% of the women feel that both partners should decide on the number of children they should have. This is 22% more than in 1991. The increase was even higher among urban women. The desire for greater co-operation is also seen when 80% of the women feel that both partners should decide on contraceptive use. Knowledge of a contraceptive method is very high, ranging from 92% (Oral contraceptive) to 11% (Billing method), with a direct correlation between knowledge and education. However, knowledge is not always translated into use, with the highest current use for any group being 70% among urban women, aged 35 - 39 years, with the lowest being 37% among teenagers. The Rhythm/Billing Method finds popular support in usage among married women (66%). 5 There has been an increase over the years in the number of babies delivered in hospitals, and the attendance of a physician at deliveries. In terms of maternal and child care, there has been a significant increase in the use of maternal and child care services. However, the apparent lack of use of the service for "new born checkup" by the Maya/Ketchi women is disturbing. This could be due to the fact that almost half of the babies born to these women take place in their home, as well as cultural practices. Almost all women feel she should breastfeed the child, but the duration of breastfeeding varies. Breastfeeding is still an option used by most mothers, but it is more likely to take place among rural women and in particular Maya/Ketchi women. Only about one quarter of babies were exclusively breast fed for the first three months. Lack of information may have contributed to the lack of any breastfeeding by the small proportion that did not breast feed their babies. It is worth noting that more than half of all women continued breastfeeding up to 9 months and just under half continued doing so up to 18 months. While the level of reported immunization remains high, the lack of evidence by means of the production of a vaccination card does not allow for validation of the information given. In addition, a significant proportion of mothers did not know or cannot recall if their babies received certain vaccinations. There has been a decline in the prevalence of Diarrhea and Acute Respiratory Infection among children over the years. It is heartening to see many more mothers paying particular attention to these diseases and making much more use of ORS in the treatment of diarrhea. In homes where there is a pit latrine and the water supply is not treated, there is a greater likelihood of the presence of this disease. The presence of both of these diseases is more likely in rural areas and among the Mestizo and Maya/Ketchi children. All of the above have resulted in a continued decline in infant mortality. While the knowledge of HIV/AIDS is high, the knowledge of its mode of transmission except for heterosexual sex, is low, particularly male sexual intercourse (26%). Almost one third of all women perceive themselves to be at risk. This is particularly so among women with high education, women in a visiting relationship and Garifuna women. And while the knowledge of condoms is very high, only a very small proportion, less than 15%, use them during intercourse. However, its use is very high, about 33%, among both Garifuna women and women in a visiting relationship. Those who currently use a condom during sexual intercourse, do so always or most of the time. 6 CHAPTER I GENERAL BACKGROUND 1 Historical. Geographical, Demographic, and Social Background Belize is an independent country geographically located on the isthmus of Central America. It is bordered on the North by Mexico, on the West and South by Guatemala and on the East by the Caribbean Sea. Originally, Belize was a British colony but obtained political independence on September 21, 1981. Regionally, Belize is a member of CARICOM, the Caribbean Community of Nations, as well as of ECLAC, the Economic Commission for Latin America and the Caribbean. The country is approximately 8,866 square miles (22,700 square kilometers) and is divided into six (6) administrative districts, namely, Corozal and Orange Walk in the north, Belize in the east, Cayo in the west and Stann Creek and Toledo in the south. Each of these districts is further sub-divided into a recognized urban and rural area, and the significance of these divisions lies in the fact that there are sharp socio-economic differences between them. Preliminary results from the National Population and Housing Census 2000 show that at mid- year 2000, the population of the country was 249,800 with an annual population growth rate of 2.7%. The estimated crude birth rate and crude death rate in 1999 were 25.1 per thousand population and 5.7 per thousand population respectively, resulting in a rate of natural increase of 19.4. This compares with rates of natural increase of 33.8 at the beginning of the decade, which clearly represents a significant decline in the rate of natural increase during the period. In any study of Reproductive Health, the age distribution of the population is very important. Of particular significance for example, is the proportion of women of childbearing age, since this will assist greatly in projecting future population size. The age distribution also provides important sub-groups for analysis, such as Young Adults and the Child and Infant sub- groups. The table below shows Belize's total population in April, 1999. 8 Table Showing Total Population By Age an Sex 9 Age Both Sexes Total 0 - 13 14 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 and over DK/NS Male Total 0 - 13 14 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 and over DK/NS Female Total 0 - 13 14 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 and over DK/NS Apr 1996 221,120 86,645 31,865 16,965 14,800 13,830 12,845 9,355 8,005 5,490 5,505 3,740 11,805 270 110,610 44,555 16,425 7,940 6,640 6,425 6,105 4,810 4,200 2,655 2,915 1,900 5,820 220 110,510 42,090 15,440 9,025 8,160 7,405 6,740 4,545 3,805 2,835 2,590 1,840 5,985 50 Apr 1997 228,695 91,190 31,440 18,120 14,720 14,975 12,970 10,340 7,870 5,820 5,390 4,220 11,285 355 113,905 46,090 16,065 9,055 6,445 7,410 6,205 5,165 4,030 2,630 2,990 2,015 5,605 200 114,790 45,100 15,375 9,065 8,275 7,565 6,765 5,175 3,840 3,190 2,400 2,205 5,680 155 Apr 1998 236,975 91,050 34,485 19,050 15,700 15,155 14,020 10,425 8,290 6,890 5,680 4,940 11,105 185 117,640 46,315 17,285 9,310 7,125 7,010 6,660 5,160 4,240 3,545 2,925 2,455 5,485 125 119,335 44,735 17,200 9,740 8,575 8,145 7,360 5,265 4,050 3,345 2,755 2,485 5,620 60 Apr 1999 243,390 93,035 33,730 19,700 16,310 15,400 14,965 11,965 8,555 7,280 5,345 4,500 12,605 0 121,565 47,540 17,180 9,380 7,605 7,450 7,080 5,715 4,475 3,650 2,905 2,205 6,380 0 121,825 45,495 16,550 10,320 8,705 7,950 7,885 6,250 4,080 3,630 2,440 2,295 6,225 0 1.2 Population Policies and Programmes Experience has shown that the adoption and promotion of positive population policies can have significant socio-economic effects on people, and can improve their quality of life. To date however, Belize has not adopted a Population Policy, even though such a policy has been drafted. Despite the lack of an articulated population policy, the Ministry of Health of Belize does encourage and promote reproductive health to a great extent. Also, among the Non Governmental Community, a very vibrant Belize Family Life Association (BFLA) has been successfully promoting family planning and family life education. 1.3 Objectives of the 1999 Family Health Survey of Belize The main objectives of the 1999 Family Health Survey of Belize are to have an updated database for urgent use in decisions related to family health. More specifically, the survey will provide urgently needed information on fertility of females, infant and child mortality, family practices, and the use of maternal and child health services in Belize. There presently exists a dire need for updated data on Reproductive Health, among others, and an FHS at this time would meet most of these urgent needs. The major users of the results of this survey will include the Ministry of Health, the BFLA and the Ministries of Human and Economic Development. Of course, the survey will provide a rich database for use by socio-economic and demographic researchers, as was the case with the database from the 1991 survey. It is also hoped that local research units, like that of the recently established University of Belize, will take full advantage of the primary data collected in this survey. 1.4 Coverage of the 1999 Survey The survey carried out in 1999 was of females aged 15 to 49 years. This is similar to the survey done in 1991. In both surveys, a scientifically selected sample of women was used. In the 1999 survey, 4,164 women were selected in the final sample from all six (6) districts of the country. An interview was done with each selected woman in the survey and this provided information on a broad cross section of topics. Some of these topics included the birth history 10 of the woman, contraceptive knowledge and use, use of Maternal and Child Health facilities and behavioural risks. In order to enrich the analysis, basic social and economic characteristics like educational level, employment status, and so on were also collected. 1.5 Administration of the Survey The Central Statistical Office (CSO) of Belize was the major implementation agency for the survey. However, there were other local collaborating agencies, including the BFLA and the Ministry of Health, whose contributions were significant especially at the preparatory stages of the project. Foreign collaborating agencies included the Caribbean Development Bank (CDB), which provided most of the funding, including the provision of a regional consultant to assist the CSO at the preparatory stages and in the preparation of reports; UNICEF, which also provided funding support for this survey and who were the major funding agency of the Male survey; and the Centers for Disease Control, which assisted with the training of CSO field staff and the analysis of the data. 1.6 The Sample Design The sample finally used was a scientific sample, and was selected as follows. The survey sought to interview 3,500 women between the ages of 13 and 49 years i.e. in their childbearing age. It was expected to interview only one eligible female per household even if there was more than one eligible respondent. Preliminary investigations revealed that, to achieve an objective of 3,500 interviews, it would be necessary to target some 6,700 households. It was also necessary to analyse the data at the district and urban/rural levels. Allowing for a non-response rate of 10% meant that about 7,400 households would have to be selected. The estimated number of households in the country at the time was 46,648. Hence, a sampling fraction of 1/6 was estimated to be necessary to obtain this number of households. To achieve the above, the total number of households in the country was broken up into clusters of approximately 38 households and distributed proportionately among the districts. This resulted in 1,200 clusters being formed for the country. Of this, 1/6 or 200 clusters were selected to be interviewed. This yielded approximately 7,600 households, which is well over the minimum of 7,400 needed to obtain 3,500 successful interviews. It 11 turned out that 4,164 successful interviews were completed, taking into account non-contacts and refusals. 1.7 The Questionnaire Design From the outset, it was realized that efforts must be exerted to update the 1991 survey as a minimum. However, it was strongly felt that some expansion of depth, if not scope, could also be done. A preparatory committee comprising representation from the Ministry of Health, the BFLA, UNICEF and the CSO was established, and one of this committee's first tasks was to put together a suitable questionnaire to collect the required information. Contacts with the CDC through the person of Dr. Paul Stupp and with Mr. Stan Terrel of the regional programme on HIV/AIDS were extremely beneficial in guiding the discussions on the final questionnaire. These two gentlemen provided samples of both males and females questionnaires which enriched the committee's deliberations, and afforded a hybrid questionnaire in the end, tailored to meet the needs of Belize. The final questionnaire was then translated into Spanish, the second language of Belize. Spanish-speaking interviewers administered the questionnaire in Spanish among the respondents who preferred to be interviewed in this language. A copy of the questionnaire is appended at the back of this report. 1.8 Recruitment and Training From the beginning, it was decided that only female interviewers would be used for the Family Health Survey of females. These interviewers were centrally trained over a period of four days, i.e. 23-26 October, 1999, on the female questionnaire. The CSO staff was responsible for the training, and this team comprised a Senior Statistician and another Statistician. These two officers were supported by the regional consultant, who was in country for the training. These lead trainers were assisted in administrative and logistical matters by a Statistician (Ag.), two Statistical Officers and two Statistical Assistants. Their task included matters such as venue preparations, hotel arrangements for interviewers, payments to trainees and eventually to the fieldstaff, distribution of training materials as well as other administrative and logistical matters. Personnel trained included the six District Supervisors, who form a part of the permanent staff of the CSO and who are each based in one of Belize's six administrative 12 areas. These officers are also charged with the responsibility for recruitment of field supervisors, interviewers and editors in their particular district. In addition, other personnel trained included one Assistant District Supervisor who was hired specifically for the survey, seven (7) Field Supervisors, sixty one (61) Interviewers and seven (7) Editors. The first morning of the training session was dedicated to administrative matters dealing with payments and roles of different survey personnel, as well as to general survey topics such as interviewing techniques and procedures and concepts and definitions. Following this, the various sections of the questionnaire were timetabled over the remaining days, leaving adequate time at the end for paired interviews, mock interviews, as well as some live interviews in the field. 1.9 Fieldwork The fieldwork for the female Family Health Survey started on schedule on October 30, 1999, and was to last for five (5) weeks. A pilot survey had been done prior to the main fieldwork, and from this pilot, some changes to the questionnaire were incorporated, and some logistics were corrected. The administration of the fieldwork was similar to the administration of all of the CSO's household surveys, with the staff from headquarters liasing directly with the District Supervisor. This officer, in turn, had at least one Field Supervisor assisting him with the implementation of the fieldwork at the district level. In the case of the Belize District, however, because of the population size of this district, a headquarter staff member was assigned on a full time basis to assist the District Supervisor, who also had assistance from at least three (3) Field Supervisors. A very important task of the Field Supervisor, in addition to his task of correcting, guiding and training of his interviewers to carry out the work, was to do some sample re-interviews of households already interviewed by the interviewers. This helps greatly in enhancing a higher quality of information collected. The District Supervisor was also required to do sample re-interviews, and was the manager of all the operations at the district level. 1.10 Summary This chapter presented background information on the country of Belize, with its six (6) districts, urban and rural divisions, and its many villages. Background information on the survey methodology has also been discussed here. The major points relating to the sample design, the drafting of the questionnaire, the recruitment and training of field staff, and the 13 actual conduct of the fieldwork are all useful information, and are therefore presented in this chapter. More background information on the respondents will now be discussed in chapter two (2). 14 CHAPTER 2 CHARACTERISTICS OF THE SURVEY POPULATION 2.1 Introduction Chapter one focused on the general background of the country and of the survey itself. In chapter two, background information relating to socio-economic characteristics of the women in the survey will be presented. Although the idea here, is not to discuss these characteristics in any detail, they are nevertheless being presented in order to provide some useful overview of the prevailing circumstances of the final 4,164 respondents ultimately interviewed in the survey. 2.2 General Housing Characteristics Tables 2.1 to 2.7 present various statistics on the general housing situation of the sampled respondents who provided information in the survey. Table 2.1 shows that 61% of women live in dwelling units whose main construction material for flooring is 'Cement'. In addition, another 32% live in dwelling units with wooden floors. Almost 6%, however, still live in dwelling units with 'Dirt' floors. Further, there are strong regional differences with respect to this characteristic. For example, even though the appropriate table is not presented, the data do show that, whereas in most of the districts 'Cement' is the most commonly used material for floor construction, in Toledo rural in particular, 37% (the largest share) of the women live in houses with a dirt floor. Only 29% live in units with cement floors and 34% in units with wooden floors. Differences between urban and rural areas within this district can also be illustrated by contrasting the above with data from Punta Gorda Town, with 61% of its dwelling units having 'Cement' floor and only 1% having 'Dirt' floors. Other housing characteristics also give useful information about the situation of the women in the survey. The type of 'Lighting' which the household uses, as well as fuel used for 'Cooking' within the household are two such variables. Table 2.2 shows that the main source (86%) of 'Lighting' for households is the Belize Electricity Limited (BEL). In the case of fuel for 'Cooking', over 83% use mainly 'Butane' gas. Again, though, these figures at the country level are disguising differences at the urban/rural and district levels. For example, in the Stann Creek District, whereas in Dangriga, which is the main urban area, more than 15 98% of households use electricity from the BEL for their lighting, in Stann Creek rural only 69% are so privileged. In the Toledo District, the difference between the urban and the rural areas is even more acute. In the town of Punta Gorda, 95% of households use electricity from BEL, but in the rural parts of the Toledo District only 23% have this luxury. It is true that another 11% of rural households in this district have their own private generator, but this leaves 22% using 'Kerosene' and another 13% using 'Gas Lamps'. It is worrying to note that another 32% of these residents report that they got their lighting from another source. The latter may very well be 'Candles' which could pose a great danger to the safety of the householders, particularly the children. With respect to fuel used for cooking, Table 2.3 shows that 'Butane Gas' is the most popular (83%). However, the table also shows that a sizeable (14%) proportion of women continue to use 'Wood' as their main fuel for cooking. Again there are distinct regional differences. In the Toledo District, for example, whereas in the urban area 94% (figure not shown) use mainly 'Butane Gas' here, in the rural areas 68% of the women use 'Wood' as their main fuel for cooking. The data (not shown) also reveal that 20% of women in the rural parts of the Cayo District continue to rely on 'Wood' as their main source of fuel. The main source of drinking water is also a good indicator of the socio-economic circumstances prevailing. Table 2.4 presents this information for the women in the survey. From the data in this table, it is clear that approximately 29% of the women get their water from a VAT/DRUM or WELL (not piped). Only 17% get their drinking water from a public pipe in the dwelling and another 16% from a public pipe in the yard. It is good to note, however, that another 12% use 'Purified Water'. From these data, it can be concluded that, whereas almost 45% are certain to be using treated water for drinking, another 48% may be at risk, since their source is private piped into dwelling, vat, drum or well. The remaining 7% are most certainly at risk, since their source of drinking water is a river, stream, pond or public well i.e. water which is not properly treated. Information about the type of toilet facilities available to women in their households was also gathered in the survey. Together with the other housing characteristics, information here can give a very good idea of the socio-economic conditions of women. Table 2.5 presents results relating to type of toilet facilities available. The table shows that 49% of women have access to a toilet either linked to the sewer system or linked to a septic tank, but over 47% continue to use a 'Pit Latrine'. More than 25% of the latter use non ventilated pit latrines, which are known to be the less sanitary of the two types of latrines. It is good to note, though, that less than 5% of women report that they have no type of toilet facility at all. In 1991, more than 5% were living with this condition. 16 The number of bedrooms per dwelling unit is another good indicator of living conditions since it can reveal the level of 'overcrowdedness' within the household. Table 2.6 shows that over 65% of women live in dwelling units with 2 or 3 bedrooms. This finding shows a marked improvement in the living conditions of women from the situation in 1991. However, it is noted that a worrying 22% are still living in houses with one or no bedrooms. This latter situation certainly warrants much attention, with the aim of improving these conditions. Finally, respondents were asked to state whether certain household durables were available in their households. Table 2.7 presents these results. Over 69% of the women own at least one radio. Of concern, however, is the 10% who do not have even one radio in their household. In addition, it is comforting to note that over 63% of women have access to at least one television set in their homes. The potentially rich effect of the television set as a source of education and useful information cannot be overemphasized. However, the data also show that more than 21% do not have any television set. With respect to ownership of a video recorder, it is perhaps not surprising that 73% do not own one. The video recorder may perhaps continue to be a luxury item, which most people can either ill afford, or which may be of much lower priority than other household durables. It is noted that ownership of a refrigerator, which may be a necessity nowadays, is much higher with approximately 62% of the respondents reporting that they owned at least one refrigerator. Over half of the women also own a washing machine, which is also becoming a necessity in Belizean households. It should be noted with some concern, however, that these data also show that 93% of women in Belize do not have access to a personal computer. If the 'Digital Divide' is to be narrowed, accelerated access to, and use of, personal computers within the households will be necessary. 2.3 General Characteristics Tables 2.8 to 2.11 present some of the major characteristics of the survey population. The first table presents a simple frequency distribution relating to the country of birth of the respondents. As expected, most women (82%) were born in Belize. However, 9% of them recorded their country of birth as Guatemala, and another 3% as Honduras. A further 3% were born in San Salvador. These data show that similar to the situation in 1991, the largest percentage of immigrant women are from the neighbouring Central American countries, in particular from Guatemala. These women are therefore mainly of Mestizo or Hispanic origin. 17 The general ethnic composition of the female population is presented in Table 2.9. From the table it is clear that the largest ethnic group is the Mestizo (38%). This is followed by Creoles (24%), Spanish (15%), Mayas (9%) and Garifuna (6%). Although not identical, this ethnic distribution is reflective of the female population at large, as obtained from other surveys (see Labour Force Survey 1999). Respondents were also asked to report their religion or religious denomination, as well as how often they attend religious services. Tables 2.10 and 2.11 present these results. It is clear from Table 2.10 that the most popular religious denomination continues to be Roman Catholicism (52%), followed by Pentecostal (7%) and the Seventh Day Adventists (6%). Seven percent report (7%) that they belong to no religion. Only 5% and 4% reported their religion as Anglican or Methodist respectively. It is clear that the more recent religious denominations, like the Pentecostals, which have more recently come to Belize, have far surpassed the latter two traditional ones (Anglicans and Methodists) in terms of number of followers, and may even be attracting a sizable share of the Roman Catholics. When asked how often they attend religious services, however, only 47% reported that they do so at least once per week. Another 20% reported that they only attend services on special occasions like weddings, whereas a further 17% do so at least once per month. It is interesting to note that when frequency of attendance is cross tabulated by religious affiliations (table not shown), it is seen that the most dedicated, in terms of frequency of attendance, are those of the BAHAI FAITH (97% reporting attending services once per week). This is followed by the PENTECOSTALS (81%). Members of the three (3) traditional denominations i.e. ROMAN CATHOLICS, ANGLICANS and METHODISTS, report 39%, 30% and 26% attending religious services weekly. Table 2.12 shows that just over 60% of the women speak ENGLISH 'Very Well', whereas another 23% do so 'Not So Well'. An alarming 17%, however, can barely speak the country's official language. When the respondents were asked how well they speak SPANISH, 57% reported that they do so 'Very Well'. This is certainly a reflection of the ethnic distribution referred to earlier, where it is noted that over 50% reported their ethnic origin as either Mestizo or Spanish. Not surprisingly, almost 32% of the women can barely speak the Spanish language, which has become the second language of Belize. 18 Finally, respondents were asked for their highest level of education completed, and about their economic activity. Table 2.13 shows that most women completed Primary level of education only. Another 14% reported that they have completed High School, and a further 8% have completed the tertiary level. Of the latter, 2% went to University. However, the statistic that stands out most here is that 29% of our women have no formal education. Although it can be convincingly argued that, currently, many more females than in the past are furthering their education, perhaps even more so than their male peers, the low level of formal education of our present mothers should surely be of some concern. With respect to the women's work status, the data show that only 28% worked for pay, profit or family gain in the week prior to the interview. When those who did not work in the past week were further questioned about whether they have ever worked, only 34% reported that they had ever done so. These figures are reflective of Belize's female population at large, who, for the large part, continue to engage in household duties. 2.4 Summary In this chapter, an attempt has been made to 'paint' a reasonable picture of the socio- economic situation of the women in the survey. In summary, these women are largely of Mestizo ethnic origin, with approximately 20% being of immigrant background. Most have a Roman Catholic religious background, but less than half reported attending religious services weekly. Approximately 61% speak ENGLISH very well and just over 56% speak SPANISH very well. Almost 30% have no formal education at all, and most of the other 70% have completed Primary school only. Just over a quarter of the women have ever worked before, reflecting the fact that, even though it may be changing rapidly, traditionally Belizean women have tended to be housewives. 19 TABLE 2-1 BELIZE: Material Used For Flooring 1999 Family Health Survey (Percent Distribution) Main Construction Material Used for Flooring Percent No. of Cases (Unweighted) Wood Cement Dirt Other Unknown 32.6 61.0 5.7 ** ** (1177) (2203) (206) (21) (6) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-2 BELIZE: Fuel Used For Lighting 1999 Famüy Health Survey (Percent Distribution) Type of Lighting Used Percent No. of Cases (Unweighted) Gas Lamp Kerosene Lamp Electricity From BEL Electricity From a Private Generator Other Unknown 3.1 5.2 85.8 2.4 3.3 ** (111) (189) (3099) (87) (120) (7) Total 100.0 (3613) ** Less than 25 cases. i TABLE 2-3 BELIZE: Fuel Used For Cooking 1999 Family Health Survey (Percent Distribution) Type of Fuel Used For Cooking Percent No. of Cases (Unweighted) Wood Gas (Butane) Kerosene Electricity Other Unknown 13.7 83.7 1.1 ** ** ** (494) (3023) (41) (18) (18) (19) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-4 BELIZE: Source Of Drinking Water 1999 Family Health Survey (Percent Distribution) Main Source of Drinking Water Supply Percent No. of Cases (Unweighted) Private, Piped into Dwelling Private Vat/ Drum/ Well Not Piped Public, Piped into Dwelling Public, Piped into Yard Public Stand Pipe or Hand Pump Public Well River, Stream, Creek, Pond, Spring Purified Water Other Unknown 16.6 28.4 16.4 16.7 3.1 2.1 2.1 12.7 1.5 ** (599) (1025) (594) (604) (112) (77) (76) (459) (54) (13) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-5 BELIZE: Type Of Toilet Facility 1999 Family Health Survey (Percent Distribution) Type of Toilet Facility Percent No. of Cases (Unweighted) WC Linked to WASA Sewer System WC Linked to Septic Tank Pit Latrine, Ventilated and Elevated Pit Latrine, Ventilated and Not Elevated Pit Latrine, Ventilated Compost Pit Latrine, Not Ventilated None Other Unknown 22.0 27.2 13.0 7.8 0.9 25.5 2.5 1.0 ** 796 981 468 282 31 920 89 36 10 Total 100.0 (3613) ** Less than 25 cases. TABLE 2-6 BELIZE: Number Of Bedrooms 1999 Family Health Survey (Percent Distribution) Number of Bedrooms Percent No. of Cases (Unweighted) 0 1 2 3 4 5 6 7 8 10 Unknown 3.4 19.1 39.0 26.7 8.2 2.2 ** ** ** ** ** (123) (689) (1409) (964) (297) (81) (18) (3) (5) (1) (23) Total 100.0 (3613) * Less than 25 cases. TABLE 2-7 BELIZE: Owoership of Communications Media 1999 Family Health Survey (Percent Distribution) No. of Radios Percent No. of Cases (Unweighted) 0 1 2 3 4 5 6 8 Unknown 9.7 70.2 14.0 4.3 1.1 ** ** ** ** (350) (2538) (506) (154) (39) (18) (3) (2) (3) Total 100.0 (3613) No. of Television Sets Percent No. of Cases (Unweighted) 0 1 2 3 4 5 6 8 Unknown 21.4 64.1 11.7 2.2 ** ** ** ** ** (772) (2316) (424) (79) (14) (3) (1) (1) (3) Total 100.0 (3613) No. of Video Recorders Percent No. of Cases (Unweighted) 0 1 2 3 Unknown 73.2 25.5 1.1 ** ** (2646) (921) (38) (5) (3) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-8 BELIZE: Country Of Birth 1999 Family Health Survey (Percent Distribution) No. of Cases Country Born Percent (Unweighted) Antigua and Barbuda ** (1) Bahamas ** (2) Belize 82.0 (2961) British Virgin Islands ** (1) Grenada, Carriacou, Petit Martinique ** (2) Guyana ** (2) Jamaica ** (6) Trinidad and Tobago ** (1) Cuba ** (2) Haiti ** (1) Canada ** (5) India ** (1) Nigeria ** (1) United Kingdom ** (2) Honduras 2.8 (101) USA ** (17) Mexico 0.7 (27) Guatemala 8.9 (322) Other Central America ** (8) Other South America ** (3) El Salvador 2.8 (101) Italy ** (1) China ** (5) Taiwan ** (3) Other Far East Countries ** (1) Unknown 1.0 (36) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-9 BELIZE: Ethnic Group 1999 FamUy Health Survey (Percent Distribution) Ethnic Group Percent No. of Cases (Unweighted) Black/ African Caucasian/ White Chinese Creole East Indian Garifuna Maya Ketchi Maya Mopan Mennonite Mestizo Yucatan Maya Spanish Other Unknown ** ** ** 24.2 3.9 5.5 5.5 3.1 ** 38.5 1.4 14.8 1.1 0.7 (15) (14) (10) (875) (141) (199) (199) (113) (5) (1392) (49) (533) (41) (27) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-10 BELIZE: Religious Denomination 1999 Family Health Survey (Percent Distribution) No. of Cases Religious Denomination Percent (Unweighted) Anglican 5.4 (195) Bahai Faith ** (3) Baptist 4.2 (153) Hindu ** (1) Jehova Witness 1.9 (69) Mennonite 0.7 (26) Methodist 3.5 (127) Mormon ** (13) Muslim ** (2) Nazarene 2.9 (104) Pentecostal 6.9 (251) Roman Catholic 52.6 (1902) Salvation Army ** (3) Seventh Day Adventist 5.6 (203) None 7.2 (259) Other 8.1 (293) Unknown ** (9) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-11 BELIZE: Frequency Of Attendance at Religious Service 1999 Family Health Survey (Percent Distribution) Frequency For Attending Religious Service Percent No. of Cases (Unweighted) At Least Once a Week At Least Once a Month Less Than Once a Month Special Occasions Only (Weddings, etc.) Does Not Attend At All Unknown 48.6 17.8 5.3 23.0 4.6 ** (1626) (597) (178) (768) (153) (23) Total 100.0 (3345) ** Less than 25 cases. TABLE 2-12 BELIZE: Language Spoken 1999 Family Health Survey (Percent Distribution) How Well Speak English Percent No. of Cases (Unweighted) Very Well Not So Well Barely/ Not at All Unknown 59.9 22.5 17.5 ** (2165) (814) (631) (3) Total 100.0 (3613) How Well Speak Spanish Percent No. of Cases (Unweighted) Very Well Not So Well Barely/ Not at All Unknown 57.2 10.8 31.7 ** (2067) (391) (1146) (9) Total 100.0 (3613) ** Less than 25 cases. TABLE 2-13 BELIZE: Highest School Level Completed 1999 Family Health Survey (Percent Distribution) Level of Highest School Percent No. of Cases (Unweighted) None Primary High School BTTC/BCA/BNS Sixth Form or Equivalent University Unknown 27.5 48.3 15.7 1.3 5.1 2.0 ** (992) (1744) (567) (46) (183) (71) (10) Total 100.0 (3613) ** Less than 25 cases. CHAPTER 3 SEXUAL ACTIVITY 3.1 Introduction This chapter addresses the issues of females' sexual activity, in particular women's age and the age of their partner at first sexual intercourse. Also addressed are issues related to whether they were in school at first sexual intercourse and whether this was on a consensual basis. It also examines their sexual activity over the past 30 days and 3 months prior to the survey. These issues are further examined by selected characteristics. 3.2 Age at first sexual intercourse Approximately 18% of the females have not had their first sexual intercourse. The proportion of rural women (57%) that have not had sexual intercourse before is higher than that of urban women (43%) and, the majority (56%) of Mestizo females, Roman Catholics (52%), non-working females and teenagers (75%) have not had sexual intercourse before. The mean age at first sexual intercourse is 18 years. However, this age increases as the age of the female increases. The mean age at first intercourse for females in the 15-19 age group is 16 years and for the 40-44 age group it is 18 years. These figures suggest that as the woman gets old she tends to report an older age at first sexual intercourse or that younger females are now having sex earlier. It would be interesting to follow the teenage cohort five years later and see what age they would report for their first sexual intercourse. A comparison of the major ethnic groups shows that the mean age at first sexual intercourse is highest (18 years) among Mestizo women (see Table 3.1). There is little difference by working status and religion. 3.3 Level of education at first sexual intercourse Table 3.2 shows that among those who have had sexual intercourse, 18% were in school at the time they had their first sexual intercourse. This rate is higher among urban women (24%) and among Garifuna (42%) and Creole (33%) women. The majority (80%) of women had not completed high school at the time of first sexual intercourse. This rate was higher among rural and Maya women (see Table 3.3) 20 3.4 Relationship to first male When asked if the first sexual intercourse was on a consensual basis, the majority (96%) of women said "Yes". There are no differences between urban and rural women and little differences among the major ethnic groups (see Table 3.4). Most (47%) of the women had their first sexual intercourse with a fiance/boyfriend and 44% with their husband/partner. The majority of urban women (58%) had their first sexual intercourse with a fiancé/boyfriend, whereas the majority of rural women (60%) had their first with their husband/partner. The majority of females in the 15-19 age group (56%) stated that their first sexual intercourse was with a boyfriend/fiancé. Ten percent (10%) of the women say that their male partner was in school at the time they had their first sexual intercourse. This figure is lower than that of the women that were in school at first sexual intercourse and indicates that some females in school have sex with males that are not in school. This rate is higher among urban, Garifuna and Creole women. The majority of women (61%) say the males had not completed high school (see Table 3.7). 3.5 Contraceptive use at first sexual intercourse Only 17% of the females say that they had used a contraceptive method when they first had sexual intercourse (see Table 3.8). This rate is higher among urban women, teenagers and women in the Belize District. Approximately 62% of those who used contraceptives say that their male partner used a condom and 29% had used the pills. Table 3.9 shows that condom use is highest among Garifuna women, while, the pills/oral is highest among Mestizo women. When the females first had their sexual intercourse, both they and their partner in the majority of cases (61%) were the ones that made the decision to use a contraceptive. Twenty-five percent (25%) of them say it was their own decision and 13% say it was their partner's decision (see Table 3.10). They used contraceptives mainly to prevent pregnancies (77%) and to prevent both pregnancies and HIV/AIDS (21%). Table 3.11 presents the rates by residence and ethnic group. The females who did not use any contraceptive at first sexual intercourse were asked, "Why didn't you or your partner use a contraceptive method during this first sexual intercourse?" Most of them (38 %) say that they "did not know of any method", while 27% 21 say that they did not expect to have sexual intercourse" and 22% say that they "did not want to use any method." 3.6 Sexual intercourse in the last 30 days and last 3 months Almost 70% of the females have had sex with a male within the 30 days prior to the survey. More rural compared to urban women, and more Mestizo women compared to other ethnic groups had sex in the last 30 days. The likelihood of having sex in the last 30 days increases with age up to 29 years. Thereafter, there are no clear patterns (see Table 3.12) The females who did not have sex in the 30-day period were asked, "Have you had sexual intercourse with a male in the last 3 months?" Only 33% have had sex in the last 3 months. The differentials for residences, age and ethnic group are presented in Table 3.13. The majority (95%) of them that have had sexual intercourse in the 3 months prior to the survey have had only one sexual partner. Almost all (97.7%) of them had their last sexual intercourse on a consensual basis and with their husband/common-law husband (80%) and fiance/boyfriend (13%). 3.7 Summary The mean age at first sexual intercourse is higher for females compared to their male partners at first sexual intercourse. More females were in school compared to their male partners. The majority of rural women had their first sexual intercourse with their husband/partner, while the majority of urban women had theirs with a fiancé/boyfriend. The majority of women did not use a contraceptive at first sexual intercourse. However, condom use is the most popular form among those who use a contraceptive at first sexual intercourse. Both partners made the decision to use a contraceptive and that was done mainly to prevent pregnancies. The majority of the women have had sex in the last thirty days. The majority of those who had had sex in the last 3 months, did so with their husbands. 22 TABLE 3-1 BELIZE: Mean Age at First Sexual Intercourse by Selected Characteristics Women Aged 15-44 1999 Family Health Survey (Percent Distribution) No. of Cases* Selected Characteristics Mean Age (Unweighted) Total 17.6 (2816) Residence Urban 17.7 (1358) Rural 17.4 (1458) District Corozal 18.5 (476) Orange Walk 18.1 (493) Belize 17.2 (839) Cayo 18.0 (490) Stann Creek 16.6 (259) Toledo 16.8 (259) Age 15-19 15.6 (236) 20-24 17.0 (534) 25-29 17.8 (634) 30-34 17.9 (613) 35-39 18.5 (467) 40-44 18.0 (332) Ethnic Group Creole 17.3 (671) Mestizo 18.0 (1507) Garifuna 16.8 (166) Maya/Ketchi 16.6 (280) Other 17.6 (192) TABLE 3-1 continued BELIZE: Mean Age at First Sexual Intercourse by Selected Characteristics Women Aged 15-44 1999 Family Health Survey (Percent Distribution) No. of Cases* Selected Characteristics Mean Age (Unweighted) Religion Anglican 17.1 (155) Baptist 17.1 (115) Methodist 16.9 (105) Nazarene 17.7 (84) Pentecostal 17.0 (192) Roman Catholic 17.7 (1477) Other 17.8 (473) None 17.4 (215) Working Status Working 17.8 (854) Not working 17.5 (1962) * For the purpose of calculating the mean, those who answered "Don't Know" and those who have never had sexual intercourse were omitted, for a total of 761. * Excludes 23 cases for whom ethnic group is unknown. * Excludes 9 cases for whom religion is unknown. * Excludes 4 cases for whom working status is unknown. TABLE 3-2 BELIZE: In School at Time of First Sexual Intercourse, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) In School First Intercourse Selected Characteristics Yes No Total No. of Cases* (Unwieghted) Total 17.8 82.2 100.0 (2911) Residence Urban 24.0 76.0 100.0 (1416) Rural 11.7 88.3 100.0 (1495) Ethnic Group Creole 33.3 66.7 100.0 (716) Mestizo 8.4 91.6 100.0 (1530) Garifuna 41.9 58.1 100.0 (174) Maya/Ketchi 2.5 97.5 100.0 (290) Other 23.5 76.5 100.0 (201) * Excludes 16 cases for whom in school at time of first sexual intercourse is unknown. * Excludes 24 cases for whom ethnic group is unknown. TABLE 3-3 BELIZE: Level of Education Completed at Time of First Sexual Intercourse, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Level of Education Completed Primary BTTC/ No. of Cases* Selected Characteristics None School High School BCA/BNS Sixth Form University Total (Unweighted) Total 30.1 50.0 14.9 0.6 3.7 0.7 100.0 (2909) Residence Urban 18.9 52.9 20.9 0.6 5.6 1.0 100.0 (1415) Rural 41.4 47.0 8.7 0.6 1.8 0.4 100.0 (1494) Ethnic Group Creole 7.7 61.6 25.1 0.4 4.3 0.9 100.0 (714) Mestizo 40.4 43.7 10.8 0.7 3.8 0.6 100.0 (1532) Garifuna 16.4 66.9 14.0 0.8 1.9 0.0 100.0 (174) Maya/Ketchi 56.6 38.7 3.4 0.9 0.4 0.0 100.0 (289) Other 17.4 49.1 22.8 0.4 7.4 2.9 100.0 (200) * Excludes 18 cases for whom education level is unknown. * Excludes 24 cases for whom ethnic group is unknown. TABLE 3-4 BELIZE: First Sexual Intercourse on Consensual Basis, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Consensual Basis Selected Characteristics Yes No Total No. of Cases* (Unwieghted) Total 96.0 4.0 100.0 (2888) Residence Urban 96.0 4.0 100.0 (1400) Rural 96.0 4.0 100.0 (1488) Ethnic Group Creole 94.8 5.2 100.0 (706) Mestizo 96.8 3.2 100.0 (1523) Garifuna 94.5 5.5 100.0 (172) Maya/Ketchi 96.3 3.7 100.0 (288) Other 95.4 4.6 100.0 (199) * Excludes 24 cases for whom ethnic group is unknown. * Excludes 39 cases for whom first sexual intercourse on consensual basis is unknown. TABLE 3-5 BELIZE: Relationship to The First Male, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Relationship to First Male Incest Incest Husband/ Visiting Fiance/ Casual Mother's (Father/ (Other No. of Cases* Selected Characteristics Common-law Partner Boyfriend Friend Acquaintance Partner Brother) Relative) Other Total (Unweighted) Total 44.4 4.3 46.5 3.5 0.3 0.3 0.2 0.2 0.2 100.0 (2887) Residence Urban 29.0 6.6 58.4 4.5 0.2 0.5 0.4 0.2 0.2 100.0 (1405) Rural 59.9 . 2.0 34.6 2.5 0.4 0.2 0.0 0.2 0.2 100.0 (1482) District Corozal 70.9 2.7 22.8 1.8 0.5 0.0 0.2 0.5 0.8 100.0 (479) Orange Walk 59.9 2.0 33.5 2.2 0.6 1.4 0.0 0.2 0.3 100.0 (495) Belize 13.9 10.6 69.4 5.3 0.0 0.3 0.2 0.2 0.2 100.0 (876) Cayo 60.2 0.4 34.9 3.1 0.3 0.0 0.7 0.1 0.1 100.0 (504) Stann Creek 28.7 0.5 67.3 2.9 0.3 0.0 0.0 0.3 0.0 100.0 (266) Toledo . 74.5 0.3 21.1 3.6 0.6 0.0 0.0 0.0 0.0 100.0 (267) Age 15- 19 32.5 4.8 55.9 5.0 0.7 0.0 0.8 0.0 0.4 100.0 (239) 20-24 33.7 4.4 57.3 3.4 0.2 0.1 0.2 0.2 0.3 100.0 (546) 25-29 43.5 4.9 47.1 2.5 0.4 1.0 0.0 0.4 0.1 100.0 (653) 30-34 49.1 4.1 41.2 4.8 0.3 0.3 0.0 0.2 0.0 100.0 (631) 35-39 52.9 5.9 36.7 3.4 0.3 0.0 0.0 0.2 0.6 100.0 (477) 40-44 51.8 1.3 43.5 2.4 0.0 0.4 0.6 0.0 0.0 100.0 (341) TABLE 3-5 continued BELIZE: Relationship to The First Male by Selected Characteristics Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Relationship to First male Incest Incest Husband/ Visiting Fiance/ Casual Mother's (Father/ (Other No. of Cases* Selected Characteristics Common-law Partner Boyfriend Friend Acquaintance Partner Brother) Relative) Other Total (Unweighted) Ethnic Group Creole 12.6 7.7 75.1 3.5 0.1 0.3 0.3 0.0 0.4 100.0 (701) Mestizo 60.7 2.8 31.5 3.5 0.3 0.5 0.1 0.3 0.3 100.0 (1523) Garifuna 9.6 4.3 79.9 5.4 0.0 0.0 0.4 0.4 0.0 100.0 (173) Maya/Ketchi 82.5 1.0 13.6 2.1 0.8 0.0 0.0 0.0 0.0 100.0 (290) Other 26.5 7.1 60.3 4.5 0.8 0.0 0.8 0.0 0.0 100.0 (200) Religion Anglican 10.0 6.1 77.9 4.8 0.0 0.4 0.0 0.4 0.4 100.0 (165) Baptist 35.0 9.8 53.3 1.3 0.6 0.0 0.0 0.0 0.0 100.0 (123) Methodist 12.8 9.7 70.7 6.7 0.0 0.0 0.0 0.0 0.0 100.0 (108) Nazarene 38.0 7.2 50.0 4.1 0.0 0.0 0.0 0.0 0.8 100.0 (86) Pentecostal 61.6 1.5 31.8 4.1 0.0 0.0 0.0 0.4 0.6 100.0 (193) Roman Catholic 43.3 4.2 47.5 3.4 0.5 0.5 0.3 0.2 0.1 100.0 (1511) Other 58.4 2.7 34.7 3.1 0.0 0.4 0.1 0.0 0.6 100.0 (481) None 60.5 2.3 33.1 3.0 0.0 0.0 0.8 0.3 0.0 100.0 (220) * Excludes 24 cases for whom ethnic group is unknown. * Excludes 9 cases for whom religion is unknown. * Excludes 4 cases for whom working status is unknown. * Excludes 28 cases for whom relationship to the first male is unknown. TABLE 3-6 BELIZE: Male in School at Time of Female's First Sexual Intercourse, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) School First - Intercourse Selected Characteristics Yes No Unknown Total No. of Cases* (Unweighted) Total 9.5 86.5 4.0 100.0 (2927) Residence Urban 12.7 82.7 4.7 100.0 (1426) Rural 6.3 90.4 3.3 100.0 (1501) Ethnic Group Creole 13.7 81.7 4.6 100.0 (719) Mestizo 6.6 89.4 4.0 100.0 (1539) Garifuna 20.8 73.9 5.3 100.0 (175) Maya/Ketchi 1.9 97.3 0.9 100.0 (290) Other 13.8 81.2 5.0 100.0 (204) * Excludes 24 cases for whom ethnic group is unknown. TABLE 3-7 BELIZE: Level of Education Completed by First Male, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Level of Education Completed Primary High BTTC/ No. of Cases* Selected Characteristics None School School BCA/BNS Sixth Form University Unknown Total (Unweighted) Total 16.3 44.7 17.8 0.4 6.1 1.9 12.8 100.0 (2812) Residence Urban 8.8 44.9 24.7 0.5 8.9 2.3 10.0 100.0 (1360) Rural 23.8 44.5 10.9 0.4 3.3 1.5 15.7 100.0 (1452) Ethnic Group Creole 4.5 46.4 25.0 0.2 8.5 1.4 13.9 100.0 (688) Mestizo 22.1 42.6 15.5 0.5 5.4 2.0 11.8 100.0 (1477) Garifuna 4.9 60.6 18.5 1.2 8.9 2.0 3.9 100.0 (165) Maya/Ketchi 33.3 40.9 3.4 0.3 0.8 0.3 21.1 100.0 (288) Other 4.8 42.7 27.9 0.0 6.7 5.9 11.9 100.0 (194) * Excludes 23 cases for whom ethnic group is unknown. TABLE 3-8 BELIZE: Use of Contraceptive at First Sexual Intercourse, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Contraceptive Method Used Selected Characteristics Yes No Unknown Total No. of Cases* (Unweighted) Total 17.0 81.3 1.7 100.0 (2919) Residence Urban 22.6 74.5 2.8 100.0 (1424) Rural 11.2 88.2 0.6 100.0 (1495) District Corozal 15.1 83.7 1.2 100.0 (483) Orange Walk 10.1 89.6 0.3 100.0 (499) Belize 26.4 69.9 3.7 100.0 (891) Cayo 13.7 85.3 1.0 100.0 (512) Stann Creek 13.3 85.9 0.8 100.0 (267) Toledo 8.0 92.0 0.0 100.0 (267) Age 15-19 29.6 68.1 2.3 100.0 (241) 20-24 24.9 73.7 1.4 100.0 (549) 25-29 15.8 82.2 2.0 100.0 (665) 30-34 16.7 81.3 1.9 100.0 (637) 35-39 10.7 87.4 1.9 100.0 (483) 40-44 6.6 92.6 0.8 100.0 (344) Ethnic Group Creole 24.1 72.5 3.4 100.0 (718) Mestizo 14.3 84.9 0.8 100.0 (1532) Garifuna 19.7 78.7 1.6 100.0 (175) Maya/Ketchi 3.4 96.4 0.3 100.0 (290) Other 25.8 70.1 4.1 100.0 (204) Religion Anglican 24.2 72.3 3.5 100.0 (166) Baptist 17.5 80.6 1.9 100.0 (125) Methodist 25.9 67.3 6.9 100.0 (110) Nazarene 23.7 75.5 0.8 100.0 (86) Pentecostal 9.9 88.5 1.6 100.0 (196) Roman Catholic 17.4 81.3 1.3 100.0 (1530) Other 14.0 84.8 1.2 100.0 (484) None 12.6 85.5 1.9 100.0 (222) * Excludes 24 cases for whom ethnic group is unknown. * Excludes 9 cases for whom religion is unknown. TABLE 3-9 BELIZE: Contraceptive Method Used, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Method Used Vaginal Rythym/ Male Pills/Oral Condom Condoms Foaming Calendar Sterilization/ No. of Cases* Selected Characteristics Contraceptives Injection (Male) (Female) Tablets Method Withdrawal Vasectomy Total (Unweighted) Total 29.4 2.4 62.6 0.5 1.0 1.1 2.9 0.2 100.0 (473) Residence Urban 27.5 2.0 64.6 0.7 0.9 1.0 3.1 0.2 100.0 (316) Rural 33.5 3.2 58.3 0.0 1.3 1.3 2.4 0.0 100.0 (157) Ethnic Group Creole 24.3 1.3 68.8 0.4 0.8 0.0 3.9 0.4 100.0 (179) Mestizo 39.2 4.2 50.9 0.0 0.9 1.5 3.3 0.0 100.0 (201) Garifuna 11.9 0.0 82.2 2.0 0.0 4.0 0.0 0.0 100.0 (34) Maya/Ketchi ** ** ** ** ** ** ** ** 100.0 (9) Other 21.4 1.6 70.8 1.6 3.1 1.6 0.0 0.0 100.0 (50) * Excludes 3 cases for whom ethnic group is unknown. * Excludes 2 cases for whom method used is unknown. ** Less than 25 cases. TABLE 3-10 BELIZE: Decision to Use Contraceptive, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Whose Decision to Use Method Decision Partner's Made Do Not No. of Cases* Selected Characteristics My Decision Decision Together Remember Total (Unweighted) Total 25.2 13.1 61.2 0.4 100.0 (472) Residence Urban 24.7 11.5 63.1 0.7 100.0 (316) Rural 26.2 16.6 57.2 0.0 100.0 (156) Ethnic Group Creole 32.4 8.9 58.2 0.4 100.0 (178) Mestizo 22.5 16.7 60.1 0.7 100.0 (200) Garifuna 19.8 7.9 72.3 0.0 100.0 (34) Maya/Ketchi ** ** ** ** 100.0 (9) Other 19.1 16.5 64.4 0.0 100.0 (51) * Excludes 3 cases for whom ethnic group is unknown. * Excludes 3 cases for whom decision is unknown. ** Less than 25 cases. TABLE 3-11 BELIZE: Reason For Using Contraceptive, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Reason to Use Contraceptive Methods Prevent Prevent STI's/HIV/ No. of Cases* Selected Characteristics Pregnancies AIDS Both Other Total (Unweighted) Total 76.9 2.0 20.8 0.3 100.0 (473) Residence Urban 77.9 2.4 19.5 0.2 100.0 (317) Rural 74.9 1.3 23.3 0.5 1C0.0 (156) Ethnic Group Creole 72.4 3.8 23.8 0.0 100.0 (179) Mestizo 78.3 1.0 20.0 0.7 100.0 (201) Garifuna 78.2 2.0 19.9 0.0 100.0 (34) Maya/Ketchi ** ** ** ** 100.0 (9) Other 83.9 0.0 16.1 0.0 100.0 (50) * Excludes 3 cases for whom ethnic group is unknown. * Excludes 2 cases for whom reason to use contraceptive is unknown. ** Less than 25 cases. TABLE 3-12 BELIZE: Sexual Intercourse in The Last 30 Days, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Sexual Intercourse in Last 30 Days Selected Characteristics Yes No Unknown Total No. of Cases* (Unweighted) Total 70.4 28.4 1.2 100.0 (2927) Residence Urban 67.9 30.8 1.3 100.0 (1426) Rural 72.9 25.9 1.2 100.0 (1501) Age 15-19 57.0 42.7 0.3 100.0 (242) 20-24 66.4 32.8 0.8 100.0 (552) 25-29 77.3 21.1 1.7 100.0 (666) 30-34 74.1 25.2 0.7 100.0 (639) 35-39 70.7 27.2 2.2 100.0 (483) 40-44 71.2 27.3 1.5 100.0 (345) Ethnic Group Creole 65.9 32.6 1.4 100.0 (719) Mestizo 74.6 24.3 1.2 100.0 (1539) Garifuna 59.9 39.4 0.7 100.0 (175) Maya/Ketchi 70.7 28.5 0.8 100.0 (290) Other 68.3 29.6 2.1 100.0 (204) * Excludes 24 cases for whom ethnic group is unknown. TABLE 3-13 BELIZE: Sexual Intercourse in The Last 3 Months, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Sexual Intercourse in Last 3 Months Selected Characteristics Yes No Unknown Total No. of Cases* (Unweighted) Total 32.7 63.6 3.6 100.0 (777) Residence Urban 30.0 65.7 4.3 100.0 (409) Rural 36.0 61.2 2.9 100.0 (368) Age 15-19 31.4 68.0 0.6 100.0 (88) 20-24 34.3 64.9 0.8 100.0 (156) 25-29 28.9 63.0 8.1 100.0 (142) 30-34 36.2 61.3 2.5 100.0 (154) 35-39 30.8 62.3 6.9 100.0 (136) 40-44 34.1 62.1 3.8 100.0 (101) Ethnic Group Creole 31.5 64.9 3.6 100.0 (223) Mestizo 32.7 63.1 4.2 100.0 (352) Garifuna 28.2 70.0 1.8 100.0 (68) Maya/Ketchi 36.3 63.7 0.0 100.0 (77) Other 38.6 53.4 8.0 100.0 (57) * Excludes 6 cases for whom ethnic group is unknown. TABLE 3-14 BELIZE: Relationship With Last Male With Whom Had Sexual Intercourse, by Selected Characteristics Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Relationship to the Last Male With Whom Had Sexual Intercourse Husband/ Visiting Fiance/ Casual No. of Cases* Selected Characteristics Commonlaw Partner Boyfriend Friend Acquaintance Other Total (Unweighted) Total 79.5 6.3 12.7 1.1 0.3 0.1 100.0 (2914) Residence Urban 71.7 9.9 16.6 1.3 0.3 0.2 100.0 (1416) Rural 87.4 2.7 8.7 1.0 0.3 0.0 100.0 (1498) Age 15- 19 52.7 6.4 35.8 3.9 0.7 0.5 100.0 (241) 20-24 65.7 7.6 24.5 1.2 0.8 0.0 100.0 (551) 25-29 82.0 8.1 8.9 0.8 0.1 0.0 100.0 (660) 30-34 88.4 4.4 6.3 1.0 0.0 0.0 100.0 (638) 35-39 91.1 4.8 3.7 0.3 0.0 0.1 100.0 (481) 40-44 88.6 6.2 4.1 0.7 0.0 0.4 100.0 (343) Ethnic Group Creole 64.1 13.2 20.8 1.5 0.4 0.0 100.0 (714) Mestizo 89.4 3.5 6.0 0.7 0.3 0.2 100.0 (1536) Garifuna 54.8 9.6 32.9 2.7 0.0 0.0 100.0 (174) Maya/Ketchi 93.2 0.3 4.7 1.9 0.0 0.0 100.0 (289) Other 73.3 5.0 20.5 0.4 0.0 0.8 100.0 (201) * Excludes 24 cases for whom ethnic group is unknown. * Excludes 13 cases for whom relation ship with last male is unknown. CHAPTER 4 FERTILITY, RELATIONSHIP AND REPRODUCTIVE HISTORY 4.1 Introduction This chapter presents a description of the levels, trends and differentials of fertility based on the 1999 Family Health Survey. Where possible, comparisons are made with the 1991 data. Furthermore, every effort is made to highlight teenage fertility. 4.2 Levels and Differentials Total Fertility Rate (TFR) is one of the main tools used for measuring fertility levels and is defined as the average number of children a woman would have over her lifetime if she were to experience the current age specific fertility rates for a five-year period. Results from the 1999 FHS show that the TFR among women in the 15-44 age group is 3.7 (see Table 4.1). This figure is lower than the 1991 TFR of 4.5 and indicates a declining trend in fertility. Differentials of age specific fertility rates and total fertility rates by residence, years of education, number of household amenities, work status, ethnicity and religion are presented in Table 4.2. TFR is lowest for working women (2.41), women that have 8 to l0 household amenities (2.4) and women with nine or more years of education (2.73). A comparison of the corresponding ratings in 1991 (2.9, 2.7 & 3.2, respectively) shows that the first and second lowest TFR shifted positions. The highest TFR are among women that have less than 3 household amenities (6.82) and women with less than eight years of education (5.08). These two groups of women were ranked the same in 1991. Women in the urban areas have lower fertility rates (3.1) than women in rural areas (4.2). This difference of almost one child per woman is lower compared to 1991 when rural women had almost 2 children more than urban women. These figures indicate a higher rate of fertility decline in rural areas (28%) compared to urban areas (20%). Mestizo women also experienced a 28% decline in fertility. This rate of fertility decline is the highest compared to any other sub-group of women. Even though Mestizo women have the highest fertility decline, their fertility rate remains higher than that of the Creoles, who experienced a 23 14% decline. However, the differential between these groups is reduced from almost two children in 1991 to fewer than one child in 1999. Creole women have the lowest fertility rate (3.11) compared to the Mestizo (3.45) and other ethnic groups (4.75). The corresponding rates in 1991 were 3.6,4.8 and 5.4 respectively. The two southern districts have the highest TFR, 5.6 in Toledo and 5.2 in Stann Creek, while Belize District has the lowest TFR, 3.0 (see Figure 4.2). The corresponding rates for the northern districts are 3.0 and 3.4 for Corozal and Orange Walk respectively. TFR in Cayo District is 3.7. Even though Belize District has the lowest TFR, its teenage fertility rate is among the highest, along with those for Stann Creek and Toledo. The two northern districts have the lowest teenage fertility rates. As is expected, fertility rates decrease as the years of education increase. Women with less than eight years of education have 5.08 children compared to 2.73 for those with nine or more years of education. This difference of 2.35 children between the lowest and highest levels of education is lower compared to 1991 when the difference was 2.8. Women who work have almost 2 children less than women who do not work. This difference is also less than the corresponding differential in 1991 (2.3). Roman Catholic women also experienced a high rate (25%) of fertility decline. Their TFR was 4.6 in 1991 compared to 3.43 in 1999. The corresponding rates for Protestant women are 4.2 and 3.85 respectively. These figures show that, compared to the Protestants, fertility among Roman Catholic was higher in 1991 but lower in 1999. Women who live in households with fewer than three amenities have a TFR of 6.82. This rate is higher compared to 1991, (6.7) and is 4.4 children more than those who have 8 to 10 amenities. This group of women is the only sub-group that has an increase in fertility. The 20-24 age group remains the modal age group of childbearing and is the same for almost all sub-groups of women. This low modal age group of childbearing is consistent with early marriage/union and the initiation of contraception by married women only after they have had children during their first 4-5 years of marriage. Nevertheless, the fertility decline (20%) for this age group indicates greater delays in marriages and earlier uses of contraception among married women. Women who work outside the home have similar age specific fertility rates among the 20-24 and the 25-29 age groups, 117 & 116 respectively. Therefore, their modal age group of childbearing may be 24 considered as ages 20-29. In 1991, the modal age group of childbearing for women who worked was 25-29. The age specific fertility rate is the annual number of births per 1000 women in that age during a year. The 1999 FHS shows that all the age groups experienced a decline in age specific fertility rate compared to 1991 (see figure 4.1). However, the youngest five year age group (15-19 years) experienced the greatest decline, from 137 births per 1000 women in 1991 to 95 in 1999. This significant decline (31%) in teenage fertility may be a result of increased female participation in tertiary level education, delayed marriages and increased awareness of contraception and family life education. 4.3 Retrospective Fertility Retrospective fertility is defined as the total cumulative fertility to all women over their lifetime. Unlike the total fertility rate, which is a period rate that describes recent fertility over a 5 years period, the retrospective fertility gives the average number of children born per woman. Table 4.3 presents the average number of children per woman by age and selected characteristics. The differentials in retrospective fertility for these cohorts of women are similar when compared to the differentials experienced in the period total fertility rates. Urban women have fewer children than rural women, Creoles have fewer children than other ethnic groups and working women have fewer children than women who do not work. Women with the highest level of education have the least number of children. By the time a woman completes her reproductive years (ages 40-44), she has an average of 5.2 children. This is higher than the period TFR and lower than the corresponding number in 1991, when the average number of children per woman was 6.1. A more detailed look at the percent distribution of all women by age and children ever born as presented in Tables 4.4 shows that 36% of all women and 9% of currently married women had not begun childbearing at the time of the survey. These rates are higher than the corresponding rates for 1991, 34% and 8% respectively. Among the teenagers, 87% of them did not have any children at the time of the survey in 1999 compared to 82% in 1991. The decrease in the percentage of teens not having children is even higher among currently married teens. In 1991, 27% of them did not have any children at the time of the survey compared to 36% in 1999. These figures represent a 30% decrease in the percentage of teens that did not have any children at the time of the surveys. 25 4.4 Nuptiality Age at marriage is one of the factors that can significantly reduce fertility levels. If sexual intercourse is confined within marriage, the years of exposure for a woman to become pregnant are reduced as the age at marriage increases. An increase in the mean age at marriage increases the mean age at childbearing, which lowers population growth rate and increases the doubling time of a population. The majority of the women (55%) are in a union, and of these, 33% are married and 22% in a common-law union. Approximately 6% are in a visiting relationship and 38% are single. The differentials in marital status for selected characteristics (see Table 4.5) show that a higher proportion of rural women is married (38%) compared to urban women (28%). However, a higher proportion of urban women live in a common law union (28%) compared to rural women (20%). Only 5% of the teenagers are married and 9% live in a common-law union. Almost half (49%) of the Maya women are married and they represent the highest proportion of married women compared to the other ethnic groups. Garifuna women have the lowest percentage of married women (17%), while 21% of Creoles and 38% of Mestizo women are married. The proportions of single women in each of the four major ethnic groups are similar and range from 37% for the Garifuna and Mayas to 40% for the Creoles. The differences are more striking with respect to common-law union, which range from 13% among the Maya to 31% among the Garifuna. One quarter of Creole women live in a common-law union compared to 20% of Mestizo. All the ethnic groups experienced a decrease in marriage rates. However, the Garifuna and Mestizo experienced the highest rates of decrease i.e., 18% and 16% respectively. The data on marital status by education level show that, as the level of education increases, the proportion of married women decreases until secondary level, and then increases at the post secondary level. Half of the women with no education are married compared to less than one quarter (23%) of those with secondary education. This low rate of marriage among women with secondary level of education may indicate their intentions to continue their education before getting married. The rate of marriage among those with post secondary education is the same as those that have completed primary education (35%). The factors that may have influenced each of these groups may have differed. Roman Catholics have a lower rate of marriage (32%) and higher rate of common-law union (22%) compared to Protestants, 34% and 21%, respectively. Women who do not work have higher rates of 26 marriage (34%) and common-law union (23 %) compared to women who work, 31% and 19% respectively. Less than 1% of the women are widowed, separated or divorced. A comparison of the 1991 and 1999 figures on marital status shows that the rate of marriage, as well as common-law union, has decreased. During the 1990s, more women preferred to remain single i.e. an increase from 34% in 1991 to 38% in 1999. The proportion of single women is higher than that of any other marital status. This was not the case in 1991 when married women represented the highest proportion. This decrease in the rates of marriage and common-law union however, was not experienced by all sub-groups of women. The rate of teenagers in union decreased from 18% in 1991 to 15% in 1999. These figures represent a 15.4% decrease, which is consistent with the decrease in teenage fertility. There is not much difference in the proportion of single teenagers , 78% in 1999 and 79% in 1991. However, the proportion of teenagers in visiting relationships has increased by 45%. The median age at first union by age group ranges from 16.0 to 19.0 years (see Table 4.6). This age is lower compared to 1991, when median age at first union ranged from 20 to 21 years. This indicates an earlier entry into union and the potential for higher fertility. Nevertheless, the teenagers have been postponing childbearing as indicated by the significant decline in fertility among this age group. 4.5 Fertility Preferences Planning Status of last pregnancy Asking women 15-44 who had become pregnant in the last five years, if they had "wanted to become pregnant and if no, was it because they wanted no more children or wanted to wait longer before another pregnancy, determines the planning status of last pregnancy. The answers to these questions classify the pregnancy as planned, mistimed or unwanted. A combination of the mistimed and unwanted pregnancies may be classified as unplanned pregnancies. Over the five-year period prior to the survey, 42% of the respondents had at least one pregnancy. Among those who had at least one pregnancy, almost 72% of them had planned the last pregnancy, 15% was mistimed and 10% was unwanted (25% unplanned). The percentage of planned pregnancies has increased and unwanted pregnancies decreased compared to 1991 when the corresponding rates were 65% and 13% respectively. The 27 percentage of mistimed pregnancies is 4% higher compared to 1991. The differences in the status of last pregnancy by selected characteristics are presented in Table 4.7 A comparison among the various age groups shows that mistimed pregnancies decrease with age, while the rate of unwanted pregnancies increases. Among the 15-19 age group, 19% of them had at least one pregnancy in the past 5 years. The rate is lower compared to 1991 when 21% of teenagers had at least one pregnancy during the same time period. Approximately 73% of the teens planned their last pregnancy. This rate is slightly lower compared to 1991, when 75% of the teens planned their last pregnancy. Women who have one (1) living child are more likely to have planned their last pregnancy compared to those who have two or more children. Eighty-one percent of them had planned their last pregnancy. This rate decreases as the number of living children increases. Garifuna women have the highest rate (39%) of unplanned pregnancies compared to the other major ethnic groups. 4.6 Current Pregnancy Intentions Nine percent (9%) of the women were pregnant at the time of the survey and 12% desired pregnancy, whereas 72% had no desire to become pregnant. Table 4.8 presents the current pregnancy intention of currently married women by selected characteristics. The highest percentage of pregnant women at the time of the survey was among the teenagers (19%), women with no living children (18%) and Maya women (14%). There are no clear patterns of pregnancy intentions according to age group. However, the proportion of teenagers (66%) that does not desire pregnancy is the lowest compared to women in the other age groups. Another 15% of the teenagers desire to become pregnant. In 1991, 20% of the teens were pregnant at the time of the survey, while almost 58% of them did not desire pregnancy and 16% wanted to become pregnant. The desire to become pregnant decreases with the number of living children and increases with the level of education. Maya women have the highest proportion who desire pregnancy and were pregnant at the time of the survey. This is a reflection of their high fertility. The Garifuna women have the lowest percentage that was pregnant at the time of the survey. 28 The majority (58%) of women who were not using contraceptives did not desire pregnancy. This type of behaviour results in unplanned pregnancies that are either mistimed or unwanted. The majority (91%) of those using contraceptives do not desire pregnancy. However, 8% desire pregnancy even though they are still using contraceptive. Forty-six percent (46%) of the currently married fecund women want no more children (see Table 4.9). This rate is higher among rural women (49%) and increases with age and the number of living children. 4.7 Summary The findings presented above are in the expected directions. Fertility rates have declined among all sub-groups of women, especially among teenagers. The differences in fertility rates at the urban/rural level, education level, and among the major ethnic groups are less compared to 1991. This indicates that increased awareness and access to contraceptives are reaching women at all levels. More women preferred to remain single during the 1990s compared to the 1980s. However, the percentage that lives in common-law union did not change very much. Marriage rates are highest among Maya and lowest among Garifuna women. Even though the median age at first union is younger compared to 1991, this did not result in increased fertility among the younger women, as is expected with early unions. There has been an increase in the percentage of pregnancies that are planned compared to 1991. Unwanted pregnancies increase with age, while mistimed pregnancies decrease with age. A higher percentage of Mestizo and Maya had planned their last pregnancies compared to Creole and Garifuna women. It is expected that fertility rates will continue to decline as family planning education becomes more integrated in the school curriculum and access to family planning services is enhanced. 29 30 31 TABLE 4-1 BELIZE: Number of Births, Woman-Years of Exposure, and Age-Specific Fertility Rates, 1994 -1999: Women Aged 15-44 1999 Family Health Survey Age-Specific Age Group Number of Births Years of Exposure Fertility Rate 15-19 767 8072 95 20-24 1170 6096 192 25-29 971 5393 180 30-34 666 5135 130 35-39 338 4084 83 40-44 127 3386 38 45-49 20 1230 16 Total Fertility Rate 3.67 TABLE 4-2 BELIZE: Age-Specific Fertility Rates and Total Fertility Rate, by Selected Characteristics: (period Oct 94-Sept 99): Women Aged 15-44 1999 Family Health Survey Age Specific fertility Rates Selected Characteristics 15-19 20-24 25-29 30-34 35-39 40-44 TFR No. of Women Total 95 192 180 130 83 38 3.67 (3883) Residence Urban 92 169 152 122 50 17 3.12 (1851) Rural 97 215 209 137 115 56 4.2 (2032) Years of Education 0-7 years 154 265 222 174 122 61 5.08 (1086) 8 years 110 185 183 116 77 25 3.6 (1314) 9+ years 64 164 143 104 45 22 2.73 (1469) No. Household Amenities 0-2 183 340 329 209 162 125 6.82 (406) 3-7 105 208 179 143 93 38 3.96 (2224) 8-10 57 128 134 92 53 16 2.42 (1253) Work Status Working 70 117 116 96 43 25 2.41 (1143) Not working 103 233 215 151 101 44 4.32 (2740) Ethnicity Creole 86 191 163 90 59 16 3.11 (937) Mestizo 87 182 169 127 78 36 3.45 (2070) Other 120 216 222 181 118 64 4.75 (876) Religion Protestant 102 206 197 119 82 38 3.85 (1225) Catholic 87 175 168 134 77 34 3.43 (2044) None/Other 107 219 185 136 103 48 4.04 (614) District Corozal 88 195 138 114 52 19 3.03 (669) Orange Walk 69 168 194 118 78 32 3.38 (690) Belize 99 182 142 103 53 19 2.99 (1141) Cayo 73 180 183 139 100 30 3.66 (709) Stann Creek 117 239 251 177 135 81 5.19 (335) Toledo 156 259 272 211 141 78 5.59 (339) TABLE 4-3 BELIZE: Average Number of Children per Woman, by Age and Selected Characteristics: Women Aged 15-44 1999 Family Health Survey Age at Survey Selected Characteristics 15-19 20-24 25-29 30-34 35-39 40-44 Total Total 0.2 1.1 2.2 3.4 4.1 5.2 2.4 Residence Urban 0.2 1.0 1.9 2.9 3.6 4.2 2.1 Rural 0.2 1.2 2.6 4.0 4.7 6.1 2.7 Years of Education 0-7 years 0.3 1.7 3.3 4.5 4.9 6.5 3.6 8 years 0.2 1.2 2.2 3.6 4.3 5.0 2.7 9+ years 0.1 0.8 1.7 2.2 3.2 3.9 1.4 No. Household Amenities 0-2 0.3 2.1 4.0 5.4 6.1 7.5 3.5 3-7 0.2 1.2 2.3 3.7 4.3 5.5 2.5 8-10 0.1 0.6 1.6 2.5 3.4 4.4 2.0 Work Status Working 0.1 0.7 1.4 2.6 3.6 4.9 2.3 Not working 0.2 1.3 2.7 3.9 4.4 5.4 2.5 Ethnic Group Creole 0.1 1.1 2.0 2.9 3.5 4.8 2.1 Mestizo 0.1 1.0 2.2 3.3 4.2 5.3 2.4 Other 0.3 1.2 2.6 4.4 4.6 5.6 2.8 Religion Protestant 0.2 1.2 2.3 3.6 4.1 5.2 2.5 Catholic 0.2 0.9 2.2 3.2 4.1 5.2 2.3 None/Other 0.2 1.2 2.4. 4.1 4.1 5.4 2.5 TABLE 4-4 BELIZE: All Women and Women Currently in a Union by Age and Number of Children Ever Born Women Aged 15-44 1999 Family Health Survey (Percent Distribution) All Women Age at Surgery No. of Children 15-19 20-24 25-29 30-34 35-39 40-44 Total 0 86.5 44.2 19.8 10.3 6.7 5.2 35.9 1 10.5 25.3 18.0 10.1 8.2 5.1 12.9 2 2.8 16.4 22.9 19.4 13.1 9.2 12.6 3 0.2 9.2 17.6 15.2 16.1 11.6 10.0 4 0.0 4.2 9.8 13.9 15.8 16.3 8.3 5 0.0 0.5 6.1 10.7 13.3 12.2 6.4 6 0.0 0.2 3.5 8.9 9.2 12.5 5.0 7 0.0 0.0 1.4 6.0 7.7 4.2 2.9 8 0.0 0.0 0.5 3.8 4.3 8.6 2.3 9 0.0 0.0 0.1 1.6 2.3 2.8 1.3 10+ 0.0 0.0 0.2 0.1 3.2 12.3 2.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases (Unweighted) 716 673 704 666 495 359 3883 Average No. of Children 0.2 1.1 2.2 3.4 4.1 5.2 2.4 Women Currently in Union Age at Surgery Number of Children 15-19 20-24 25-29 30-34 35-39 40-44 Total 0 35.5 16.4 9.8 5.2 4.2 3.8 9.0 1 47.6 31.5 15.6 9.2 5.9 4.2 14.4 2 15.5 26.8 27.2 19.9 13.6 10.0 18.2 3 1.3 16.0 20.5 15.9 16.0 11.2 14.6 4 0.0 8.0 11.1 14.3 16.6 17.2 12.4 5 0.0 1.0 8.4 11.2 13.7 11.0 9.5 6 0.0 0.2 4.6 10.9 9.6 12.1 7.6 7 0.0 0.0 1.8 6.6 9.0 5.1 4.6 8 0.0 0.0 0.6 4.7 5.1 9.2 3.7 9 0.0 0.0 0.2 2.0 2.4 2.4 1.9 10+ 0.0 0.0 0.3 0.2 3.8 13.7 4.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases (Unweighted) 153 406 550 550 417 282 2574 Average No. of Children 0.8 1.7 2.7 3.8 4.4 5.4 3.6 TABLE 4-5 BELIZE: Union Status by Selected Characteristics at Time of Survey: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Union Status Common-law Visiting No. of Cases* Selected Characteristics Single Married Union Relationship Widowed Separated Divorced Total (Unweighted) Total 37.9 33.7 21.8 6.4 0.0 0.1 0.1 100.0 (3554) Residence Urban 37.8 28.7 23.8 9.6 0.0 0.0 0.1 100.0 (1699) Rural 38.0 38.5 20.0 3.4 0.0 0.1 0.1 100.0 (1855) Age 15-19 79.1 5.3 9.4 6.1 0.0 0.0 0.0 100.0 (708) 20-24 39.1 19.1 29.9 11.9 0.0 0.0 0.0 100.0 (661) 25 - 29 20.9 43.5 28.6 6.9 0.0 0.0 0.0 100.0 (693) 30-34 15.9 53.7 26.8 3.5 0.0 0.0 0.0 100.0 (651) 35-39 10.2 59.2 26.1 3.5 0.0 0.4 0.6 100.0 (491) 40-44 16.5 60.9 18.3 4.0 0.2 0.0 0.2 100.0 (350) Education Level None 16.8 51.5 26.8 5.0 0.0 0.0 0.0 100.0 (142) Incomplete Primary 30.1 41.7 26.4 1.6 0.1 0.0 0.0 100.0 (834) Complete Primary 36.9 35.3 23.4 4.1 0.0 0.0 0.2 100.0 (1193) Secondary 47.4 23.0 19.2 10.3 0.0 0.1 0.0 100.0 (1011) Post Secondary 37.2 36.8 12.7 13.0 0.0 0.2 0.2 100.0 (374) No. of Household Amenities 0-2 32.4 45.1 20.1 2.2 0.2 0.0 0.0 100.0 (373) 3-7 37.2 31.8 25.7 5.1 0.0 0.1 0.1 100.0 (2038) 8-10 40.4 33.5 16.5 9.5 0.0 0.0 0.1 100.0 (1143) TABLE 4-5 continued BELIZE: Union Status by Selected Characteristics at Time of Survey: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Union Status Common-law Visiting No. of Cases* Selected Characteristics Single Married Union Relationship Widowed Separated Divorced Total (Unweighted) Ethnic Group Creole 39.8 21.7 24.9 13.3 0.0 0.2 0.1 100.0 (865) Mestizo 38.1 38.6 20.3 2.8 0.0 0.0 0.1 100.0 (1909) Garifuna 36.9 17.3 31.2 14.6 0.0 0.0 0.0 100.0 (199) Maya/Ketchi 36.6 49.1 12.8 1.5 0.0 0.0 0.0 100.0 (359) Other 30.6 34.8 27.9 6.3 0.0 0.0 0.3 100.0 (222) Religion Roman Catholic 37.9 32.5 22.3 7.1 0.0 0.0 0.2 100.0 (1876) Protestant 37.8 34.6 20.7 6.8 0.0 0.1 0.1 100.0 (1129) None 31.3 30.9 33.0 4.3 0.0 0.6 0.0 100.0 (254) Other 43.9 40.9 13.5 1.6 0.0 0.0 0.0 100.0 (295) Working Status Working 38.6 31.4 19.5 9.9 0.0 0.2 0.3 100.0 (1039) Not working 37.6 34.7 22.8 4.9 0.0 0.0 0.0 100.0 (2515) * Excludes 10 cases for whom education level is unknown. * Excludes 27 cases for whom ethnic group is unknown. * Excludes 9 cases for whom religion is unknown. * Excludes 5 cases for whom work status is unknown. * Excludes 10 cases for whom marital status is unknown. TABLE 4-6 BELIZE: Women Whose First Union was Before Selected Ages and Median Age at First Union, According to Age at time of Survey: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Age Age at First Union 15-19 20-24 25-29 30-34 35-39 40-44 <15 <18 <20 <22 <25 13.7 64.3 76.6 76.6 76.6 4.4 36.2 62.0 78.6 87.3 4.4 30.6 52.4 72.3 87.9 6.2 33.0 52.0 66.7 82.3 4.0 30.0 56.6 69.9 80.8 7.4 34.6 56.2 71.7 82.5 Ever Married 21.7 65.2 83.5 92.4 95.4 96.1 Median Age at First Union 16.0 18.0 19.0 19.0 19.0 18.0 No. of Cases (Unweighted) (171) (456) (598) (615) (461) (337) TABLE 4-7 BELIZE: Planning Status of Last Pregnancy, by Selected Characteristics: Women, Aged 15-44, Who Had Been Pregnant During the Last Five Years 1999 Family Health Survey (Percent Distribution) Unplanned Selected Characteristics Planned Mistimed Unwanted Unknown Total No. of Cases* (Unweighted) Total 72.1 15.0 10.1 2.8 100.0 (1396) Residence Urban 73.3 16.2 8.0 2.5 100.0 (562) Rural 71.2 14.2 11.6 3.1 100.0 (834) Age 15-19 73.1 20.3 2.8 3.7 100.0 (105) 20-24 71.8 20.4 5.0 2.9 100.0 (321) 25-29 77.6 14.0 5.9 2.5 100.0 (400) 30-34 72.6 13.8 10.9 2.7 100.0 (343) 35-39 68.6 9.1 19.5 2.8 100.0 (168) 40-44 54.7 9.2 32.4 3.7 100.0 (59) No. of Living Children 0 ** ** ** ** 100.0 (4) 1 81.0 14.3 2.1 2.6 100.0 (273) 2 78.7 17.2 1.6 2.5 100.0 (331) 3 76.7 14.5 6.6 2.2 100.0 (244) 4 66.1 16.8 15.4 1.8 100.0 (197) 5 62.6 11.7 20.3 5.3 100.0 (121) 6+ 60.8 14.1 21.4 3.7 100.0 (226) Education Level 0-7 73.6 .10.7 12.8 2.9 100.0 (507) 8 71.2 16.4 10.1 2.3 100.0 (457) 9+ 71.2 18.4 7.0 3.4 100.0 (432) Ethnic Group Creole 68.8 18.0 10.0 3.2 100.0 (263) Mestizo 75.5 13.2 8.6 2.6 100.0 (778) Garifuna 57.9 19.8 19.1 3.2 100.0 (69) Maya/Ketchi 75.8 12.8 9.4 2.0 100.0 (205) Other 53.6 23.3 17.2 6.0 100.0 (81) * Excludes 4 cases for whom education level is unknown. * Excludes 6 cases for whom ethnic group is unknown. ** Less than 25 cases. TABLE 4-8 BELIZE: Current Pregnancy Intention, by Selected Characteristics: Currently Married Women, Aged 15-44 1999 Family Health Survey (Percent Distribution) Do not Currently Desire Desire No of Cases* Selected Characteristics Pregnant Pregnancy Pregnancy Menopausal Unknown Total (Unweighted) Total 9.4 12.2 76.2 0.1 2.0 100.0 (2327) Residence Urban 7.7 12.6 78.5 0.0 1.2 100.0 (1034) Rural 10.9 11.9 74.3 0.2 2.7 100.0 (1293) Age 15-19 18.9 14.7 65.9 0.0 0.5 100.0 (152) 20-24 12.3 13.5 71.9 0.0 2.3 100.0 (400) 25-29 10.4 16.4 71.3 0.0 1.9 100.0 (547) 30-34 11.2 10.8 75.6 0.0 2.3 100.0 (540) 35-39 7.2 10.7 80.9 0.0 1.2 100.0 (415) 40-44 0.9 8.2 86.9 0.7 3.2 100.0 (273) No. of Living Children 0 18.3 41.3 38.7 0.0 1.7 100.0 (226) 1 10.3 16.1 72.8 0.0 0.8 100.0 (389) 2 7.7 11.3 79.6 0.0 1.3 100.0 (499) 3 9.2 8.9 81.5 0.0 0.5 100.0 (402) 4 5.3 5.3 86.7 0.0 2.7 100.0 (309) 5 10.5 3.8 84.0 0.4 1.3 100.0 (185) 6+ 8.4 5.2 80.6 0.4 5.4 100.0 (317) Education Level 0-7 12.0 11.1 73.6 0.0 3.3 100.0 (759) 8 8.7 11.6 77.2 0.2 2.3 100.0 (810) 9+ 7.7 14.1 77.6 0.1 0.5 100.0 (758) Ethnic Group Creole 8.3 13.7 76.7 0.0 1.3 100.0 (475) Mestizo 9.3 11.8 78.2 0.0 0.7 100.0 (1326) Garifuna 4.0 17.9 78.1 0.0 0.0 100.0 (107) Maya/Ketchi 14.2 9.0 66.7 0.6 9.5 100.0 (262) Other 10.1 12.1 74.1 0.5 3.2 100.0 (157) Contraceptive Use Currently Using 0.5 7.5 90.6 0.0 1.4 100.0 (1316) Not Using 20.8 18.3 57.9 0.2 2.8 100.0 (1011) * Excludes 4 cases for whom education level is unknown. * Excludes 20 cases for whom ethnic group is unknown. * Excludes 5 cases for whom contraceptive use is unknown. TABLE 4-9 BELIZE: Women Who Want No More Children, by Residence and Selected Characteristics: Currently Married Fecund Women Aged 15-44 1999 Belize Family Health Survey (Percent Distribution) Residence Selected Characteristics Total Urban Rural Total 46.2 (2030) 42.9 (891) 48.8 (1139) Age 15-19 22.3 (148) 20.6 (63) 23.5 (85) 20-24 35.6 (390) 34.1 (182) 37.0 (208) 25-29 42.7 (501) 37.6 (218) 46.6 (283) 30-34 51.0 (473) 45.6 (204) 55.0 (269) 35-39 59.1 (330) 58.6 (152) 59.6 (178) 40-44 61.7 (188) 59.7 (72) 62.9 (116) No. of Living Children 0 0.5 (194) 0.9 (107) 0.0 (87) 1 23.9 (364) 25.1 (207) 22.3 (157) 2 47.0 (453) 46.9 (209) 47.1 (244) 3 54.7 (333) 52.5 (139) 56.2 (194) 4 61.7 (264) 63.8 (105) 60.4 (159) 5 66.4 (152) 71.2 (52) 64.0 (100) 6+ 70.7 (270) 75.0 (72) 69.2 (198) Educational Level 0-7 51.4 (671) 44.1 (177) 54.0 (494) 8 47.0 (689) 48.0 (277) 46.4 (412) 9+ 40.1 (670) 39.1 (437) 42.1 (233) Ethnic Group Creole 45.9 (412) 41.0 (256) 53.8 (156) Mestizo 45.3 (1163) 42.2 (472) 47.5 (691) Garifuna 50.5 (93) 47.0 (66) 59.3 (27) Maya/Ketchi 49.1 (232) 56.0 (25) 48.3 (207) Other 46.9 (130) 45.8 (72) 48.3 (58) * Excludes 4 cases for whom education level is unknown. * Excludes 18 cases for whom ethnic group is unknown. CHAPTER 5 ATTITIDES TOWARDS CHILDBEARING AND CONTRACEPTION 5.1 Introduction This chapter addresses women's attitudes and opinion towards childbearing and contraception. In particular, it looks at issues relating to ideal family size, spacing and a woman's right to decide about her pregnancy, including whether or not to have an abortion. 5.2 Family Planning Messages When respondents were asked if they have heard of any family planning messages on the radio, television or in a local newspaper over the past six months, the majority said that they have not heard such messages on any of the media. However, almost 41% hear family planning messages on radio, 36% on television and 16% in the local newspaper. These figures indicate that radio is the most popular medium for family planning messages, and local newspapers the least popular. Table 5.1 shows that only a small percentage (15%) of teenagers get family planning information from newspapers. Sixty six percent (66%) of the respondents hear family messages from the Belize Family Life Association (BFLA1). There is not much difference in the percentage by age group and by work status that hears family planning messages from BFLA. Sixty-five percent (65%) of teens get family planning messages from BFLA. The majority of respondents from the major ethnic groups hear family planning messages form the BFLA. However, the rates are higher among Creole and Garifuna , 78% and 76% respectively compared to Mestizo and Maya, which are similar (see Table 5.2). 5.3 Meaning of Family Planning Respondents were also asked, "What does the term 'family planning' mean to you?" Their definitions vary. However, the majority of them (56%). say that this term means 'planning the number of children.' Some of them think that family planning also means 'planning the time when to have children' (37%) and 'planning when to start a family' (32%). 1 BFLA is the leading NGO promoting reproductive health and family life education in Belize. 2 The Garifuna and Creole live predominantly in Dangriga and Belize City, the two urban areas where the BFLA was first established. This may have influence their exposure to family planning messages from BFLA. 32 5.4 Reasons to limit the number of children When asked to give their opinion on the main reason a woman might wish to limit the number of children she has, the vast majority (72%) think that a woman's 'financial situation' is the main reason. Other reasons given include problems related to childcare (7%) and work (5%). A higher percentage of rural (9%) compared to urban women (5%) think that childcare problem is a reason for limiting the number of children. Even though the majority of women from the various ethnic groups think that financial problem is the main reason for limiting the number of children a woman might have, the proportions range from 50% of Maya to 81% of Creole women (see Table 5.4). 5.5 Right to decide about pregnancy and reasons to terminate pregnancy Approximately 69% of the respondents think that a woman always has the right to decide about her pregnancy, including whether to have an abortion. Table 5.5 shows that 68% of teenage respondents think they have the right to decide. This proportion is one of the lowest compared to the other age groups. The majority of all the major ethnic groups except the Maya (45%) think that a woman always has the right to decide about her pregnancy. However, the proportion is much higher among Garifuna (87%) and Creole (85%) compared to Mestizo (63%) women. Seventy one percent (71%) of women who work think they have the right to decide compared to 68% of non-working women. When asked under what circumstances they think it should be acceptable to have an abortion, most of the women think that it is acceptable for 'health reasons of the mother' (44%), 'pregnancy resulting from rape' (37%) and 'health reasons of the child' (36%) (see Table 5.6). These figures indicate that more than one half of the women think that there is no acceptable reason for having an abortion. Almost all the women (94%) believe that it is not acceptable for a woman to have an abortion just because she is not married or the father does not want the child (91%). 5.6 Age at First Sexual Intercourse and First Child Most of the women (41%) believe that age 18 is the earliest age a woman can legally consent to having sexual intercourse. They believe that a woman and a man should be 18 years before they have their first sexual intercourse (see Table 5.7). Maya women believe that a woman should be 18 years and a man 19 years before they have their first sexual 33 intercourse. Women in the other ethnic groups believe that a woman and a man should have the same age. Table 5.8 shows that women believe that a woman is responsible enough to have her first child is at age 20 years and the man at age 21 years. These figures suggest that women expect the woman and/or man to use a form of contraception, since they believe that both a woman and a man should have sexual intercourse at an earlier age than when they are responsible enough to have their first child. Urban women believe that a woman should be 21 years and rural women believe that a woman should be 20years before having the first child. Both groups of women believe a man should be a year older. Women believe that a woman is responsible enough to have her first child when she is mature enough (32%), is in a stable union (24%), or has completed her education (19%). They also believe that a man should be mature enough (32%), economically stable (22%) and in a stable union (20%). These figures (see Tables 5.9 and 5.10) show that the women believe that it is most important for both woman and man to be mature enough. However, they believe it is more important for a man to be economically stable and for a woman to complete her education before they are responsible enough to have their first child. A higher proportion of urban women (19%) compared to rural women (7%) believe that a woman should be economically stable before she has her first child. More Maya women (33%) compared to the other ethnic groups believe that a woman should be in a stable union. 5.7 Breastfeeding Approximately all the respondents (99%) agree that a woman should breastfeed her child (see Table 5.11). Most of them (36%).believe that the child should be breastfed for 12 months. Some (13%) believe that the child should be breastfed for 2 years and another 12% think that breastfeeding should go on as long as possible. Most of the respondents (24%) also believe that the child should be six months before the mother stops giving only breast milk. Sixteen percent (16%) think that the child should get only breast milk until age one. Forty-one percent (41%) of the women believe that a woman is less likely to get pregnant when she is breastfeeding than when she is not. Almost 32% think that the likelihood of getting pregnant is the same if the woman breastfeeds or not. 34 5.8 Ideal Family Size The respondents were asked, "If you could choose exactly the number of children to have in your whole life, how many would that be?" This information was used to estimate the ideal family size. Table 5.12 shows that the mean ideal family size is 3.8 children. Urban women prefer smaller family size than rural women and Mestizo women prefer a smaller family size compared to any other ethnic group. Family size decreases as age and education level increase. However there is no difference in ideal family size for women who are attending formal school and those who are not. There is also no difference between Roman Catholic and Protestant women, but their ideal family size is higher than that for women who do not have a religion. Corresponding figures for 1991 show that the mean ideal family size has increased for all sub-groups of women. Some noticeable differentials in 1991 have also changed. At that time, Roman Catholics preferred a larger family size than Protestanta, and Creole women preferred a smaller family size than any other ethnic group. The mean ideal family size is slightly higher than the mean number of living children (3.3). This is so for all sub-groups of women and indicates that the women want more children than they actually have. This was not the case in 1991 when the mean ideal family size was slightly lower than the actual mean number of living children. At that time, Creole, Mestizo, and rural women wanted fewer children than they actually have. Women who have no children have a mean ideal family size of 3.4, which is slightly lower than that for those women who have children and higher than the 1991 mean ideal family size (2.9) (see Table 5.13). 5.9 Opinions About Childbearing The majority (80%) of the respondents thinks that both partners should decide the number of children a couple wants to have. Table 5.14 indicates that 9% think that the wife/partner should make the decision, while 5% think that the husband/partner should make the decision. A comparison of urban and rural women shows that a higher percent of urban women think that both partners should decide and a higher percentage of rural women think that the husband/partner should decide. A higher proportion of Creole women (85%) compared to any other major ethnic group think that both partners should decide. More than 35 one half of Maya women think that the decision should be made by their husband/partner and 13% of them think that it is "Fate, up to God" to decide. These rates among the Mayas are the highest compared to other ethnic groups. Eighty percent (80%) of the women think that both partners should decide on the number of children a couple should have (see Table 5.15). This rate is 22% higher compared to 1991 and suggests a positive effort toward better communication and decision- making within families. The increase is even higher in the urban areas. There is a 13% decrease in the proportion of rural women who think that their husbands should make the decision. The proportion of rural women who think that the decision is "Fate, up to God" has also decreased from 10% in 1991 to 3% in 1999. Creole and Garifuna women, in 1991, had the lowest proportion of those who think that both partners should decide and the highest proportion that think that the wife/partner should decide. They now have the highest proportion of those who think that partners should make the decision and a much lower proportion of those who think that the wife/partner should make the decision. There has been a 29% increase in the proportion of Maya women who think that the husband/partner should make the decision. About 90% of the respondents think that the ideal time interval between children is 2 or more years. A more detailed look at those who prefer to have an interval of less than two years shows that this shorter interval is more acceptable among rural women, Garifuna, women not using contraceptive and women with less than 8 years of education (see Table 5.16). The 1991 figures show that a higher percentage (95%) preferred 2 or more years of interval. This indicates that there has been an increase in the proportion of women who prefer a shorter interval than 2 years between children. 5.10 Contraception The majority (80%) of the respondents think that both partners should decide whether a person should use a method of contraception, 9% think that the wife/partner should decide and 5% think that the husband/partner should decide. Tables 5.17-19 present rates by urban/rural, educational level and ethnicity. Urban women are more likely than rural women to state that both partners should decide. However, rural women are more likely to state that husband/partner should decide. Never married women are more likely than ever-married women to state that both partners should decide. Women with 9 or more years of education 36 are most likely to state that both partners should decide and those with less than 8 years of education are the most likely to state that husband/partner should decide whether a person should use a method of contraception. Creole women are the most likely to state that both partners should decide. Garifuna women are the most likely to state that wife/partner should decide and the Maya women are the most likely to state that husband/partner should decide. 5.11 Summary The majority of women think that a woman has the right to decide about her pregnancy, including whether to have an abortion. Some of them agree that it is acceptable to have an abortion for health reasons of the mother and the child and for pregnancy resulting in rape. Most of them believe that a woman and a man should be the same age when they have their first sexual intercourse, but a man should be older than a woman before he is responsible enough to have his first child. The women believe that both partners should decide on the number of children a couple should have. This is an increase compared to 1991 and indicates better communications and decision making within the homes. 37 TABLE 5-1 BELIZE: Source of Family Planning Messages in Past Six Months, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Local No. of Cases Selected Characteristics Radio Television Newspaper (Unweighted) Total 40.0 35.5 16.2 (3613) Residence Urban 42.0 40.1 17.1 (1729) Rural 38.1 31.3 15.3 (1884) District Corozal 51.1 55.5 21.3 (618) Orange Walk 43.3 36.5 12.2 (641) Belize 38.9 38.9 17.4 (1063) Cayo 39.1 32.9 17.8 (666) Stann Creek 39.2 19.4 15,2 (311) Toledo 25.2 16.0 9.2 (314) Age 15-19 35.4 31.0 14.9 (716) 20-24 38.8 36.6 17.5 (673) 25-29 40.4 36.5 14.6 (704) 30-34 40.2 36.4 14.4 (666) 35-39 46.9 42.4 20.3 (495) 40-44 44.5 34.2 17.0 (359) TABLE 5-2 BELIZE: BFLA Messages, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Received Message from BFLA Selected Characteristics Yes No Unknown Total No. of Cases* (Unweighted) Total 65.6 18.7 15.7 100.0 (1876) Residence Urban 71.4 15.4 13.2 100.0 (945) Rural 59.5 22.2 18.3 100.0 (931) District Corozal 58.0 31.4 10.6 100.0 (429) Orange Walk 53.8 20.5 25.7 100.0 (326) Belize 74.9 10.0 15.1 100.0 (537) Cayo 65.1 18.9 16.0 100.0 (348) Stann Creek 80.1 9.2 10.7 100.0 (138) Toledo 53.0 35.1 11.9 100.0 (98) Age 15-19 64.9 17.9 17.1 100.0 (332) 20-24 66.9 17.7 15.4 100.0 (341) 25-29 66.4 16.6 17.0 100.0 (378) 30-34 65.0 21.7 13.3 100.0 (351) 35-39 64.0 22.7 13.3 100.0 (285) 40-44 66.9 16.0 17.1 100.0 (189) Ethnic Group Creole 79.1 8.3 12.6 100.0 (516) Mestizo 57.8 24.9 17.3 100.0 (1025) Garifuna 73.5 18.5 7.9 100.0 (111) Maya/Ketchi 55.9 21.3 22.9 100.0 (104) Other 68.0 15.0 17.0 100.0 (120) * Excludes 15 cases for whom ethnic group is unknown. TABLE 5-3 BELIZE: Meaning of Family Planning, by Residence and Ethnic Group: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Ethnic Group Meaning of Family Planning Urban Rural Creole Mestizo Garifuna Maya/Ketchi Other Unknown Total No. of Cases (Unweighted) Planning the Number of Children 52.2 47.8 27.1 54.9 6.1 5.1 6.0 0.7 100.0 (2022) Planning the Time When to Have Children 56.0 44.0 32.2 49.1 6.1 4.8 7.2 0.6 100.0 (1348) Planning When to Start a Family 55.5 44.5 36.7 45.2 6.7 3.7 7.2 0.5 100.0 (1171) Planning Sexual Life/Relations 53.3 46.7 32.5 51.0 5.4 4.5 5.5 1.1 100.0 (182) Planning the Family Budget/Expenses 50.8 49.2 32.7 50.1 5.7 3.2 7.7 0.7 100.0 (431) Preventing Unwanted Pregnancies 54.0 46.0 32.7 47.4 4.9 6.1 8.1 0.9 100.0 (507) Preventing STIs 63.2 36.8 48.3 25.2 8.4 5.1 13.0 0.0 100.0 (153) Preventing Abortion 64.6 35.4 41.8 37.4 4.2 2.1 14.5 0.0 100.0 (164) Use of Contraceptive Methods 59.5 40.5 35.6 44.9 6.3 5.3 7.2 0.7 100.0 (452) Use of Condom 52.1 47.9 39.6 41.1 7.2 5.8 5.8 0.5 100.0 (115) Family Health 56.0 44.0 28.7 54.5 5.8 4.4 6.3 0.4 100.0 (321) Infertility Treatment 61.4 38.6 14.0 37.4 0.0 14.9 33.7 0.0 100.0 (14) Family Life Education 53.3 46.7 23.5 62.1 6.3 2.8 4.8 0.5 100.0 (460) Sexual Education/Sexual Hygiene 60.4 39.6 29.0 48.0 9.0 1.4 11.2 1.3 100.0 (99) Medical check-ups During Pregnancy 50.2 49.8 33.4 38.1 8.1 9.6 10.8 0.0 100.0 (82) Other 53.7 46.3 12.7 52.1 23.1 8.5 2.1 1.5 100.0 (29) Unknown 32.1 67.9 14.7 44.4 3.7 32.1 4.3 0.8 100.0 (554) TABLE 5-4 BELIZE: Reasons a Woman May Wish to Limit the Number of Children She Has, by Residence and Ethnic Group: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Ethnic Group Limit Number of Children Total Urban Rural Creole Mestizo Garifuna Maya/Ketchi Other Financial 72.1 76.6 67.8 80.6 72.5 66.1 50.3 76.6 Work Related 5.0 5.5 4.5 4.1 5.3 10.4 4.0 2.7 Schooling 3.0 2.9 3.1 2.2 3.3 3.9 1.5 5.0 Health of Mother 3.2 2.7 3.6 3.6 2.5 2.9 5.6 2.6 Physical Appearance 0.5 0.4 0.5 0.5 0.4 1.0 0.9 Child Care Problem 6.9 5.2 8.5 3.5 7.1 2.3 17.9 4.6 Health of Child 1.2 1.1 1.2 0.6 1.3 1.6 1.1 2.4 Other 1.7 2.1 1.4 1.6 2.0 2.3 0.7 1.0 Unknown 6.6 3.5 9.4 3.4 5.5 9.4 18.9 4.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (3586) (1712) (1874) (875) (1925) (199) (361) (226) * Excludes 27 cases for whom ethnic group is unknown. TABLE 5-5 BELIZE: A Woman's Rights to Decide About Pregnancy, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Right to Decide About Pregnancy Selected Characteristics Yes No Unknown Total No. of Cases* (Unweighted) Total 68.6 27.6 3.8 100.0 (3574) Residence Urban 74.4 22.8 2.8 100.0 (1708) Rural 63.2 32.0 4.8 100.0 (1866) Age 15-19 67.9 28.1 4.0 100.0 (711) 20-24 67.7 27.7 4.5 100.0 (664) 25-29 70.7 26.5 2.8 100.0 (700) 30-34 69.1 28.0 2.8 100.0 (656) 35-39 71.8 25.0 3.3 100.0 (492) 40-44 64.5 29.9 5.6 100.0 (351) Ethnic Group Creole 84.0 13.9 2.1 100.0 (872) Mestizo 61.7 34.4 3.9 100.0 (1916) Garifuna 88.7 10.4 0.9 100.0 (199) Maya/Ketchi 45.8 44.5 9.7 100.0 (361) Other 80.5 16.6 2.9 100.0 (226) Religion Anglican 85.2 11.8 3.1 100.0 (195) Baptist 60.8 29.5 9.7 100.0 (153) Methodist 91.7 8.3 100.0 (127) Nazarene 71.7 24.5 3.8 100.0 (103) Pentecostal 57.5 36.8 5.7 100.0 (247) Roman Catholic 71.6 25.0 3.3 100.0 (1886) Other 58.1 37.8 4.1 100.0 (606) None 59.9 36.4 3.7 100.0 (257) Working Status Working 71.2 26.2 2.7 100.0 (1047) Not working 67.5 28.1 4.3 100.0 (2527) * Excludes 27 cases for whom ethnic group is unknown. * Excludes 9 cases for whom religion is unknown. * Excludes 5 cases for whom working status is unknown. TABLE 5-6 BELIZE: Acceptable Reasons to Terminate Pregnancy, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) If Both For Health If Mother If Father Parents Do For Reasons of For Health Pregnancy Woman No. of Selected Does Not Does Not Not Want Economic The Reasons of Resulting is Not Cases* Characteristics Want Want Child Child Reasons Mother The Child From Rape Married Other Unknown Total (Unweighted) Total 16.2 9.2 17.1 16.9 44.0 35.7 37.3 6.4 15.6 14.6 100.0 (3574) Residence Urban 16.7 10.5 19.9 22.2 54.3 47.7 48.7 7.4 14.0 12.7 100.0 (1708) Rural 15.8 7.9 14.5 11.9 34.4 24.5 26.6 5.6 17.1 16.4 100.0 (1866) Age 15-19 19.4 11.6 18.3 18.1 40.0 32.7 38.6 5.8 14.8 16.0 100.0 (711) 20-24 16.1 9.2 18.1 18.0 41.3 35.1 39.6 6.7 15-2 14.3 100.0 (664) 25-29 15.8 8.0 16.1 17.2 46.3 38.3 37.7 6.4 14.3 15.3 100.0 (700) 30-34 15.1 8.1 14.7 16.7 46.7 37.2 38.6 6.7 17.3 13.3 100.0 (656) 35-39 16.1 9.0 18.2 16.3 51.5 42.2 35.2 8.2 15.9 13.6 100.0 (492) 40-44 10.4 6.2 15.5 12.2 42.9 30.9 30.1 5.2 17.5 13.8 100.0 (351) Ethnic Group Creole 17.3 11.7 21.3 23.1 59.6 51.6 53.2 6.2 9.9 5.6 100.0 (872) Mestizo 13.1 7.3 14.2 13.1 39.5 31.4 28.9 6.0 17.8 17.8 100.0 (1916) Garifuna 30.2 18.2 32.4 35.4 52.6 45.0 58.1 6.5 13.8 7.1 100.0 (199) Maya/Ketchi 20.2 6.7 10.4 6.8 18.0 8.1 21.0 6.7 19.5 27.8 100.0 (361) Other 16.3 9.3 19.2 21.0 51.6 43.3 46.4 10.7 16.8 11.6 100.0 (226) TABLE 5-6 continued BELIZE: Acceptable Reasons to Terminate Pregnancy, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) If Both For Health If Mother If Father Parents Do For Reasons of For Health Pregnancy Woman No. of Selected Does Not Does Not Not Want Economic The Reasons of Resulting is Not Cases* Characteristics Want Child Want Child Child Reasons Mother The Child From Rape Married Other Unknown Total (Unweighted) Religion Anglican 15.8 9.9 17.1 19.4 58.4 47.5 54.4 4.8 12.6 7.1 100.0 (195) Baptist 14.9 9.0 22.4 15.7 46.3 36.6 36.6 4.4 10.7 11.9 100.0 (153) Methodist 17.4 11.2 20.9 27.8 69.8 64.9 66.9 5.4 7.2 6.6 100.0 (127) Nazarene 16.8 8.6 23.9 22.0 44.0 35.5 42.3 4.4 8.2 8.8 100.0 (103) Pentecostal 12.9 8.3 12.2 9.9 31.0 21.6 24.9 8.2 14.0 11.8 100.0 (247) Roman Catholic 17.8 9.9 18.5 18.5 46.6 38.5 40.3 7.1 15.9 15.3 100.0 (1886) Other 13.2 6.7 13.8 12.1 34.4 27.1 25.0 5.1 21.4 16.9 100.0 (606) None 14.8 8.8 10.8 14.0 33.5 24.1 25.0 6.9 14.4 22.1 100.0 (257) Working Status Working 14.4 6.9 18.5 17.8 52.0 45.0 42.7 5.9 14.3 11.0 100.0 (1047) Not working 17.0 10.1 16.5 16.5 40.7 31.8 35.0 6.6 16.1 16.1 100.0 (2527) * Excludes 27 cases for whom ethnic group is unknown. * Excludes 9 cases for whom religion is unknown. * Excludes 5 cases for whom work status is unknown. TABLE 5-7 BELIZE: Mean Age of a Woman and a Man Before First Sexual Intercourse, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Mean Age of a Mean Age of a Man Woman Before First No. of Cases 1 Before First Sexual No. of Cases 2 Selected Characteristics Sexual Intercourse (Unweighted) Intercourse (Unweighted) Total 18.3 (3072) 18.5 (2881) Residence Urban 18.4 (1497) 18.3 (1420) Rural 18.3 (1575) 18.8 (1461) Ethnic Group Creole 18.4 (786) 18.5 (752) Mestizo 18.5 (1613) 18.6 (1498) Garifuna 17.9 (185) 17.7 (175) Maya/Ketchi 17.9 (286) 19.1 (272) Other 18.0 (202) 18.3 (184) 1 Excludes 26 cases for whom ethnic group is unknown. For the purpose of calculating the mean, those who answered "Don't Know" were omitted, for a total of 515 cases. 2 Excludes 24 cases for whom ethnic group is unknown. For the purpose of calculating the mean, those who answered "Don't Know" were omitted, for a total of 708 cases. TABLE 5-8 BELIZE: Mean Age a Woman and Man are Responsible to Have Their First Child, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Mean Age a Woman is Mean Age a Man is Responsible Enough to No. of Cases 1 Responsible Enough to No. of Cases 2 Selected Characteristics Have First Child (Unweighted) Have First Child (Unweighted) Total 20.4 (3320) 21.4 (3172) Residence 20.8 (1613) 21.7 (1573) Urban Rural 19.9 (1707) 21.0 (1599) Ethnic Group Creole 20.7 (832) 21.4 (796) Mestizo 20.4 (1785) 21.5 (1699) Garifuna 21.0 (191) 21.1 (185) Maya/Ketchi 19.0 (305) 20.6 (296) Other 20.4 (207) 21.6 (196) Age 15-19 20.6 (653) 21.3 (625) 20-24 20.6 (613) 21.6 (586) 25-29 20.2 (654) 21.4 (619) 30-34 20.2 (613) 21.3 (596) 35-39 20.3 (455) 21.3 (431) 40-44 20.0 (332) 21.3 (315) 1Excludes 27 cases for whom ethnic group is unknown. For the purpose of calculating the mean, those who answered "Don't Know" were omitted, for a total of 268 cases. 2Excludes 27 cases for whom ethnic group is unknown. For the purpose of calculating the mean, those who answered "Don't Know" were omitted, for a total of 418 cases. TABLE 5-9 BELIZE: The Time a Woman is Most Responsible to Have First Child, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) One to Two When She After Years After When She is When She is in a Completing Her Entering Into a Economically is Mature No. of Cases* Selected Characteristics Stable Union Education Stable Union Stable Enough Other Unknown Total (Unweighted) Total 24.4 19.1 4.6 12.8 32.1 0.9 6.1 100.0 (3586) Residence Urban 23.0 22.9 5.4 11.8 24.4 1.1 4.4 100.0 (1712) Rural 25.8 15.6 3.8 7.2 39.2 0.7 7.7 100.0 (1874) Ethnic Group Creole 20.9 29.4 5.0 16.7 23.1 1.2 3.7 100.0 (875) Mestizo 26.7 14.9 4.1 10.8 37.3 0.9 5.3 100.0 (1925) Garifuna 11.8 23.2 9.8 26.9 25.3 0.3 2.7 100.0 (199) Maya/Ketchi 32.8 7.0 2.7 3.0 35.9 0.7 17.9 100.0 (361) Other 18.8 28.0 4.7 15.9 26.7 1.0 5.0 100.0 (226) Age 15-19 24.8 21.4 3.8 12.3 29.6 0.5 7.6 100.0 (712) 20-24 22.8 15.1 5.6 16.3 33.5 0.4 6.3 100.0 (668) 25-29 25.4 19.7 3.4 12.4 34.2 1.0 4.0 100.0 (702) 30-34 23.3 20.8 5.2 12.6 30.7 2.0 5.4 100.0 (659) 35-39 21.0 20.5 6.6 11.1 32.8 1.2 6.7 100.0 (492) 40-44 30.8 15.7 3.6 10.8 33.5 0:8 4.8 100.0 (353) * Excludes 27 cases for whom ethnic group is unknown. TABLE 5-10 BELIZE: The Time a Man is Most Responsible to Have First Child, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) After One to Two Years After When He Completing Entering Into When He is When He is in a His a Stable Economicall is Mature No. of Cases* Selected Characteristics Stable Union Education Union Stable Enough Other Unknown Total (Unweighted) Total 19.7 14.4 3.7 22.0 32.2 1.0 7.0 100.0 (3586) Residence Urban 16.6 18.0 3.8 27.9 27.5 1.2 4.8 100.0 (1712) Rural 22.5 11.0 3.6 16.6 36.5 0.8 9.1 100.0 (1874) Ethnic Group Creole 17.7 21.8 5.2 26.6 23.8 1.2 3.7 100.0 (875) Mestizo 19.9 11.7 2.5 21.2 36.7 1.0 7.0 100.0 (1925) Garifuna 8.6 16.4 7.2 33.4 31.7 0.3 2.4 100.0 (199) Maya/Ketchi 32.8 4.9 3.1 5.3 34.6 0.7 18.7 100.0 (361) Other 14.3 19.3 4.3 27.9 26.7 2.0 5.6 100.0 (226) Age 15- 19 19.2 14.6 3.5 22.9 30.4 0.8 8.7 100.0 (712) 20-24 18.3 11.9 3.9 23.9 33.8 0.8 7.3 100.0 (668) 25-29 20.3 14.7 3.1 22.9 32.6 1.2 5.1 100.0 (702) 30-34 1.9.4 14.0 3.6 23.2 32.3 1.6 5.9 100.0 (659) 35-39 17.6 19.7 4.7 20.2 29.2 1.2 7.5 100.0 (492) 40-44 25.2 11.8 3.3 16.1 36.7 0.7 6.2 100.0 (353) * Excludes 27 cases for whom ethnic group is unknown. TABLE 5-11 BELIZE: Mean Perception of Ideal Number of Children a Woman Should Have and the Actual Mean Number of Children, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Ideal No. of Actual No. of Difference No. of Cases* Selected Characteristics Children Living Children Actual - Ideal (Unweighted) Total 3.8 3.3 -0.5 (2070) Residence Urban 3.5 3.0 -0.5 (1015) Rural 4.2 3.7 -0.5 (1055) Age 15-19 4.1 1.2 -2.9 (109) 20-24 3.6 1.9 -1.7 (348) 25-29 3.7 2.6 -1.1 (496) 30-34 4.0 3.6 -0.4 (485) 35-39 3.8 4.1 0.3 (376) 40-44 4.0 5.1 1.1 (256) Education Level 0-7 4.2 4.0 -0.2 (639) 8 4.0 3.5 -0.5 (717) 9+ 3.4 2.5 -0.9 (714) Marital Status Ever Married 3.8 3.4 -0.4 (2001) Never Married 3.7 1.6 -2.1 (69) Religion Roman Catholic 3.8 3.3 -0.5 (1102) Protestant 3.9 3.4 -0.5 (650) None 3.8 3.2 -0.6 (139) Other 3.9 3.4 -0.5 (179) Ethnic Group Creole 3.6 3.2 -0.4 (469) Mestizo 3.6 3.3 -0.3 (1185) Garifuna 4.6 3.3 -1.3 (117) Maya/Ketchi 5.5 4.2 -1.3 (161) Other 3.8 2.9 -0.9 (138) Attending Formal School Yes 3.2 2.0 -1.2 (39) No 3.9 3.3 -0.6 (2031) * For the purpose of calculating ideal family size, those who answered "Don't Know" or "Gods Will" were omitted. * Excludes 6 cases for who education level is unknown. * Excludes 17 cases for whom marital status is unknown. * Excludes 6 cases for whom religion is unknown. * Excludes 18 cases for whom ethnic group is unknown. * Excludes 3 cases for whom attending formal school is unknown. TABLE 5-12 BELIZE: Mean Perception of Ideal Number of Children a Woman Should Have: Women Aged 15-44 Who Want No More Children 1999 Family Health Survey (Percent Distribution) Ideal #of No. of Cases* Selected Characteristics Children (Unweighted) Total 3.4 (864) Residence Urban 3.1 (437) Rural 3.7 (427) Age 15-19 3.6 (465) 20-24 3.2 (195) 25-29 3.1 (89) 30-34 3.0 (57) 35-39 3.0 (35) 40-44 3.5 (23) Education Level 0-7 3.9 (133) 8 3.6 (269) 9+ 3.2 (462) Marital Status Ever Married 3.3 (275) Never Married 3.5 (589) Religion Roman Catholic 3.4 (479) Protestant 3.4 (252) None 3.2 (69) Other 3.7 (64) Ethnic Group Creole 3.3 (230) Mestizo 3.2 (477) Garifuna 3.5 (53) Maya/Ketchi, 5.4 (64) Other 3.3 (40) * For the purpose of calculating ideal family size, those who answered "Don't Know" or "Gods Will" were omitted. * Excludes 1 case for whom education level is unknown. * Excludes 13 cases for whom marital status is unknown. * Excludes 6 cases for whom ethnic group is unknown. TABLE 5-13 BELIZE: Who Should Decide the Number of Children a Couple Wants to Have, by Residence: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Who Should Decide Total Urban Rural Both Partners 80.2 84.5 76.3 Wife/Partner 9.2 9.9 8.6 Husband/Partner 5.0 2.0 7.8 Fate, up to God 3.4 1.5 5.1 Other 0.3 0.4 0.2 Unknown 1.9 1.7 2.1 Total 100.0 100.0 100.0 No. of Cases (Unweighted) (3613) (1729) (1884) TABLE 5-14 BELIZE: Who Should Decide the Number of Children A Couple Wants to Have, by Ethnic Group: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Ethnic Group Who Should Decide Total Creole Mestizo Garifuna Maya/Ketchi Other Both Partners 80.3 85.0 82.1 82.1 59.5 79.7 Wife/Partner 9.2 10.6 8.4 13.7 6.2 11.6 Husband/Partner 5.0 1.6 5.6 1.0 13.5 4.2 Fate, up to God 3.3 1.9 2.1 2.6 13.3 2.3 Other 0.3 0.0 0.2 0.0 0.9 1.4 Unknown 1.9 1.0 1.7 0.7 6.6 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (3586) (875) (1925) (199) (361) (226) TABLE 5-15 BELIZE: Perception of Ideal Time Interval Between Two Children, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Interval Between Children Selected Characteristics <2 2<3 3 < 4 >4 Unknown Total No. of Cases* Total 11.7 33.3 26.6 19.8 8.7 100.0 (3568) Residence Urban 10.8 32.1 26.8 21.3 8.9 100.0 (1703) Rural 12.6 34.3 26.3 18.3 8.4 100.0 (1865) Education Level 0-7 14.7 37.4 23.8 14.0 10.2 100.0 (982) 8 9.8 34.6 26.8 20.2 8.5 100.0 (1194) 9+ 11.5 29.5 28.1 23.0 7.9 100.0 (1392) Ethnic Group Creole 9.0 32.8 24.8 22.1 11.3 100.0 (868) Mestizo 10.8 32.0 28.7 21.0 7.6 100.0 (1918) Garifuna 22.5 26.4 25.0 23.5 2.6 100.0 (199) Maya/Ketchi 15.3 44.0 22.2 6.8 11.8 100.0 (359) Other 14.3 33.6 26.1 19.4 6.6 100.0 (224) Contraceptive Use Currently Using 10.4 35.5 28.8 18.9 6.4 100.0 (1534) Not Using 12.6 31.9 25.2 20.3 10.0 100.0 (2034) * Excludes 10 case for whom education level is unknown. * Excludes 27 cases for whom ethnic group is unknown. * Excludes 8 cases for whom contraceptive use is unknown. TABLE 5-16 BELIZE: Who Should Decide Whether a Person Should Use a Method of Contraception, by Residence and Marital Status: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Marital Status Decision Maker Total Urban Rural Ever Married Never Married Both Partners 80.2 84.4 76.2 79.4 81.8 Wife/Partner 9.3 9.9 8.7 8.9 10.0 Husband/Partner 5.0 2.1 7.7 6.3 2.3 Nurse/Doctor/Midwife 0.1 0.0 0.1 0.1 Other/ Unknown 5.5 3.6 7.3 5.4 5.9 Total 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (3576) (1703) (1873) (2755) (821) * Excludes 37 cases for whom marital status is unknown. TABLE 5-17 BELIZE:Who Should Decide Whether a Person Should Use a Method of Contraception, by Education: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Education Level Decision Maker Total 0-7 8 9+ Both Partners 80.2 67.6 80.3 88.0 Wife/Partner 9.2 9.4 10.2 8.3 Husband/Partner 5.0 11.9 4.4 1.2 Nurse/Doctor/Midwife 0.1 0.2 Other/ Unknown 5.5 10.7 5.1 2.5 Total 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (3603) (992) (1204) (1407) * Excludes 10 cases for whom education level is unknown. TABLE 5-18 BELIZE: Who Should Decide Whether a Person Should Use a Method of Contraception, by Ethnic Group: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Ethnic Group Decision Maker Total Creole Mestizo Garifuna Maya/Ketch Other Both Partners 80.3 85.0 82.1 82.1 59.5 79.7 Wife/Partner 9.2 10.6 8.4 13.7 6.2 11.6 Husband/Partner 5.0 1.6 5.6 1.0 13.5 4.2 Nurse/Doctor/Midwife 0.1 0.0 0.1 0.0 0.2 0.0 Other/ Unknown 5.4 2.9 4.0 3.3 20.7 4.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (3586) (875) (1925) (199) (361) (226) * Excludes 27 cases for whom ethnic group is unknown. CHAPTER 6 KNOWLEDGE. USE AND SOURCE OF CONTRACEPTION 6.1 Introduction This chapter on Knowledge, Use and Source of Contraception is very comprehensive and explores reasons for use and non-use currently, as well as the desire to use in the future. It covers topics concerning contraceptive methods, knowledge of fertile period, current contraceptive use, and source of contraceptive. 6.2 Knowledge of Contraceptive Methods Survey findings of women who took part in the study, who have knowledge of contraceptive methods, by method and years of education (cf. Table 6.1) indicate that knowledge of contraceptives in Belize is very high. The knowledge of all contraceptives increases with years of education. The most known method remains Oral contraceptives (92%) notwithstanding the risk of HIV/AIDS, preventable through the proper use of Condoms. However, the knowledge of Condoms as a method increases with years of education. It increases to 85% among these women. Oral contraceptives (92%) is the most known method followed by injection (88%) and by Condoms (85%). Seventy eight percent (78%) of the women know about Sterilization. The Billings Method is least known at 11%. The Rhythm method is known by 47%, but knowledge of this method increases to 83% among women with more than 13 years of education. There have been changes from the 1991 Family Health Survey. Knowledge of Oral contraceptives is down from 93%; of injection is up from 86%, of Condoms is up from 82%, of sterilization is down from 88%, of Billings is down from 16%, and of Rhythm is down from 53%. The increased knowledge of injectables may reflect increased popularity due to improved contraceptive technologies for this method. Increased knowledge of Condoms may be attributed to increased AIDS prevention measures. Reduced knowledge of sterilization may be a function of decreased access to sterilization services. Reduced knowledge of Billings/Rhythm methods may reflect less emphasis on these less reliable methods. 38 There is a direct and positive relationship between level of education attained and knowledge of contraceptives. Of those with no education, 81% report knowledge of Oral contraceptives. Knowledge is almost one hundred percent (99.5%) for those with over 13 years of education. Of those with no education, 48% report knowledge of female sterilization. Knowledge of sterilization is 94% for those with over 13 years of education. Of those with no education, 57% report knowledge of Condoms as a method; the rate is 99% for those with over 13 years of education. The corresponding rates are 2% and 35% for reported knowledge of the Billings method. Table 6.2 indicates that the Oral contraceptive is the most known method among Creole women aged 15-44 (98%), followed by Condoms (97%), injection (92%) and female sterilization (90%). Knowledge of the individual methods of contraception varies among women aged 15-44. The most widely known methods are Orals (92%), injection (88%), Condoms (85%), and sterilization (78%). The least well know methods include the Billings (11%), Withdrawal (32%), diaphragm (31%), and vaginal creams, jellies and foam (32%). Between the 1991 and 1999 surveys, knowledge of some methods decreased among women aged 15-44: Oral contraceptives by 3%, withdrawal by 4%, diaphragm by 8%, the Billings by 6%, and female sterilization by 11%. Knowledge of other methods increased among women aged 15-44: injectables by 2%, and Condoms by 3%. There are no figures to compare use rates for IUDs or Rhythm method. Table 6.3 shows that knowledge of contraceptive methods is generally higher among English-speaking and Bilingual women (15-44 years), than among Spanish-speaking women, (e.g. Orals 94.8%, English-speaking; Bilingual,95%; and Spanish-speaking, 90%). For female sterilization, the pattern is the same: 86%, English; 82%, Bilingual; and 67%, Spanish. For Condoms: 92%, English; 92%, Bilingual; and 80%, Spanish. Other vaginal methods (including creams, jellies and foam) 41%, English-speaking; 40%, Bilingual; and 17%, Spanish-speaking. As seen in Table 6.4, contraceptive knowledge is higher in the urban than in the rural areas, regardless of method. Knowledge of Oral contraceptives is higher among urban women aged 15-44 (97% vs. 89%). The same pattern is true for female sterilization (84% vs. 72%), for injections (91% vs. 85%) and for Condoms (94% vs. 77%), and Billings method (14% vs. 8%). The best-known methods, both rural and urban, are Orals, female sterilization, injection and Condoms. The least known are vaginal tablets, other vaginal methods (creams, jellies and foam), diaphragm, withdrawal and Billings. This pattern remains unchanged from the 1991 survey. 39 6.3 Knowledge of the Fertile Period Women need to know their fertile period whenever they make use of any of these methods Rhythm, Billings, or Withdrawal, and to know specifically when, during their menstrual cycle, a woman is most likely to conceive. Knowledge of the fertile period is higher among women (aged 15-44) who have ever used these methods ('ever users') than among all the survey respondents (i.e. 33% vs. 21%), according to Table 6.5. The rate is 24% among all urban respondents compared to 34% among urban ever users. For rural survey respondents, the rate is 19% among all rural respondents compared with 33% of rural ever users. Knowledge is highest among the 30-34 year age group, at 24%, for all respondents, compared with 37% for ever users of the same age. It is also 37% for ever users aged 25-29. This is the highest knowledge rate for the ever users. For the ever married women, among all the respondents, the rate of knowledge is 22%, compared to 33% for ever users. Knowledge of these methods increases with education from 10% for all respondents with 0-7 years of education, to 30% for all respondents with 9 or more years of education. Again, the rates are higher for ever users, rising from 14% for those with 0-7 years of education to 45% for those with over 9 years of education. Among Belize's various ethnic groups from the whole survey, knowledge of the fertile period is highest among Creole women (24%), and lowest for Maya/Ketchi women (14%). Higher rates are recorded for ever users, following the same pattern: 39% for Creole women; 31% for Mestizos, and 31% for Maya/Ketchi women. The 'other' group records 26% for all respondents, and 42% for ever users. In 1991, knowledge was highest among Garifuna ever users (50%), followed by Mestizo (37%). Knowledge of the fertile period among current users for all respondents is 25%, and among ever users, is 36%. Among those not currently using, knowledge is 19%, and 28% among ever users. 6.4 Current Contraceptive Use This section covers contraceptive use according to socio-demographic variables typically associated with use: marital status, age, residence, number of living children, education, socioeconomic status (measured by number of amenities found in the household), and work status. In addition, use is examined by ethnic group, principal language spoken in 40 the household, and religion. With the exception of the first table (6.6), the results presented here focus on the level of use found among women currently married, or living in consensual unions, who are 15 to 44 years of age. In the text and tables, which follow, these women are referred to collectively as "married women". All currently married women in the survey (aged 15-44) currently using contraceptive methods is 56% (Table 6.7). Of those, the most frequent users speak both English and Spanish (60%), followed by English-speakers (59%), and Spanish speakers (56%). The method most frequently used by English/Spanish-speakers are female sterilization (19%), Orals (16%) and Condoms (8%). For Spanish-speakers, the most frequently used method is female sterilization (20%), followed by Orals (15%), and injection (11%). For English-speakers, the most frequently used method is Orals (18%), followed by female sterilization (17%), and Condoms (11%). As shown in Table 6.8, the highest percentage of users of contraceptives are Catholics at 58%, followed by Protestants (57%), no professed religion (50%), and other religious adherents (46%). Except for currently married women professing no religion (21%), female sterilization is highest among currently married Catholic women (19%), followed by Protestants (17%). Contraceptive use among currently married Catholic women is highest for Orals (17% vs. 16% for Protestants), injection (9% vs. 6% for Protestants), Rhythm (4% vs. 3% for Protestants), and IUDs (1.7% vs. 1.5% for Protestants) Condom use is highest among currently married Protestant women (9%). It is 6% for Catholic women. Among currently married Catholic women, there is a reversal in the pattern of contraceptive use since the 1991 survey where the rate was less than that of Protestants (46% Catholic vs. 50% Protestant). The rate for currently married Catholic women in the 1999 survey has now surpassed that of Protestant women (58% for Catholics vs. 57% for Protestants). Currently married women who are currently not using contraceptive methods is 44% of the entire sample. More Protestant, currently married women are not using any contraceptive method (43%) than Catholic women (42%). Table 6.9 shows that use of contraceptives is higher in urban areas than rural, for all ages (i.e. 62% vs. 52%). Also, use is higher for women at all education levels in both urban and rural areas. The highest percentage of total users falls between the age group of 35-39 years at 65%, and 30-34 years at 59%. The lowest percentage of users falls between the ages of 15-19 at 37%. The highest percentage of total users in urban areas is between the ages of 35-39 (70%). In the rural areas, this 41 figure is 60%. The lowest percentages are for age group 15-19 with 46% users in urban areas, and 31% in rural areas. Contraceptive users are most frequent among women with over 9 years of education (65% of total users). The percentage for urban users is 67%, and is 61% for the rural areas. Women with more household amenities (8-10) are highest users of contraceptives (66%), both urban (67%) and rural (64%). Contraceptive use generally rises with more children. The highest rate (67%) of use overall is among women with 4 children. The comparative urban and rural rates here are 77% and 59% respectively. However, the highest percentage of contraceptive use among rural woman is at 60% after 3 children. Among women with 5 or more children, the rate of contraceptive usage tapers off in both rural and urban areas. Contraceptive use is higher among working than non-working women (63% vs. 54%). Use is higher among urban working and non-working women than among their rural counterparts. However, in both urban and rural settings, working women are more likely to be using contraceptive methods. The rate for urban working women is 65%; it is 60% among rural women. The percentage of currently married women, presently using contraception is 57% (Table 6.9). The use increases with years of education (e.g. 48% with 0-7 years, 56% with 8 years, and 65% with 9 or more years of education). Use of contraceptives among currently married women increases with age up to age 39 years. It is at 37% for the 15-19 age group, rises to 65% for the 35- 39 years old, and then drops to 58% for the 40-44 year group. Among the 35-39 years old, use is lowest (59%) among those women with 0-7 years of education as table 6.10 shows. The highest use (68%) is among women aged 35-39 with eight (8) years of education. But, among women with over 9 years of education, use rises for the 25-29 age group (from 57%--for the previous age group—to 68%). It is highest, however, for the over 9 years of education group for ages 40-44, at 73%. Among currently married women aged 15-44 years with four (4) or fewer living children, use increases with the number of living children. The percentage of currently married women presently using contraception is 67% with 4 living children, whereas it is 54% with one living child. Use of contraceptives is considerably lower among women with five (5) living children (59%) and those with six (6) living children (50%). It is noted in table 6.10 though, that among women with six (6) or more living children, use of contraceptive is highest for those with nine (9) or more years of education. 42 Table 6.10 further shows that currently married women with more amenities in the household (8-10), are generally more likely to use contraceptives when they have more years of education (65%, 0-7 years of education, and 69% for women with 9 or more years of education). For all levels of education, currently working women are more likely to use contraceptives than non-working women. 6.5 Reasons for Currently Using Contraception All current users of contraception were asked whether they were using contraceptives in order to space or to limit births. Of currently married women who had a pregnancy in the last 5 years, 54% are using contraceptives (Table 6.11). Overall, the most frequently used method is Oral contraception at 17%. Table 6.12 shows that, of currently married women, ages 15-44, currently using contraception, 49% want to limit pregnancies; 40% want to space pregnancies. The percentage responding are about the same for urban vs. rural women for wanting to space (40% vs. 41%, respectively). More urban women in this group than rural want to limit pregnancies (49% urban vs. 48% rural). Spacing is more important for younger age groups than limiting pregnancies. Limiting pregnancies becomes more important as women age. For example, among the 25-29 year age group, 64% favour contraceptive use for spacing rather than limiting births 30%, while among the 30-34 year age group, 35% favour spacing and 52% favour limiting. For currently married women with 0 living children, 44% use contraceptives for child spacing, and 8% for limiting pregnancies. The use of contraceptives for spacing decreases from 78% with 1 child, to 16% for currently married women with more than 6 children. On the other hand, the use of contraceptives for limiting pregnancies rises from 8% for currently married women with 0 living children, to 75% for currently married women with more than 6 living children. The use of contraceptives for spacing pregnancies rises with years of education among currently married women from 23% with no education, to 52% with more than 13 years. The rate falls among currently married women using contraceptives to limit pregnancies, as years of education rise (from 57% to 33%). For educated women, spacing is more important than limiting. Limiting is more important than spacing for women with less education. 43 Table 6.12 further shows that women who use the Rhythm/Billings method of contraception use it mainly for spacing pregnancies (66%) rather than for limiting (30%). This is true for all other methods, except Sterilization, which obviously limits pregnancies. Currently married Garifuna women are most likely to be using contraceptives to space pregnancies (45%), followed by Mestizos (41%), Creoles (40%), and Maya/Ketchis (33%). Currently married Maya/Ketchi women are most likely to use contraceptives to limit pregnancies (52%), followed by Mestizos, 50%; Creoles, 48%; and Garifuna (40%). 6.6 Characteristic at First Contraceptive Use The time at which a woman begins to use contraception in her reproductive years is an important factor in how much her fertility will be reduced by using contraception. A woman who begins at a later age, or after having many children, will probably avert fewer unintended births than a woman who begins at a younger age and with fewer children. The mean number of children for urban women at the time of first use of contraception is 1.2 and 2.1 for rural women (Table 6.13). This table also shows that the mean age for urban women at the time of first use of contraception is 20.8 years. It is 22.7 years for rural women. The more education a woman has, the fewer children she will have at the time of first use of contraception. Women with more than 13 years of education had on average 0.5 children at first contraceptive use as opposed to 3.2 children for women with no education. The table further shows that the less education a woman has, the later her first use of contraception. A woman with no education, tends to start using contraception at 23.6 years of age, whereas those with 13 or more years of education start at 21.1 years of age. An obvious implication of this situation is that teen pregnancies will be higher among females with less education. Women with fewer amenities begin using contraception after more children (2.8 children with 0-2 amenities), than women with more amenities (1.1 children with 8-10 amenities). Women with fewer amenities (0-2) will begin using contraception at an older age (i.e. 24 years) than women with more amenities (8-10 at age 21). Similarly, the ethnic group, Creole, with fewest children (1.2) will begin using contraception at the earliest age (21). The Maya/Kekchi have the most children (3.1) and are the oldest (25) at first use. The age of Roman Catholic women, and the number of living 44 children they have before using contraception, is about the same as for the rest of the population (1.6 cf. 1.7 children, respectively; and, 21.8 years cf. 21.5 years). For younger women (15-24), first use of contraception is greatest with no children, and decreases with more children (Table 6.14). For older women (35-39) first use is greatest after the first child; and after 4 children for women 40-49 years. Twenty-four percent of currently married women never used contraception, with 43% of those 15-19 years never using contraceptives. High proportion of non-use is also found among those 20-24, 30-34 and 40-44 years of age. 6.7 Source of Contraception According to Table 6.15, the most frequent source of contraception is the Pharmacy (43%). In descending order, the next most frequent sources are BFLA (20%), Other/Unknown (15%), Government Facility (12%), Private Facility (7%), and Outside of Belize (3%). Rural women tend to rely on BFLA and Government Facility more than urban women (16% vs. 9%, and 21% vs. 19%, respectively). Contraceptives provided by Rural Health Nurses employed at Government Facilities at the time of this survey, are supplied by the BFLA. Of rural women, 16% use the Government Facility to obtain contraceptives. Level of education is an important factor in choice of source of contraceptives (Table 6.16). Pharmacy is used most by those with nine (9) or more years of education 46%, decreasing to 40% for women with 0-7 years of education. BFLA is used most by the group with 0-7 years of education 24%, falling to 18% for women with nine (9) or more years of education. Private facilities are used much less than the other three options (Government, BFLA and Pharmacies). Table 6.17 indicates that the Pharmacy is used most by Creole (48%) followed by the BFLA. However, the Maya/Ketchi ethnic group use Government and other sources more than either the Pharmacy or the BFLA. BFLA is used most by Garifuna (27%), followed by Creole (24%), and Maya/Kekchi (21%). According to Table 6.18, most female sterilization is done by Government Facilities (71%) in Belize, while 24% of sterilizations are done outside of Belize. Pharmacy supplies 45 most of the Orals (60%), followed by BFLA (24%), and Government Facility (9%). BFLA provides the largest percentage of injection (36%), followed by Pharmacy (25%), and Government Facility (22%). Pharmacies provide most of the Condoms to currently married women (85%), followed by BFLA (8%), and Government (4%). Private Facilities provide the largest percentage of IUDs (51%), followed by BFLA (24%), and Government Facility (9%). 6.8 Reasons for Non-Use of Contraception In the 1999 Family Health Survey, non-users were asked the reasons why they were not currently using contraception. This section covers the reasons given by the respondents and the relationship between the characteristics of non-users and desire to use contraception in the future. Also, for women who want to use a method, the preferred source and method are discussed. Of married women 15-44 in the survey, 49% report reasons for non-use related to pregnancy, fecundity, and sexual activity (Table 6.19). The other 51% offer other reasons. Of those in the first group, 25% are currently pregnant, 14% had no sexual activity, and 9% desire pregnancy. Almost one percent (0.7%) are infertile. Of those in the second group, most avoid using contraception for fear of side-effects (12%), followed by 9% who did not want to use contraception, and 5% for health reasons. Also, of those in the first group, 19% in the urban areas are not sexually active, compared to 9% in rural areas. For women from the first group, 27% are rural; 23%, urban. Among rural women, the fear of side effects from use of contraceptives is greater than among urban women (16% vs. 8%). Of those not using contraceptives for religious reasons, 0.4% live in urban areas, and 0% in rural areas. They comprise 0.2% of married women 15-44 years. Selected reasons for non-use related to pregnancy, fecundity, and sexual activity are higher for women with nine or more years of education than for those with 0-7 years (59% vs. 44%); however, the rate for women with 8 years of education is 42%. Selected reasons for non-use related to other reasons are lower for women with nine or more years of education than for those with 0-7 years (56% vs. 41%). However, the rate for women with 8 years of education is 58%. 46 The fear of side effects is the more frequently cited reason for non-use of contraception (12%), and is greatest among women with 0-7 years of education (19%), while 'does not want' is greatest among women with 8 years of education (15%). Fear is also high among this same educational group (11%). The third most frequently cited reason given for non-use of contraceptives is 'health reasons' (5%). This reason is given by 6% of women with 0-7 years and 6% for women with 8 years, but then drops to 4% for women with nine or more years of education. Women not using contraceptives for religious reasons total 0.2% (0.0% at 0-7 years of education; 0.0% at 8 years; and 0.5% for nine or more years of education). Women not using contraceptives because of 'problems with past methods' comprise 0.3% of the sample; they are at 1.2% for women with 0-7 years of education, 0% for higher levels. Women not using contraceptives because 'spouse opposes' are 1% of the sample. The rate is at 2% for women with 0-7 years of education, 1% for women with 8 years, and 0% for women with nine or more years of education. 6.9 Reasons for Discontinued Use of Contraception Former users of contraception were asked why they discontinued the use of their most recent method. Table 6.21 shows that the most popular reason why women in the survey discontinued the use of contraceptives is because they desired a pregnancy (33%). The second main reason is because they had or fear side effects (25%). Among those who discontinued the use of contraceptives because of the desire for a pregnancy, most (48%) had been using Condoms. Among those who cited a fear of side effects as their main reason for discontinuing, 33% were using Injectables as the form of contraception. The table also shows that 14% who were using Condoms stopped because they did not like it or want to use it. It is also noted that among those who stopped for Health or Medical reasons, 12% were using Injectables. Only 2% claimed that they discontinued because they could not afford it, and these were using either Orals or Injectables. 6.10 Desire to Use Contraception in the Future Table 6.22 shows that among the current nonusers who desire to use a method of contraception in the future, 35% cited the use of Injectables as the method they would use. Of 47 these, 26% are from the urban areas and 42% are rural. The second most popular method for future use is Orals (27%). Here, 34% of the women are from the urban areas compared with 22% from the rural areas. Rhythm/Billings, Vaginal Methods and Condoms are among the least preferred methods for future use, as table 6.22 shows. With respect to the source of purchase of contraceptives in the future, 31% will obtain their supplies from the government facilities, while 31% will get them from the BFLA. In both cases, most of the women reside in the rural areas. The desire to use contraceptives in the future is greatest among those 20-24 years old (59%). The 15-19 age group are the second most interested (52%). The rate declines from those aged 25 to 44, (47% to 13%). The desire to use contraceptives in the future is highest after two children (50%), and after three children (48%). After one child, the desire is at 45%. The desire generally declines to women with six or more children (38%). However, 29% of currently married women with five living children desire to use contraceptives. Desire to use contraceptives in the future among women with 0-7 years of education and among those with 8 years of education is 40%, The desire is 48% among women with nine or more years of education. Desire to use contraceptives in the future is highest among Mestizo women (45%), followed by Creoles (44%), Garifuna (39%), and Maya/Kekchi women (33%). 6.11 Summary Knowledge of contraception remains high in Belize since 92% of women aged 15-44 years has knowledge of at least one method. Nevertheless, wide variations of knowledge of individual methods exist. Orals, Female Sterilization and Injection are the best known method; Diaphragm, Withdrawal and Billings are the least known methods. Knowledge of the fertile period is highest among the 30-34 year age group. Knowledge of the fertile period increases with years of education. At the time of the survey, 38% of married women were using a contraceptive method. The most prevalent methods are Female Sterilization, Orals, and Injection. Generally, use of contraceptive increases with years of education and with higher social and economic levels. Most respondents use contraceptives to limit pregnancies rather than for child spacing. Women with fewer children use contraceptives more for spacing. For younger women, the first use of contraception is greatest with no children, and decreases with more. The 48 pharmacy is the most frequent source of contraceptives, followed by the Belize Family Life Association and then by Government Facility. The most prevalent reasons for non-use of contraceptive are related to pregnancy, fecundity and sexual activity. 49 TABLE 6-1 BELIZE: Knowledge of Contraceptive Methods, by Method and Years of Education: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Years of Education Contraceptive Method Total None 1-7 8 9-12 13+ Orals 91.8 80.9 82.6 91.5 97.5 99.5 Female Sterilization 77.6 48.0 64.0 76.3 87.0 93.7 Injection 87.9 78.8 80.9 88.0 92.4 92.6 Condoms 85.4 56.8 69.1 85.6 96.0 98.7 IUD 62.0 27.2 45.7 59.6 71.2 90.2 Rhythm 46.9 17.9 29.7 39.8 58.3 83.3 Male Sterilization 43.0 12.6 22.2 34.8 57.1 83.9 Vaginal Tablets 29.7 11.1 12.6 23.0 40.5 62.9 Other Vaginal Methods** 31.8 6.6 11.6 23.7 44.6 72.5 Diaphragm 31.1 7.1 7.0 17.8 49.5 80.8 Withdrawal 31.6 9.3 11.7 23.2 43.6 73.6 Billings 10.6 1.6 3.6 5.9 13.5 35.3 No. of Cases* (Unweighted) (3603) (146) (846) (1204) (1026) (381) * Excludes 10 cases for whom years of education is unknown. ** Includes creams, jellies, and foam. TABLE 6-2 BELIZE:Knowledge of Contraceptive Method, by Method and Ethnic Group: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Ethnic Group Contraceptive Method Total Creole Mestizo Garifuna Maya/Ketch Other*** Orals 91.8 97.5 92.4 96.7 69.9 96.8 Female Sterilization 77.5 90.7 74.9 89.8 46.0 86.6 Injection 88.0 92.0 89.2 86.7 69.1 95.1 Condoms 85.4 96.5 86.0 97.9 42.8 96.1 IUD 62.1 74.4 60.8 70.6 22.0 82.1 Rhythm 47.0 55.8 47.7 48.3 19.5 50.6 Male Sterilization 43.1 54.2 42.0 49.8 13.4 49.9 Vaginal Tablets 29.7 41.3 26.6 35.8 8.0 38.7 Other Vaginal Methods** 31.7 44.5 27.9 44.3 5.9 41.8 Diaphragm 31.0 47.1 24.5 44.0 8.1 44.5 Withdrawal 31.5 46.8 26.1 42.2 6.5 45.4 Billings 10.5 15.5 9.1 14.8 0.8 13.0 No. of Cases* (Unweighted) (3586) (875) (1925) (199) (361) (226) * Excludes 27 cases for whom ethnic group is unknown. ** Includes creams, jellies, and foam. *** Primarily includes East Indians, Asians, and those of European Ancestry. TABLE 6-3 BELIZE: Knowledge of Contraceptive Methods, by Method and Language Spoken: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Language Spoken Contraceptive Method Total English Spanish English/ Spanish Other Orals 91.8 94.8 89.9 95.0 74.6 Female Sterilization 77.6 86.4 67.9 82.4 55.8 Injection 87.9 90.3 87.2 91.0 69.2 Condoms 85.4 91.5 79.6 91.8 57.3 IUD 62.0 70.4 51.1 70.6 35.1 Rhythm 46.9 50.7 38.1 58.1 26.6 Male Sterilization 43.1 49.6 29.8 54.8 24.7 Vaginal Tablets 29.7 37.6 17.9 35.7 17.0 Other Vaginal Methods** 31.8 41.1 17.2 40.1 15.6 Diaphragm 31.1 43.5 11.2 40.1 17.6 Withdrawal 31.6 42.3 14.9 39.5 16.9 Billings 10.6 13.4 4.8 14.9 5.0 No. of Cases (Unweighted) (3613) (1269) (1171) (896) (277) ** Includes creams, jellies, and foam. TABLE 6-4 BELIZE: Knowledge of Contraceptive Method, by Method and Residence Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Contraceptive Method Total Urban Rural Orals 91.8 96.6 87.3 Female Sterilization 77.6 84.0 71.5 Injection 87.9 91.0 85.1 Condoms 85.4 94.2 77.2 IUD 62.0 71.7 53.0 Rhythm 46.9 52.4 41.8 Male Sterilization 43.1 49.7 36.9 Vaginal Tablets 29.7 36.0 23.9 Other Vaginal Methods** 31.8 39.6 24.4 Diaphragm 31.1 40.1 22.7 Withdrawal 31.6 40.6 23.1 Billings 10.6 13.5 7.8 No. of Cases (Unweighted) (3613) (1729) (1884) ** Includes creams, jellies and foam. TABLE 6-5 BELIZE: Women Who Have Ever Used Rhythm, Billing, or Withdrawal With Correct Knowledge of When During the Menstrual Cycle a Woman is Most Likely to Get Pregnant: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Ever Users of Rhythm, Selected Characteristics All Respondents* Billings or Withdrawal Total 21.1 (3568) 33.4 (389) Residence Urban 23.6 (1703) 33.6 (197) Rural 18.7 (1865) 33.2 (192) Age 15- 19 18.0 (712) ** (22) 20-24 21.9 (663) 28.0 (80) 25-29 21.3 (696) 36.8 (73) 30-34 24.1 (655) 36.8 (101) 35-39 23.1 (492) 29.9 (75) 40-44 20.6 (350) 31.4 (38) Ever Married Ever Married 21.8 (2720) 33.1 (376) Never Married 19.3 (813) ** (8) Unknown 25.8 (35) ** (5) Education Level 0-7 10.1 (982) 13.6 (55) 8 18.6 (1194) 19.6 (107) 9+ 30.0 (1392) 44.5 (227) Ethnic Group Creole 24.1 (868) 38.6 (108) Mestizo 19.2 (1918) 31.1 (195) Garifuna 30.9 (199) 17.6 (26) Maya/Ketchi 13.9 (359) 31.2 (29) Other 26.3 (224) 41.8 (31) Contraceptive Use Currently Using 25.0 (1534) 35.5 (294) Not Using 18.7 (2034) 27.7 (95) * Excludes 10 cases for whom education level is unknown. * Excludes 8 cases for whom contraceptive use is unknown. * Excludes 27 cases for whom ethnic group is unknown. ** Less than 25 cases. TABLE 6-6 BELIZE: Current Contraceptive Use, by Method and Marital Status: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Marital Status Married/ Sep./ Div./ Visiting Current Use and Method Total In Union Widowed Partner Not in Union Currently Using 37.5 56.1 ** 56.8 6.8 Female Sterilization 11.1 18.0 ** 5.4 1.9 Orals 11.0 15.6 ** 23.5 1.9 Injection 4.7 7.6 ** 4.8 0.4 Rythym/ Billings 2.0 3.5 ** 0.6 0.2 Condoms 5.7 6.6 ** 19.0 2.1 IUD 0.9 1.5 ** 1.3 0.1 Other 2.1 3.3 ** 2.3 0.2 Not Currently Using 62.5 43.9 42.6 43.2 93.2 Total 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (3596) (2353) (6) (197) (1040) * Excludes 7 cases for whom contraceptive use is unknown. * Excludes 10 cases for whom marital status is unknown. ** Less than 25 cases. TABLE 6-7 BELIZE: Current Contraceptive Use, by Method and Language Spoken: Currently Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Language Spoken English/ Current Use and Method Total English Spanish Spanish Other Currently Using 56,1 58,7 55.6 59.9 36.0 Female Sterilization 18.0 17.2 20.1 18.5 10.3 Orals 15.6 17.6 15.2 16.2 6.9 Injection 7.6 5.4 10.8 7.3 4.4 Rythym/ Billings 3.5 2.9 2.1 6.6 3.1 Condoms 6.6 11.2 2.4 7.5 2.6 IUD 1.5 1.3 1.5 1.7 1.5 Other 3.3 3.0 3.5 2.1 7.2 Not Currently Using 43,9 41.3 44.4 40.1 64,0 Total 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (2353) (748) (867) (556) (182) * Excludes 5 cases for whom current primary contraceptive method is unknown. TABLE 6-8 BELIZE: Current Contraceptive Use, by Method and Religion: Currently Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Religion Current Use and Method Total Catholic Protestant None Other Currently Using 56.1 58.3 57.0 50.1 46.3 Female Sterilization 18.0 19.0 16.7 20.9 14.6 Orals 15.6 16.6 16.0 14.3 9.3 Injection 7.6 9.0 6.0 5.9 7.5 Rythym/ Billings 3.5 4.4 2.5 1.4 3.3 Condoms 6.6 6.0 9.0 3.6 4.6 IUD 1.5 1.7 1.5 0.8 1.2 Other 3.3 1.7 5.4 3.3 5.8 Not Currently Using 43.9 41.7 43.0 49.9 53.7 Total 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (2344) (1225) (734) (187) (198) * Excludes 5 cases for whom current primary contraceptive method is unknown. * Excludes 9 cases for whom religion is unknown. TABLE 6-9 BELIZE: Current Contraceptive Use, by Residence and Selected Characteristics: Currently Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Selected Characteristics Total* Urban Rural Total 56.5 (2350) 62.1 (1049) 52.0 (1301) Age 15-19 37.3 (153) 45.5 (66) 31.0 (87) 20-24 50.9 (405) 60.0 (190) 42.8 (215) 25-29 57.0 (547) 62.1 (240) 53.1 (307) 30-34 58.5 (547) 60.8 (245) 56.6 (302) 35-39 64.7 (417) 69.7 (198) 60.3 (219) 40-44 57.7 (281) 64.5 (110) 53.2 (171) Education Level 48.2 (769) 56.3 (208) 45.3 (561) 0-7 8 56.4 (817) 58.6 (338) 54.9 (479) 9+ 64.8 (764) 66.8 (503) 60.9 (261) Household Amenities 31.6 (288) ** (22) 31.2 (266) 0-2 3-7 56.8 (1376) 58.7 (554) 55.5 (822) 8- 10 66.3 (686) 67.2 (473) 64.3 (213) No. of Living Children 0 29.0 (231) 33.9 (124) 23.4 (107) 1 53.6 (392) 57.4 (223) 48.5 (169) 2 60.9 (506) 64.4 (239) 57.7 (267) 3 65.3 (404) 72.2 (176) 60.1 (228) 4 66.8 (310) 76.7 (133) 59.3 (177) 5 59.1 (186) 70.1 (67) 52.9 (119) 6+ 50.2 (321) 58.6 (87) 47.0 (234) Working Status Working 62.6 (617) 64.6 (356) 59.8 (261) Not working 54.3 (1733) 60.8 (693) 50.0 (1040) * Excludes 4 cases for whom education level is unknown. * Excludes 4 cases for whom work status is unknown. ** Less than 25 cases. TABLE 6-10 BELIZE: Current Contraceptive Use, by Years of Education and Selected Characteristics: Currently Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Education Level Selected Characteristics Total* 0-7 8 9+ Total 56.5 (2350) 48.2 (769) 56.4 (817) 64.8 (764) Age 15-19 37.3 (153) 19.6 (51) 38.3 (60) 57.1 (42) 20-24 50.9 (405) 45.4 (119) 48.0 (127) 57.2 (159) 25-29 57.0 (547) 46.1 (167) 54.0 (174) 68.4 (206) 30-34 58.5 (547) 49.0 (194) 62.8 (180) 64.7 (173) 35-39 64.7 (417) 59.1 (132) 67.7 (167) 66.9 (118) 40-44 57.7 (281) 53.8 (106) 52.3 (109) 72.7 (66) No. of Living Children 0 29.0 (231) 7.1 (42) 28.7 (87) 38.2 (102) 1 53.6 (392) 35.4 (79) 46.7 (120) 65.3 (193) 2 60.9 (506) 52.6 (133) 62.2 (172) 65.2 (201) 3 65.3 (404) 59.1 (132) 63.7 (135) 73.0 (137) 4 66.8 (310) 59.5 (121) 67.7 (124) 78.5 (65) 5 59.1 (186) 50.0 (88) 63.1 (65) 75.8 (33) 6+ 50.2 (321) 43.7 (174) 54.4 (114) 69.7 (33) No. of Household Amenities 0-2 31.6 (288) 26.9 (186) 38.8 (85) ** (17) 3-7 56.8 (1376) 53.6 (509) 56.9 (517) 61.1 (350) 8-10 66.3 (686) 64.9 (74) 62.3 (215) 68.8 (397) Working Status Working 62.6 (617) 54.0 (124) 57.0 (151) 68.1 (342) Not working 54.3 (1733) 47.1 (645) 56.3 (666) 62.1 (422) * Excludes 4 cases for whom education level is unknown. * Excludes 4 cases for whom work status is unknown. ** Less than 25 cases. TABLE 6-11 BELIZE: Current Contraceptive Use, by Method and Planning Status of Last Pregnancy Currently Married Women Aged, 15-44 Who Had a Pregnancy in the Last 5 Years 1999 Family Health Survey (Percent Distribution) Planning Status Current Use and Method Total Planned Mistimed Unwanted Unknown Currently Using 53.9 52.8 54.8 63.8 42.3 Female Sterilization 11.3 10.2 10.1 21.3 7.9 Orals 16.9 16.8 17.2 17.1 17.0 Injection 9.9 9.6 10.8 11.1 9.0 Rythym/ Billings 3.9 4.4 2.9 2.6 0.0 Condoms 6.5 6.6 7.0 6.1 1.9 IUD 1.5 1.6 2.0 0.6 2.2 Other 3.9 3.5 4.8 5.1 4.2 Not Currently Using 46.1 47.2 45.2 36.2 57.7 Total 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (1404) (1026) (211) (127) (40) * Excludes 2 cases for whom contraceptive use is unknown. TABLE 6-12 BELIZE: Reasons for Currently Using Contraception, by Selected Characteristics: Currently Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Space Limit No. of Cases* Selected Characteristics Pregnancies Pregnancies Other Total (Unweighted) Total 40.4 48.5 11.1 100.0 (1294) Residence Urban 40.2 49.2 10.6 100.0 (633) Rural 40.6 47.9 11.6 100.0 (661) Age 15-19 64.6 19.0 16.4 100.0 (57) 20-24 65.8 23.0 11.2 100.0 (204) 25-29 63.5 29.9 6.5 100.0 (302) 30-34 35.3 53.7 11.0 100.0 (310) 35-39 24.6 65.2 10.2 100.0 (264) 40-44 12.3 71.3 16.4 100.0 (157) No. of Living Children 0 43.8 8.4 47.8 100.0 (67) 1 78.0 15.8 6.2 100.0 (209) 2 52.9 39.6 7.5 100.0 (301) 3 33.9 54.8 11.3 100.0 (256) 4 28.4 62.3 9.3 100.0 (199) 5 24.5 63.0 12.5 100.0 (109) 6+ 16.3 75.3 8.3 100.0 (153) Years of Education None 22.8 57.4 19.8 100.0 (51) 1-7 34.7 56.3 9.0 100.0 (311) 8 37.1 52.0 10.9 100.0 (448) 9-12 48.1 41.4 .10.5 100.0 (343) 13+ 51.5 33.3 15.2 100.0 (141) TABLE 6-12 continued BELIZE: Reasons for Currently Using Contraception, by Selected Characteristics: Currently Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Space Limit No. of Cases* Selected Characteristics Pregnancies Pregnancies Other Total (Unweighted) Current Method Female Sterilization 1.0 79.2 19.8 100.0 (369) Orals 65.5 30.0 4.5 100.0 (392) Injection 53.9 43.8 2.3 100.0 (189) Rythym/ Billings 66.0 31.0 3.0 100.0 (80) Condoms 44.5 32.5 23.0 100.0 (148) IUD 63.5 36.5 0.0 100.0 (44) Other 54.1 39.5 6.5 100.0 (72) Ethnic Group Creole 40.0 48.0 12.0 100.0 (294) Mestizo 40.8 49.9 9.3 100.0 (770) Garifuna 44.8 39.7 15.5 100.0 (53) Maya/Ketchi 33.0 51.7 15.3 100.0 (80) Other 41.8 43.0 15.1 100.0 (97) * Excludes 2 cases for whom years of education is unknown. * Excludes 12 cases for whom ethnic group is unknown. * Excludes 25 cases for whom reason for currently using contraception is unknown. TABLE 6-13 BELIZE: Mean Age and Mean Number of Children at Time of First Contraceptive Use: Women Aged 15-44 Who Have Ever Used Contraception 1999 Family Health Survey (Percent Distribution) Mean No. No. of Cases* Selected Characteristics Children Mean Age (Unweighted) Residence Urban 1.2 20.8 (1104) Rural 2.1 22.7 (1009) Years of Education None 3.2 23.6 (74) 1-7 2.7 23.4 (455) 8 1.8 21.8 (707) 9-12 1.0 20.4 (615) 13+ 0.5 21.1 (262) Household Amenities 0-2 2.8 23.7 (147) 3-7 1.9 22.0 (1230) 8-10 1.1 20.9 (736) Ethnic Group Creole 1.2 20.5 (572) Mestizo 1.8 22.3 (1135) Garifuna 1.6 20.7 (126) Maya/Ketchi 3.1 24.5 (119) Other 1.0 20.7 (161) Religion Roman Catholic 1.6 21.8 (1124) Other 1.7 21.5 (989) Total 1.6 "21.7 (2113) * Excludes 4 cases for whom years of education is unknown. * Excludes 19 cases for whom ethnic group is unknown. * Excludes 3 cases for whom religion is unknown. TABLE 6-14 BELIZE: Number of Living Children at Time of First Contraceptive Use According to Actual Age: Ever Married Women Aged 15-44 1999 Family Health Survey (Percent Distribution) No. of Children at First Use Never No. of Cases* Actual Age 0 1 2 3 4+ Used Total (Unweighted) Total 24.0 23.7 10.7 5.6 12.3 23.7 100.0 (2712) 15-19 34.8 19.3 3.2 0.0 0.0 42.6 100.0 (201) 20-24 35. 5 26.7 6.3 3.4 1.1 27.0 100.0 (491) 25-29 23. 4 31.9 12.5 7.1 6.7 18.4 100.0 (613) 30-34 24. 6 20.2 11.2 6.2 15.6 22.4 100.0 (611) 35-39 17. 4 25.4 13.2 8.2 18.0 17.8 100.0 (463) 40-44 11. 9 15.0 14.7 6.1 28.3 23.9 100.0 (333) * Excludes 31 cases for whom number of children at first use is unknown. TABLE 6-15 BELIZE: Source of Contraception by Residence: Women Aged 15-44 Currently Using Contraception 1999 Family Health Survey (Percent Distribution) Residence Source of Contraception Total Urban Rural Government Facility 12.3 8.7 16.3 BFLA 19.9 19.2 20.6 Pharmacy 42.6 50.8 33.9 Private Facility 7.4 8.6 6.0 Outside of Belize 2.9 1.5 4.5 Other/Unknown 14.8 11.2 18.6 Total 100.0 100.0 100.0 No. of Cases (Unweighted) (930) (457) (473) TABLE 6-16 BELIZE: Source of Contraception by Year of Education: Currently Married Women Age 15-44 Currently Using Contraception 1999 Family Health Survey (Percent Distribution) Education Level Source of Contraception Total 0-7 8 9+ Government Facility 12.4 14.9 15.6 8.2 BFLA 19.9 24.2 20.0 17.6 Pharmacy 42.7 40.2 40.5 45.8 Private Facility 7.4 4.6 6.9 9.2 Outside of Belize 2.9 2.9 1.9 3.7 Other/Unknown 14.8 13.2 15.2 15.4 Total 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (929) (227) (312) (390) * Excludes 1 case for whom education level is unknown. TABLE 6-17 BELIZE: Source of Contraception by Ethnicity Currently Married Women Age 15-44 Currently Using Contraception 1999 Family Health Survey (Percent Distribution) Ethnic Group Source of Contraception Total Creole Mestizo Garifuna Maya/Ketchi Other Government Facility 12.1 7.8 13.2 3.2 26.1 15.8 BFLA 19.7 24.0 17.4 27.4 20.8 14.8 Pharmacy 42.9 47.5 42.1 39.9 22.0 50.1 Private Facility 7.5 7.5 8.9 2.2 3.5 4.4 Outside of Belize 3.0 0.6 5.1 0.0 0.0 0.0 Other/Unknown 14.9 12.6 13.3 27.3 27.6 14.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (921) (217) (538) (47) (50) (69) * Excludes 9 cases for whom ethnic group is unknown. TABLE 6-18 BELIZE: Source of Contraception for Methods Requiring Resupply or Surgical Intervention: Currently Married Women Age 15-44 Currently Using Contraception 1999 Family Health Survey (Percent Distribution) Source of Contraception Total Current Primary Contraceptive Method Female Sterilization Orals Injection Condoms IUD Other Government Facilities 32.2 70.9 8.8 22.3 4.3 8.7 12.8 BFLA 14.2 0.0 23.6 35.8 8.0 23.5 3.2 Pharmacy/Drugstore 30.4 0.0 59.8 25.1 85.4 0.0 6.7 Private Facilities 6.9 4.9 4.5 13.2 0.4 51.4 3.6 Outside of Belize 10.3 23.5 3.3 3.1 1.3 16.4 3.6 Other/unknown 6.0 0.6 0.0 0.4 0.6 0.0 70.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 No. of Cases (Unweighted) (1177) (385) (383) (184) (130) (44) (51) TABLE 6-19 BELIZE: Reasons for Not Currently Using Contraception Currently Married Women Age 15-44 Not Currently Using Contraception 1999 Family Health Survey (Percent Distribution) Residence Reasons for Nonuse Total Urban Rural Reasons Related to Pregnancv, Fecunditv, and Sexual Activity 49.0 54.2 43.9 Currently Pregnant 25.1 23.1 27.1 Desires Pregnancy 9.2 11.3 7.1 Not Sexually Active 14.0 18.7 9.4 Infertile 0.7 1.0 0.3 Otter Reasons 51.0 45.8 56.1 Had or Fear Side Effects 12.0 7.9 16.1 Does Not Want 9.1 9.7 8.5 Lacks Knowledge of Methods 0.5 0.0 1.0 Health Reasons 5.0 4.6 5.5 Lacks Money 1.4 0.7 2.1 Spouse Opposes 0.9 0.9 0.9 Embarrassed to Use 0.1 0.0 0.3 Religious Reasons 0.2 0.4 0.0 Advanced Age 1.8 2.7 1.0 Problems with Past Methods 0.3 0.0 0.7 Other 16.0 15.3 16.7 Unknown 3.5 3.7 3.4 Total 100.0 100.0 100.0 No. of Cases (Unweighted) (492) (234) (258) TABLE 6-20 BELIZE: Reasons for Not Currently Using Contraception, by Years of Education: Currently Married Women Age 15-44 Not Currently Using Contraception 1999 Family Health Survey (Percent Distribution) Education Level Reasons for Nonuse Total 0-7 8 9+ Reasons Related to Pregnancv, Fecundity, and Sexual Activity 49.0 44.3 42.3 58.6 Currently Pregnant 25.1 27.9 21.9 26.0 Desires Pregnancy 9.2 6.7 8.4 11.7 Not Sexually Active 14.0 9.2 11.5 19.9 Infertile 0.7 0.5 0.5 0.9 Other Reasons 51.0 55.7 57.7 41.4 Had or Fear Side Effects 12.0 19.2 11.4 7.2 Does Not Want 9.1 4.3 14.7 7.5 Lacks Knowledge of Methods 0.5 0.6 1.0 0.0 Health Reasons 5.0 5.5 6.2 3.6 Lacks Money 1.4 3.7 1.0 0.0 Spouse Opposes 0.9 2.0 1.0 0.0 Embarrassed to Use 0.1 0.5 0.0 0.0 Religious Reasons 0.2 0.0 0.0 0.5 Advanced Age 1.8 2.4 1.5 1.8 Problems with Past Methods 0.3 1.2 0.0 0.0 Other 16.0 10.8 17.9 18.2 Unknown 3.5 5.5 3.0 2.6 Total 100.0 100.0 100.0 100.0 No. of Cases (Unweighted) (492) (148) (167) (177) TABLE 6-21 BELIZE: Reasons Stopped Using Contraception, by Last Method Used: Currently Married Women Age 15-44 Who Had Used Contraception in the Past but are not Currently Using 1999 Family Health Survey (Percent Distribution) Last Method Used Reasons Stopped Using Contraception Total Orals Injection Condoms Other Desires Pregnancy 32.9 31.4 24.4 48.1 39.7 Had or Fears Side Effects 24.7 26.1 33.4 10.0 16.7 Does not Like or Want to Use 8.7 9.7 5.0 13.8 6.4 Method Not Effective 1.5 1.2 0.0 2.6 4.4 Health or Medical Reasons 8.6 8.3 12.1 1.3 10.5 Not Sexually Active 3.9 2.7 6.2 4.9 2.9 Lack of Money 1.8 2.6 2.1 0.0 0.0 Far Distance Source 0.3 0.3 0.7 0.0 0.0 Other 14.5 14.2 12.2 16.8 18.1 Unknown 3.2 3.5 3.8 2.5 1.2 Total 100.0 100.0 100.0 100.0 100.0 No. of Cases* (Unweighted) (487) (254) (113) (58) (62) * Excludes 5 cases for whom method used when stopped using contraception is unknown. TABLE 6-22 BELIZE: Nonusers Who Desire to Use a Method in the Future, by Method of Choice and Source Where Method Would be Obtained, by Residence: Currently Married Women Age 15-44 1999 Family Health Survey (Percent Distribution) Residence Method of Choice Total Urban Rural Orals 26.8 33.7 21.8 Female Sterilization 22.5 22.0 22.8 Injection 35.4 26.2 42.1 IUD 6.0 7.6 4.9 Rhythm/Billings 2.9 3.4 2.6 Vaginal Methods 0.5 1.2 0.0 Condoms 2.1 1.7 2.4 Other 0.5 0.0 0.9 Unknown 3.2 4.1 2.5 Total 100.0 100.0 100.0 No. of Cases (Unweighted) (346) (137) (209) Source Where Method Would be Obtained Government Facilities 30.5 21.5 37.2 BFLA 31.0 30.7 31.3 Pharmacy/Drugstore 21.0 29.1 15.0 Private Facilities 14.4 18.3 11.6 Other 3.0 0.5 4.9 Total 100.0 100.0 100.0 No. of Cases* (Unweighted) (346) (137) (209) * Excludes 3 cases for whom source of contraception is unknown. CHAPTER 7 WOMEN IN NEED OF FAMILY PLANNING SERVICES 7.1 Introduction This chapter focuses on those women who are in need of family planning services. In the chapter, the various socioeconomic characteristics of those women who are most in need of these services are highlighted. Differences in need by age, residence and years of education of the woman are some of the key issues discussed here. 7.2 Characteristics of Women in Need of Family Planning Services Of the total married fecund women, who are not presently desiring pregnancy, 59% are using a contraceptive (Table 7.1). The most prevalent methods in order of choice are orals (24%), injectables (12%), condoms (10%) and Rhythm/Billing method (5%). While the proportion using a contraceptive is much greater among urban women (66%) than rural women (53%), the method of choice remains in the same order and in about the same proportion. The same also applies to those married fecund women who say they want no more children. Fifty three percent (53%) are currently using a method, with urban women being more likely to do so (62%) than rural women (46%). However, as with those who do not at present desire pregnancy, the order of choice is the same and again in about the same proportion (Table 7.2). Fifteen percent of the women interviewed are in need of family planning services. This need is greatest among women in a union (21%), women with 4 or more children, over 20%, women with less than 7 years of primary education, over 20% and Garifuna women, 27%. In every case mentioned, the need is substantially greater among women in the rural areas. While there is no clear pattern of need by age group, it appears that the need is greater among women 30 years old and over and as before greater among rural women of that age (Table 7.3). Of the women who are in need of Family Planning Services, 47% have used a method of contraception before, while 46% desire to use a method in the future. While more urban women (54%) than rural women (46%) have used a method, the proportion desiring to use a 50 method in the future is the same (46%) (Table 7.5). There is not much difference in the proportion of ever married women who used a contraceptive and who desire to use one in the future. However, there are significant differences by age group and number of children. Women 15 to 19 years show greater desire to use a contraceptive method (61%) than those who have ever used one (24%). The same can be said of women 20 to 24 years, although the difference is not as great, 69% as against 49%. Beyond 24 years, the desire to use a contraceptive method declines, and it becomes progressively lesser than the proportion that ever used one. The same pattern applies when the number of living children is taken into account, although this is predictable given the correlation between age and the number of children ever had. After 3 children, the desire to use a contraceptive is lesser than past use. The desire to use is less than past use among all the ethnic groups, even though the proportion is highest among Creole women, 65% ever using a method as against 55% desiring to use one (Table 7.5). 7.3 Summary Most women need family planning services for purposes of child spacing. More women in unions require family planning services than those never in a union. The need for family planning services is greater among rural women than among urban women. The greatest need occurs among women of the age group 20-24 years, as well as among women with fewer years of education. By Ethnicity, the greatest need for family planning services is among the Maya/Kekchi ethnic group, followed by the Garifuna and Mestizo ethnic groups. Also, those women who have six (6) or more children have the greatest need for these services. 51 TABLE 7-1 BELIZE: Contraceptive Use by Method and Residence: Currently Married Fecund Women Aged 15-44 Not Desiring a Pregnancy Who Are Using Contraceptives, 1999 Family Health Survey (Percent Distribution) Residence Current Use and Method Total Urban Rural Currently Using 58.9 65.9 53.0 Orals 24.1 29.1 20.0 Injection 12.2 13.6 11.0 Rythym/ Billings 5.1 5.3 4.9 Condoms 10.2 13.0 8.0 IUD 2.2 2.2 2.3 Other 5.0 2.7 6.9 Not Currently Using 41.1 34.1 47.0 Total 100.0 100.0 100.0 No. of Cases* (Unweighted) (1386) (604) (782) * Excludes sterilized women and women who said they were either subfecund or menopausal. * Excludes 3 cases for whom contraceptive use is unknown. TABLE 7-2 BELIZE: Contraceptive Use by Method and Residence: Currently Married Fecund Women Aged 15-44 Wanting No More Children Who Are Using Contraceptives, 1999 Family Health Survey (Percent Distribution) Residence Current Use and Method Total Urban Rural Currently Using 52.8 62.1 45.8 Orals 20.6 25.2 17.1 Injection 11.4 13.0 10.3 Rythym/ Billings 5.1 6.0 4.5 Condoms 9.1 12.9 6.2 IUD 2.0 2.5 1.7 Other 4.5 2.5 6.0 Not Currently Using 47.2 37.9 54.2 Total 100.0 100.0 100.0 No. of Cases* (Unweighted) (945) (387) (558) * Excludes sterilized women and women who said they were either subfecund or menopausal. * Excludes 2 cases for whom contraceptive use is unknown. TABLE 7-3 BELIZE: In Need of Family Planning Services, by Selected Characteristics: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Residence Selected Characteristics Total Urban Rural Total 14.5 (3540) 11.2 (1683) 17.6 (1857) Marital Status Currently in Union 20.8 (2334) 16.2 (1039) 24.5 (1295) Formerly in union 5.6 (392) 6.6 (256) 3.7 (136) Never in union 1.0 (814) 1.0 (388) 0.9 (426) Age 15-19 8.4 (705) 6.2 (325) 10.3 (380) 20-24 15.7 (655) 13.8 (318) 17.5 (337) 25-29 15.5 (689) 12.2 (328) 18.6 (361) 30-34 17.4 (649) 12.5 (313) 22.0 (336) 35-39 15.1 (491) 9.9 (242) 20.1 (249) 40-44 16.8 (351) 14.0 (157) 19.1 (194) No. of Living Children 0 3.3 (1046) 2.9 (516) 3.6 (530) 1 16.3 (540) 13.4 (314) 20.4 (226) 2 18.2 (584) 15.6 (294) 20.7 (290) 3 15.6 (467) 12.1 (215) 18.7 (252) 4 21.2 (353) 15.8 (158) 25.6 (195) 5 16.6 (205) 10.1 (79) 20.6 (126) 6+ 30.4 (345) 25.2 (107) 32.8 (238) Years of Education None 23.8 (143) 14.9 (47) 28.1 (96) 1-7 21.2 (838) 21.3 (225) 21.2 (613) 8 15.3 (1193) 13.3 (503) 16.8 (690) 9- 12 9.8 (1001) 8.6 (649) 11.9 (352) 13+ 6.0 (365) 4.2 (259) 10.4 (106) Ethnic Group Creole 10.9 (855) 8.8 (555) 14.7 (300) Mestizo 1.4.6 (1913) 12.4 (814) 16.2 (1099) Garifuna 14.5 (193) 14.6 (144) 14.3 (49) Maya/Ketchi 26.7 (359) 16.7 (42) 28.1 (317) Other 8.6 (220) 8.6 (128) 8.7 (92) * Excludes 37 cases for whom marital status is unknown. * Excludes 10 cases for whom education level is unknown. * Excludes 27 cases for whom ethnic group is unknown. TABLE 7-4 BELIZE: In Need of Family Planning Services, by Residence and Selected Characteristics Women, Aged 15 - 44, 1999 Family Health Survey (Percent Distribution) Residence Selected Characteristics Total* Urban Rural Total 100.0 (520) 40.2 59.8 Marital Status Married/In Union 91.4 34.3 57.0 Visiting Partner 5.1 3.7 1.4 Not in Union 3.5 2.1 1.4 Age 15- 19 12.9 4.6 8.3 20-24 21.6 10.9 10.7 25-29 17.1 6.9 10.1 30-34 19.9 6.9 12.9 35-39 15.0 5.2 9.8 40-44 13.6 5.8 7.8 No. of Living Children 0 7.5 3.3 4.1 1 18.3 9.9 8.4 2 19.8 9.1 10.7 3 11.9 4.4 7.5 4 14.2 5.9 8.3 5 5.5 1.1 4.3 6+ 22.9 6.5 16.4 Education Level None 6.9 1.7 5.2 Incomplete Primary 31.7 8.6 23.2 Complete Primary 35.9 15.1 20.9 Secondary 20.0 11.7 8.3 Post Secondary 5.4 3.2 2.3 Ethnic Group Creole 20.1 10.5 9.6 Mestizo 52.3 21.6 30.7 Garifuna 6.1 4.7 1.3 Maya/Ketchi 18.2 1.5 16.7 Other 3.4 2.0 1.4 * Excludes 2 cases for whom education level is unknown. * Excludes 3 cases for whom ethnic group is unknown. TABLE 7-5 BELIZE: In Need of Family Planning Services: Women Aged 15-44 Who Ever Used Contraception;and Who Desire to Use Contraception in the Future, by Selected Characteristics: Women, Aged 15-44, 1999 Family Health Survey (Percent Distribution) Ever Used Desire to Use No. of Cases* Selected Characteristics Contraception Contraceptive (Unweighted) Total 46.5 46.4 (515) Residence Urban 53.5 46.4 (189) Rural 42.0 46.4 (326) Marital Status Ever Married 47.2 46.1 (507) Never Married ** ** (8) Age 15-19 24.3 61.1 (59) 20-24 47.2 69.4 (103) 25-29 52.2 46.2 (107) 30-34 50.7 47.4 (113) 35-39 51.9 24.8 (74) 40-44 47.5 18.9 (59) No. of Living Children 0-1 25.1 45.1 (34) 2 48.0 54.5 (88) 3 43.2 49.5 (73) 4 51.6 37.3 (75) 5 33.9 32.2 (34) 6+ 54.5 41.9 (105) Education Level 0-7 35.5 41.4 (212) 8 49.1 42.7 (183) 9+ 60.0 59.4 (120) Ethnic Group Creole 65.3 54.9 (93) Mestizo 49.2 47.3 (279) Garifuna 42.8 38.4 (28). Maya/Ketchi 23.0 - 35.6 (96) Other ** ** (19) * Excludes 5 cases for whom marital status is unknown. * Excludes 2 cases for whom education level is unknown. * Excludes 3 cases for whom ethnic group is unknown. ** Less than 25 cases. CHAPTER 8 FAMILY LIFE EDUCATION 8.1 Introduction There have been some changes in the Primary and Secondary school curriculum since 1991. The Ministry of Education has spearheaded a School Health and Physical Education (SHAPES) curriculum as part of a regional initiative and commitment to fulfill the goals of the Convention on the Rights of the Child (CRC). Added support was given to this initiative when the Belize Family Life Association conducted a teenage pregnancy national survey, done by Dr. Turbani Jagdeo. It highlights the fact that access to sex education is influenced by socioeconomic status, mediated more often, through the schools attended by middle- and higher-income children. Young people get most of their sexual and reproductive health information from their peers, followed by the home and the school. The finding indicates an opportunity to provide correct information using peer-to-peer education methods, and by strengthening outreach to parent programmes. 8.2 Findings The general consensus of women 13 to 34 years of age, is that the topics of Human Reproduction (94%), contraception (89%) and STI's, including HIV/AIDS (95%), should be taught in school, with the ideal age for teaching such subjects being mainly between the ages of 10 to 14 years, over 75% in each case. Most of these women received information about pregnancy and how it occurs (60%), but little about birth control methods (34%) from their parents or guardian (Table 8.3 & 8.5). Of those who received information 69% had received information on pregnancy and 60% information on birth control methods between the ages of 10 and 14 years (Tables 8.4&8.6). Only 42% (Table 8.7) had a class or course of family life or sex education while in school and most of them, 77%, while they were between the ages of 11 and 16 years (Table 8.8). The course was done by a teacher most of the time, 82%, although a counsellor or psychologist (5%), physicians/nurse (4%), or a person from BFLA (6%) also taught the 52 course (Table 8.10). The course included information on counseling, 58%, clinic services (34%) and distribution of contraceptives (29%). Only a small proportion, 13%, had any course in Family life or sex education outside of school, (Table 8.12) and this was carried out mainly by BFLA, 30%, or a youth group, 11%, or was given in a doctor's office, 14% (Table 8.13). The main person teaching the first course on family life or sex education outside of school was either a school teacher, 10%, a physician/nurse 24%, or someone from BFLA, 20%. A religious person, 9%, peers/friends, 9%, or a youth officer, 5%, also taught the course (Table 8.14). In over 80% of the time, information in the course included the human/reproductive system, the woman's menstrual cycle, pregnancy and how it works, modern birth control methods, IUD or injections, condoms, diseases from sexual contact and STI's including HIV/AIDS. Parenting and values and roles were also included (Table 8.15). Information on counseling, clinic services and distribution of contraceptives was also included (Table 8.16). The preferred source of information on family life and sex education were Parents/Guardian (34%), BFLA (16%), Teachers (6%), Books/publication (9%) or health personnel (11%). Peers/friends were a preferred source in only 5% of the cases (Table 8.17). Most of these women (68%) know where to go for information on sex or contraception. The main places are Government clinic/Health Clinic, 20%, or BFLA (47%) although a doctor's office, 9%, and the Government hospital, 9%, are also good sources (Table 8.19). In terms of sexually transmitted diseases, this same proportion know where to go and the sources are the same (Tables 8.20 & 8.21). Similar sentiments are expressed about HIV/AIDS with the responses being about the same. 8.3 Summary As with the findings of the male survey, there is strong support for the provision of family life education in schools. The majority of respondents thought that the topics of STIs including HIV/AIDS, Human Reproduction, and Contraception should be introduced to students between the ages of 10 and 13. 53 Parents and guardians provided information to 62% of young women, aged 13-34 regarding pregnancy and how it occurs. Most respondents received this information at 12 years. Most of the women, currently aged 13-34, who received information about family life or sex education in school, did so between the ages of 12 and 16. The sources about family life and sex education topics most frequently cited by women are the Belize Family Life Association (47%) and Government (20%). Sixty-eight percent (68%) of women knew where to go for information about Sexually Transmitted Infections. The sources most frequently cited were the Belize Family Life Association and a Government Facility. 54 TABLE 8-1 BELIZE: Opinion on Which Topics Schools Should Teach: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Topics Schools Should Teach TOTAL Yes No Unknown No. of Cases (Unweighted) Human Reproduction 100 93.6 3.9 2.5 (3613) Contraception 100 89.2 7.5 3.2 (3613) STI's-HIV-AIDS 100 94.5 3.2 2.2 (3613) TABLE 8-2 BELIZE: Ideal Age When Topics Should Be First Taught: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Topics Human STI's-HIV- Ideal Age Reproduction Contraception AIDS 5 0.9 0.6 0.8 6 0.8 0.6 0.9 7 1.0 0.5 0.8 8 3.1 2.4 3.0 9 5.5 4.9 5.3 10 21.2 19.8 22.0 11 10.0 10.0 9.9 12 24.7 24.3 24.9 13 14.7 14.5 14.7 14 6.8 7.3 6.8 15 4.2 5.4 3.9 16 1.5 2.0 1.2 17 0.4 0.7 0.5 18 1.0 1.5 1.0 19 0.1 0.0 0.1 20 0.2 0.4 0.2 Unknown 4.2 5.1 4.1 Total 100.0 100.0 100.0 No. of Cases (Unweighted) (3613) (3613) (3613) TABLE 8-3 BELIZE: Knowledge About Pregnancy From Parents/Guardians: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Have Received Information From Parents or Guardians About Pregnancy and How it Occurs Percent Yes 60.2 No 39.2 Unknown 0.6 Total 100 No. of Cases (Unweighted) (2758) TABLE 8-4 BELIZE: Age When Received Knowledge About Pregnancy: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Age Percent 6 0.2 7 0.2 8 0.7 9 2.3 10 6.7 11 7.3 12 22.1 13 20.4 14 12.6 15 11.1 16 5.7 17 2.2 18 2.3 19 0.6 20 0.7 21 0.3 22 0.2 23 0.3 24 0.0 25 0.0 26 0.0 27 0.1 Unknown 4.0 Total 100.0 No. of Cases (Unweighted) (1574) TABLE 8-5 BELIZE: Knowledge About Birth Control Methods Received From Parents/Guardians: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Received Information Percent Yes 34.4 No 65.0 Unknown 0.6 Total 100.0 No. of Cases (Unweighted) (2758) TABLE 8-6 BELIZE: Age When Knowledge About Birth Control Methods Received: Women Aged 15-44 1999 Family Health Survey (Percent Distribution). Age Percent 6 0.1 7 0.0 8 0.6 9 1.3 10 4.6 11 6.3 12 18.3 13 18.9 14 12.2 15 15.0 16 8.0 17 4.1 18 3.4 19 1.1 20 1.7 21 0.3 22 0.5 23 0.3 24 0.2 25 0.1 26 0.1 27 0.2 28 0.0 29 0.1 30 0.2 31 0.0 32 0.1 Unknown 2.5 Total 100.0 No. of Cases (Unweighted) (878) TABLE 8-7 BELIZE: Received a Class on Family Life or Sex Education: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Have Received a Class or Course About Family Life or Sex Education in School Percent Yes 42.2 No 56.9 Unknown 0.9 Total 100 No. of Cases (Unweighted) (2758) TABLE 8-8 BELIZE: Age When Received First Class or Course About Family Life or Sex Education: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Age Percent 6 0.0 7 0.0 8 0.1 9 0.3 10 1.5 11 5.4 12 15.6 13 23.1 14 19.0 15 14.4 16 11.2 17 3.3 18 2.4 19 1.2 20 0.0 21 0.0 22 0.1 23 0.1 24 0.1 25 0.0 26 0.0 27 0.2 Unknown 2.0 Total 100.0 No. of Cases (Unweighted) (1084) TABLE 8-9 BELIZE: Education Level When First Class/Course Received: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Education Level Percent None 0.8 Incomplete Primary 34.1 Complete Primary 28.4 Secondary 34.0 Post Secondary 2.3 Unknown 0.4 Total 100.0 No. of Cases (Unweighted) (1048) TABLE 8-10 BELIZE: Main Person To Teach First Class/Course About Family Life or Sex Education in School: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Main Person Percent School Teacher 82.2 Counselor or Psychologist 5.1 Physician/ Nurse 3.6 Belize Family Life Association Officer (BFLA) 5.5 COMPAR/ Min. of Human Development Personnel 0.0 Youth Officer (YMCA, SCOUTS, etc.) 0.2 Peers/ Friends 0.1 Parent/ Guardian 0.3 Religious Person 0.7 Volunteer 1.0 Other 0.7 Unknown 0.6 Total 100.0 No. of Cases (Unweighted) (1048) TABLE 8-11 BELIZE: Type of Information on Adolescent Services Included in First Class/Course: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Type of Information Total Yes No Unknown No. of Cases (Unweighted) Counseling 100 58.3 39.9 1.8 (1048) Clinic Services 100 33.7 63.6 2.6 (1048) Distribution of Contraceptives 100 29.3 67.8 2.9 (1048) TABLE 8-12 BELIZE: Received Formal Class or Course on Family Life or Sex Education Outside of School or Home: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Received Formal Class/Course Percent Yes 13.4 No 85.8 Unknown 0.7 Total 100 No. of Cases (Unweighted) (2758) TABLE 8-13 BELIZE: Main Organization Conducting Course On Family Life Or Sex Education: Women Aged 15-44 Who Received Course 1999 Family Health Survey (Percent Distribution) Main Organization Percent Doctor's Office/ Clinic 13.8 NOPCA 2.0 Belize Family Life Association (BFLA) 29.8 COMPAR/ Min. of Human Development Personnel 1.1 SHAPES 0.4 Youth Group (YMCA, Scouts, etc.) 11.4 Peer Group 9.4 Church 9.3 Volunteer 5.2 Other 14.5 Unknown 3.1 Total 100.0 No. of Cases (Unweighted) (376) TABLE 8-14 BELIZE: Main Person Who Taught Family Life Or Sex Education: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Main Person Percent School Teacher 10.2 Counselor or Psychologist 8.4 Physician/ Nurse 24.0 Belize Family Life Association Officer (BFLA) 20.3 COMPAR/ Min. of Human Development Personnel 0.9 Youth Officer (YMCA, SCOUTS, etc.) 5.4 Peers/ Friends 8.5 Parent/ Guardian 3.7 Religious Person 8.5 Volunteer 4.4 Other 4.7 Unknown 1.1 Total 100.0 No. of Cases (Unweighted) (376) TABLE 8-15 BELIZE: Topics Included In First Class/Course: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) No. of Cases Topics Total Yes No Unknown (Unweighted) The Human Reproductive System 100.0 84.2 14.5 1.3 (376) The Woman's Menstrual Cycle or Period 100.0 85.4 13.1 1.6 (376) Pregnancy and How It Works 100.0 90.7 8.4 0.9 (376) Modern Birth Control Methods Such As The Pill, IUD or Injections 100.0 82.6 16.4 1.0 (376) Condoms 100.0 82.9 15.9 1.2 (376) Diseases That Can Result From Sexual Contacts 100.0 85.6 13.2 1.1 (376) STI's/HIV/AIDS 100.0 83.4 14.9 1.7 (376) Parenting 100.0 75.9 22.2 1.9 (376) Values and Roles 100.0 73.7 23.2 3.0 (376) TABLE 8-16 BELIZE: Inclusion Of Services For Adolescents In Class/Course: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Services Included Total Yes No Unknown No. of Cases (Unweighted) Counseling 100.0 72.1 24.9 3.0 (376) Clinic Services 100.0 63.1 34.5 2.3 (376) Distribution of Contraceptives 100.0 56.3 42.0 1.7 (376) TABLE 8-17 BELIZE: Preferred Source Of Information About Family Life Or Sex Education: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Preferred Source of Information About Family Life or Sex Education Topics Percent Parents/ Guardians 33.6 Sisters/ Brothers 1.8 Belize Family Life Association (BFLA) 15.7 Teachers 6.3 Peers/ Friends 4.9 Media 5.3 Counselor 0.8 Books/ Publications 8.9 Internet 0.1 Religious Leader 0.5 Health Personnel 10.9 Other 2.5 Unknown 8.6 Total 100.0 No. of Cases (Unweighted) (2758) TABLE 8-18 BELIZE: Knowledge of Where to Go for Information on Sex or Contraceptive: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Knowledge of Where To Go Percent Yes 68.1 No 30.3 Unknown 1.6 Total 100.0 No. of Cases (Unweighted) (2758) TABLE 8-19 BELIZE: Source Of Information On Sex Or Contraception: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Source Percent Government Clinic/ Health Center 19.7 Private Doctor/ Clinic 8.8 Government Hospital 9.1 Private Hospital 0.8 Belize Family Life Association (BFLA) 47.1 Pharmacy/ Drugstore 1.8 Church 0.1 Family Member 6.3 Friend/ Neighbor 0.8 Community Health Worker 3.6 Supermarket/ Bar/ Grocery Store 0.1 Other 1.6 Unknown 0.1 Total 100.0 No. of Cases (Unweighted) (1925) TABLE 8-20 BELIZE: Knowledge of Where to Go to Get Information on STI's: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Knowledge of Where to Go Percent Yes 67.9 No 30.8 Unknown 1.3 Total 100 No. of Cases (Unweighted) (2758) TABLE 8-21 BELIZE: Source Of Information On STI's: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Source Percent Government Clinic/ Health Center 23.2 Private Doctor/ Clinic 13.8 Government Hospital 15.6 Private Hospital 1.7 Belize Family Life Association (BFLA) 37.6 Pharmacy/ Drugstore 0.3 Church 0.1 Family Member 2.4 Friend/ Neighbor 0.5 Community Health Worker 2.7 Supermarket/ Bar/ Grocery Store 0.0 Other 2.0 Unknown 0.1 Total 100.0 No. of Cases (Unweighted) (1919) TABLE 8-22 BELIZE: Knowledge of Where to Go to Get Information on HIV/AIDS: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Knowledge of Where to Go No. of Cases (Unweighted) Yes 66.0 No 32.4 Unknown 1.6 Total 100.0 No. of Cases (Unweighted) (2758) TABLE 8-23 BELIZE: Source Of Information On HIV/AIDS: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Source Percent Government Clinic/ Health Center 26.4 Private Doctor/ Clinic 12.1 Government Hospital 14.8 Private Hospital 1.6 Belize Family Life Association (BFLA) 36.4 Pharmacy/ Drugstore 0.1 Church 0.1 Family Member 2.2 Friend/ Neighbor 0.3 Community Health Worker 2.8 Supermarket/ Bar/ Grocery Store 0.0 Other 3.2 Unknown 0.1 Total 100.0 No. of Cases (Unweighted) (1836) TABLE 8-24 BELIZE: Source of Information Received on Sex or Contraceptives by Education Level: Women Aged 15-44 1999 Family Health Survey (Percent Distribution) Education Level No. of Cases Incomplete Complete Post Source TOTAL None Primary Primary Secondary Secondary Unknown (Unweighted) Government Clinic/ Health Center 100.0 1.3 41.6 23.0 32.3 1.8 0.0 (149) Private Doctor/ Clinic 100.0 2.2 20.5 25.7 48.1 2.9 0.7 (119) Government Hospital 100.0 0.0 39.2 28.6 28.8 2.6 0.9 (70) Private Hospital 100.0 0.0 14.9 34.0 51.1 0.0 0.0 (10) Belize Family Life Association (BFLA) 100.0 0.6 28.9 31.1 36.2 2.8 0.3 (442) Pharmacy/ Drugstore 100.0 10.1 19.7 33.1 33.7 3.4 0.0 (18) Church 100.0 0.0 0.0 100.0 0.0 0.0 0.0 (1) Family Member 100.0 0.0 35.6 29.8 34.6 0.0 0.0 (51) Friend/ Neighbor 100.0 0.0 64.9 35.1 0.0 0.0 0.0 (5) Community Health Worker 100.0 0.0 25.3 41.6 31.8 0.0 1.3 (28) Supermarket/ Bar/ Grocery Store 100.0 0.0 0.0 0.0 100.0 0.0 0.0 (1) Other 100.0 0.0 33.9 25.9 40.1 0.0 0.0 (22) Total 100.0 0.9 31.3 29.4 35.8 2.2 0.3 (9Í6) CHAPTER 9 USE AND POTENTIAL DEMAND FOR SURGICAL CONTRACEPTION 9.1 Introduction Compared to the Family Health Survey of 1991, female sterilization remains the most prevalent method of contraception in Belize, accounting for 19% of all contraceptive use in 1991, and 18% in the 1999 survey. Because of the importance of female sterilization in controlling unwanted pregnancies in Belize, this chapter provides additional data on sterilization and the demand for this procedure. Specifically, this chapter discusses the characteristics of women with tubal ligations, post-operative regret, interest in sterilization among women who want to limit their family size, reasons for lack of interest in sterilization, and reasons for failure to follow through among interested and informed women. 9.2 Profile of Sterilized Women According to Table 9.1, at the time of the survey there was little difference between urban and rural women with respect to the use of the sterilization method (51% urban cf. 49% rural). But, of the currently married survey population using sterilization, there is a difference (46% cf. 54%, respectively). In the 1991 survey, more urban married women accessed sterilization than rural. In most countries, surgical contraceptive methods are more accessible to urban women. Most women are sterilized between the ages of 30 and 34. At the time of the survey, the largest number of sterilized women (33%) is between the ages of 35 and 39. The mean age of women at the time of sterilization was 36.1 years, up from 29.7 in 1991. The mean age of sterilization of the sample at the time of the survey is 36.2 years, up from 35%. Of currently married women, the age of sterilization was 30.9. Most sterilized women surveyed (25%) already had 6+ living children. Sterilization is low among women with few children. After 3 children, 25% of sterilized women used this procedure. Of the currently married population, most of the sterilized women (20%) used the procedure after having 2 children; and 17% after having 6+ children. At the time of the survey, the mean number of living children of sterilized women was 4.4; currently married women have 3.2. At the time of the survey, the level of 55 sterilization as a contraceptive method rose to 30% among women with 8 years of education. The figure decreased to 8% among users

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