Armenia -Demographic and Health Survey - 2006

Publication date: 2006

#TOGPKC &GOQITCRJKE�CPF *GCNVJ�5WTXG[ # TO GPKC����� & GO QITCRJKE�CPF�* GCNVJ�5 WTXG[ ���� Armenia Demographic and Health Survey 2005 National Statistical Service Yerevan, Armenia Ministry of Health Yerevan, Armenia ORC Macro Calverton, Maryland USA December 2006 National Statistical Service Ministry of Health This report summarizes the findings of the 2005 Armenia Demographic and Health Survey (ADHS), which was conducted by the National Statistical Service and the Ministry of Health of the Republic of Armenia. ORC Macro provided technical assistance and the U.S. Agency for International Development (USAID) provided funding under the terms of contract number GPO- C-00-03-00002-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. The ADHS is part of the worldwide MEASURE DHS program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the ADHS may be obtained from the National Statistical Service, 3 Government House, Republic Avenue, 375010 Yerevan, Armenia (Telephone: 37410 524-326 and Fax: 37410 521-921). Additional information about the DHS project may be obtained from ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705 (Telephone 301-572-0200 and Fax 301-572-0999). Recommended citation: National Statistical Service [Armenia], Ministry of Health [Armenia], and ORC Macro. 2006. Armenia Demographic and Health Survey 2005. Calverton, Maryland: National Statistical Service, Ministry of Health, and ORC Macro. Contents | iii CONTENTS Page Tables and Figures . vii Acknowledgments . xv Preface . xvii Summary of Findings . xix Map of Armenia . xxiv CHAPTER 1 INTRODUCTION 1.1 Territory .1 1.2 Demographic Characteristics .1 1.3 Health Care System in Armenia .1 1.4 Objectives and Organization of the Survey .5 1.5 Response Rates.7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Population.9 2.2 Housing Characteristics.18 2.3 Wealth Quintiles .24 2.4 Birth Registration .25 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3.1 Background Characteristics of Respondents .27 3.2 Educational Level of Respondents.29 3.3 Exposure to Mass Media .31 3.4 Employment .31 3.5 Occupation .36 3.6 Employment .39 CHAPTER 4 FERTILITY 4.1 Current Fertility .41 4.2 Fertility Differentials by Background Characteristics .42 4.3 Fertility Trends.44 4.4 Fertility Rates From NSS and the ADHS .44 iv | Contents 4.5 Children Ever Born and Living .44 4.6 Birth Intervals .45 4.7 Age at First Birth .47 4.8 Teenage Pregnancy and Motherhood .49 CHAPTER 5 CONTRACEPTION 5.1 Knowledge of Contraceptive Methods .51 5.2 Ever Use of Contraception .52 5.3 Current Use of Contraception.55 5.4 Current Use by Background Characteristics.57 5.5 Number of Children at First Use .58 5.6 Knowledge of the Fertile Period.59 5.7 Access to Family Planning .60 5.8 Discontinuation Within 12 Months of Use .62 5.9 Reasons for Using Traditional Methods .63 5.10 Intention to Use Family Planning among Nonusers .63 5.11 Exposure to Family Planning Messages in the Mass Media.66 5.12 Contact of Nonusers with Family Planning Providers.69 5.13 Men’s Attitudes toward Family Planning .70 5.14 Informed Choice .71 CHAPTER 6 ABORTION 6.1 Pregnancy Outcomes.73 6.2 Lifetime Experience with Induced Abortion .75 6.3 Rates of Induced Abortion .77 6.4 Trends in Induced Abortion.78 6.5 Use of Contraceptive Methods Before Abortion .80 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY 7.1 Marital Status.81 7.2 Age at First Marriage and Sexual Intercourse .82 7.3 Recent Sexual Activity.87 7.4 Postpartum Amenorrhea, Abstinence, and Insusceptibility .90 7.5 Menopause .90 CHAPTER 8 FERTILITY PREFERENCES 8.1 Fertility Preferences .91 8.2 Need for Family Planning .93 8.3 Fertility Planning .95 Contents | v 8.4 Ideal Number of Children.96 8.5 Wanted and Unwanted Fertility.98 CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Assessment of Data Quality.99 9.2 Levels and Trends in Childhood Mortality . 100 9.3 Infant Mortality Rates from the National Statistical Service and the ADHS. 102 9.4 Socioeconomic Differentials in Childhood Mortality . 104 9.5 Demographic Differentials in Childhood Mortality . 106 9.6 Perinatal Mortality . 107 9.7 High-Risk Fertility Behavior. 108 CHAPTER 10 REPRODUCTIVE HEALTH 10.1 Antenatal Care. 113 10.2 Assistance and Medical Care at Delivery . 117 10.3 Postnatal Care . 120 10.4 Women’s Health Care . 123 CHAPTER 11 CHILD HEALTH 11.1 Characteristics of Delivery. 127 11.2 Vaccination Coverage . 127 11.3 Acute Respiratory Infection. 131 11.4 Fever . 132 11.5 Diarrhea . 132 11.6 Disposal of Children’s Stools . 136 CHAPTER 12 NUTRITION 12.1 Nutritional Status of Children. 139 12.2 Breastfeeding and Supplementation. 142 12.3 Infant And Young Child Feeding (IYCF) Practices. 150 12.4 Anemia in Children . 154 12.5 Micronutrient Intake in Children. 156 12.6 Nutritional Status of Women . 158 12.7 Anemia in Women . 160 12.8 Micronutrient Intake in Women . 162 vi | Contents CHAPTER 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS 13.1 Knowledge of HIV/AIDS and Methods of HIV Prevention . 163 13.2 Rejection of Misconceptions About AIDS Transmission and Comprehensive Knowledge of AIDS . 167 13.3 Social Aspects of HIV/AIDS . 170 13.4 Multiple Sexual Partnerships . 173 13.5 Paid Sex . 176 13.6 Prevalence of Sexually Transmitted Infections . 176 13.7 Prevalence of Injections . 178 13.8 HIV/AIDS-Related Knowledge and Behavior among Youth. 180 13.9 Age at First Sex among Youth and Condom Use . 182 CHAPTER 14 ADULT HEALTH 14.1 Access to and Utilization of Health Care Services. 187 14.2 Use of Smoking Tobacco . 196 14.3 Tuberculosis . 198 14.4 Hypertension. 205 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Cash Earnings . 211 15.2 Use of Earnings . 212 15.3 Household Decisionmaking . 214 15.4 Attitudes towards Wife Beating . 217 15.5 Attitudes towards Refusing Sexual Relations . 220 15.6 Indicators of Women’s Empowerment . 223 15.7 Current Use of Contraception by Women’s Status . 224 15.8 Women’s Status and Ideal Family Size and Unmet Need . 225 15.9 Women’s Status and Reproductive Health Care. 226 REFERENCES. 229 APPENDIX A SAMPLE DESIGN . 231 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 235 APPENDIX C DATA QUALITY TABLES . 267 APPENDIX D PERSONS INVOLVED IN THE ARMENIA 2005 DEMOGRAPHIC AND HEALTH SURVEY . 275 APPENDIX E QUESTIONNAIRES . 281 Tables and Figures | vii TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews.7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS Table 2.1 Household population by age, sex, and residence.10 Table 2.2 Household composition .11 Table 2.3 Children’s living arrangements and orphanhood.12 Table 2.4.1 Educational attainment of the household population: Male.14 Table 2.4.2 Educational attainment of the household population: Female .15 Table 2.5 School attendance ratios .17 Table 2.6 Housing characteristics.19 Table 2.7 Household drinking water .21 Table 2.8 Household sanitation facility .22 Table 2.9 Household possessions.24 Table 2.10 Population distribution by wealth quintile .25 Table 2.11 Birth registration of children under five .26 Figure 2.1 Population pyramid.10 Figure 2.2 Age-specific school attendance rates, by sex.18 Figure 2.3 Households with electricity and LPG/Natural gas for cooking .20 Figure 2.4 Households with drinking water piped into the house and flush toilet to piped sewer system, by residence .23 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .28 Table 3.2.1 Educational attainment by background characteristics: Women .29 Table 3.2.2 Educational attainment by background characteristics: Men.30 Table 3.3.1 Exposure to mass media: Women .32 Table 3.3.2 Exposure to mass media: Men.33 Table 3.4 Employment status .35 Table 3.5.1 Occupation: Women .37 Table 3.5.2 Occupation: Men .38 Table 3.6 Employment characteristics .39 Figure 3.1 Percent distribution of women and men age 15-49 by employment status .34 Figure 3.2 Respondents currently employed, by residence and education.36 viii | Tables and Figures CHAPTER 4 FERTILITY Table 4.1 Current fertility.41 Table 4.2 Fertility by background characteristics .43 Table 4.3 Trends in age-specific fertility rates.44 Table 4.4 Children ever born and living .45 Table 4.5 Birth intervals .46 Table 4.6 Age at first birth.47 Table 4.7 Median age at first birth by background characteristics .48 Table 4.8 Teenage pregnancy and motherhood.49 Figure 4.1 Age-specific fertility rates for the three-year period preceding the survey, by residence .42 Figure 4.2 Total fertility rates for the three years preceding the survey, by residence and education .47 Figure 4.3 Percentage of births occurring less than 24 months and a prior birth, by residence and education CHAPTER 5 CONTRACEPTION Table 5.1 Knowledge of contraceptive methods.52 Table 5.2 Knowledge of contraceptive methods by background characteristics .53 Table 5.3.1 Ever use of contraception: Women .54 Table 5.3.2 Ever use of contraception: Men.54 Table 5.4 Current use of contraception.55 Table 5.5 Trends in contraceptive use.57 Table 5.6 Current use of contraception by background characteristics .58 Table 5.7 Number of living children at first use of contraception.59 Table 5.8 Knowledge of fertile period .59 Table 5.9 Source of modern contraceptive methods .60 Table 5.10 Cost of modern contraceptive methods.60 Table 5.11 Informed choice.62 Table 5.12 First-year contraceptive discontinuation rates .63 Table 5.13 Reasons for discontinuing contraceptive methods.64 Table 5.14 Reasons for using traditional methods .65 Table 5.15 Future use of contraception .65 Table 5.16 Reasons for not intending to use contraception .66 Table 5.17 Preferred method of contraception for future use.67 Table 5.18.1 Exposure to family planning messages: Women.68 Table 5.18.2 Exposure to family planning messages: Men .69 Table 5.19 Contact of nonusers with family planning providers.71 Figure 5.1 Contraceptive use among married women .56 Figure 5.2 Trends in current contraceptive use among married women .56 Figure 5.3 Transportation to source of contraceptive supply.61 Figure 5.4 Men’s attitudes toward contraception .70 Tables and Figures | ix CHAPTER 6 ABORTION Table 6.1 Pregnancy outcome by background characteristics .74 Table 6.2 Lifetime experience with induced abortion .76 Table 6.3 Induced abortion rates .77 Table 6.4 Induced abortion rates by background characteristics.78 Table 6.5 Use of a contraception before pregnancy .80 Figure 6.1 Trends in pregnancy outcomes.75 Figure 6.2 Age-specific fertility rates and abortion rates, 2005.78 Figure 6.3 Trends in age-specific abortion rates, 2000 and 2005.79 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 7.1 Current marital status .81 Table 7.2 Age at first marriage .83 Table 7.3 Age at first sexual intercourse .84 Table 7.4 Median age at first marriage .85 Table 7.5 Median age at first sexual intercourse.86 Table 7.6.1 Recent sexual activity: Women .88 Table 7.6.2 Recent sexual activity: Men.89 Table 7.7 Postpartum amenorrhea, abstinence, and insusceptibility .90 Table 7.8 Menopause.90 Figure 7.1 Marital status of respondents .82 Figure 7.2 Median age at first sexual intercourse among respondents, by residence and education .84 CHAPTER 8 FERTILITY PREFERENCES Table 8.1 Fertility preferences by number of living children .91 Table 8.2 Desire to limit childbearing .93 Table 8.3 Need for family planning.94 Table 8.4 Fertility planning status.95 Table 8.5 Ideal number of children.96 Table 8.6 Mean ideal number of children.97 Table 8.7 Wanted fertility rates.98 Figure 8.1 Desire for more children among currently married women and men.92 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Early childhood mortality rates . 101 Table 9.2 Comparison of infant mortality rates. 103 Table 9.3 Early childhood mortality rates by socioeconomic characteristics . 105 Table 9.4 Early childhood mortality rates by demographic characteristics. 106 Table 9.5 Perinatal mortality . 107 Table 9.6 High-risk fertility behavior . 108 x | Tables and Figures Figure 9.1 Trends in infant mortality, according to 2000 ADHS and 2005 ADHS. 102 Figure 9.2 Trends in infant mortality based on estimates from the national statistical service (NSS) and the 2005 ADHS. 104 Figure 9.3 Infant mortality rates for the 10-year period preceding the survey, by residence and wealth quintile. 105 Figure 9.4 Births in the last five years in categories of high-risk fertility behavior. 109 CHAPTER 10 REPRODUCTIVE HEALTH Table 10.1 Antenatal care. 114 Table 10.2 Number of antenatal care visits and timing of first visit . 115 Table 10.3 Components of antenatal care. 116 Table 10.4 Place of delivery. 118 Table 10.5 Assistance during delivery . 119 Table 10.6 Timing of postnatal checkup . 121 Table 10.7 provider at first postnatal checkup. 122 Table 10.8 Last visit to gynecologist . 123 Table 10.9 Last breast examination. 125 Figure 10.1 Antenatal care provider. 115 Figure 10.2 Reasons for gynecological visit. 124 CHAPTER 11 CHILD HEALTH Table 11.1 Child’s birth weight and size at birth . 128 Table 11.2 Vaccinations by source of information. 129 Table 11.3 Vaccinations by background characteristics . 130 Table 11.4 Prevalence of acute respiratory infection . 131 Table 11.5 Prevalence and treatment of fever. 133 Table 11.6 Prevalence of diarrhea . 134 Table 11.7 Knowledge of ORS packets . 135 Table 11.8 Diarrhea treatment. 136 Table 11.9 Feeding practices during diarrhea. 136 Table 11.10 Disposal of children’s stools. 137 Figure 11.1 Treatment of acute respiratory infection among children under five . 132 CHAPTER 12 NUTRITION Table 12.1 Nutritional status of children . 140 Table 12.2 Initial breastfeeding. 144 Table 12.3 Breastfeeding status by age. 146 Table 12.4 Median duration of breastfeedin . 148 Table 12.5 Frequency of breastfeeding . 149 Table 12.6 Foods consumed by children in the day or night preceding the interview. 150 Table 12.7 Infant and young child feeding (IYCF) practices in Armenia . 152 Table 12.8 Prevalence of anemia in children . 155 Tables and Figures | xi Table 12.9 Micronutrient intake among children . 157 Table 12.10 Presence of iodized salt in household. 158 Table 12.11 Nutritional status of women by background characteristics . 159 Table 12.12 Prevalence of anemia in women . 160 Table 12.13 Micronutrient intake among mothers . 161 Figure 12.1 Nutrition status of children under age five . 141 Figure 12.2 Trends in nutritional status of children under five . 142 Figure 12.3 Among last-born children in the five years prior to the survey who ever received a prelacteal liquid, percentage given specific liquids. 145 Figure 12.4 Trends in infant feeding practices of children under 6 months and 6-8 months. 147 Figure 12.5 Infant and young child feeding (IYCF) practices . 153 CHAPTER 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS Table 13.1 Knowledge of AIDS. 162 Table 13.2 Knowledge of HIV prevention methods. 164 Table 13.3.1 Misconceptions and comprehensive knowledge about AIDS: women . 166 Table 13.3.2 Misconceptions and comprehensive knowledge about AIDS: men . 167 Table 13.4.1 Accepting attitudes toward those living with HIV: women . 169 Table 13.4.2 Accepting attitudes toward those living with HIV: men. 170 Table 13.5.1 Multiple sexual partners and higher-risk sexual intercourse: women. 172 Table 13.5.2 Multiple sexual partners and higher-risk sexual intercourse: men. 173 Table 13.6 Payment for sexual intercourse. 174 Table 13.7 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms. 175 Table 13.8 Prevalence of medical injections . 177 Table 13.9 Comprehensive knowledge about AIDS and of a source for condoms among youth. 179 Table 13.10 Age at first sexual intercourse among young women and men . 181 Table 13.11 Condom use at first sexual intercourse among youth . 182 Table 13.12 Premarital sexual intercourse and condom use during premarital sexual intercourse among young men. 183 Figure 13.1 Percentage who know about using condoms, limiting sex, etc. . 163 CHAPTER 14 ADULT HEALTH Table 14.1 Utilization of the health system . 188 Table 14.2 Results of consultation with an eye doctor. 190 Table 14.3 Problems in accessing health care . 192 Table 14.4 Cost of consultation . 193 Table 14.5 Knowledge of the family medicine program n . 194 Table 14.6 Reasons for not approving of family medicine . 196 Table 14.7 Use of tobacco: men. 197 Table 14.8 Knowledge of tuberculosis. 199 Table 14.9.1 Knowledge of symptoms of tuberculosis: women . 201 xii | Tables and Figures Table 14.9.2 Knowledge of symptoms of tuberculosis: men. 202 Table 14.10 Knowledge that tuberculosis can be cured and attitude towards a family member’s TB . 204 Table 14.11.1 Levels of hypertension: women. 208 Table 14.11.2 Levels of hypertension: men . 209 Figure 14.1 Consultation with eye doctors . 189 Figure 14.2 Meaning of “Family Medicine”. 195 Figure 14.3 Approval of family medicine program . 195 Figure 14.4 Awareness of hypertension and treatment status. 207 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women. 212 Table 15.2 Control over women's earnings and relative magnitude of women's cash earnings . 213 Table 15.3 Women's control over her own earnings and over those of her husband/partner. 214 Table 15.4 Women's participation in decisionmaking . 215 Table 15.5 Women’s participation in decisionmaking by background characteristics. 216 Table 15.6.1 Attitude toward wife beating: women . 218 Table 15.6.2 Attitude toward wife beating: men . 219 Table 15.7.1 Attitude toward refusing sex with husband: women . 221 Table 15.7.2 Attitude toward refusing sexual intercourse with husband: men . 222 Table 15.8 Indicators of women's empowerment: women . 224 Table 15.9 Current use of contraception by women's status . 225 Table 15.10 Women's empowerment and ideal number of children and unmet need for family planning . 226 Table 15.11 Reproductive health care by women's empowerment . 227 Figure 15.1 Distribution of married women by number of household decision in which they participate. 215 APPENDIX A SAMPLE DESIGN Table A.1 Sample implementation: Women . 233 Table A.2 Sample implementation: Men. 234 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1.1 List of selected variables for sampling errors, Armenia 2005: Women. 237 Table B.1.2 List of selected variables for sampling errors, Armenia 2005: Men . 238 Table B.2.1 Sampling errors for the national sample, Armenia 2005: Women . 239 Table B.2.2 Sampling errors for the national sample, Armenia 2005: Men. 240 Table B.3.1 Sampling errors for the urban sample, Armenia 2005: Women. 241 Table B.3.2 Sampling errors for the urban sample, Armenia 2005: Men . 242 Table B.4.1 Sampling errors for the rural sample, Armenia 2005: Women. 243 Table B.4.2 Sampling errors for the rural sample, Armenia 2005: Men . 244 Tables and Figures | xiii Table B.5.1 Sampling errors for the Yerevan sample, Armenia 2005: Women . 245 Table B.5.2 Sampling errors for the Yerevan sample, Armenia 2005: Men. 246 Table B.6.1 Sampling errors for the Aragatsotn sample, Armenia 2005: Women. 247 Table B.6.2 Sampling errors for the Aragatsotn sample, Armenia 2005: Men . 248 Table B.7.1 Sampling errors for the Ararat sample, Armenia 2005: Women . 249 Table B.7.2 Sampling errors for the Ararat sample, Armenia 2005: Men. 250 Table B.8.1 Sampling errors for the Armavir sample, Armenia 2005: Women. 251 Table B.8.2 Sampling errors for the Armavir sample, Armenia 2005: Men . 252 Table B.9.1 Sampling errors for the Gegharkunik sample, Armenia 2005: Women . 253 Table B.9.2 Sampling errors for the Gegharkunik sample, Armenia 2005: Men . 254 Table B.10.1 Sampling errors for the Lori sample, Armenia 2005: Women. 255 Table B.10.2 Sampling errors for Lori Armenia 2005: Men . 256 Table B.11.1 Sampling errors for the Kotayk sample, Armenia 2005: Women . 257 Table B.11.2 Sampling errors for the Kotayk sample, Armenia 2005: Men. 258 Table B.12.1 Sampling errors for the Shirak sample, Armenia 2005: Women . 259 Table B.12.2 Sampling errors for the Shirak sample, Armenia 2005: Men. 260 Table B.13.1 Sampling errors for the Syunik sample, Armenia 2005: Women . 261 Table B.13.2 Sampling errors for the Syunik sample, Armenia 2005: Men. 262 Table B.14.1 Sampling errors for the Vayots Dzor, Armenia 2005: Women. 263 Table B.14.2 Sampling errors for the Vayots Dzor sample, Armenia 2005: Men . 264 Table B.15.1 Sampling errors for the Tavush sample, Armenia 2005: Women. 265 Table B.15.2 Sampling errors for the Tavush sample, Armenia 2005: Men . 266 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution. 267 Table C.2.1 Age distribution of eligible and interviewed women. 268 Table C.2.2 Age distribution of eligible and interviewed men . 268 Table C.3 Completeness of reporting. 269 Table C.4 Births by calendar years . 270 Table C.5 Reporting of age at death in days. 271 Table C.6 Reporting of age at death in months . 272 ACKNOWLEDGMENTS The National Statistical Service of the Republic of Armenia and the Ministry of Health of the Republic of Armenia wish to express their appreciation to those involved in the implementation of the 2005 Armenia DHS survey and the preparation of this report. Particular thanks go to: • U.S. Agency for International Development (USAID/Armenia), for providing the funding for organizing and conducting the 2005 Armenia Demographic and Health Survey (ADHS). • ORC Macro, for providing technical support, training for fieldwork staff, consultations, recommendations, and analyses of the data collected. • UNICEF/Armenia and UNFPA/Armenia, for providing technical and administrative support. • The technical staff of the ADHS, the input of field staff and data quality teams, and the valuable contribution of all experts and organizations, whose joint efforts ensured the effective implementation of the survey. Also to 6,707 households whose participation made it possible to obtain the reliable information collected in the survey. Stepan Mnatsakanyan President of the National Statistical Service of the Republic of Armenia Norayr Davidyan Minister of Health of the Republic of Armenia Acknowledgments | xv PREFACE The 2005 Armenia Demographic and Health Survey (ADHS) was a nationally representative sample survey designed to provide information on population and health issues in Armenia. The ADHS was conducted by the National Statistical Service and the Ministry of Health of the Republic of Armenia September-December 2005. ORC Macro provided technical support for the survey through the MEASURE DHS project. The MEASURE DHS project is sponsored by the United States Agency for International Development (USAID) to assist countries worldwide in obtaining information on key population and health indicators. USAID/Armenia provided funding for the survey. UNICEF/Armenia and UNFPA/Armenia supported the survey through in-kind contributions. The purpose of the 2005 ADHS was to collect national- and regional-level data on fertility and contraceptive use, maternal and child health, adult health, and AIDS and other sexually transmitted diseases. Thus, much of the information collected in the survey represents updated estimates of basic health and demographic indicators covered in the 2000 ADHS (NSS, MOH, and ORC Macro, 2001). The survey obtained detailed information on these issues from women of reproductive ages and, on certain topics, from men as well. Data are presented by region (marz) when sample size permits. The survey findings provide estimates for a variety of demographic indicators. The 2005 ADHS results are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of and health services for the people of Armenia. The 2005 ADHS also contributes to the growing international database on demographic and health indicators. Preface | xvii Summary of Findings │ xix SUMMARY OF FINDINGS The Armenia Demographic and Health Survey (ADHS) is a nationally representative survey of 6,566 women and 1,447 men age 15-49. Survey fieldwork was conducted during the period of September to December 2005. The ADHS was conducted by the National Statis- tical Service and the Ministry of Health of the Republic of Armenia. The MEASURE DHS Project provided technical support for the survey. The U.S. Agency for International Development (USAID)/Armenia provided funding, and the United Nations Children=s Fund (UNICEF)/ Armenia and the UN Population Fund (UNFPA)/ Armenia supported the survey through in-kind contributions. CHARACTERISTICS OF RESPONDENTS Armenia is an ethnically homogeneous country; virtually all respondents are Armenian and reported that they are Christians. The majority, approximately 60 percent, live in urban areas. Yerevan accounts for more than one-third of all respondents. All households in Armenia have electricity and a majority of households have water piped into the residence, a flush toilet, a finished floor, and a color television. All but a handful of women and men in the sample have attended school. Approximately 40 percent have reached only secondary school, one-quarter have reached secondary-special school, and one- quarter have attended university. Twenty-nine percent of women and 66 percent of men were employed in the 12 months prior to the survey. FERTILITY Fertility rates. A useful index of the level of fertility is the total fertility rate (TFR), which indicates the number of children a woman would have if she passed through the childbearing ages at the current age-specific fertility rates. For the three years preceding the survey, the survey estimate of the TFR was 1.7 children per woman. This is below replacement level. The survey found that the TFR is only slightly lower in urban areas (1.6 children per woman) than in rural areas (1.8 children per woman). Time trends. The total fertility rate of 1.7 is identical to the TFR measured in the 2000 ADHS for the three years preceding that survey, indicating no recent change in overall fertility levels. Age at first birth. Research has shown that childbearing in the teenage years is associated with increased social and health problems for both the mother and her child. The survey found that only 2 percent of women age 15-19 had given birth. Moreover, almost all births to teenage women occurred at ages 18 and 19. Thus, the median age at initiation of childbearing in Armenia is about 22 years. Birth intervals. Research has shown that children born soon after a previous birth, especially those born within two years of the previous birth, have an increased risk of morbidity and mortality. In Armenia, 32 percent of second and higher order births occur after a birth interval of less than two years. The proportion of closely spaced births declines as education of the mother increases. Fertility preferences. Among currently married women, 71 percent reported that they either wanted no more children or were sterilized. Another 22 percent wanted another child, and 7 percent were infecund (unable to conceive) or undecided about having another child. CONTRACEPTION Knowledge and ever use. Knowledge of contra- ception is widespread in Armenia. Among married women, knowledge of at least one method is universal (99 percent). On average, married women reported knowing of six methods of contraception. Three-quarters (76 percent) of married women have used a method of con- traception at some time. xx │ Summary of Findings Current use. Over half (53 percent) of married women reported that they were currently using a contraceptive method: 20 percent using modern methods and 34 percent using traditional methods. By far, the most commonly used method is withdrawal; more than half of all users (28 out of 53 percent) are using withdrawal. The second most common method—the IUD—is used by only 9 percent of married women. Overall levels of contraceptive use are similar for women in urban and rural areas and across educational categories and wealth quintile (between 42 and 60 percent). Nevertheless, urban women and women with more education show distinctive behavior patterns by relying more on modern methods (the IUD and condom) and less on traditional methods (in particular, withdrawal). Trends in current use. Use of contraception has declined from 61 percent of married women in the 2000 ADHS to 53 percent in 2005. Use of both modern and traditional methods has declined. Method failure. A woman may discontinue use of contraception for many reasons, including the desire to have more children, health concerns, or lack of exposure to the risk of pregnancy. In Armenia, the single most prevalent reason for discontinuation is method failure, i.e, becoming pregnant while using a method. The method most commonly used in Armenia, withdrawal, has the second highest failure rate after periodic abstinence (rhythm). Twenty-one percent of women practicing withdrawal experience a contraceptive failure within 12 months of starting use. Future use. Among married women who were not using contraception, 29 percent reported that they intended to use in the future. When asked which method they would prefer to use, approximately one-third of non-users said the IUD, while one-quarter said withdrawal and about one-fifth said condoms. Source of supply. Most modern method users obtained their methods through the public sector (53 percent), primarily hospitals and polyclinics. Forty-two percent obtained their contraceptives from the private sector, primarily pharmacies. INDUCED ABORTION In Armenia, as in all of the former Soviet Union, induced abortion has been a primary means of fertility control for many years. Abortion rates. The use of abortion can be measured by the total abortion rate (TAR) which indicates the number of abortions a woman would have in her lifetime if she passed through her childbearing years at the current age-specific abortion rates. The survey estimate of the TAR indicates that a woman in Armenia will have an average of 1.8 abortions during her lifetime. This rate is considerably lower than the comparable rate in the 2000 ADHS of 2.6. Despite this decline, almost half (45 percent) of pregnancies end in an induced abortion. Abortion differentials. The TAR is significantly higher in rural areas (2.2 abortions per woman) than in urban areas (1.5 abortions per woman). Contraceptive failure and abortion. When formulating policies designed to improve the reproductive health of women, it is useful to know the contraceptive behavior of women who resort to abortion as a means of fertility control. Over half (52 percent) of all abortions were to women who were using contraception and experienced method failure, a large proportion of whom were using withdrawal. Greater access to and use of more reliable methods would reduce the incidence of abortion. CHILDHOOD MORTALITY Trends in childhood mortality. Data from the 2005 ADHS indicate that there has been a decline in childhood mortality over the recent five years. For example, infant mortality has declined from 36 deaths per 1,000 live births for the approximate period 1996-2000 to 26 for the period 2001-2005. There has been a similar decline in under-five mortality from 39 to 30 deaths per 1,000 births. Differentials in infant mortality. The survey found levels of infant mortality to be slightly higher in rural areas than in urban areas. Infant mortality levels are also much higher among children of poorer women than among children of women in the higher wealth quintiles. MATERNAL AND CHILD HEALTH AND UTRITION N Antenatal care. Armenia has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. Overall, the levels of antenatal care and delivery assistance are high. Ninety-three percent of mothers receive antenatal care from professional health providers (doctors, nurses, and midwives). In urban areas, 94 percent of care is provided by doctors, as opposed to 83 percent in rural areas. Seven in ten pregnant women make four or more antenatal care visits, although there is a significant urban-rural differential. In terms of content of care, almost all women said they were weighed, had their blood pressure tested and gave blood and urine specimens (98-99 percent); however less than half say that they were informed about pregnancy complications. Delivery care. Overall, almost all births are delivered under the supervision of a trained medical professional (98 percent) and occur at health facilities (97 percent). Home deliveries are more common in Gegharkunik and Aragatsotn regions. Childhood vaccinations. The health cards maintained at the health facilities are the primary source of vaccination data. Almost all children age 12-23 months have received vaccinations for BCG, DPT1 and polio 1. Coverage is also high for the second and third doses of both DPT and polio. Seventy-two percent of children age 12-23 months had received the MMR (measles, mumps, rubella) vaccination before the survey. Only 60 percent of children 12-23 months of age had received all the basic vaccinations (BCG, MMR, and three doses each of DPT and polio) at any time before the survey; however, since MMR is routinely given at 12 months of age, this may represent an underestimate of coverage. Nevertheless, there has been a sharp decline in coverage, from 76 percent of children in 2000 to 60 percent in 2005. Treatment of diarrhea. The ADHS asked about the treatment of children who suffered from diarrhea during the two weeks preceding the survey. Overall, 65 percent of children under five with diarrhea in the two weeks before the survey were given either oral rehydration salts or increased fluids (oral rehydration therapy). For almost one-fifth of children with diarrhea, mothers reported that they engaged in the hazardous prac- tice of curtailing fluid intake. On a more positive note, 70 percent of mothers who had a birth in the five years preceding the survey know about oral rehydration salts (ORS). Breastfeeding. Ninety-seven percent of children born in the five years preceding the survey were breastfed at some time. Although the median duration of breastfeeding is 11 months, the durations of exclusive and predominant breastfeeding (breastfeeding plus plain water) are short (one month and three months, respectively). Nutritional status. In the ADHS, the height and weight of children under five years of age were measured. These data are used to determine the nutritional status of children, i.e., the percentage of children who are stunted (measured in terms of height-for-age), wasted (weight-for-height), or underweight (weight-for-age). Stunting is a sign of chronic, long-term undernutrition; wasting is a sign of acute, short-term undernutrition; and underweight is a composite measure that takes into account both chronic and acute undernutrition. In a well-nourished population of children, it is expected that slightly more than 2 percent of children will be stunted or wasted. In Armenia, 13 percent of children under age five are stunted and 5 percent are wasted. Overall, 4 percent of children are underweight. There has been no change in the proportion of children stunted since 2000; however, there has been a slight increase in the proportions wasted (from 2 to 5 percent) and underweight (from 3 to 4 percent). Anthropometric data were also collected from all women age 15-49. According to the findings of the ADHS, approximately four in ten Armenian Summary of Findings │ xxi women weigh more than they should: 27 percent are overweight and 16 percent are obese. There is a positive relationship between age and obesity: the prevalence of obesity, for example, increases from 2 percent among women age 15-19 to one- third of women age 40-49. More than half of women age 30 and older are either overweight or obese, a serious public health challenge for Armenia. Anemia. Determining anemia levels among women and their children under five was one component of the ADHS. Overall, 37 percent of children age 6-59 months have anemia: 17 percent have mild anemia, but 19 percent have moderate anemia and 1 percent have severe anemia. A comparison of data from the 2000 and 2005 ADHS surveys suggests that anemia rates among children have increased by 50 percent over the last five years, from 24 percent of children 6-59 months in 2000 to 37 percent in 2005. The increase is concentrated in Yerevan and Gegharkunik regions and it is possible that data collection problems may account for some of the implausible trend. Similarly, the proportion of women with anemia appears to have doubled from 12 percent in 2000 to 25 percent in 2005. Again, the increase is concentrated in Yerevan and Gegharkunik. When these two regions are removed from the analysis, the increase in anemia among women is marginal. HIV/AIDS AND OTHER SEXUALLY RANSMITTED INFECTIONS T The currently low level of HIV infection in Armenia provides a unique window of opportunity for early targeted interventions to prevent further spread of the disease. However, the increases in the cumulative incidence of HIV infection suggest that this window of opportunity is rapidly closing. Knowledge and attitudes. Almost all respon- dents reported that they have heard of HIV/AIDS and roughly 70-80 percent of women and men know about the three main ways to reduce its transmission, namely, abstinence, being faithful to one uninfected partner, and using condoms. Nevertheless, only about one-quarter of respondents have ‘comprehensive’ knowledge about HIV, i.e, they know that using condoms consistently and having one faithful partner can reduce the chance of getting HIV, that a healthy- looking person can have the AIDS virus, and that HIV cannot be transmitted by mosquito bites or by sharing food with someone who has AIDS. Stigma surrounding AIDS is widespread in Armenia. Few women and men say they would be willing to care for a relative sick with AIDS in their own homes and even fewer say they would buy fresh vegetables from a shopkeeper who had the AIDS virus. Sexual behavior. Only 12 percent of men and a negligible fraction of women reported having had more than one sexual partner in the 12 months before the survey and one-quarter of men reported having sex outside of a marital or cohabiting relationship (higher-risk sex). Condom use. A large majority of men (76 percent) reported using a condom at the most recent higher risk sexual encounter. Only about two-thirds of youth age 15-24 said they knew a place where they could obtain a condom. ADULT HEALTH The major causes of death in Armenia are similar to those in industrialized countries (cardiovascular diseases, cancer, and accidents), but there is also a rising incidence of certain infectious diseases, such as tuberculosis. Women=s health. Less than half of all women have been seen by a gynecologist in the five years preceding the survey and only 30 percent of Armenian women had visited a gynecologist during the 12 months preceding the survey. The most common reason for a visit is for a routine examination or for maternal care, however, almost one-fifth are for abortions. Only 20 percent of Armenian women know about breast self-examinations. Only 10 percent of women have performed a breast exam in the three months prior to the survey and only 1 percent had a breast exam from a health professional in the year prior to the survey. These data underscore the need to improve women=s health services in Armenia. xxii │ Summary of Findings Tuberculosis. Most men and women have heard of tuberculosis; however, only slightly over half of respondents correctly identify the mode of tuberculosis transmission (through the air when coughing). Almost 80 percent of women and men cite coughing as a symptom of tuberculosis. Eye care. Eight in ten women and men have never visited an eye doctor. Most of those who do get care, go to get glasses. Smoking. Survey data show a slight decline in the proportion of men age 15-49 who smoke, from 67 percent in 2000 to 64 percent in 2005. The proportion of women who report smoking remains negligible at 2 percent. Hypertension. The 2005 ADHS included blood pressure measurement for consenting adults age 15-49. Results indicate that about one-quarter of adults in Armenia are classified as hypertensive. A very disturbing finding is that four out of five respondents with high blood pressure are unaware that they are hypertensive. Summary of Findings │ xxiii xxiv | Map of Armenia INTRODUCTION 1 1.1 TERRITORY The Republic of Armenia is a small, mountainous country, 90 percent of which is located more than 1,000 meters above sea level. The country is located in southwestern Asia, between the Caucasus and Near Asia (the area between the Kur and Araks rivers). The country is bordered by Georgia and Azerbaijan on the north and east, and by Turkey and Iran on the west and south. The area of the country is 29,743 square kilometers, 46.8 percent of which is agricultural land, 36.4 percent mountains and high- lands, 11.2 percent forests, and 5.6 percent water surface. In Armenia, the largest lake is Lake Sevan, which has a surface area of 1,253 square kilometers. The longest river is the Araks. The highest point in the country is the peak of Aragats (4,090 meters); the lowest point is the De- bet River (390 meters). The longest distance between the northwest and the southeast is 360 kilometers, and the longest distance between west and east is 200 kilometers. The country is subdivided into 11 re- gions (marzes), which includes the region of Yerevan, the capital city of Armenia. 1.2 DEMOGRAPHIC CHARACTERISTICS According to the most recent census, the population of Armenia is 3.2 million, of which 51.7 per- cent are female. The urban population consists of 64.1 percent of the total population. Armenians are a mobile people, with approximately two-thirds of ethnic Armenians living in other countries. The exodus of Armenians began during the first World War, when the territory of Arme- nia was divided between the warring Ottoman and Russian Empires. 1.3 HEALTH CARE SYSTEM IN ARMENIA Historical Background The radical changes that have been taking place after the declaration of independence in Armenia could not help but affect the health system. The implementation of fundamental reforms in this important social area, the departure from the monopolistic state financing, the use of various sources of financing, and the transition to the self-management methods in the health sector brought to light the shortcomings remaining from the Soviet years. The present health system of Armenia has inherited the positive and negative features of the Soviet health system. On the positive side, it incorporates a rather developed structure and network, and suffi- cient staffing. However, the system is largely focused on hospital care, as well as deficiencies in the pri- mary health system and a generally low quality of medical care. In the former Soviet Union, health care was highly centralized. Medical services were basically ac- cessible for the whole population. After independence, the unfavorable socioeconomic and political situa- tion brought forward the need for developing a program of radical reforms. The system reforms initiated since the mid-1990s were based on the condition that health services could no longer be freely provided to the whole population. Thereafter, a majority of the population had Introduction | 1 to pay the full cost of medical services. Although the government tried to provide free medical care to vulnerable groups of the population under state-guaranteed programs, the under-financing of the health sector implied that even the persons included in these groups had to make partial payments. Thus, the changes violated the principle of equity and caused concerns about the deterioration of the population’s health. Basic Principles of Health Policy Armenia began reforming the health care sector at an early stage following independence. Recog- nizing health and health care as a fundamental human right, the strategy identified the major components of health care reform to involve a reorientation of health services towards a balanced partnership between primary and hospital care; the promotion of health and prevention of disease through tackling the deter- minants of health; and a shift from the narrow biomedical model towards a social, multiprofessional, and multisectoral approach to health and health care. The current long-term directions and objectives include a combination of the following character- istics in service organization and delivery: • Increase accessibility and utilization, especially at the primary health care level; • Improve (refine) the system’s organizational structure and governance; • Introduce evidence-based clinical standards and implement continuous quality improvement programs; • Enhance consumers’ participation and responsibility in the clinical decisionmaking process; • Integrate patient safety programs and medical error management into the system; and • Assure rational linkages between the different levels of health care delivery. A population’s health status is a major determinant of human development, providing the ground for promoting economic and social growth of the society. Armenia has entered the new millennium with an orientation to the internationally recognized policies and strategies, including those in the health sector. Armenia recognizes basic health values, which include: • Health as a basic human right; • Equity in health issues and solidarity in the actions aimed at the health standards; and • Involvement and responsibility of individuals and institutions in the continuous development of the health system. In conformity with the said values, Armenia identifies the following internationally recognized health policy objectives: • Promotion and protection of people’s health over the whole life span; and • Reduction of the incidence of the leading diseases and injuries and mitigation of the suffering caused by them. The main directions of health sector development in Armenia arise from the basic provisions of the Government’s Action Plan and the document “Health for All in the 21st Century” adopted by the World Health Organization. The main tasks of the health system reforms are—given available resources and po- tential—ensuring citizens’ constitutional right to health care, improving access to state-guaranteed free medical care, and initiating targeted balancing of the social and market values in the sector. In order to ensure the hygiene and epidemiological security of the population, it is planned to intensify activities aimed at prevention of infectious and mass non-infectious diseases, as well as the formation, strengthen- ing, and further development of public health. 2 | Introduction It is known that the number, capacity, and staffing potential of health facilities currently operating in the system essentially exceed the actual demand for medical care, including the demand under state- guaranteed programs. As a result, the resources allocated from the state budget to these programs are channeled not to ensuring quality health care, but to the maintenance of the whole system, including the payment of salaries of the staff with an inadequate workload. At that, these resources barely cover the current expenses of the medical care providers and are insufficient for providing the necessary pharma- ceutical and technological supply or for increasing the salaries of the medical staff. Pursuant to govern- ment decrees, the health system optimization will continue in the regions and the city of Yerevan. The long-term continuous optimization programs provide for structural reforms and rationalization of the sys- tem, accurate assessment of health care needs, identification and rationing of the required capacities through the consolidation of premises and services, reorganization of ineffective health organizations, and redistribution of vacated capacities. Further reforms of the health system financing mechanisms will be aimed at the reduction of the unofficial turnover, introduction of objective criteria for counterpart payments, clinical-economic stan- dards, and reimbursement for provided services. The development of the hospital care system will pro- ceed with short- and long-term planning aimed at introducing specific financing mechanisms, improving cost-efficiency, reducing excess capacities, and ensuring the quality of medical care. In order to ensure the provision of high-quality, accessible, and targeted health care to the population and to improve cost- efficiency, it is planned to practice selection-based placement of the state order. The issue of medical insurance is one of the most important components of health system reforms; at that, it should be viewed not only as a means to involve additional sources of financing, but also to en- sure better access to health care, to instill the principles of social equity, to enhance the targeted use of resources, and to improve the efficiency of medical services. In order to provide the legislative framework for the introduction and development of the mandatory medical insurance system, the Law on Mandatory Medical Insurance is to be adopted. The introduction of medical insurance is based on the “Concept Paper on Introduction of Medical Insurance” developed by Ministry of Health (MOH) and approved by the gov- ernment. In the arrangement of medical care, it is envisaged to essentially enhance the role of the primary unit. The main focus in the development of the ambulatory-polyclinic system, which appears to be the most important unit in primary care, is on forming the family medicine system and ensuring an adequate volume and quality of free ambulatory-polyclinic services through the use of borrowed and direct budget- ary resources. The main direction in the drug and technological policy will be the improvement of their accessibil- ity, safety, and rational use. Actions will be taken for improving the state system of drug quality assur- ance, introducing prescription forms, and ensuring affordability of drug prices. Medical equipment ac- quired through budgetary allocations and international grants will first be provided to improve the technical instrumentation of the primary care unit, with preference given to medical institutions in the regions, as well as to the technical reinforcement—on a competitive basis—of the second- and third-level medical institutions providing really accessible medical care to the vulnerable groups of the population. In relation to the further improvement of the medical education and scientific systems, it is planned to contract the volume of admissions to basic medical education and to improve the postgraduate educa- tion unit through partially transferring the educational process to the regional training centers. Within the framework of international collaboration in the health sector, it is planned to channel the international collaboration programs to the improvement of the population’s health, to further coordinate Introduction | 3 the gradually decreasing humanitarian assistance, and to encourage foreign investments in the system in- cluding those for the instrumentation of modern technologies. The next 10-12 years should be viewed as an important period from the perspective of adjusting the situation created in the health sector and assuring the prerequisites for the future development of the sys- tem. Health Care Financing Historically, the state budget was the primary funding source for health care. Currently, the health system is financed both from local and international sources. The main local sources are the state budget and direct out-of-pocket payments by the population. International financing sources are general humani- tarian donations and project-specific support. The state budget remains the main formal source of financing. State funds are derived from gen- eral tax revenues. State health expenditures are not sufficient to support the core system and to meet the health needs of the population. In 2000, actual public health care expenditure amounted to only 4.4 per- cent of the state budget, about 1.0 percent of the gross domestic product (GDP). However, this share has since risen to 7.4 percent of the state budget in 2005 (1.4 percent of GDP). This increase has been attrib- uted to the strengthening of sustainable budgetary policy introduced by the government, as well as a wider public acceptance of poverty reduction and related programs that are directed towards improving health as national priority. The 2005 health budget is projected to reach 8.2 percent of the total state budget and to rise to 10 percent by 2008 and 12 percent by 2015 (Ministry of Health, 2004). This trend indicates that health has become a higher priority in the allocation of funds across sectors of the state budget. However, state allocations are still too low to meet the costs of the benefits package. Official external health financing sources include humanitarian aid (donations of medical supplies and equipment) as well as credit and grant programs with or in coordination with the MOH. Grants and credit projects financed by foreign governments and international and multilateral organizations are now the dominant form of external support in immunization, maternal and child health, reproductive health, adolescent health, iodine deficiency, and HIV/AIDS prevention that emphasizes prevention of mother-to- child transmission of HIV. Family Planning Policies The main objectives of family planning programs in Armenia are to ensure safe motherhood among women of reproductive age, to decrease health risks during pregnancy, and to reduce reliance upon abortion as a method of family planning while promoting more modern and effective methods of contraception. In Armenia, abortion is a common method used to terminate unwanted pregnancies. Al- though originally outlawed in 1920, abortion was legalized by the Soviet Union in 1955 because of in- creases in mortality associated with illegal abortions. Today, abortion is legal during the first 12 weeks of pregnancy. In certain cases, an abortion may be performed until 22 weeks of gestation if there is medical or social justification. Abortions are performed in hospitals by trained medical staff. Despite decreases in recent years, the incidence of abortion remains an important issue for Armenian health care because of its negative effects on women’s health. Although contraceptives are distributed free of charge, health consultations are not free. For many years, oral contraceptives were not commonly available in Armenia because of the order “On the Side Effects and Complications of Oral Contraceptives” enacted by the MOH of the former Soviet Union in 1974. This document in effect banned the distribution and use of oral contraceptives. Currently, obtaining oral contraceptives or an abortion is not a problem in Armenia. In 2002 the Parliament of Armenia 4 | Introduction adopted a new law on reproductive health and reproductive human rights. According to this law, use of contraception (including oral contraceptives) is legal in Armenia. Also, in 2005 the Government of Ar- menia proposed a law on abortion. According to this law, abortion is legal when carried out with drugs. 1.4 OBJECTIVES AND ORGANIZATION OF THE SURVEY The 2005 Armenia Demographic and Health Survey (2005 ADHS) is the second in a series of na- tionally representative sample surveys designed to provide information on population and health issues in Armenia. As in the 2000 ADHS, the primary goal of the 2005 survey was to develop a single integrated set of demographic and health data pertaining to the population of the Republic of Armenia. In addition to integrating measures of reproductive, child, and adult health, another feature of the 2005 ADHS survey is that the majority of data are presented at the marz (region) level. The 2005 ADHS was conducted by the National Statistical Service (NSS) and the MOH of the Republic of Armenia from September through December 2005. ORC Macro provided technical support for the survey through the MEASURE DHS project. MEASURE DHS is a worldwide project, sponsored by the United States Agency for International Development (USAID), with a mandate to assist countries in obtaining information on key population and health indicators. USAID/Armenia provided funding for the survey, while the United Nations Children’s Fund (UNICEF)/Armenia and the United Nations Popu- lation Fund (UNFPA)/Armenia supported the survey through in-kind contributions. The 2005 ADHS collected national- and regional-level data on fertility and contraceptive use, maternal and child health, adult health, and HIV/AIDS and other sexually transmitted diseases. The sur- vey obtained detailed information on these issues from women of reproductive age and, on certain topics, from men as well. Data are presented by marz wherever sample size permits. The 2005 ADHS results are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of and health services for the people of Armenia. The 2005 ADHS also contributes to the growing international database on demographic and health-related variables. Sample Design and Implementation The sample was designed to permit detailed analysis—including the estimation of rates of fertil- ity, infant/child mortality, and abortion—for the national level, for Yerevan, and for total urban and total rural areas separately. Many indicators can also be estimated at the regional (marz) level. A representative probability sample of 7,565 households was selected for the 2005 ADHS sam- ple. The sample was selected in two stages. In the first stage, 308 clusters were selected from a list of enumeration areas in a subsample from a master sample that was designed from the 2001 Population Cen- sus. In the second stage, a complete listing of households was carried out in each selected cluster. House- holds were then systematically selected for participation in the survey. All women age 15-49 who were either permanent residents of the households in the 2005 ADHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. Interviews were completed with 6,566 women. In addition, in a subsample of one-third of all the house- holds selected for the survey, all men age 15-49 were eligible to be interviewed if they were either per- manent residents or visitors present in the household on the night before the survey. Interviews were completed with 1,447 men. Introduction | 5 Questionnaires Three questionnaires were used in the 2005 ADHS: a Household Questionnaire, a Women’s Questionnaire, and a Men’s questionnaire. The Household and Individual Questionnaires were based on model survey instruments developed in the MEASURE DHS program and on questionnaires used in the 2000 ADHS. The model questionnaires were adapted for use by experts from the NSS and MOH. Input was also sought from a number of non-governmental organizations. The questionnaires were developed in English and translated into Armenian. The Household and Individual Questionnaires were pretested in June 2005. The Household Questionnaire was used to list all usual members of and visitors to the selected households and to collect information on the socioeconomic status of the household. The first part of the Household Questionnaire collected information on the age, sex, educational attainment, and relationship to the household head of each household member or visitor. This information provides basic demographic data for Armenian households. It also was used to identify the women and men who were eligible for the individual interview (i.e., women and men age 15-49). In the second part of the Household Questionnaire, there were questions on housing characteristics (e.g., flooring material, source of water, type of toilet fa- cilities), on ownership of a variety of consumer goods, and other questions relating to the socioeconomic status of the household. In addition, the Household Questionnaire was used to record height and weight measurements of women, men, and children under age five; hemoglobin measurement of women and children under age five; and blood pressure measurement of women and men. The Women’s Questionnaire obtained data from women age 15-49 on the following topics: • Background characteristics • Pregnancy history • Antenatal, delivery, and postnatal care • Knowledge, attitudes, and use of contraception • Reproductive and adult health • Health care utilization • Vaccinations, birth registration, and health of children under age five • Episodes of diarrhea and respiratory illness of children under age five • Breastfeeding and weaning practices • Marriage and recent sexual activity • Fertility preferences • Knowledge of and attitude toward HIV/AIDS and other sexually transmitted infections The Men’s Questionnaire, administered to men age 15-49, focused on the following topics: • Background characteristics • Health and health care utilization • Marriage and recent sexual activity • Attitudes toward and use of condoms • Knowledge of and attitude toward HIV/AIDS and other sexually transmitted infections • Attitudes toward women’s status 6 | Introduction Training of Field Staff The main survey training, which was conducted by the NSS, was held during a three-week period in August and was attended by all supervisors, field editors, interviewers, and quality control personnel. The training included lectures, demonstrations, practice interviewing in small groups, and examinations. The health technicians, who were recruited by the MOH, were trained separately during the same period. They received training in anthropometric measurement, anemia testing, and blood pressure measurement. All field staff participated in four days of field practice. Fieldwork and Data Processing Thirteen teams collected the survey data; each team consisted of four female interviewers, a male interviewer, a field editor, and a team supervisor. A health technician was also assigned to each team. Fieldwork began in early September 2005 and was completed by early December 2005. Senior DHS tech- nical staff visited teams regularly to review the work and monitor data quality. The processing of the 2005 ADHS results began shortly after the fieldwork commenced. Com- pleted questionnaires were returned regularly from the field to NSS headquarters in Yerevan, where they were entered and edited by data processing personnel who were specially trained for this task. The data processing personnel included a supervisor, a questionnaire administrator who ensured that the expected number of questionnaires from all clusters were received, several office editors, 10 data entry operators, and a secondary editor. The concurrent processing of the data was an advantage because the senior ADHS technical staff were able to advise field teams of problems detected during the data entry. In particular, tables were generated to check various data quality parameters. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed in January 2006. 1.5 RESPONSE RATES Table 1.1 Results of the household and individual interviews Number of households and respondents selected, number of interviews, and response rates, according to residence, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Result Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household interviews Households selected 5,446 2,119 7,565 Households occupied 5,032 1,971 7,003 Households interviewed 4,806 1,901 6,707 Household response rate1 95.5 96.4 95.8 Individual interviews: women Number of eligible women 4,732 2,041 6,773 Number of eligible women interviewed 4,592 1,974 6,566 Eligible women response rate2 97.0 96.7 96.9 Individual interviews: men Number of eligible men 1,126 504 1,630 Number of eligible men interviewed 999 448 1,447 Eligible men response rate2 88.7 88.9 88.8 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Table 1.1 presents household and individual response rates for the survey. A total of 7,565 households were selected for the sample, of which 7,003 were occupied at the time of fieldwork. The main reason for the difference is that some of the dwelling units that were occupied during the household listing operation were either vacant or the household was away for an extended period at the time of interviewing. Of the occupied households, 96 percent were successfully interviewed. In these households, 6,773 women were identified as eligible for the individual interview, and inter- views were completed with 97 percent of them. Of the 1,630 eligible men identified, 89 percent were successfully interviewed. Response rates are almost identical in urban and rural areas. Introduction | 7 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter provides a summary of the demographic and socioeconomic characteristics of the household population in the 2005 ADHS, including age, sex, place of residence, educational status, and household characteristics. Information collected on the characteristics of the households and respondents is important in understanding and interpreting the findings of the survey and also provides some indica- tion of the representativeness of the survey. A household is defined as a person or group of related and unrelated persons who live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for cooking and eating their food. The questionnaire for the 2005 ADHS distinguishes between the de jure population (persons who usually live in a selected household) and the de facto population (persons who stayed the night before the interview in the house- hold). According to the 2005 ADHS data, the differences between these populations are small. Tabula- tions for the household data presented in this chapter are primarily based on the de facto population. Due to the way the sample was designed, the number of cases in some regions may appear small because they are weighted to make the regional distribution nationally representative. Throughout this report, numbers in the tables reflect weighted numbers. To ensure statistical reliability, percentages based on 25 to 49 unweighted cases are shown within parentheses, and percentages based on fewer than 25 un- weighted cases are suppressed. 2.1 CHARACTERISTICS OF THE POPULATION Age-Sex Structure Age and sex are important demographic variables and form the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. Table 2.1 presents the percent distribution of the de facto population by five-year age groups, according to urban-rural residence and sex. The information is used to construct the population pyramid shown in Figure 2.1. The total de facto population was 24,443. The data show that in Armenia there are more women than men; 54 percent of the population is female. The gender disparity is more pronounced in urban areas than in rural areas (81 and 88 men per 100 women, respectively). Among the youngest age groups, how- ever, there are more males than females. It is not until the 15-19 age cohort that women outnumber men (Figure 2.1). Overall, this imbalance in the sex ratio among the working age population strongly suggests that the outmigration from Armenia has been disproportionately selective of men. About two-thirds of the population is in the 15-64 age group, also referred to as the economically active population. The proportion of the population falling within this age group is significantly higher in urban areas (67 percent) than in rural areas (61 percent). This difference may be largely attributed to high levels of rural-urban migration, especially among the young in search of jobs and higher education. The disproportionately low percentage of the population in the 60-64 age group is probably due to low levels of fertility during World War II (Figure 2.1). Household Population and Housing Characteristics | 9 Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age group, according to sex and residence, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban Rural Total –––––––––––––––––––––– –––––––––––––––––––––– –––––––––––––––––––––– Age Male Female Total Male Female Total Male Female Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <5 6.8 5.4 6.1 8.5 4.6 6.4 7.5 5.1 6.2 5-9 7.1 4.7 5.8 9.0 7.4 8.1 7.9 5.7 6.7 10-14 8.9 7.3 8.0 12.0 9.3 10.5 10.1 8.1 9.0 15-19 9.1 8.6 8.8 9.5 9.5 9.5 9.3 9.0 9.1 20-24 9.0 9.1 9.1 8.3 8.2 8.2 8.7 8.8 8.8 25-29 7.8 7.4 7.6 5.9 6.8 6.4 7.1 7.2 7.2 30-34 5.9 6.1 6.0 4.6 5.3 5.0 5.4 5.8 5.6 35-39 5.4 5.7 5.6 5.5 6.1 5.8 5.5 5.8 5.7 40-44 6.5 7.2 6.9 7.4 8.2 7.8 6.9 7.6 7.2 45-49 7.1 7.9 7.5 6.7 6.8 6.7 6.9 7.5 7.2 50-54 6.8 8.0 7.4 5.0 6.4 5.8 6.1 7.4 6.8 55-59 5.2 5.5 5.4 3.2 3.7 3.5 4.4 4.8 4.7 60-64 3.3 3.0 3.1 2.0 2.1 2.1 2.8 2.7 2.7 65-69 5.0 4.7 4.8 3.7 5.4 4.6 4.5 5.0 4.8 70-74 2.7 3.6 3.2 4.2 3.7 3.9 3.3 3.7 3.5 75-79 2.4 3.2 2.8 3.2 4.0 3.6 2.7 3.5 3.1 80 + 1.0 2.3 1.7 1.2 2.5 1.9 1.1 2.4 1.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number1 6,824 8,392 15,222 4,310 4,912 9,221 11,134 13,304 24,443 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1Total includes five persons whose sex was not stated. Figure 2.1 Population Pyramid 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Percent Male Female ADHS 2005 Age 10 | Household Population and Housing Characteristics The data further indicate that 22 percent of the population is under 15 years of age. The propor- tion under 15 is larger in the rural areas than in the urban areas (25 and 20 percent, respectively). This is evidence of higher fertility in the rural areas (see Chapter 4). The percentages of the 10-14 and 15-19 year-old cohorts are larger than younger age cohorts, which may largely be due to the fertility peaks of both 1986 and 1990-1991—the second of which was the so-called “compensation period” following the earthquake of 1988. Household Composition Table 2.2 presents the percent distribution of households in the 2005 ADHS sample by sex of the head of the household and by household size for urban and rural areas and mean size of household. These characteristics are important because they are often associated with differences in household socioeco- nomic levels. For example, female-headed households are frequently poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individu- als. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. In general, heads of household in Armenia are male (64 percent). This is lower than that recorded in the 2000 ADHS (71 percent). Households in the urban areas are more likely than in rural areas to be headed by a woman (37 percent compared with 33 percent). The average household size in Armenia is 3.8 persons, compared with 4.3 persons in 2000. The average household size in rural areas is much larger than in urban areas (4.2 compared with 3.5 members). The increase over time in the proportion of female- headed households and the smaller average household size would be consistent with continued outmigra- tion, particularly of men. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Characteristic Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex of head of household Male 62.6 66.9 64.1 Female 37.4 33.1 35.9 Total 100.0 100.0 100.0 Number of usual members 1 14.5 10.3 13.1 2 17.9 14.4 16.7 3 17.4 11.3 15.3 4 22.1 19.6 21.3 5 13.4 18.0 14.9 6 9.8 14.8 11.5 7 3.0 7.5 4.5 8 1.2 2.7 1.7 9+ 0.8 1.4 1.0 Total 100.0 100.0 100.0 Number of households 4,429 2,278 6,707 Mean size 3.5 4.2 3.8 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure members, i.e., usual residents. Household Population and Housing Characteristics | 11 Children’s Living Arrangements and Orphanhood Detailed information on living arrangements and orphanhood for children under 18 years of age is presented in Table 2.3. Of the 6,903 children under age 18 recorded in the 2005 ADHS, four in five live with both parents, 16 percent live with their mother only, 1 percent live with their father only, and 2 per- cent live with neither of their natural parents. The table also provides data on the extent of orphanhood, that is, the proportion of children who have lost one or both parents. Three percent of children under 18 years have lost their fathers. Very few children have lost their mothers or both parents. Table 2.3 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Living Living with mother with father Not living with but not father but not mother either parent Missing Living –––––––––––– –––––––––––––– –––––––––––––––––––––––––– informa- with Only Only tion on Number Background both Father Father Mother Mother Both father mother Both father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age <2 87.8 11.5 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.3 100.0 659 2-4 87.1 11.2 0.9 0.0 0.0 0.4 0.0 0.0 0.0 0.3 100.0 867 5-9 82.8 13.6 1.6 0.4 0.3 0.8 0.1 0.1 0.0 0.4 100.0 1,619 10-14 78.2 15.0 2.9 0.9 0.6 1.5 0.1 0.0 0.0 0.7 100.0 2,212 15-17 72.2 14.5 4.7 0.5 1.5 3.5 0.1 0.0 0.3 2.6 100.0 1,547 Sex Male 80.1 14.2 2.5 0.5 0.6 1.1 0.0 0.0 0.1 0.9 100.0 3,641 Female 79.8 13.3 2.5 0.6 0.6 2.0 0.1 0.1 0.1 1.1 100.0 3,260 Residence Urban 78.8 14.2 2.4 0.6 0.4 2.1 0.0 0.1 0.1 1.3 100.0 3,941 Rural 81.5 13.2 2.7 0.4 0.8 0.8 0.1 0.0 0.1 0.5 100.0 2,962 Region Yerevan 78.7 13.9 2.1 0.7 0.2 2.2 0.0 0.1 0.1 2.0 100.0 2,230 Aragatsotn 87.6 6.7 3.5 1.0 0.0 0.6 0.3 0.0 0.0 0.1 100.0 350 Ararat 82.4 8.0 5.5 0.9 2.4 0.5 0.1 0.0 0.1 0.2 100.0 615 Armavir 86.2 10.1 0.8 0.5 0.3 1.5 0.3 0.0 0.0 0.3 100.0 687 Gegharkunik 65.7 31.1 1.3 0.1 0.7 0.8 0.0 0.0 0.0 0.3 100.0 522 Lori 84.4 9.5 2.0 1.0 1.0 1.4 0.0 0.0 0.0 0.7 100.0 554 Kotayk 82.6 10.7 2.5 0.2 0.6 2.2 0.0 0.0 0.3 0.9 100.0 569 Shirak 73.4 21.4 2.9 0.0 0.4 1.1 0.0 0.0 0.4 0.3 100.0 634 Syunik 86.4 7.6 3.5 0.0 0.2 1.3 0.4 0.0 0.0 0.7 100.0 304 Vayots Dzor 88.5 3.1 5.0 0.0 0.8 0.7 0.0 0.0 0.0 1.8 100.0 119 Tavush 77.2 18.6 2.3 0.3 0.2 1.2 0.1 0.0 0.0 0.2 100.0 320 Wealth quintile Lowest 79.9 13.2 3.8 0.3 1.1 1.1 0.2 0.0 0.0 0.4 100.0 1,613 Second 78.0 16.8 2.0 0.6 0.7 1.0 0.0 0.0 0.2 0.7 100.0 1,425 Middle 77.0 15.9 2.2 0.5 0.2 2.4 0.1 0.0 0.3 1.5 100.0 1,291 Fourth 80.0 13.0 2.8 0.3 0.3 2.3 0.0 0.1 0.0 1.1 100.0 1,324 Highest 85.5 9.6 1.4 0.9 0.3 1.1 0.0 0.0 0.0 1.2 100.0 1,250 Total <15 82.2 13.5 1.9 0.5 0.3 1.0 0.1 0.0 0.0 0.5 100.0 5,356 Total <18 80.0 13.8 2.5 0.5 0.6 1.5 0.1 0.0 0.1 0.9 100.0 6,903 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes two children (weighted) with missing information on sex. Table is based on de jure members, i.e., usual residents. 12 | Household Population and Housing Characteristics Differentials in fosterhood and orphanhood by background characteristics are not large. As ex- pected, older children are more likely than younger children to be fostered and orphaned; older children are less likely than younger children to live with both parents and more likely than younger children to have lost one or both parents. Small differences in living arrangements are found between rural and urban children. However, Vayots Dzor and Aragatsotn have the highest proportion of children living with both parents (89 percent and 88 percent, respectively), while Gegharkunik has the lowest (66 percent). Table 2.3 shows that children’s living arrangements have no specific pattern according to the household wealth index. Table 2.3 also presents the extent of orphanhood among children under age 15 to allow compari- son with data from the 2000 ADHS. There has been a shift in the proportions of children under 15 by their living arrangements since 2000. Overall, the proportion of children under 15 living with both parents has declined from 90 percent in 2000 to 82 percent in 2005. This is due to a substantial increase in the proportion of children who live only with their mothers, but whose fathers are alive (from 5 percent to 14 percent). This trend is particularly pronounced in Gegharkunik, Shirak, and Yerevan regions. These areas are also subject to high male migration away from home. Education The educational attainment of household members is an important determinant of their opportuni- ties and behaviors. Many phenomena such as use of health facilities, reproductive behavior, health of children, and proper hygienic habits are associated with the educational level of household members, es- pecially women. The school system in Armenia has three levels. The first level, primary school, consists of grades one through three for students age 7-9.1 The second level, or middle school, consists of grades 4-8 for students age 10-14. The first two levels together are called general basic education and are compulsory. The third level, or high school, comprises grades 9 and 10. The three levels together (primary school plus middle school plus high school) are referred to as a full general secondary education. Students who have completed a minimum of eight grades may enroll in specialized secondary education. There are two tracks within specialized secondary education. The first track consists of profes- sional-technical institutions that train students in a variety of specializations. Students who have com- pleted at least primary and middle school are eligible for this secondary-special track. The second track prepares specialists with mid-level qualifications, such as teachers, midwives, and mechanics. This track can be completed in two years by students who have completed the tenth grade, or it can be completed in four years by students who completed the eighth grade. University and postgraduate education prepares higher level specialists. Students who complete a full general secondary education may enroll in university. Tables 2.4.1 and 2.4.2 present information on the educational attainment of the Armenian popula- tion age six and over. Virtually all Armenians have gone to school. The median number of years of schooling is 9.5 years for men and 9.8 years for women. The proportion of the population with no educa- tion is low (less than 2 percent), with the highest levels being among those age six to nine (reflecting some who have not yet started school) and those 65 years and older. Individuals residing in urban areas have significantly higher levels of university education than those in rural areas. One in three individuals 1 Since 2005, according to law children are allowed to enter school starting at 6 years and 6 months. Household Population and Housing Characteristics | 13 living in the capital city of Yerevan has attended university. Wealth status has a strong positive relation- ship with education; 45 percent of men in the highest wealth quintile have at least some university educa- tion, compared with 4 percent of men in the lowest quintile. The corresponding proportions for women are 42 percent and 4 percent, respectively. Table 2.4.1 Educational attainment of the household population: Male Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed, median num- ber of years completed, and percentage with general basic and general secondary completed, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended Median –––––––––––––––––––––––––––––––––––––––––––––––––––– number High of years General General Number Background No Primary Middle school Specialized of basic secondary of characteristic education (1-3) (4-8) (9-10) secondary Higher Total schooling completed1 completed2 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 7.6 92.0 0.5 0.0 0.0 0.0 100.0 0.7 0.0 0.0 725 10-14 0.5 12.3 86.7 0.2 0.2 0.0 100.0 4.9 6.7 0.2 1,120 15-19 0.9 0.3 30.5 44.4 5.0 19.0 100.0 8.9 95.9 46.6 1,032 20-24 0.5 0.7 17.2 40.0 12.1 29.5 100.0 9.8 97.4 81.2 971 25-29 0.0 0.3 16.5 40.0 14.8 28.4 100.0 9.8 99.1 82.7 790 30-34 0.5 0.0 9.0 31.3 26.7 32.5 100.0 11.6 99.0 90.5 600 35-39 0.2 0.0 9.1 35.5 34.1 21.1 100.0 11.2 99.6 90.6 610 40-44 0.4 0.0 9.4 32.1 34.7 23.4 100.0 11.4 98.5 90.0 764 45-49 0.2 0.2 9.9 33.2 32.2 24.5 100.0 11.4 98.6 89.7 774 50-54 0.0 0.3 8.9 37.0 31.5 22.4 100.0 11.2 98.5 90.8 677 55-59 0.5 0.4 10.2 32.1 26.5 30.3 100.0 11.6 98.9 89.0 492 60-64 1.0 1.2 19.5 33.6 21.4 23.3 100.0 9.9 89.6 77.8 310 65+ 3.3 3.4 35.9 23.9 13.9 19.6 100.0 9.4 71.8 56.9 1,287 Residence Urban 0.8 7.5 19.9 26.4 18.6 26.8 100.0 9.8 81.4 69.5 6,270 Rural 2.1 10.2 31.7 31.9 15.2 8.8 100.0 9.1 71.2 53.3 3,882 Region Yerevan 0.6 7.3 17.7 24.0 17.3 33.0 100.0 10.0 83.2 72.4 3,657 Aragatsotn 2.4 10.6 22.7 28.0 26.2 10.2 100.0 9.5 74.5 61.8 462 Ararat 1.2 8.0 29.0 41.1 12.6 8.1 100.0 9.3 77.7 59.4 865 Armavir 1.9 8.6 34.5 28.4 14.8 11.9 100.0 9.1 71.6 52.5 903 Gegharkunik 2.1 11.9 27.7 30.1 16.2 11.9 100.0 9.2 71.4 55.2 608 Lori 2.2 10.1 24.9 28.5 21.1 13.2 100.0 9.4 73.1 60.3 795 Kotayk 1.5 8.7 25.4 32.2 17.3 14.9 100.0 9.4 77.7 61.8 852 Shirak 2.2 7.8 31.6 28.0 15.0 15.4 100.0 9.2 70.5 55.3 883 Syunik 0.2 7.7 22.2 27.8 26.8 15.2 100.0 9.7 81.1 66.9 496 Vayots Dzor 1.8 7.7 26.5 41.8 13.4 8.8 100.0 9.3 75.8 59.6 186 Tavush 0.5 12.8 31.9 28.0 13.4 13.5 100.0 9.1 70.9 52.9 444 Wealth quintile Lowest 2.9 11.8 39.7 29.1 12.3 4.2 100.0 7.9 65.4 43.6 2,027 Second 1.4 9.5 27.6 35.3 17.0 9.2 100.0 9.3 75.4 58.5 1,997 Middle 1.2 6.1 22.9 32.5 22.5 14.8 100.0 9.6 80.5 67.2 1,987 Fourth 0.6 8.3 19.0 27.0 19.3 25.7 100.0 9.8 81.4 69.3 2,072 Highest 0.3 7.1 13.2 18.9 15.6 45.0 100.0 11.7 84.5 77.7 2,068 Total 1.3 8.6 24.4 28.5 17.3 19.9 100.0 9.5 77.5 63.3 10,152 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed grade 8 or higher 2 Defined as having completed high school (grade 10) or having attended either specialized secondary or higher. The proportions may be slightly overestimated because some students enroll in specialized secondary after completing only grade 8. 14 | Household Population and Housing Characteristics Table 2.4.2 Educational attainment of the household population: Female Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed, median number of years completed, and percentage with general basic and general secondary completed, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling Median ––––––––––––––––––––––––––––––––––––––––––––––––––––– number High of years General General Number Background No Primary Middle school Specialized of basic secondary of characteristic education (1-3) (4-8) (9-10) secondary Higher Total schooling completed1 completed2 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 11.1 88.9 0.1 0.0 0.0 0.0 100.0 0.8 0.0 0.0 655 10-14 0.5 11.1 88.0 0.2 0.1 0.1 100.0 5.0 9.3 0.2 1,072 15-19 0.3 0.2 19.5 42.3 17.2 20.6 100.0 9.3 98.1 61.1 1,192 20-24 0.3 0.1 7.3 29.0 30.4 32.9 100.0 11.8 99.3 92.0 1,171 25-29 0.2 0.3 7.4 36.2 28.1 27.8 100.0 11.4 99.1 90.7 958 30-34 0.1 0.0 4.4 35.8 32.6 27.1 100.0 11.5 99.4 94.9 772 35-39 0.8 0.0 4.3 35.3 35.7 23.3 100.0 11.5 98.5 94.1 777 40-44 0.2 0.7 3.6 40.4 36.1 19.0 100.0 11.2 99.1 95.4 1,005 45-49 0.0 0.5 4.8 36.4 39.2 19.0 100.0 11.3 99.0 94.5 994 50-54 0.4 0.4 6.3 32.9 37.5 22.2 100.0 11.5 98.2 92.5 985 55-59 0.0 0.5 11.0 32.4 29.5 26.7 100.0 11.6 97.8 88.0 645 60-64 0.5 0.4 19.4 36.2 23.9 19.6 100.0 9.8 91.2 79.6 357 65+ 5.1 4.8 35.6 28.2 13.1 13.2 100.0 9.2 67.8 52.7 1,933 Residence Urban 1.1 5.3 15.6 26.1 26.0 25.9 100.0 10.5 84.4 75.9 7,889 Rural 2.5 8.8 24.7 35.9 20.8 7.4 100.0 9.4 75.0 61.1 4,630 Region Yerevan 1.0 4.6 13.8 22.8 24.7 33.0 100.0 11.4 86.4 78.6 4,583 Aragatsotn 1.9 5.8 20.3 37.7 26.1 8.2 100.0 9.5 79.5 67.0 515 Ararat 1.0 8.5 23.9 36.4 22.4 7.9 100.0 9.4 78.3 65.1 974 Armavir 2.5 9.5 24.2 32.7 22.7 8.3 100.0 9.4 74.8 61.6 1,097 Gegharkunik 3.4 9.9 23.2 35.9 19.5 8.2 100.0 9.3 73.4 59.8 819 Lori 1.9 6.4 18.2 35.0 25.1 13.5 100.0 9.7 81.0 70.9 1,060 Kotayk 2.1 8.0 18.8 32.8 24.3 14.0 100.0 9.6 78.5 69.0 983 Shirak 1.9 5.9 24.2 33.4 21.6 12.9 100.0 9.5 77.9 64.8 1,152 Syunik 0.5 6.6 19.9 25.6 32.9 14.4 100.0 9.9 80.5 71.1 554 Vayots Dzor 1.6 6.0 20.1 41.9 21.5 8.9 100.0 9.5 80.1 70.2 205 Tavush 2.6 8.9 24.0 28.7 24.1 11.6 100.0 9.5 75.8 61.6 577 Wealth quintile Lowest 3.5 9.9 31.2 36.0 15.5 4.0 100.0 9.1 69.7 52.3 2,503 Second 1.7 6.4 21.8 37.9 24.1 7.9 100.0 9.5 79.8 67.5 2,505 Middle 1.4 5.8 17.2 30.0 27.9 17.7 100.0 9.8 82.5 73.3 2,564 Fourth 0.9 6.2 13.8 26.7 28.9 23.6 100.0 10.7 84.9 77.4 2,469 Highest 0.5 4.6 10.7 17.8 23.9 42.3 100.0 12.1 87.8 81.9 2,477 Total 1.6 6.6 19.0 29.7 24.1 19.0 100.0 9.8 80.9 70.4 12,518 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Totals include 0.1 percent of cases with missing data that are not shown separately. 1 Completed grade 8 or higher 2 Defined as having completed high school (grade 10) or having attended either specialized secondary or higher. The proportions may be slightly overestimated because some students enroll in specialized secondary after completing only grade 8. Household Population and Housing Characteristics | 15 Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex, residence, region, and wealth quintile are shown in Table 2.5. The NAR indicates participation in general basic education (primary and middle school) for the population age 7-14 and high school for the popula- tion age 15-16. The GAR measures participation at each level of schooling among those of any age from 6 to 24. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.2 A NAR of 100 percent would indicate that all children in the official age range for the level are attending education at that level. The GAR can exceed 100 percent if there is significant over age or under age participation at a given level of schooling. In Armenia, school attendance among school-age household members is high. The overall NAR for general basic education is 94 and the GAR is 101. A comparison of the NAR and GAR indicates that approximately 7 percent of students are either under age or over age. Attendance ratios are virtually the same by sex, region, and urban-rural residence. The NAR for the high school level is much lower than that recorded in the 2000 ADHS (72 ver- sus 87). The GAR, however, is approximately the same (90 versus 92). This suggests that there has been an increase in over age or under age participation in high school. Indeed, a comparison of the NAR and GAR indicates that approximately 17 percent of students are either under age or over age. The gender parity index (GPI), or the ratio of the female to the male GAR at the general basic and high school levels, indicates the magnitude of the gender gap in attendance ratios. If there is no gender difference, the GPI will be equal to one. GPI will be closer to zero if the disparity is in favor of males. If the gender gap favors females, the GPI will exceed one. Table 2.5 shows the GPI is 0.96 in the general basic level and 1.15 in the high school level, which indicates that there is a substantial gender gap in favor of females at the secondary level. Figure 2.2 presents the age-specific attendance rates (ASAR) for the population age 6-24, by sex. The ASAR indicates participation in schooling at any level, from primary through higher education. The closer the ASAR is to 100 percent, the higher the proportion of a given age attending school. In Armenia, almost all youths of general basic age (7-14) attend school, and there are no signifi- cant differences by gender. Among the high-school-age population (15-16), attendance ratios begin to decline, particularly among males. It should be noted that among young people age 17 to 19, a signifi- cantly higher proportion of females than males are attending school. This is also the age when many young men are required to serve in the military. In Armenia, virtually all students in grades 2 through 8 are promoted every year, and nearly all stay in school until grade 8. Findings from the 2005 ADHS show that the dropout rate after eighth grade is 9 percent. This means that these children stop studying after the compulsory years of school (estimates not shown). 2 Students who are over age for a given level of schooling may have started school over age, may have repeated one or more grades in school, or may have dropped out of school and later returned. 16 | Household Population and Housing Characteristics Table 2.5 School attendance ratios Net attendance ratios (NAR), gross attendance ratios (GAR), and gender parity index (GPI) for the de jure household popu- lation by sex and level of schooling, according to background characteristics, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Net attendance ratio1 Gross attendance ratio2 Gender Background –––––––––––––––––––––––––– ––––––––––––––––––––––––––– parity characteristic Male Female Total Male Female Total index 3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– GENERAL BASIC ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 94.1 92.6 93.4 102.9 98.0 100.4 0.95 Rural 95.1 92.2 93.7 102.2 99.1 100.7 0.97 Region Yerevan 94.1 91.6 92.9 104.0 97.3 100.8 0.94 Aragatsotn 93.5 92.9 93.2 100.4 98.3 99.5 0.98 Ararat 93.8 94.5 94.2 99.6 103.7 101.7 1.04 Armavir 97.0 89.7 93.3 101.5 93.9 97.7 0.93 Gegharkunik 96.5 95.2 95.8 107.2 100.5 103.8 0.94 Lori 92.4 92.2 92.3 97.4 98.0 97.7 1.01 Kotayk 92.5 96.9 94.7 99.7 103.3 101.5 1.04 Shirak 94.7 87.5 91.3 101.9 92.4 97.5 0.91 Syunik 96.7 94.3 95.4 106.9 98.0 102.2 0.92 Vayots Dzor 95.0 95.8 95.4 101.2 100.7 101.0 1.00 Tavush 96.9 95.1 96.1 108.9 108.8 108.8 1.00 Wealth quintile Lowest 94.9 91.1 93.1 102.0 99.0 100.6 0.97 Second 95.4 92.3 93.9 103.4 95.8 99.9 0.93 Middle 93.6 91.8 92.7 99.2 99.6 99.4 1.00 Fourth 95.2 94.8 95.0 106.0 99.3 102.7 0.94 Highest 93.5 92.4 93.0 102.3 98.1 100.3 0.96 Total 94.6 92.4 93.5 102.6 98.4 100.6 0.96 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– HIGH SCHOOL ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 68.0 74.8 71.4 85.4 96.5 91.0 1.13 Rural 70.1 76.9 73.2 81.0 95.2 87.5 1.18 Region Yerevan 63.4 68.5 66.1 83.9 93.8 89.1 1.12 Aragatsotn 77.1 92.3 86.5 92.6 101.7 98.3 1.10 Ararat 62.9 52.9 59.0 77.0 74.7 76.1 0.97 Armavir 71.2 67.0 69.3 74.5 89.0 80.9 1.19 Gegharkunik 67.4 85.6 75.7 78.6 97.2 87.1 1.24 Lori 90.0 71.3 78.3 115.9 87.2 98.0 0.75 Kotayk 56.7 87.3 69.0 67.3 96.7 79.1 1.44 Shirak 75.0 88.9 81.9 91.0 121.7 106.3 1.34 Syunik 83.3 95.4 88.6 90.9 110.4 99.5 1.22 Vayots Dzor 78.4 82.0 79.6 87.0 92.6 88.9 1.06 Tavush 76.2 85.3 80.5 87.6 97.0 92.1 1.11 Wealth quintile Lowest 54.3 73.6 63.9 61.8 90.7 76.2 1.47 Second 74.0 79.1 76.2 90.8 97.7 93.8 1.08 Middle 75.5 79.6 77.5 91.5 112.2 101.4 1.23 Fourth 67.8 68.1 67.9 80.2 86.1 82.8 1.07 Highest 76.2 77.7 77.1 98.6 95.5 96.7 0.97 Total 68.9 75.6 72.2 83.4 96.0 89.5 1.15 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 The NAR for general basic school is the percentage of the primary and middle-school-age (7-14 years) population that is attending primary or middle school. The NAR for high school is the percentage of the high-school-age (15-16 years) popula- tion that is attending grades 9 or 10. By definition, the NAR cannot exceed 100 percent. 2 GAR for general basic school is the total number of primary and middle school students, expressed as a percentage of the official general basic-school-age population. The GAR for high school is the total number of high school students, expressed as a percentage of the official high-school-age population. If there are significant numbers of over age and under age stu- dents at a given level of schooling, the GAR can exceed 100 percent. 3 The (GPI) for general basic school is the ratio of the general basic school GAR for females to the GAR for males. The Gender Parity Index for high school is the ratio of the high school GAR for females to the GAR for males. Household Population and Housing Characteristics | 17 Figure 2.2 Age-Specific School Attendance Rates, by Sex 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percentage of the population Male Female ADHS 2005 2.2 HOUSING CHARACTERISTICS To assess the socioeconomic conditions under which the population lives, respondents were asked to give specific information about their household environment. Type of water source, sanitation facilities, and floor material are characteristics that affect the health status of household members, particu- larly children. They also indicate the socioeconomic status of households. Tables 2.6 to 2.8 present major housing characteristics by urban-rural residence. All households in Armenia have electricity (Table 2.6). A majority of households and population in the country have a finished floor, use liquid petroleum gas (LPG) or natural gas for cooking, and have a specific place for cooking inside the house. Overall, most of the respondents in urban areas live in envi- ronments with adequate sanitary conditions. In rural areas, living conditions are more mixed. Parquet or polished wood floors are most common in urban areas (63 percent). In rural areas, the majority of households have wooden plank floors (67 percent) while 2 percent of households have an earth or sand floor. Almost half of households (45 percent) have two rooms used for sleeping. There is little difference between urban and rural households. Cooking fuel appears to have changed dramatically since 2000. The proportion of households us- ing electricity for cooking has declined from 37 percent in 2000 to 14 percent in 2005. Conversely, the proportion using LPG or natural gas has increased from 14 percent to 80 percent in the same time period. Differences in coding categories between the two surveys could account for some of the apparent shifts. Figure 2.3 shows the percentage of households using electricity or LPG/natural gas for cooking. The last panel in Table 2.6 shows the distribution of the very small proportion of households that use biomass fuel (5 percent) by type of stove they use. The majority of these households in Armenia (three in four) use an open fire without chimney or hood. One in six households uses an open fire or stove with a chimney or hood. Rural households are much more likely to use this type of stove than urban households. 18 | Household Population and Housing Characteristics Table 2.6 Housing characteristics Percentage of households with electricity and percent distribution of households by housing charac- teristics, according to residence, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence –––––––––––––––– De jure Characteristic Urban Rural Total population1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Electricity 99.9 99.7 99.8 99.8 Flooring material Earth, sand 0.5 2.0 1.0 1.0 Wood planks 20.8 66.9 36.5 39.0 Parquet, polished wood 63.4 12.6 46.2 44.5 Vinyl, asphalt strips 9.1 5.8 8.0 6.8 Ceramic tiles 2.7 1.3 2.2 2.2 Cement 1.9 8.2 4.0 4.4 Other/missing 1.7 3.2 2.2 2.1 Total 100.0 100.0 100.0 100.0 Rooms for sleeping One 34.7 23.8 31.0 19.4 Two 45.9 41.6 44.5 47.4 Three or more 18.5 33.5 23.6 32.2 Missing 0.9 1.1 1.0 1.0 Total 100.0 100.0 100.0 100.0 Cooking fuel Electricity 15.9 15.6 15.8 14.2 Liquid petroleum gas (LPG) 39.9 31.3 36.9 36.2 Natural gas 43.4 41.0 42.6 44.9 Other/missing 0.8 12.2 4.6 4.8 Total 100.0 100.0 100.0 100.0 Place for cooking In the house 98.9 92.9 96.9 96.7 In a separate building 0.6 4.5 1.9 2.1 Outdoors 0.2 2.6 1.0 1.0 Other/missing 0.3 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 Number of households 4,429 2,278 6,707 25,235 Type of fire/stove among households using solid fuel2 Closed stove with chimney/hood 1.8 6.8 6.2 6.9 Open fire/stove with chimney/hood 3.0 16.9 15.4 16.1 Open fire/stove without chimney/hood 75.5 75.7 75.7 74.6 Other/missing 19.6 0.6 2.7 2.5 Total 100.0 100.0 100.0 100.0 Number of households/de jure population 34 269 303 1,149 using solid fuel ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Household members, i.e., usual residents 2 Solid fuel includes coal/lignite, charcoal, wood/straw/shrubs, and animal dung. Household Population and Housing Characteristics | 19 16 16 16 80 83 72 Total Residence Urban Rural 0 20 40 60 80 100 Percentage of households Electricity for cooking LPG/natural gas for cooking Figure 2.3 Households with Electricity and LPG/ Natural Gas for Cooking ADHS 2005 Drinking Water The source of drinking water is an indicator of whether it is suitable for drinking. Table 2.7 pro- vides information on the source of drinking water, time to obtain the water, the age and sex of the person who usually collects the drinking water, and the treatment of water used for drinking. The table presents the percentage of households as well as the percentage of the de jure population living in those house- holds. Three in four households in Armenia have their drinking water piped directly into the house (Fig- ure 2.4). Urban households are much more likely than rural households to have piped water in their house (94 percent compared with 39 percent). In rural areas, 36 percent of households have their drinking water piped to the yard or plot. Because most households use water that is available in the dwelling, less than 10 percent of Armenians have to go out to get drinking water. In households with no water in the house, wa- ter is collected most frequently by an adult woman (age 15 or older). This is particularly true in rural areas (16 percent). Because households may use more than one method to treat water to make it safer to drink, water treatment is given as the percentages of households using the treatment method and the percentage of the de jure population (usual residents) of those households, rather than a percent distribution. Data in Table 2.7 show that no treatment is done in 89 percent of households. The most frequently used treatment for water is boiling (8 percent). 20 | Household Population and Housing Characteristics Table 2.7 Household drinking water Percent distribution of households by source of drinking water, time to obtain drinking water, and person who usually collects drinking water, according to residence; percent distribution of the de jure household population by the same characteristics; and percentage of households and of the de jure household population using various water treatment prior to drinking, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– De jure Characteristic Urban Rural Total population1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Source of drinking water Improved Piped water into dwelling 93.6 38.8 75.0 73.0 Piped into yard/plot 3.8 36.2 14.8 16.1 Other protected 2.0 17.9 7.4 7.7 Non-improved Tanker truck 0.0 6.1 2.1 2.4 Other unprotected 0.1 0.4 0.2 0.3 Other/missing 0.5 0.7 0.6 0.5 Total 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 97.7 77.8 91.0 90.4 Less than 30 minutes 1.5 14.9 6.1 6.5 30 minutes or longer 0.7 6.8 2.8 2.8 Don’t know/missing 0.1 0.4 0.2 0.2 Total 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult male 15+ 0.5 3.7 1.6 1.6 Adult female 15+ 1.6 16.4 6.6 7.1 Male child under age 15 0.0 0.6 0.2 0.3 Female child under age 15 0.1 0.6 0.3 0.4 Water on premises 97.7 77.8 91.0 90.4 Other/Missing 0.1 0.8 0.3 0.3 Total 100.0 100.0 100.0 100.0 Water treatment prior to drinking Boiled 8.7 5.4 7.6 8.3 Other 2.6 2.5 2.6 2.5 No treatment 88.8 90.8 89.4 88.7 Don’t know/missing 0.7 1.9 1.1 1.2 Number of households/de jure population 4,429 2,278 6,707 25,235 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Household members, i.e., usual residents Household Population and Housing Characteristics | 21 Sanitation Facility Table 2.8 shows the proportion of households and of the de jure population with access to hygi- enic sanitation facilities. Hygienic status is determined by type of facility used and whether or not it is a shared facility. A household’s toilet/latrine facility is classified as hygienic if it is used only by household mem- bers (i.e., not shared) and the type of facility effectively separates human waste from human contact. The types of facilities that are most likely to accomplish this are flush or pour flush into a piped sewer sys- tem/septic tank/pit latrine, ventilated improved pit latrine, pit latrine with a slab, and a composting toilet. A household’s sanitation facility is classified as unhygienic if it is shared with other households or if it does not effectively separate human waste from human contact. Most households in Armenia use improved sanitation facilities that are not shared with another household (Table 2.8). Two in three households in Armenia use a flush toilet connected to piped sewer system (Figure 2.4) and 18 percent use a ventilated improved pit latrine. Flush toilets are widespread in urban areas (92 percent), while VIP latrines are the most common type of facility in rural areas (47 per- cent). It should be noted that the 2005 ADHS questionnaire categorized sanitation facilities differently than the 2000 ADHS questionnaire and thus it is difficult to compare data from the two surveys. Table 2.8 Household sanitation facility Percent distribution of households by type of sanitation facility; and percent distribution of the de jure population by type of sanitation facility, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence –––––––––––––––––– De jure Characteristic Urban Rural Total population1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Improved, not shared Flush/pour flush to piped sewer system 92.1 17.3 66.7 64.1 Flush/pour flush to septic tank 0.3 0.3 0.3 0.3 Flush/pour flush to a pit latrine 1.0 7.1 3.1 3.6 Ventilated improved pit (VIP) latrine 2.9 47.2 18.0 19.3 Pit latrine with a slab 0.6 7.5 3.0 3.1 Not improved Any facility shared with other households 1.6 3.1 2.1 1.9 Flush/pour flush not to sewer/septic tank/pit latrine 0.5 0.2 0.4 0.3 Pit latrine without slab/open pit 0.5 17.0 6.1 7.1 Bucket 0.2 0.1 0.1 0.1 No facility/bush/field 0.1 0.0 0.1 0.1 Other/missing 0.2 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 Number of households/de jure population 4,429 2,278 6,707 25,235 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Household members, i.e., usual residents 22 | Household Population and Housing Characteristics 75 94 39 67 92 17 Total Residence Urban Rural 0 20 40 60 80 100 Percentage of households Piped water Piped sewer system Figure 2.4 Households with Drinking Water Piped into the House and Flush Toilet to Piped Sewer System, by Residence ADHS 2005 Household Possessions The availability of durable goods is a proximate measure of household socioeconomic status. Moreover, particular goods have specific benefits: having access to a radio or a television exposes house- hold members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transportation allows greater access to many services away from the local area. Table 2.9 provides infor- mation on household ownership of durable goods (e.g., radios, televisions, telephones, refrigerators) and means of transportation (e.g., bicycles, motorcycles, automobiles). Table 2.9 shows that urban households are more likely than rural households to own durable goods, while rural households are more likely to own a means of transportation. Overall, 85 percent of Armenian households have color televisions, 82 percent have refrigerators, 72 percent have land line (non-mobile) telephones, and 67 percent have a washing machine. Both mobile and non-mobile tele- phones are much more common in urban areas than in rural areas. While 84 percent of urban households have a non-mobile telephone, the corresponding proportion in the rural areas is only 49 percent. One in four households in Armenia has a car or truck, while only 5 percent have a bicycle. Rural households are more likely than urban households to own a car or truck. Bicycles are also more common in rural areas than in urban areas (12 percent and 2 percent, respectively). Forty-one percent of Armenian households own agricultural land; the proportion is understanda- bly higher in rural than urban areas (85 percent vs. 17 percent). One-quarter of Armenian households own farm animals. Household Population and Housing Characteristics | 23 Table 2.9 Household possessions Percentage of households with various household effects, means of transportation, agricul- tural land, and farm animals by residence; and percentage of de jure household population with various household effects, means of transportation, agricultural land, and farm animals, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence De jure Possession Urban Rural Total population1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household effects Radio 34.7 17.8 28.9 29.6 Black and white television 11.1 18.6 13.6 12.1 Color television 88.5 77.3 84.7 88.0 Washing machine 69.2 62.7 67.0 71.3 Vacuum cleaner 54.1 24.7 44.1 46.5 Computer 12.1 2.0 8.7 9.1 Mobile telephone 39.2 19.4 32.5 37.1 Non-mobile telephone 83.5 49.4 71.9 72.5 Refrigerator 86.3 74.8 82.4 84.0 Camera 46.1 27.7 39.9 45.6 Means of transportation Bicycle 1.9 11.6 5.2 6.7 Animal-drawn cart 0.1 1.6 0.6 0.7 Motorcycle/scooter 0.2 1.2 0.6 0.8 Car/truck 22.6 27.6 24.3 29.7 Ownership of agricultural land 17.3 85.4 40.5 45.2 Ownership of farm animals 5.1 63.7 25.0 30.4 Number of households/ 4,429 2,278 6,707 25,235 de jure population ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Household members, i.e., usual residents 2.3 WEALTH QUINTILES The wealth index is a recently developed measure that has been tested in a number of countries in relation to inequities in household income, use of health services, and health outcomes (Rutstein 2004, Rutstein et al., 2000). The wealth index is constructed by assigning a weight or factor score to each household asset through principal components analysis. These scores were summed by household, and individuals were ranked according to the total score of the household in which they resided. The sample was then divided into population quintiles—five groups with the same number of individuals in each. At the national level, approximately 20 percent of the population is in each wealth quintile. Table 2.10 shows the distribution of the population across the five wealth quintiles, by urban and rural areas and region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. For example, over three-fourths of the rural population is in the lowest and second-lowest wealth quintiles. This compares to approximately six in ten urban residents who are in the two highest wealth quintiles. 24 | Household Population and Housing Characteristics Table 2.10 Population distribution by wealth quintile Percent distribution of the de jure population by wealth quintile, according to residence and region, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Wealth quintile Number of –––––––––––––––––––––––––––––––––––––––––––– de jure Residence/region Lowest Second Middle Fourth Highest Total population1 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 3.6 12.9 24.2 28.7 30.7 100.0 15,703 Rural 47.1 31.8 12.9 5.9 2.3 100.0 9,531 Region Yerevan 0.7 6.8 20.8 30.7 41.0 100.0 9,115 Aragatsotn 54.2 26.4 8.4 8.0 3.1 100.0 1,091 Ararat 27.3 38.3 21.1 10.0 3.3 100.0 2,101 Armavir 39.9 27.1 14.2 12.9 5.9 100.0 2,201 Gegharkunik 33.8 28.7 19.3 11.6 6.6 100.0 1,578 Lori 25.0 24.3 21.3 17.4 12.0 100.0 2,190 Kotayk 13.2 21.4 26.8 20.6 17.9 100.0 2,044 Shirak 32.6 35.5 19.7 9.2 3.0 100.0 2,184 Syunik 16.0 14.0 21.9 31.5 16.6 100.0 1,137 Vayots Dzor 38.8 30.9 15.3 9.8 5.2 100.0 462 Tavush 46.0 21.5 19.4 7.9 5.3 100.0 1,130 Total 20.0 20.0 19.9 20.1 20.0 100.0 25,235 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Household members, i.e., usual residents 2.4 BIRTH REGISTRATION In Armenia, birth registration is recognized as one of children’s rights. The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certifi- cate is issued at the time of registration or later as proof of the registration of the birth. In the 2005 ADHS, for all children born since January 2000, mothers were asked if their child had been registered. Table 2.11 gives the percentage of children under five years of age whose births were officially registered and the percentage who had a birth certificate at the time of the survey. Not all children who are regis- tered may have a birth certificate because some certificates may have been lost or were never issued. However, all children with a certificate have been registered. Household Population and Housing Characteristics | 25 Birth registration is almost universal in Armenia, with 96 percent of births in the five years pre- ceding the survey registered, and practically all of these births have a certificate. Small variations are found across subgroups of children. The proportion of births that are registered ranges from 90 percent in Shirak to 100 percent in Tavush. Table 2.11 Birth registration of children under five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of children whose births are registered: ––––––––––––––––––––––––––––––– Had Didn’t have Number Background a birth a birth Total of characteristic certificate certificate registered children –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age <2 95.6 0.5 96.1 659 2-4 96.0 0.6 96.6 867 Sex Male 96.2 0.4 96.6 839 Female 95.3 0.8 96.1 687 Residence Urban 97.0 0.2 97.1 928 Rural 94.0 1.2 95.2 598 Region Yerevan 96.6 0.0 96.6 573 Aragatsotn 96.0 2.7 98.7 82 Ararat 96.4 1.5 97.9 141 Armavir 93.6 0.0 93.6 133 Gegharkunik 96.0 0.2 96.3 122 Lori 94.8 2.8 97.6 99 Kotayk 97.0 0.0 97.0 123 Shirak 90.0 0.0 90.0 91 Syunik 95.1 1.9 97.0 66 Vayots Dzor 95.9 0.0 95.9 21 Tavush 99.5 0.0 99.5 75 Wealth quintile Lowest 90.8 2.6 93.4 293 Second 93.4 0.0 93.4 301 Middle 96.3 0.0 96.3 297 Fourth 99.5 0.3 99.8 328 Highest 98.6 0.0 98.6 307 Total 95.8 0.6 96.4 1,526 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure household members, i.e., usual residents. 26 | Household Population and Housing Characteristics BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 The purpose of this chapter is to provide a demographic and socioeconomic profile of the 2005 ADHS sample. Information on the basic characteristics of women and men interviewed in the survey is essential for the interpretation of findings presented later in the report and can provide an approximate indication of the representativeness of the survey. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 presents the percent distribution of interviewed women and men age 15-49 by back- ground characteristics including age, marital status, educational level, place of residence, and region. As noted in Chapter 1, all women age 15-49 who were usual residents or present in the household on the night before the interviewer’s visit were eligible to be interviewed in the 2005 ADHS. Men age 15-49 were interviewed in every third household.1 In order not to double count respondents, the tables in this report are based on the de facto population, that is, those who stayed in the household the previous night. For the most part, the male and female populations represented in the sample are evenly distrib- uted by age, but there are some noticeable exceptions. For example, there are lower proportions of women and men in their thirties compared with in older and younger age groups. This is notable because people in this age group tend to be economically active. A majority of both women and men are married (or living together). Compared with the results of the 2000 ADHS, there is a much lower proportion of men who are married or living with a woman (56 percent versus 68 percent). This can be explained in part by a larger cohort of the youngest men (age 15- 19) and the exclusion in 2005 of men aged 50-54. Seven percent of women are divorced, separated, or widowed as opposed to 1 percent of men. Thirty-one percent of women and 43 percent of men have never been married. Almost two-thirds of the population live in urban areas, the majority of those in Yerevan. There is considerable variation by region. All but a tiny handful of the respondents interviewed had attended school at some time. Approximately 10 percent of respondents attended only basic general education, while about 40 percent reached high school or general secondary. Thirty percent of women have attended a specialized secondary institution, as have 22 percent of men. Approximately one-quarter of respondents have at least some higher education. 1 In the 2000 ADHS, men age 15-54 in every third household were included in the survey. Background Characteristics of Respondents | 27 Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by background characteristics, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––– Background Weighted Weighted Unweighted Weighted Weighted Unweighted characteristic percent number number percent number number ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 17.1 1,123 1,136 20.2 292 295 20-24 17.2 1,131 1,067 16.3 237 239 25-29 14.2 929 910 14.0 202 183 30-34 11.4 749 709 10.8 156 157 35-39 10.8 711 720 10.4 150 138 40-44 14.7 965 1,024 13.8 199 210 45-49 14.6 958 1,000 14.6 211 225 Marital status Never married 31.1 2,043 2,006 42.5 615 614 Married 60.8 3,995 4,064 49.6 717 754 Living together 0.7 49 48 6.7 98 61 Divorced/separated 4.9 325 281 0.9 13 15 Widowed 2.4 155 167 0.3 4 3 Residence Urban 63.9 4,194 4,592 63.1 913 999 Rural 36.1 2,372 1,974 36.9 534 448 Region Yerevan 37.6 2,468 1,141 37.8 547 262 Aragatsotn 4.5 292 553 4.9 71 142 Ararat 7.0 462 545 7.6 110 108 Armavir 8.6 567 613 9.6 139 146 Gegharkunik 6.7 443 593 5.6 81 123 Lori 8.2 537 464 6.0 87 56 Kotayk 8.6 563 562 10.4 151 128 Shirak 8.6 563 583 6.8 98 112 Syunik 4.3 281 537 4.6 67 139 Vayots Dzor 1.6 107 407 2.1 31 106 Tavush 4.3 285 568 4.4 64 125 Education Basic general1 8.1 529 506 14.1 205 193 Secondary general 37.2 2,440 2,522 40.5 586 601 Specialized secondary 30.4 1,997 2,141 21.5 310 328 Higher 24.4 1,600 1,397 23.9 346 325 Total 100.0 6,566 6,566 100.0 1,447 1,447 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Unweighted numbers refer to the number of interviews actually completed. Education refers to the highest level of educa- tion attended, whether or not that level was completed. 1 Includes a tiny proportion with no education. 28 | Background Characteristics of Respondents 3.2 EDUCATIONAL LEVEL OF RESPONDENTS Tables 3.2.1 and 3.2.2 show the educational level of female and male respondents by selected background characteristics. Education has been almost universal in Armenia for some time; the median years of schooling for women is 10.8 years and for men is 9.9 years. Table 3.2.1 Educational attainment by background characteristics: Women Percent distribution of women by highest level of schooling attended, median number of years completed, and percentage with general basic and general secondary completed, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended Median ––––––––––––––––––––––––––––––––––––––––––––––––––––– number High of years General General Number Background No Primary Middle school Specialized of basic secondary of characteristic education (1-3) (4-8) (9-10) secondary Higher Total schooling completed1 completed2 women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.0 0.2 18.7 43.7 16.3 21.1 100.0 9.4 98.6 62.6 1,123 20-24 0.2 0.0 6.8 29.8 30.6 32.6 100.0 11.7 99.5 92.7 1,131 25-29 0.0 0.8 7.6 35.5 27.6 28.5 100.0 11.4 99.0 90.4 929 30-34 0.0 0.2 4.4 36.9 32.0 26.7 100.0 11.4 99.3 94.8 749 35-39 0.3 0.0 4.1 35.8 35.7 24.2 100.0 11.5 98.8 94.6 711 40-44 0.1 0.8 3.6 40.9 35.9 18.7 100.0 11.1 98.8 95.4 965 45-49 0.0 0.5 4.8 37.3 38.9 18.5 100.0 11.3 99.0 94.4 958 Residence Urban 0.0 0.3 5.8 30.2 31.4 32.3 100.0 11.5 99.3 90.6 4,194 Rural 0.2 0.5 10.8 49.4 28.7 10.3 100.0 9.7 98.5 84.2 2,372 Region Yerevan 0.0 0.3 5.6 25.6 28.6 39.9 100.0 11.9 99.2 91.1 2,468 Aragatsotn 0.0 0.0 6.9 51.2 31.2 10.7 100.0 9.8 100.0 86.0 292 Ararat 0.0 0.1 10.2 46.1 32.7 11.0 100.0 9.8 98.4 88.2 462 Armavir 0.0 0.9 11.7 44.5 30.4 12.5 100.0 9.8 98.0 84.2 567 Gegharkunik 0.4 0.0 11.7 48.8 27.2 11.9 100.0 9.7 99.0 82.2 443 Lori 0.2 0.1 4.3 45.7 31.5 18.1 100.0 10.0 99.6 90.7 537 Kotayk 0.1 0.5 9.0 43.2 31.0 16.2 100.0 9.9 98.7 87.1 563 Shirak 0.3 0.0 9.2 42.6 29.6 18.3 100.0 9.9 98.9 86.3 563 Syunik 0.2 0.8 5.8 29.2 43.5 20.6 100.0 11.5 98.9 89.3 281 Vayots Dzor 0.0 0.5 5.4 51.9 29.9 12.3 100.0 9.8 99.2 90.3 107 Tavush 0.0 1.2 10.3 39.0 32.5 17.0 100.0 9.9 98.3 84.0 285 Wealth quintile Lowest 0.2 0.8 16.4 54.2 22.3 6.1 100.0 9.6 97.2 77.5 1,164 Second 0.1 0.2 8.3 48.2 33.6 9.6 100.0 9.8 99.5 88.0 1,284 Middle 0.0 0.1 6.2 36.5 35.9 21.3 100.0 11.0 99.6 90.0 1,303 Fourth 0.1 0.1 6.0 31.0 33.9 28.8 100.0 11.5 99.3 90.9 1,375 Highest 0.0 0.5 2.8 20.0 25.8 50.9 100.0 12.4 99.1 93.4 1,440 Total 0.1 0.3 7.6 37.2 30.4 24.4 100.0 10.8 99.0 88.3 6,566 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed grade 8 or higher 2 Defined as having completed high school (grade 10) or having attended either specialized secondary or higher. The proportions may be slightly overestimated because some students enroll in specialized secondary after completing only grade 8. There are small differentials across subgroups of the population. Younger women, women in the poorest households, and those in rural areas have less education than other women. Nevertheless, based on the median, half of the women have at least ten years of education. Education is closely related to wealth status; women in the lowest wealth quintile have the least education while women in the highest wealth quintile have the most education. Women in Yerevan and Syunik are better educated than women in other regions; the median years of schooling for women in these regions is 11.5 years or higher, while in other regions it is 10 years or less. Background Characteristics of Respondents | 29 As Table 3.2.2 shows, the pattern of educational attainment among men is similar to that of women. Younger men and men in rural areas generally have a lower level of education. Thirty percent of urban men have some university-level education or higher, compared with 14 percent of rural men. Wealth status is positively associated with education; while 7 percent of men in the lowest wealth quintile have higher education, the corresponding proportion for men in the highest wealth quintile is 53 percent. There is considerable variation by region, with men in Yerevan and Syunik having more years of educa- tion than men from other regions. Table 3.2.2 Educational attainment by background characteristics: Men Percent distribution of men by highest level of schooling attended, median number of years completed, and percentage with general basic and general secondary completed, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Highest level of schooling attended Median ––––––––––––––––––––––––––––––––––––––––––––––––––––– number High of years General General Number Background No Primary Middle school Specialized of basic secondary of characteristic education (1-3) (4-8) (9-10) secondary Higher Total schooling completed1 completed2 men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.8 0.4 23.7 53.3 4.8 17.0 100.0 8.9 98.4 47.7 292 20-24 0.0 0.0 18.0 46.0 11.4 24.5 100.0 9.7 99.3 81.4 237 25-29 0.0 0.0 16.3 42.5 13.9 27.3 100.0 9.8 97.9 82.2 202 30-34 0.0 0.0 7.5 30.1 28.3 34.1 100.0 11.8 99.7 92.2 156 35-39 1.1 0.0 7.4 40.6 33.5 17.3 100.0 10.8 99.1 91.7 150 40-44 0.0 0.0 7.3 30.9 40.7 21.1 100.0 11.8 99.6 92.7 199 45-49 0.8 0.2 7.2 31.0 31.2 29.6 100.0 12.1 98.8 91.7 211 Residence Urban 0.4 0.2 10.8 36.4 22.3 29.9 100.0 10.3 98.8 83.8 913 Rural 0.3 0.0 18.6 47.4 20.0 13.7 100.0 9.6 99.2 73.5 534 Region Yerevan 0.4 0.0 10.8 32.6 22.8 33.4 100.0 11.4 99.0 84.6 547 Aragatsotn 0.0 0.0 16.9 34.3 32.7 16.1 100.0 9.9 97.7 78.0 71 Ararat 1.5 0.0 7.3 61.0 18.7 11.5 100.0 9.6 98.7 79.5 110 Armavir 0.0 0.0 25.7 44.0 18.3 12.1 100.0 9.5 99.1 69.7 139 Gegharkunik 0.0 0.0 15.1 40.4 30.3 14.1 100.0 9.8 98.7 81.7 81 Lori 2.0 0.0 13.6 42.1 13.9 28.4 100.0 9.8 98.4 78.1 87 Kotayk 0.0 0.7 16.7 52.3 10.6 19.7 100.0 9.6 98.9 75.8 151 Shirak 0.0 0.0 13.0 38.3 23.7 25.0 100.0 9.8 99.9 78.3 98 Syunik 0.0 0.6 11.2 32.8 29.3 26.1 100.0 10.5 99.7 80.2 67 Vayots Dzor 0.0 0.0 5.8 72.9 9.8 11.5 100.0 9.5 99.6 82.1 31 Tavush 0.0 0.0 17.5 37.5 27.6 17.4 100.0 9.8 99.8 78.5 64 Wealth quintile Lowest 0.0 0.0 26.6 46.7 19.3 7.3 100.0 9.4 99.4 68.8 261 Second 0.0 0.0 11.2 51.2 26.8 10.8 100.0 9.7 99.2 81.0 264 Middle 1.2 0.3 11.1 43.0 26.6 17.8 100.0 9.8 98.4 80.4 326 Fourth 0.6 0.1 12.5 38.9 18.4 29.6 100.0 10.0 98.2 81.7 316 Highest 0.0 0.0 8.1 23.3 15.9 52.7 100.0 12.5 99.7 87.1 280 Total 0.4 0.1 13.6 40.5 21.5 23.9 100.0 9.9 98.9 80.0 1,447 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed grade 8 or higher 2 Defined as having completed high school (grade 10) or having attended either specialized secondary or higher. Some students enroll in specialized secondary after completing only grade 8. 30 | Background Characteristics of Respondents 3.3 EXPOSURE TO MASS MEDIA The 2005 ADHS collected information on the exposure of women and men to both the broadcast and print media. This information is important because it can help program managers plan the dissemina- tion of information on health, family planning, nutrition, and other programs. The results are presented in Tables 3.3.1 and 3.3.2. At least once a week, 97 percent of Armenian women watch television, 53 percent read a news- paper, and 33 percent listen to the radio (Table 3.3.1). Only 2 percent do not regularly have access to mass media, and 23 percent have access to all three media. Younger women are more likely than older women to read newspapers or magazines and have access to the three types of media. Exposure to media has a strong positive association with education and wealth status. For example, while 44 percent of women in the highest wealth quintile have access to all three media, the corresponding proportion for women in the lowest wealth quintile is only 5 percent. Ur- ban women are about twice as likely to be exposed to mass media as their rural counterparts. Overall, women from Syunik, Vayots Dzor, and Yerevan are the most likely to have access to all media. Interestingly, men have different patterns of media exposure by age from that of women (Table 3.3.2). Younger men are in general less likely than older men to be exposed to three media, partly because they are less likely to read a newspaper on a weekly basis. Across regions, exposure to the three media ranges from 37 percent in Yerevan to 5 percent or less for men in Ararat, Gegharkunik, Shirak, and Vay- ots Dzor. There has apparently been a large increase in the proportion of women who read a newspaper once a week, from 29 percent in 2000 to 53 percent in 2005. Television watching has also increased, from 88 percent of women who said they watched at least once a week in 2000 to 97 percent in 2005. Slight changes in the wording of the questions between the two surveys may account for some of the trends. 3.4 EMPLOYMENT In the 2005 ADHS, respondents were asked a number of questions to determine their employment status at the time of the survey and continuity of employment in the 12 months prior to the survey. The measurement of women’s employment is difficult because some of the activities that women do, espe- cially work on family farms, family businesses, or in the informal sector, are often not perceived by women themselves as employment and hence are not reported as such. To avoid underestimating women’s employment, the 2005 ADHS survey asked women several questions to ascertain their em- ployment status. First, women were asked, “Aside from your own housework, are you currently work- ing?” Women who answered “no” to this question were then asked, “As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business, or work on the fam- ily farm or in the family business. Are your currently doing any of these things or any other work?” Women who answered “no” to this question were asked, “Have you done any work in the last 12 months?” Women are considered currently employed if they answered “yes” to either of the first two questions. Women who answered “yes” to the third question are not currently employed but have worked in the past 12 months. All employed women were asked their occupation; whether they were paid in cash, in kind, or not at all; and for whom they worked. Background Characteristics of Respondents | 31 Table 3.3.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background charac- teristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure –––––––––––––––––––––––––––––––––– Reads a All No newspaper/ Watches Listens to three mass magazine television the radio media media at least at least at least at least at least Number Background once once once once once of characteristic a week a week a week a week a week women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 64.0 97.7 35.8 26.5 1.0 1,123 20-24 56.4 97.6 41.6 29.3 1.8 1,131 25-29 48.8 97.5 31.1 20.5 1.9 929 30-34 51.1 97.5 33.2 22.0 1.9 749 35-39 50.9 96.9 30.0 22.0 2.3 711 40-44 47.0 95.6 27.9 17.1 3.5 965 45-49 46.4 95.7 28.0 18.5 2.9 958 Residence Urban 58.0 98.0 39.9 27.9 1.2 4,194 Rural 43.0 95.1 20.5 13.1 3.9 2,372 Region Yerevan 60.6 98.2 48.9 34.0 0.9 2,468 Aragatsotn 46.0 94.0 27.5 14.9 4.2 292 Ararat 43.9 98.9 26.2 18.9 1.0 462 Armavir 46.4 94.5 20.6 13.4 5.0 567 Gegharkunik 47.8 96.8 5.2 3.6 2.5 443 Lori 50.2 94.5 27.4 17.1 3.6 537 Kotayk 49.7 95.5 36.3 22.9 3.6 563 Shirak 41.4 98.5 13.8 9.2 0.9 563 Syunik 66.5 97.6 42.8 36.3 1.7 281 Vayots Dzor 57.0 97.7 44.4 36.1 1.4 107 Tavush 40.5 94.7 5.7 3.1 4.7 285 Education Basic general 30.1 89.3 23.5 10.8 8.6 529 Secondary general 40.7 96.7 25.8 14.6 2.5 2,440 Specialized secondary 54.1 97.8 31.5 21.4 1.4 1,997 Higher 76.3 98.8 48.6 40.2 0.5 1,600 Wealth quintile Lowest 30.5 90.9 11.1 5.4 7.2 1,164 Second 46.4 96.1 23.3 14.3 2.7 1,284 Middle 54.8 98.7 26.2 17.7 0.4 1,303 Fourth 58.6 98.7 40.9 27.4 1.0 1,375 Highest 68.2 99.4 57.5 43.7 0.4 1,440 Total 52.6 97.0 32.9 22.6 2.2 6,566 32 | Background Characteristics of Respondents Table 3.3.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteris- tics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of mass media exposure –––––––––––––––––––––––––––––––––– Reads a All No newspaper/ Watches Listens to three mass magazine television the radio media media at least at least at least at least at least Number Background once once once once once of characteristic a week a week a week a week a week men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 26.0 99.0 35.1 17.3 1.0 292 20-24 30.6 100.0 51.9 21.1 0.0 237 25-29 31.1 99.3 57.6 22.1 0.0 202 30-34 43.1 99.3 52.9 26.5 0.0 156 35-39 36.0 98.3 53.7 24.2 1.7 150 40-44 40.9 97.8 44.3 24.6 1.8 199 45-49 39.8 98.7 39.1 21.2 0.5 211 Residence Urban 39.9 98.9 55.8 28.0 0.7 913 Rural 25.0 99.1 31.2 11.4 0.7 534 Region Yerevan 45.6 99.0 72.7 37.3 0.6 547 Aragatsotn 40.0 100.0 48.7 26.2 0.0 71 Ararat 15.0 100.0 23.7 3.4 0.0 110 Armavir 33.0 100.0 62.0 24.4 0.0 139 Gegharkunik 36.9 99.5 8.9 4.0 0.0 81 Lori 31.4 95.3 30.1 8.1 1.9 87 Kotayk 28.8 98.5 43.7 18.1 1.5 151 Shirak 4.0 98.0 3.4 1.8 2.0 98 Syunik 25.8 99.3 16.7 7.3 0.0 67 Vayots Dzor 8.4 98.2 9.3 5.4 1.8 31 Tavush 52.1 100.0 21.8 15.8 0.0 64 Education Basic general 11.2 98.9 33.5 6.4 0.5 205 Secondary general 24.8 99.2 41.6 14.7 0.7 586 Specialized secondary 29.0 98.8 46.8 14.8 0.9 310 Higher 69.2 98.8 63.0 49.5 0.7 346 Wealth quintile Lowest 21.9 98.1 27.1 9.0 1.4 261 Second 21.1 98.3 29.9 7.6 1.7 264 Middle 33.9 100.0 39.4 17.7 0.0 326 Fourth 39.4 99.5 59.8 26.7 0.0 316 Highest 53.7 98.7 74.6 46.6 0.6 280 Total 34.4 99.0 46.7 21.9 0.7 1,447 Background Characteristics of Respondents | 33 Table 3.4 shows the percent distribution of female and male respondents by employment status according to background characteristics. Twenty-seven percent of women reported being currently employed, 2 percent were employed in the 12 months preceding the survey but not working at the time of the survey, and 71 percent were not employed in the 12 months preceding the survey (Figure 3.1). Almost twice as many men as women reported being currently employed (50 percent versus 27 percent). Nonetheless, one-third of men reported that they were not employed during the 12 months preceding the survey. Women who are formerly married are more likely than other women to be employed at the time of the survey (Table 3.4). For men, those who are currently married are most likely to be employed. Figure 3.1 Percent Distribution of Women and Men Age 15-49 by Employment Status MenWomen Did not work in last 12 months 71% Currently employed 27% Not currently employed 2% Not currently employed 16% Did not work in last 12 months 34% Currently employed 50% ADHS 2005 Employment among women and men increases with age, education, and wealth quintile. Figure 3.2 depicts the differentials by residence and education. Differences in employment between rural and urban women are not significant; however, urban men are more likely to be employed than rural men. Employment among women is highest in Syunik and Tavush (47 and 41 percent, respectively) while in Shirak the proportion is only 13 percent. For men, employment rates range from 64 percent in Armavir to 26 percent in Vayots Dzor. 34 | Background Characteristics of Respondents Table 3.4 Employment status Percent distribution of women and men age 15-49 by employment status, according to background characteristics, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Women Men –––––––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in Not Employed in Not last 12 months employed last 12 months employed –––––––––––––––––––– in the –––––––––––––––––––– in the Not 12 months Number Not 12 months Number Background Currently currently preceding of Currently currently preceding of characteristic employed1 employed the survey Total women employed1 employed the survey Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 3.3 0.3 96.4 100.0 1,123 4.9 13.4 81.6 100.0 292 20-24 17.7 2.4 79.8 100.0 1,131 36.6 15.9 47.5 100.0 237 25-29 25.4 3.3 71.3 100.0 929 68.1 12.8 19.1 100.0 202 30-34 32.1 2.7 65.2 100.0 749 70.0 20.0 10.0 100.0 156 35-39 39.0 1.8 59.2 100.0 711 71.8 15.2 12.0 100.0 150 40-44 39.0 2.5 58.6 100.0 965 64.6 21.1 14.1 100.0 199 45-49 42.4 3.0 54.6 100.0 958 68.9 14.0 17.1 100.0 211 Marital status Never married 19.3 1.5 79.2 100.0 2,043 26.1 14.6 59.3 100.0 615 Married/living together 28.1 2.3 69.6 100.0 4,044 68.8 16.2 14.7 100.0 815 Divorced/separated/ widowed 50.5 5.3 44.2 100.0 479 * * * * 17 Number of living children 0 20.2 1.8 78.0 100.0 2,352 30.0 14.8 55.3 100.0 688 1-2 29.4 2.3 68.3 100.0 2,812 73.2 15.0 11.8 100.0 519 3+ 33.7 2.8 63.6 100.0 1,402 59.6 20.4 19.0 100.0 240 Residence Urban 27.9 2.1 70.0 100.0 4,194 53.2 12.4 34.1 100.0 913 Rural 25.4 2.5 72.0 100.0 2,372 45.5 21.5 32.9 100.0 534 Region Yerevan 29.4 2.4 68.2 100.0 2,468 57.2 9.7 32.8 100.0 547 Aragatsotn 15.8 4.4 79.8 100.0 292 42.2 21.0 36.8 100.0 71 Ararat 37.8 0.1 62.1 100.0 462 41.8 9.5 48.7 100.0 110 Armavir 30.5 4.7 64.7 100.0 567 64.0 9.5 26.5 100.0 139 Gegharkunik 19.9 0.8 79.4 100.0 443 53.0 22.1 24.9 100.0 81 Lori 17.9 1.5 80.5 100.0 537 28.0 54.2 17.9 100.0 87 Kotayk 22.4 2.8 74.8 100.0 563 51.1 21.4 27.4 100.0 151 Shirak 13.0 1.0 86.0 100.0 563 42.0 3.4 54.6 100.0 98 Syunik 47.3 2.1 50.6 100.0 281 46.9 28.1 25.0 100.0 67 Vayots Dzor 20.7 0.3 78.5 100.0 107 26.0 4.2 67.9 100.0 31 Tavush 41.4 2.8 55.8 100.0 285 40.4 24.2 35.5 100.0 64 Education Basic general 16.8 1.6 81.6 100.0 529 36.8 21.8 41.3 100.0 205 Secondary general 19.5 1.5 78.9 100.0 2,440 43.1 15.5 41.4 100.0 586 Specialized secondary 30.8 3.0 66.1 100.0 1,997 60.6 21.1 18.3 100.0 310 Higher 37.0 2.5 60.5 100.0 1,600 61.7 7.9 30.0 100.0 346 Wealth quintile Lowest 23.7 2.8 73.5 100.0 1,164 42.2 24.3 33.3 100.0 261 Second 23.5 1.7 74.7 100.0 1,284 44.2 18.1 37.7 100.0 264 Middle 27.3 3.2 69.5 100.0 1,303 49.1 16.1 34.8 100.0 326 Fourth 28.6 1.4 70.1 100.0 1,375 47.2 14.0 38.3 100.0 316 Highest 31.1 2.2 66.7 100.0 1,440 69.0 7.3 23.8 100.0 280 Total 27.0 2.2 70.7 100.0 6,566 50.4 15.8 33.7 100.0 1,447 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 “Currently employed” is defined as having done work in the past seven days and includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Background Characteristics of Respondents | 35 Figure 3.2 Respondents Currently Employed, by Residence and Education 62 61 43 37 46 53 50 37 31 20 17 25 28 27 0 10 20 30 40 50 60 70 80 90 100 Higher Specialized secondary Secondary general Basic general EDUCATION Rural Urban RESIDENCE Total Percentage of respondents currently employed Women 15-49 Men 15-49 ADHS 2005 3.5 OCCUPATION In the survey, respondents who indicated that they were currently working were asked about the kind of work that they did. Their responses were recorded verbatim and served as the basis for the coding of occupation that occurred in the central office. Table 3.5.1 shows the percent distribution of employed women in the 12 months preceding the survey by occupation, according to background characteristics. Information on a woman’s occupation not only allows an evaluation of the woman’s source of income but also has implications for her empowerment. Almost half (45 percent) of employed women are in professional, technical, or managerial posi- tions, and 20 percent are employed in sales and services. Two in ten women work in agriculture. Women with specialized secondary or higher education, women living in households in the highest wealth quin- tile, and urban women are more likely to hold professional, technical, or managerial jobs. There is a rela- tionship between the number of children that a woman has and her occupation. Women with more chil- dren are more likely to be employed in the agriculture sector. In regions where agricultural work is scarce, such as Yerevan, Gegharkunik, Lori, and Shirak, more than half of women work in professional positions. On the other hand, two in three women in Ararat were engaged in agricultural jobs. 36 | Background Characteristics of Respondents Table 3.5.1 Occupation: Women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteris- tics, Armenia 2001 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Don’t Number Background technical/ and Skilled skilled Agri- know/ of characteristic managerial Clerical services manual manual culture missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 (38.3) (3.8) (34.1) (0.4) (7.1) (16.3) (0.0) (100.0) 40 20-24 53.1 8.8 23.7 2.8 0.2 9.7 1.8 100.0 228 25-29 53.2 9.3 17.4 2.1 0.8 16.2 0.9 100.0 267 30-34 48.5 2.8 20.4 4.6 2.8 20.9 0.0 100.0 261 35-39 47.3 3.1 16.8 3.3 3.0 25.8 0.6 100.0 290 40-44 38.9 3.8 18.9 7.1 8.3 22.8 0.1 100.0 400 45-49 39.5 3.5 22.0 5.2 7.6 21.8 0.4 100.0 434 Marital status Never married 51.4 14.5 22.4 3.7 1.2 6.3 0.5 100.0 425 Married or living together 46.1 2.0 15.6 4.6 4.3 27.0 0.4 100.0 1,229 Divorced/separated/widowed 31.8 2.8 37.3 4.9 11.1 10.9 1.1 100.0 268 Number of living children 0 52.6 13.2 21.4 3.5 1.7 7.0 0.5 100.0 518 1-2 48.5 2.3 21.2 4.8 5.5 16.8 0.9 100.0 892 3+ 32.2 0.8 17.1 4.6 5.8 39.4 0.0 100.0 511 Residence Urban 54.1 6.5 26.0 5.6 4.4 2.9 0.5 100.0 1,258 Rural 28.5 1.8 9.0 2.1 5.0 52.9 0.7 100.0 663 Region Yerevan 54.1 7.4 26.6 5.9 3.9 1.7 0.5 100.0 784 Aragatsotn 42.8 1.1 10.2 3.1 3.0 39.8 0.0 100.0 59 Ararat 21.5 0.7 5.6 1.6 4.1 66.6 0.0 100.0 175 Armavir 28.0 0.6 16.5 3.7 4.6 45.5 1.1 100.0 200 Gegharkunik 55.6 3.2 19.0 5.9 3.0 13.3 0.0 100.0 91 Lori 59.2 5.2 17.4 3.1 1.9 10.9 2.2 100.0 104 Kotayk 48.1 3.6 22.4 4.4 16.5 4.4 0.6 100.0 142 Shirak 55.0 8.4 31.4 0.0 2.3 2.9 0.0 100.0 79 Syunik 44.3 5.1 13.1 3.7 2.1 31.3 0.4 100.0 139 Vayots Dzor 39.7 6.9 19.4 13.1 14.6 4.1 2.2 100.0 22 Tavush 26.2 2.6 12.5 3.0 1.9 53.5 0.2 100.0 126 Education Basic general 3.8 0.5 29.6 2.9 16.3 47.0 0.0 100.0 97 Secondary general 8.9 1.8 29.8 11.4 7.8 39.5 0.8 100.0 514 Specialized secondary 50.1 5.5 19.9 2.4 4.3 17.2 0.6 100.0 677 Higher 76.2 7.3 11.2 1.1 0.4 3.5 0.3 100.0 633 Wealth quintile Lowest 16.5 1.5 11.7 2.3 6.3 61.4 0.4 100.0 308 Second 32.5 2.9 18.4 2.8 7.6 34.6 1.1 100.0 324 Middle 37.7 7.7 25.0 8.2 6.2 14.4 0.9 100.0 398 Fourth 56.4 4.8 25.8 5.2 3.9 3.9 0.0 100.0 411 Highest 69.3 6.0 18.0 3.1 0.6 2.6 0.4 100.0 479 Total 45.3 4.9 20.2 4.4 4.6 20.2 0.5 100.0 1,921 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. Background Characteristics of Respondents | 37 Table 3.5.2 shows that among employed men, 25 percent hold professional, technical, or managerial jobs, 27 percent are in sales and services, 19 percent work as skilled manual laborers, and 18 percent work in agriculture. Men show similar variations across subgroups as women. However, the relationship between the number of children a man has and his occupation is less clear than that for women. Table 3.5.2 Occupation: Men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Professional/ Sales Un- Don’t Number Background technical/ and Skilled skilled Agri- know/ of characteristic managerial Clerical services manual manual culture missing Total men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 (0.3) (3.1) (21.8) (23.4) (12.5) (39.0) (0.0) (100.0) 54 20-24 19.3 2.0 22.8 24.7 8.0 22.3 0.9 100.0 124 25-29 27.0 2.3 31.4 17.7 11.9 9.8 0.0 100.0 164 30-34 31.6 0.0 27.0 18.2 10.5 12.6 0.0 100.0 140 35-39 23.1 1.0 25.4 22.7 7.5 20.2 0.0 100.0 131 40-44 20.6 1.1 35.3 15.0 7.1 21.0 0.0 100.0 171 45-49 35.3 1.1 23.0 18.5 7.9 14.3 0.0 100.0 175 Marital status Never married 19.5 1.6 23.9 23.5 10.8 20.3 0.4 100.0 251 Married or living together 27.2 1.3 28.4 18.0 8.2 17.0 0.0 100.0 693 Divorced/separated/widowed * * * * * * * * 15 Number of living children 0 21.2 1.9 23.3 23.2 10.1 19.9 0.3 100.0 308 1-2 28.7 1.1 34.1 15.4 9.1 11.6 0.0 100.0 457 3+ 22.4 1.1 18.2 22.5 6.9 28.8 0.0 100.0 192 Residence Urban 32.2 1.7 34.5 20.2 9.4 1.9 0.2 100.0 600 Rural 13.1 0.8 15.6 18.0 8.4 44.1 0.0 100.0 358 Region Yerevan 37.0 1.2 34.6 17.0 9.0 1.2 0.0 100.0 366 Aragatsotn 8.7 2.8 15.3 23.0 7.3 42.9 0.0 100.0 45 Ararat 14.3 0.0 23.3 30.3 6.6 25.5 0.0 100.0 57 Armavir 13.2 2.5 14.1 12.1 10.9 47.1 0.0 100.0 103 Gegharkunik 15.9 1.8 20.5 20.6 1.4 39.7 0.0 100.0 61 Lori (15.4) (0.0) (33.8) (20.6) (8.4) (21.9) (0.0) (100.0) 72 Kotayk 24.6 2.8 13.1 35.9 11.5 11.1 1.0 100.0 110 Shirak 17.1 1.3 50.3 8.1 18.7 4.4 0.0 100.0 44 Syunik 27.0 0.0 19.8 12.4 2.7 38.1 0.0 100.0 50 Vayots Dzor (24.2) (0.0) (48.9) (3.0) (18.7) (5.2) (0.0) (100.0) 9 Tavush 18.4 0.0 33.3 15.1 10.2 23.0 0.0 100.0 41 Education Basic general 3.8 2.0 23.7 24.9 17.4 28.2 0.0 100.0 120 Secondary general 13.2 0.3 29.2 25.4 11.0 20.5 0.3 100.0 343 Specialized secondary 15.8 1.1 32.7 23.5 8.2 18.6 0.0 100.0 254 Higher 62.1 2.7 21.2 3.7 2.8 7.5 0.0 100.0 241 Wealth quintile Lowest 7.6 0.0 15.4 18.2 11.7 47.1 0.0 100.0 174 Second 9.7 2.0 25.3 23.9 9.1 29.8 0.0 100.0 165 Middle 19.5 0.0 31.0 25.3 10.4 13.4 0.5 100.0 213 Fourth 35.2 2.2 29.3 16.1 12.6 4.5 0.0 100.0 193 Highest 47.3 2.5 33.7 13.8 2.1 0.7 0.0 100.0 213 Total 25.0 1.4 27.4 19.3 9.0 17.7 0.1 100.0 958 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 un- weighted cases and has been suppressed. 38 | Background Characteristics of Respondents 3.6 EMPLOYMENT CHRACTERISTICS Table 3.6 shows the percent distribution of women who were employed in the 12 months preced- ing the survey by type of earnings, type of employer, and continuity of employment. Type of earnings refers to whether they were paid in cash, in kind, or not at all. Women who reported being currently em- ployed were asked about their employer—whether they were employed by a relative, a nonrelative, or were self-employed. Additionally, women were also asked whether they worked continuously throughout the year or seasonally. Overall, 80 percent of employed women earn cash only, 4 percent were paid in cash and in kind, and 15 percent received no payment. Men are more likely to receive compensation than women—84 per- cent receive cash and only 6 percent work for no payment (not shown in table). Seven in ten women who work in agriculture did not receive payment, while 96 percent who work in nonagricultural jobs were paid in cash. Table 3.6 shows that 71 percent of women who work are employed by a nonrelative, 21 percent are employed by a family member, and 8 percent are self-employed. As expected, most women who work in agriculture are employed by a family member (69 percent), while most of those who hold a position in nonagricultural jobs were employed by nonfamily members (86 percent). With regard to continuity of employment, the data show that three-fourths of employed women work all year. Most women who work in agriculture work seasonally (80 percent), while most of those who work in nonagricultural jobs work all year (90 percent). Table 3.6 Employment characteristics Percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Non- Agricultural agricultural Employment characteristics work work Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of earnings Cash only 19.7 95.6 80.2 Cash and in-kind 10.4 2.3 3.9 In-kind only 1.4 0.3 0.5 Not paid 68.5 1.7 15.2 Missing 0.0 0.1 0.2 Total 100.0 100.0 100.0 Type of employer Employed by family member 69.3 8.3 20.6 Employed by nonfamily member 12.1 86.2 71.0 Self-employed 18.5 5.5 8.2 Missing 0.0 0.0 0.2 Total 100.0 100.0 100.0 Continuity of employment All year 19.9 90.0 75.7 Seasonal 80.0 7.7 22.2 Occasional 0.1 2.1 1.7 Missing 0.0 0.2 0.3 Total 100.0 100.0 100.0 Number 387 1,523 1,921 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes 10 women with missing information on type of employment who are not shown separately. Background Characteristics of Respondents | 39 FERTILITY 4 All women who were interviewed in the 2005 ADHS were asked to give a complete reproductive history. In collecting these histories, each woman was first asked about the total numbers of pregnancies that had ended in live births, induced abortions, miscarriages, and stillbirths. After obtaining these aggre- gate data, an event-by-event pregnancy history was collected. For each pregnancy, the duration, the month and year of termination, and the result of the pregnancy were recorded. Information was collected about the most recent completed pregnancy, then the next-to-last, etc. For each live birth, information was collected on the sex of the child, survival status, and age (for surviving children) or age at death (for de- ceased children). 4.1 CURRENT FERTILITY The data collected in the reproductive history were used to calculate two of the most widely used measures of current fertility: the total fertility rate (TFR) and its component age-specific fertility rates. The TFR is interpreted as the average number of children a woman would bear in her lifetime if she ex- perienced the currently observed age-specific rates throughout her reproductive years. The fertility rates refer to the three-year period before the survey (i.e., approximately from October 2002 to October 2005). According to the results of the 2005 ADHS, the TFR is 1.7 children per woman (Table 4.1). This is below replacement level fertility (which is slightly more than 2.0). The 2005 ADHS rate of 1.7 is the same as the rate estimated by the 2000 ADHS. Thus, there is no evidence of change in overall levels of fertility in Armenia over the last five years. The data suggest, however, some change in urban-rural differentials. While urban fertility is statistically the same (1.5 in 2000 versus 1.6 in 2005) there is some evidence of decline in rural areas (from 2.1 in 2000 to 1.8 in 2005). Overall, the pattern of age-specific fertility rates is the same, although there has been a shift away from childbearing at the youngest ages (15-19) to higher levels of fertility among women in their late 20s. Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Age Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 22 43 30 20-24 140 165 148 25-29 104 115 107 30-34 43 26 37 35-39 15 16 16 40-44 6 1 4 45-49 0 0 0 TFR 1.6 1.8 1.7 GFR 57 60 58 CBR 14.5 14.9 14.6 ––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Rates are for the period 1-36 months preceding the sur- vey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman. GFR: General fertility rate expressed per 1,000 women CBR: Crude birth rate expressed per 1,000 population Most childbearing takes place when women are in their 20s. The age-specific fertility rates peak at age 20-24 regardless of residence (Figure 4.1). In fact, in both urban and rural areas, fertility rates in these age groups (20-24 and 25-29) account for three-fourths of the total fertility rate. Fertility | 41 Figure 4.1 Age-specific Fertility Rates for the Three- year Period Preceding the Survey, by Residence 0 20 40 60 80 100 120 140 160 180 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age group R at e (p er 1 ,0 00 w om en ) Rural Urban ADHS 2005 4.2 FERTILITY DIFFERENTIALS BY BACKGROUND CHARACTERISTICS Table 4.2 shows the total fertility rate by background characteristics. Albeit not strong, there is a negative association between education and fertility (Figure 4.2). Women who have higher education have fewer children than women with less education (1.5 versus 1.8 or 1.9). The TFR in Yerevan is 1.7 births per woman. There appears to be marked variation between re- gions, ranging from approximately one birth per woman in Vayots Dzor to 2.5 in Aragatsotn. Undoubt- edly, some of these differences are due to sampling variability, which is quite large due to the small num- ber of respondents in each region (see Appendix B). Three percent of women reported being pregnant at the time of the survey. Small differences are found in this percentage across subgroups of women. The last column in Table 4.2 shows the mean number of children ever born to women age 40-49. This is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period and thus represents completed fertility. If fertility had re- mained stable over time, the two fertility measures, TFR and children ever born, would be equal or simi- lar. The findings show that the mean number of children ever born to women age 40-49 (2.5 children per woman) is higher than the TFR for the three years preceding the survey (1.7 children per woman), indi- cating a decline in fertility over the past 30 years. 42 | Fertility Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49, by background characteris- tics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant1 age 40-49 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 1.6 3.1 2.3 R ural 1.8 2.8 2.8 Region Yerevan 1.7 2.9 2.2 Aragatsotn 2.5 2.6 3.0 Ararat 2.0 2.5 2.8 Armavir 1.7 2.9 2.7 Gegharkunik 2.1 2.1 2.8 Lori (1.4) 4.2 2.6 Kotayk 1.8 3.6 2.8 Shirak 1.2 3.9 2.7 Syunik 1.8 2.7 2.7 Vayots Dzor (0.9) 2.9 2.8 Tavush 1.6 1.6 2.5 Education Basic general 1.9 2.7 2.6 Secondary general 1.8 3.3 2.7 Specialized secondary 1.9 2.7 2.5 Higher 1.5 2.8 2.1 Wealth quintile Lowest 1.8 3.2 2.9 Second 2.0 3.0 2.7 Middle 1.9 2.7 2.4 Fourth 1.6 3.4 2.4 H ighest 1.5 2.6 2.3 Total 1.7 3.0 2.5 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Figures in parentheses are based on 250-499 unweighted women. 1 Women age 15-49 Figure 4.2 Total Fertility Rates for the Three Years Preceding the Survey, by Residence and Education 1.5 1.9 1.8 1.9 1.8 1.6 1.7 0 1 2 Higher Specialized secondary Secondary general Basic general EDUCATION Rural Urban RESIDENCE Total Total fertility rate (children per woman) 3 ADHS 2005 Fertility | 43 4.3 FERTILITY TRENDS One of the most important and complex issues for Armenia is the decline in fertility. One method of understanding fertility trends is to examine the age- specific fertility rates over time. Because women age 50 and older were not interviewed in the survey, the rates are successively truncated as the number of years before the survey increases (see Table 4.3). Data in this table indicate that fertility has declined in the past 20 years. This decline is particularly evident among women in the youngest age groups (15-19 and 20-24) in the 10 years preceding the survey. For example, age- specific fertility among women age 20-24 declined from 178 births per 1,000 women in the period five to nine years before the survey to 146 births per 1,000 women in the period zero to four years before the survey, a decrease of 18 percent. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time of the birth, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years Mother’s age preceding the survey at time ––––––––––––––––––––––––––––––– of the birth 0-4 5-9 10-14 15-19 ––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 33 56 101 71 20-24 146 178 215 255 25-29 95 93 120 142 30-34 36 42 57 [ 77] 35-39 15 18 [32] 40-44 4 [7] 45-49 [0] ––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Age-specific fertility rates are per 1,000 women. Esti- mates in brackets are truncated. 4.4 FERTILITY RATES FROM NSS AND THE ADHS At the national level, the 2005 ADHS TFR of 1.7 is higher than the official government rates published for the same period. For example, 1.4 was the official TFR for both 2003 and 2004 based on administrative records (National Statistical Service, 2006). An important difference in the computing of these rates should be noted: whereas the ADHS rate is based on the de facto population, the official gov- ernment rates are based on the de jure population. Other factors that could contribute to the difference between fertility rates include sampling vari- ability of the ADHS estimates and underreporting of births to the government registration system. 4.5 CHILDREN EVER BORN AND LIVING Table 4.4 shows the distribution of all women and currently married women by number of chil- dren ever born. Data on the number of children ever born reflect the accumulation of births to women over their entire reproductive years and therefore have limited reference to current fertility levels, particu- larly when the country has experienced a decline in fertility. On average, women in Armenia have given birth to 1.5 children by their late twenties. Even in the oldest age groups, the mean number of children ever born is only 2.5. As expected, currently married women have had more births than all women in all age groups. Nevertheless, the mean number of chil- dren ever born does not exceed 3.0. The largest difference between the data on children ever born for cur- rently married women and all women is in the young age groups, because a large number of unmarried young women are not exposed to the risk of pregnancy. Differences at older ages reflect the impact of marital dissolution (divorce or widowhood). Among currently married women, 14 percent have had only one live-born child, 42 percent have had two children, and 27 percent have three children. Ten percent of women have had four or more chil- dren. In total, only 1 percent of currently married women age 45-49 have never had a live birth. This is an indirect indicator of primary infertility. Voluntary childlessness is rare in Armenia, and most women de- sire to have at least one child, preferably soon after marriage. 44 | Fertility Table 4.4 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Armenia 2005 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Mean Mean number number Number of children ever born Number of of –––––––––––––––––––––––––––––––––––––––––––––––––––––––– of children living Age 0 1 2 3 4 5 6+ Total women ever born children ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 97.6 2.3 0.2 0.0 0.0 0.0 0.0 100.0 1,123 0.03 0.03 20-24 64.4 20.1 14.1 1.3 0.1 0.0 0.0 100.0 1,131 0.53 0.52 25-29 27.2 17.6 41.6 10.8 2.0 0.4 0.2 100.0 929 1.45 1.41 30-34 11.4 10.5 49.7 22.4 5.1 0.5 0.3 100.0 749 2.03 1.93 35-39 6.9 10.8 42.9 29.6 8.0 0.8 1.0 100.0 711 2.28 2.19 40-44 6.7 6.1 37.9 33.4 11.3 3.4 1.2 100.0 965 2.52 2.36 45-49 6.3 9.7 32.2 35.6 11.0 3.4 1.8 100.0 958 2.53 2.35 Total 35.6 11.0 28.9 17.6 5.0 1.2 0.6 100.0 6,566 1.52 1.44 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 65.6 32.5 1.9 0.0 0.0 0.0 0.0 100.0 78 0.36 0.36 20-24 21.6 43.6 31.6 3.0 0.3 0.0 0.0 100.0 504 1.17 1.14 25-29 7.2 21.0 53.7 14.5 2.7 0.6 0.3 100.0 695 1.88 1.82 30-34 2.3 7.9 56.9 25.9 6.2 0.4 0.4 100.0 601 2.29 2.18 35-39 1.6 8.5 45.4 33.0 9.4 0.9 1.2 100.0 602 2.48 2.39 40-44 1.5 4.5 38.6 37.2 12.8 3.8 1.4 100.0 824 2.74 2.56 45-49 1.4 5.1 33.1 42.6 12.0 3.9 1.9 100.0 741 2.79 2.59 Total 6.3 14.0 42.3 27.0 7.6 1.8 0.9 100.0 4,044 2.25 2.14 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Currently married includes respondents in consensual union (living together). 4.6 BIRTH INTERVALS A birth interval is defined as the length of time between two live births. Research has shown that short birth intervals may adversely affect maternal health and children’s chances of survival. Children born too close to a previous birth, especially if the interval between the births is less than two years, are at increased risk of health problems and dying at an early age. Longer birth intervals, on the other hand, con- tribute to the improved health status of both mother and child. Table 4.5 shows the percent distribution of second and higher-order births in the five years prior to the survey by the number of months since the previous birth. The overall median birth interval is 37 months. Nonetheless, approximately one-third of births (32 percent) occur within 24 months of the previ- ous birth. Indeed, 17 percent of births occur within 18 months of a previous birth. This finding has not changed since 2000. In general younger women have shorter birth intervals than older women. While 41 percent of women age 20-29 space their births less than 24 months apart, the corresponding statistic for women 30- 39 is 16 percent. There is a strong relationship between birth interval and education. Births to mothers with basic general education have shorter intervals than births to mothers who have attended secondary education. For example, whereas 42 percent of births to mothers with basic general education are born less than 24 months after their older sibling, the corresponding statistic for women in each of the three more highly educated categories is approximately 30 percent (Figure 4.3). Measured in terms of the median number of months between births, birth intervals also vary by the selected background characteristics. Births to young mothers in their 20s and to mothers with basic education have the shortest median birth interval (28 months each). While there is no clear relationship between birth interval and wealth status, births to mothers in the lowest wealth quintile have the shortest Fertility | 45 interval compared with births to mothers in the higher wealth quintiles. Birth interval is also related to birth order and residence. For example, the median birth interval for fourth to sixth order births is 64 months compared with 34 months for second and third order births. Birth interval varies widely across regions, with the longest in Ararat (43 months) and the shortest in Gegharkunik and Tavush (less than 30 months). Table 4.5 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Median Number number of Number of months since preceding birth of months since Background –––––––––––––––––––––––––––––––––––––––––––––––––– non-first preceding characteristic 7-17 18-23 24-35 36-47 48+ Total births birth1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 * * * * * * 2 * 20-29 20.3 20.7 20.0 18.6 20.5 100.0 528 28.1 30-39 9.9 6.3 10.4 11.4 62.0 100.0 214 64.9 40-49 (3.0) (0.0) (8.5) (9.8) (78.7) (100.0) 41 (>70) Sex of preceding birth Male 16.0 18.3 17.8 16.9 31.0 100.0 386 34.3 Female 16.9 13.3 16.0 15.4 38.4 100.0 399 38.5 Survival of preceding birth Living 16.3 15.6 17.1 16.4 34.6 100.0 751 37.0 Dead (21.1) (18.6) (11.3) (9.5) (39.6) (100.0) 34 (34.9) Birth order 2-3 17.8 16.6 17.8 17.1 30.8 100.0 691 34.2 4-6 6.1 10.1 7.1 7.0 69.7 100.0 87 63.9 7 * * + * * * * 7 * Residence Urban 20.1 12.4 15.3 16.9 35.4 100.0 437 37.6 Rural 12.0 20.0 18.9 15.1 34.0 100.0 348 35.3 Region Yerevan 22.7 11.5 12.3 17.6 35.9 100.0 266 38.0 Aragatsotn 11.4 16.6 19.1 16.3 36.6 100.0 51 37.5 Ararat 11.0 11.3 15.9 16.4 45.4 100.0 72 42.8 Armavir 11.1 22.2 12.8 14.1 39.7 100.0 74 37.9 Gegharkunik 15.2 25.7 17.9 9.1 32.1 100.0 73 27.7 Lori (16.1) (22.3) (12.4) (17.2) (32.0) (100.0) 50 (33.7) Kotayk 11.0 4.4 28.8 20.8 35.0 100.0 65 41.5 Shirak (19.3) (13.9) (30.9) (13.7) (22.2) (100.0) 45 (30.4) Syunik 16.2 22.7 14.8 13.2 33.2 100.0 33 32.0 Vayots Dzor (8.1) (22.9) (33.7) (18.2) (17.0) (100.0) 9 (30.3) Tavush 13.1 23.6 19.9 17.1 26.3 100.0 47 28.5 Education Basic general 24.7 17.2 13.2 21.4 23.4 100.0 83 28.3 Secondary general 13.7 17.6 20.2 16.9 31.6 100.0 320 34.5 Specialized secondary 16.2 14.2 14.0 15.2 40.4 100.0 220 40.4 H igher 18.2 13.3 16.0 13.2 39.3 100.0 163 37.3 Wealth quintile Lowest 13.5 20.2 19.1 17.1 30.0 100.0 183 32.7 Second 12.6 17.4 16.8 14.3 39.0 100.0 163 40.2 Middle 17.2 13.4 18.5 13.4 37.5 100.0 151 36.5 Fourth 21.1 16.6 13.7 17.3 31.4 100.0 135 34.7 Highest 19.5 10.3 15.5 18.4 36.3 100.0 154 37.9 Total 16.5 15.7 16.9 16.1 34.8 100.0 785 36.9 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The median is the midpoint of the distribution of births by number of months since preceding birth. 46 | Fertility Figure 4.3 Percentage of Births Occurring Less than 24 Months after a Prior Birth, by Residence and Education 32 30 31 42 32 33 32 0 5 10 15 20 25 30 35 40 45 Higher Specialized secondary Secondary general Basic general EDUCATION Rural Urban RESIDENCE Total Percentage of non-first births in the five years preceding the survey ADHS 2005 4.7 AGE AT FIRST BIRTH Age at first birth is an important determinant of fertility. It has significant demographic conse- quences for society as a whole, as well as for the health and welfare of mothers and children. Table 4.6 shows the percentage of women age 15-49 who have given birth by specific exact ages, according to cur- rent age. For women age 25 and older, the median age at first birth is presented in the last column of the table. Table 4.6 Age at first birth Percentage of women age 15-49 who have given birth by specific exact ages, percentage who have never given birth, and median age at first birth, according to current age, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage of women who have Percentage Median given birth by exact age: who have Number age at ––––––––––––––––––––––––––––––––––––––– never of first Current age 15 18 20 22 25 given birth women birth1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 0.0 na na na na 97.6 1,123 a 20-24 0.0 3.4 15.4 na na 64.4 1,131 a 25-29 0.2 9.0 27.7 46.5 64.2 27.2 929 22.5 30-34 0.0 6.2 36.0 56.4 74.4 11.4 749 21.3 35-39 0.0 5.7 28.9 58.8 78.3 6.9 711 21.3 40-44 0.0 1.1 19.7 47.8 73.8 6.7 965 22.2 45-49 0.1 2.8 17.3 40.9 68.7 6.3 958 22.8 25-49 0.1 4.8 25.2 49.3 71.4 11.9 4,312 22.1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 1The median is the midpoint of the distribution of women by exact age at first birth. The 2005 ADHS findings indicate that childbearing among Armenian women begins relatively late. The majority of women age 20-24 (64 percent) have never given birth. The median age at first birth among women age 25 and older is between 21 and 23 years. The median age at first birth has decreased by more than one year from 22.8 years among women age 45-49 to 21.3 years among women age 30-39. However, median age at first birth seems to be increasing among younger women; the median age for women age 25-29 is 22.5 years. Fertility | 47 Changes in the median age at first birth are associated with changes in age at first marriage (see Table 7.2). Other researchers have noted that among Armenians, there is an expectation that a child will be born within the first two years of marriage (National Program on Reproductive Health, 1998). The 2005 ADHS data indicate that Armenian women of all cohorts have adhered to the practice of giving birth to a first child within two years of getting married. Among women age 25-29, for example, the median age at first marriage is almost one and a half years less than the median age at first birth (21.2 and 22.5 years, respectively). The same interval between age at first marriage and age at first birth is observed for women age 45-49 (21.5 and 22.8 years, respectively). Table 4.7 shows that, overall, there is little significant difference in the median age at first birth by background characteristics. The median age at first birth shows a positive relationship with wealth status. The median age at first birth varies only slightly by region, ranging from 21 years in Gegharkunik to 23 years in Yerevan. Table 4.7 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age, according to background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Current age Women Background ––––––––––––––––––––––––––––––––––––––––––––––––––– age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 23.6 22.4 21.6 22.7 23.1 22.7 Rural 20.7 20.0 20.8 21.4 22.5 21.1 Region Yerevan 23.9 23.0 21.8 23.5 23.3 23.2 Aragatsotn 20.9 20.1 20.8 21.6 22.2 21.3 Ararat 21.4 20.8 21.2 22.0 22.5 21.7 Armavir 21.1 20.0 21.0 21.5 23.1 21.4 Gegharkunik 19.8 20.4 20.5 21.0 22.7 20.9 Lori 21.3 20.2 (20.9) 21.1 22.9 21.3 Kotayk 21.7 21.4 20.6 21.4 21.3 21.3 Shirak 24.4 20.1 21.9 22.7 22.9 22.3 Syunik 23.3 21.6 21.1 22.2 22.5 22.2 Vayots Dzor (22.8) (20.2) (20.5) 21.9 22.8 21.5 Tavush 21.2 21.0 21.2 21.4 22.6 21.6 Education Basic general 18.9 (19.5) (19.7) (20.6) (21.4) 20.4 Secondary general 20.1 19.7 20.0 21.1 21.7 20.6 Specialized secondary 24.3 20.9 21.4 22.2 22.7 22.2 Higher a 24.5 24.3 24.9 25.4 a Wealth quintile Lowest 20.0 19.9 20.9 21.7 23.0 21.2 Second 21.6 20.5 20.9 21.6 22.8 21.5 Middle 22.0 21.8 21.1 22.2 22.5 22.1 Fourth 23.5 21.3 21.4 22.5 22.5 22.4 Highest 24.6 23.2 21.9 22.8 23.5 23.2 Total 22.5 21.3 21.3 22.2 22.8 22.1 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The median is the midpoint of the distribution of women by exact age at first birth. Figures in paren- theses are based on 25-49 unweighted cases. a = Omitted because less than 50 percent of the women had a birth before the beginning of the age group 48 | Fertility 4.8 TEENAGE PREGNANCY AND MOTHERHOOD Table 4.8 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child and percentage who have begun childbearing, by background characteristics, Armenia 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage who are Percentage –––––––––––––––––– who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15 0.0 0.0 0.0 234 16 0.0 0.8 0.8 242 17 1.3 2.6 3.9 207 18 3.5 3.0 6.5 192 19 7.3 5.1 12.4 248 Residence Urban 2.3 1.7 4.0 684 Rural 2.6 3.2 5.9 439 Region Yerevan 3.1 1.2 4.3 386 Aragatsotn 0.4 0.6 1.0 56 Ararat 6.7 0.8 7.5 66 Armavir 0.0 3.1 3.1 113 Gegharkunik 2.0 3.5 5.5 84 Lori 0.0 4.7 4.7 95 Kotayk 5.9 3.5 9.4 105 Shirak 1.3 3.8 5.1 117 Syunik 1.2 0.0 1.2 46 Vayots Dzor 0.0 0.6 0.6 18 Tavush 2.6 2.7 5.3 36 Education Basic general 2.7 1.6 4.3 212 Secondary general 3.2 3.4 6.7 491 Specialized secondary 2.2 2.8 5.0 183 Higher 0.8 0.0 0.9 237 Wealth quintile Lowest 0.9 4.4 5.3 215 Second 2.5 1.9 4.5 237 Middle 4.8 4.0 8.8 226 Fourth 4.4 1.0 5.4 196 Highest 0.0 0.2 0.2 248 Total 2.4 2.3 4.7 1,123 It is well known that adolescent pregnancy, early childbearing, and motherhood have negative socioeconomic and health consequences. Adolescent mothers are more likely to have complications during labor, which result in higher morbidity and mortality for themselves and their children. Moreover, childbearing during the teenage years frequently has adverse social consequences, particularly on female educational attainment, because women who become mothers in their teens are more likely to curtail education.1 Table 4.8 shows the percentage of women age 15-19 (teenagers) who are mothers or pregnant with their first child, by background characteristics. Overall, 5 percent of teenagers in Armenia have begun childbearing, 2 percent are already mothers, and 2 percent are pregnant with their first child. As expected, the proportion of young women who have begun childbearing in- creases rapidly with age, from less than 1 percent among women age 15 and 16 to 12 percent of women age 19. The variation in early childbearing by educational attainment and wealth quintile is unclear. The proportion of teenagers who have begun childbearing is highest among women with secondary general education and among women in the middle wealth quintile. Teenage fertility varies slightly by urban-rural residence. The proportion of teenagers who have begun childbearing is 4 percent in urban areas compared with 6 percent in urban ar- eas. Teenage childbearing varies significantly across regions, ranging from 1 percent in Vayots Dzor, Aragatsotn, and Syunik to 9 percent in Kotayk. In terms of trends, at the national level there is little difference overall in adolescent fertility be- tween the 2000 and 2005 ADHS surveys. Six percent of teenagers in 2000 and 5 percent of teenagers in 2005 reported either being pregnant or mothers at the time of data collection. Although the results by background characteristics vary greatly between the two surveys, this can be explained in part by sam- pling variability due to the small numbers of respondents in the samples who are teenagers. 1The legal age at marriage in Armenia is 17. Fertility | 49 CONTRACEPTION 5 The primary function of family planning programs is to advocate conscious entry into parenthood for both women and men. Contraception provides women and men with the means to achieve their de- sired number of children and to time the birth of those children. The efficacy of family planning depends on people’s knowledge of contraceptive methods and on the availability of methods to meet the varying needs of a wide spectrum of potential users. Availability of methods, in turn, depends on the quality and quantity of service providers and on available financial and technical resources. In 2002 the Parliament of Armenia adopted a new law on reproductive health and reproductive human rights. According to this law, use of contraception, including voluntary sterilization, is legal in Armenia. Family planning topics addressed in this chapter include knowledge of contraceptive methods, use of methods in the past and present, source of supply, reasons for nonuse, desire to use in the future, exposure to family planning messages, and attitudes toward family planning. Although the focus of this chapter is on women, some results from the men’s survey will also be presented because men play an im- portant role in the realization of reproductive goals. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Acquiring knowledge about fertility control is an important step towards gaining access to and then using a suitable contraceptive method in a timely and effective manner. The 2005 ADHS collected information on knowledge and use of contraception. To obtain these data, respondents were first asked to name all of the methods that they had heard about. For methods not mentioned spontaneously, a descrip- tion of the method was read, and the respondents were asked if they had heard of the method. For each method named or recognized, respondents were asked if they had ever used the method. Finally, women were asked if they (or their partners) were currently using a method. For analytical purposes, contracep- tive methods are grouped into two types in Table 5.1: modern and traditional. Modern methods include female sterilization, male sterilization, pill, intra uterine device (IUD), injectables, implants, male con- dom, female condom, diaphragm, foam/jelly, lactational amenorrhea method (LAM)1 and emergency contraception. Traditional methods include periodic abstinence (rhythm method), withdrawal, and folk methods. Table 5.1 shows that knowledge of contraception is high among both women and men. Almost all respondents know at least one method of contraception. The mean number of methods known is a rough indicator of the breadth of knowledge of family planning methods. On average, currently married women, who have the greatest exposure to the risk of pregnancy, know at least six methods. Knowledge of a mod- ern method is nearly universal. Approximately nine out of every ten married women have heard about the male condom and the IUD. Withdrawal is the most widely known traditional method (87 percent). Married men know an average of over five contraceptive methods, one less than married women. Almost all married men have heard of the condom and two-thirds have heard of the IUD. Eighty-six per- cent of married men have heard of withdrawal. 1 The 2005 ADHS questionnaire differed from the 2000 ADHS questionnaire in terms of asking about LAM. In 2000, a description of LAM would be read to the respondent if she did not recognize the term “lactational amenorrhea method.” The 2000 results suggested that the description caused many respondents to confuse the modern method of LAM w

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