Armenia - Demographic and Health Survey - 2012

Publication date: 2012

Armenia Demographic and Health Survey 2010 D em ographic and H ealth Survey A rm enia 2010 Armenia Demographic and Health Survey 2010 National Statistical Service Yerevan, Armenia Ministry of Health Yerevan, Armenia ICF International Calverton, Maryland USA April 2012 National Statistical Service Ministry of Health This report summarizes the findings of the 2010 Armenia Demographic and Health Survey (ADHS), which was conducted by the National Statistical Service and the Ministry of Health of the Republic of Armenia. ICF International provided technical assistance and the U.S. Agency for International Development (USAID) provided funding under the terms of contract number GPO-C-00-08-00008- 00. Additional support for the 2010 ADHS was received from the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or other donor organizations. 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 of the Republic of Armenia, Republic Avenue, 3 Government House, 0010, Yerevan, Republic of Armenia; Telephone: 374-10-524-213; Fax: 374-10-521-921; E-mail: info@armstat.am; Internet: http://www.armstat.am. Information about the MEASURE DHS project may be obtained from ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200; Fax: 301-572-0999; E-mail: reports@measuredhs.com; Internet: http://www.measuredhs.com. Recommended citation: National Statistical Service [Armenia], Ministry of Health [Armenia], and ICF International. 2012. Armenia Demographic and Health Survey 2010. Calverton, Maryland: National Statistical Service, Ministry of Health, and ICF International. Contents | iii CONTENTS Page TABLES AND FIGURES . vii PREFACE . xiii ACKNOWLEDGMENTS . xv SUMMARY OF FINDINGS . xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxv MAP OF ARMENIA . xxvi CHAPTER 1 INTRODUCTION 1.1 Geography, Population, History, and Economy . 1 1.2 Systems for Collecting Demographic and Health Data . 3 1.3 Health Care System Updates in Armenia . 3 1.4 Objectives and Organization of the Survey . 5 1.5 Response Rates . 8 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2.1 Housing Characteristics . 9 2.2 Wealth Quintiles . 14 2.3 Household Population by Age and Sex . 15 2.4 Household Composition . 17 2.5 Educational Attainment of Household Members . 20 2.6 Child Protection . 25 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3.1 Background Characteristics of Respondents . 31 3.2 Educational Attainment of Respondents . 32 3.3 Exposure to Mass Media . 34 3.4 Employment . 37 3.5 Occupation . 40 3.6 Employment Characteristics . 42 3.7 Employment Abroad . 43 3.8 Use of Smoking Tobacco . 46 CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY 4.1 Marital Status . 49 4.2 Age at First Marriage and Sexual Intercourse . 50 4.3 Recent Sexual Activity . 53 iv | Contents CHAPTER 5 FERTILITY 5.1 Current Fertility . 57 5.2 Fertility Differentials by Background Characteristics . 58 5.3 Fertility Trends . 59 5.4 Fertility Rates From NSS and the ADHS . 59 5.5 Children Ever Born and Living . 59 5.6 Birth Intervals . 60 5.7 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 62 5.8 Menopause . 63 5.9 Age at First Birth . 63 5.10 Teenage Pregnancy and Motherhood . 64 CHAPTER 6 FERTILITY PREFERENCES 6.1 Fertility Preferences . 67 6.2 Ideal Number of Children . 69 6.3 Fertility Planning . 71 6.4 Wanted and Unwanted Fertility . 72 CHAPTER 7 CONTRACEPTION 7.1 Knowledge of Contraceptive Methods . 75 7.2 Current Use of Contraception . 77 7.3 Current Use by Background Characteristics . 77 7.4 Access to Family Planning . 80 7.5 Informed Choice . 82 7.6 Discontinuation within 12 Months of Use . 83 7.7 Reasons for Using Traditional Methods . 85 7.8 Knowledge of the Fertile Period . 85 7.9 Need for Family Planning . 86 7.10 Future Use of Contraception . 88 7.11 Exposure to Family Planning Messages in the Mass Media . 88 7.12 Contact of Nonusers with Family Planning Providers . 90 7.13 Men’s Attitudes toward Family Planning . 92 CHAPTER 8 ABORTION 8.1 Pregnancy Outcomes . 95 8.2 Lifetime Experience with Induced Abortion . 97 8.3 Rates of Induced Abortion . 99 8.4 Trends in Induced Abortion . 100 8.5 Use of Contraceptive Methods before Abortion . 101 8.6 Reasons for Abortion . 102 8.7 Method of Abortion . 103 8.8 Cost of Abortion . 104 8.9 Counseling on Post-Abortion Use of Family Planning . 105 Contents | v CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Assessment of Data Quality . 107 9.2 Levels and Trends in Childhood Mortality . 109 9.3 Comparison of Rates from the National Statistical Service and the ADHS . 111 9.4 Socioeconomic Differentials in Childhood Mortality . 111 9.5 Demographic Differentials in Childhood Mortality . 112 9.6 Perinatal Mortality . 113 9.7 High-Risk Fertility Behavior . 114 CHAPTER 10 REPRODUCTIVE HEALTH 10.1 Antenatal Care . 117 10.2 Assistance and Medical Care at Delivery . 123 10.3 Postnatal Care for the Mother . 128 10.4 Postnatal Care for the Newborn . 131 10.5 Problems in Accessing Health Care . 132 10.6 Breast Examination and Pap Smear Test . 134 CHAPTER 11 CHILD HEALTH 11.1 Child’s Weight and Size at Birth . 139 11.2 Vaccination Coverage . 140 11.3 Trends in Vaccination Coverage . 143 11.4 Acute Respiratory Infection . 144 11.5 Fever. 145 11.6 Diarrhea . 146 11.7 Knowledge of ORS Packets . 150 11.8 Disposal of Children’s Stools . 150 CHAPTER 12 NUTRITION 12.1 Nutritional Status of Children . 153 12.2 Breastfeeding and Supplementation . 158 12.3 Infant and Young Child Feeding (IYCF) Practices . 164 12.4 Micronutrient Intake in Children . 166 12.5 Micronutrient Intake in Women . 168 CHAPTER 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS 13.1 Knowledge of HIV/AIDS and Methods of HIV Prevention . 171 13.2 Rejection of Misconceptions about HIV/AIDS Transmission and Comprehensive Knowledge of AIDS . 175 13.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 179 13.4 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS . 181 13.5 Attitudes toward Negotiating Safer Sex . 184 13.6 Attitudes toward Condom Education for Youth . 186 13.7 High-Risk Sex . 188 13.8 Coverage of Prior HIV Testing . 193 vi | Contents 13.9 Knowledge about Sexually Transmitted Infections and Self-Reporting of STIs . 195 13.10 Prevalence of Medical Injections . 198 13.11 HIV/AIDS-Related Knowledge and Behavior among Youth . 200 CHAPTER 14 ACCESS TO AND UTILIZATION OF PRIMARY HEALTH CARE SERVICES 14.1 Primary Health Care Provider . 210 14.2 Utilization of Primary Health Care Services . 214 14.3 Preventive Health Examination Visits . 216 14.4 Exposure to General Health Care Messages in the Media . 217 14.5 Health Insurance . 219 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Cash Earnings. 221 15.2 Control Over Cash Earnings and Relative Magnitude of Women’s Earnings . 222 15.3 Ownership of Assets . 226 15.4 Women’s Participation in Decisionmaking . 228 15.5 Attitudes toward Wife Beating . 232 15.6 Indicators of Women’s Empowerment . 236 15.7 Current Use of Contraception by Women’s Status . 237 REFERENCES . 239 APPENDIX A SAMPLE DESIGN FOR THE 2010 ARMENIA DHS (2010 ADHS) . 243 A.1 Introduction . 243 A.2 Objectives of the Sample Design . 243 A.3 Sample Frame . 243 A.4 Stratification . 243 A.5 Sample Allocation . 244 A.6 Sample Selection . 245 A.7 Sample Implementation . 245 A.8 Sample Weights . 245 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 249 APPENDIX C DATA QUALITY TABLES . 267 APPENDIX D PERSONS INVOLVED IN THE 2010 ARMENIA DEMOGRAPHIC AND HEALTH SURVEY . 273 APPENDIX E QUESTIONNAIRES . 277 Tables and Figures | vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 8 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION Table 2.1 Household drinking water . 10 Table 2.2 Household sanitation facilities . 11 Table 2.3 Hand washing . 12 Table 2.4 Household characteristics . 13 Table 2.5 Household possessions . 14 Table 2.6 Wealth quintiles . 15 Table 2.7 Household population by age, sex, and residence . 16 Table 2.8 Household composition . 17 Table 2.9 Birth registration of children under age 5 . 18 Table 2.10 Children's living arrangements and orphanhood . 19 Table 2.11 Educational attainment of the female household population . 21 Table 2.12 Educational attainment of the male household population . 22 Table 2.13 School attendance ratios . 23 Table 2.14 Child discipline . 26 Table 2.15 Child labor . 28 Table 2.16 Child labor and school attendance . 29 Figure 2.1 Population Pyramid . 16 Figure 2.2 Percentage of Children under Age 15 Who Live Only with Their Mother but Whose Father is Alive, Armenia 2000, 2005, and 2010 . 20 Figure 2.3 Age-specific Attendance Rates of the De Facto Population 5 to 24 Years . 24 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . 32 Table 3.2.1 Educational attainment: Women . 33 Table 3.2.2 Educational attainment: Men . 34 Table 3.3.1 Exposure to mass media: Women . 35 Table 3.3.2 Exposure to mass media: Men . 36 Table 3.4.1 Employment status: Women . 38 Table 3.4.2 Employment status: Men. 39 Table 3.5.1 Occupation: Women . 41 Table 3.5.2 Occupation: Men . 42 Table 3.6 Type of employment: Women . 43 Table 3.7 Respondent's employment abroad . 44 Table 3.8 Husband's employment abroad . 45 Table 3.9.1 Use of tobacco: Women . 47 Table 3.9.2 Use of tobacco: Men . 48 Figure 3.1 Women's and Men's Employment Status in the Past 12 Months . 37 Figure 3.2 Trends in Employment Status, Armenia 2000-2010 . 40 viii | Tables and Figures CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY Table 4.1 Current marital status . 49 Table 4.2 Age at first marriage . 50 Table 4.3 Median age at first marriage by background characteristics. 51 Table 4.4 Age at first sexual intercourse . 52 Table 4.5 Median age at first intercourse by background characteristics . 53 Table 4.6.1 Recent sexual activity: Women . 54 Table 4.6.2 Recent sexual activity: Men . 56 CHAPTER 5 FERTILITY Table 5.1 Current fertility . 57 Table 5.2 Fertility by background characteristics . 58 Table 5.3 Trends in age-specific fertility rates . 59 Table 5.4 Children ever born and living . 60 Table 5.5 Birth intervals . 61 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 62 Table 5.7 Menopause . 63 Table 5.8 Age at first birth . 64 Table 5.9 Median age at first birth . 64 Table 5.10 Teenage pregnancy and motherhood . 65 Figure 5.1 Trends in Age-Specific Fertility Rates, Armenia 2000, 2005, and 2010 . 58 CHAPTER 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences by number of living children . 67 Table 6.2.1 Desire to limit childbearing: Women . 68 Table 6.2.2 Desire to limit childbearing: Men . 69 Table 6.3 Ideal number of children . 70 Table 6.4 Mean ideal number of children . 71 Table 6.5 Fertility planning status . 72 Table 6.6 Wanted fertility rates . 73 CHAPTER 7 CONTRACEPTION Table 7.1 Knowledge of contraceptive methods . 76 Table 7.2 Current use of contraception by age . 77 Table 7.3 Current use of contraception by background characteristics . 78 Table 7.4 Trends in the current use of contraception . 80 Table 7.5 Source of modern contraception methods . 81 Table 7.6 Informed choice . 83 Table 7.7 Contraceptive discontinuation rates . 84 Table 7.8 Reasons for discontinuation . 85 Table 7.9 Knowledge of fertile period . 86 Table 7.10 Need and demand for family planning among currently married women . 87 Table 7.11 Future use of contraception . 88 Table 7.12 Exposure to family planning messages . 89 Table 7.13 Contact of nonusers with family planning providers . 91 Table 7.14 Men's attitudes toward use of contraception by women . 92 Tables and Figures | ix Figure 7.1 Trends in Contraceptive Use among Currently Married Women . 79 Figure 7.2 Transportation to Source of Contraceptive Supply . 82 Figure 7.3 Family Planning Counseling of Nonusers by Type of Health Provider . 91 CHAPTER 8 ABORTION Table 8.1 Pregnancy outcome by background characteristics . 96 Table 8.2 Lifetime experience with induced abortion . 98 Table 8.3 Induced abortion rates . 99 Table 8.4 Induced abortion rates by background characteristics. 100 Table 8.5 Trends in age-specific abortion rates . 101 Table 8.6 Use of contraception before pregnancy . 102 Table 8.7 Reason for abortion . 103 Table 8.8 Method of abortion . 104 Table 8.9 Cost of the last abortion . 105 Figure 8.1 Trends in Pregnancy Outcomes, Armenia 2000, 2005, and 2010 . 97 Figure 8.2 Age-Specific Fertility Rates and Induced Abortion Rates, Armenia 2010 . 99 Figure 8.3 Trends in Age-Specific Induced Abortion Rates, Armenia 2000, 2005, and 2010 . 100 Figure 8.4 Counseling on Post-Abortion Family Planning at the Facility Where the Most Recent Abortion Was Conducted . 106 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Early childhood mortality rates . 109 Table 9.2 Comparison of infant mortality from registration and survey . 111 Table 9.3 Early childhood mortality rates by socioeconomic characteristics . 112 Table 9.4 Early childhood mortality rates by demographic characteristics . 113 Table 9.5 Perinatal mortality . 114 Table 9.6 High-risk fertility behavior . 115 Figure 9.1 Early Childhood Mortality Rates, Armenia 1996-2010 . 110 Figure 9.2 Trends in Infant Mortality, Armenia 1986-2010 . 110 CHAPTER 10 REPRODUCTIVE HEALTH Table 10.1 Antenatal care . 118 Table 10.2 Number of antenatal care visits and timing of first visit . 119 Table 10.3 Components of antenatal care . 120 Table 10.4 Eligibility for free ANC services and payment for the last ANC visit . 122 Table 10.5 Payment for the last ANC visit . 123 Table 10.6 Place of delivery . 124 Table 10.7 Assistance during delivery . 125 Table 10.8 Payment for delivery of the last birth . 127 Table 10.9 Access for free delivery services before and after July 2008 . 128 Table 10.10 Timing of first postnatal checkup for the mother . 129 Table 10.11 Type of provider of first postnatal checkup for the mother . 130 Table 10.12 Timing of first postnatal checkup for the newborn . 131 Table 10.13 Type of provider of first postnatal checkup for the newborn . 132 Table 10.14 Problems in accessing health care . 133 Table 10.15 Last breast self-examination . 134 Table 10.16 Breast examination by a health provider . 136 Table 10.17 Pap smear test . 137 x | Tables and Figures Figure 10.1 Eligibility for Free ANC Services . 121 Figure 10.2 Eligibility for Free Delivery Services . 126 Figure 10.3 Trends in Recent Breast Self-Examination (BSE) . 135 CHAPTER 11 CHILD HEALTH Table 11.1 Child's weight and size at birth . 139 Table 11.2 Vaccinations by source of information . 141 Table 11.3 Vaccinations by background characteristics . 142 Table 11.4 Vaccinations in the first year and a half of life . 143 Table 11.5 Prevalence of symptoms of ARI . 145 Table 11.6 Prevalence of fever . 146 Table 11.7 Prevalence of diarrhea . 147 Table 11.8 Diarrhea treatment . 148 Table 11.9 Feeding practices during diarrhea . 149 Table 11.10 Knowledge of ORS packets . 150 Table 11.11 Disposal of children's stools . 151 Figure 11.1 Trends in Vaccination Coverage among Children Age 18-29 Months, Armenia 2000-2010 . 144 CHAPTER 12 NUTRITION Table 12.1 Nutritional status of children . 155 Table 12.2 Initial breastfeeding . 159 Table 12.3 Breastfeeding status by age . 160 Table 12.4 Median duration of breastfeeding . 162 Table 12.5 Foods and liquids consumed by children in the day or night preceding the interview . 163 Table 12.6 Infant and young child feeding (IYCF) practices . 164 Table 12.7 Micronutrient intake among children . 167 Table 12.8 Micronutrient intake among mothers . 169 Figure 12.1 Nutritional Status of Children by Age . 156 Figure 12.2 Trends in Nutritional Status of Children under Age 5 . 157 Figure 12.3 Infant Feeding Practices by Age . 161 Figure 12.4 IYCF Indicators on Breastfeeding Status . 162 Figure 12.5 IYCF Indicators on Minimum Acceptable Diet . 166 CHAPTER 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS Table 13.1 Knowledge of AIDS . 172 Table 13.2 Knowledge of HIV prevention methods . 174 Table 13.3.1 Comprehensive knowledge about AIDS: Women . 176 Table 13.3.2 Comprehensive knowledge about AIDS: Men . 177 Table 13.4 Knowledge of prevention of mother to child transmission of HIV . 180 Table 13.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 182 Table 13.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 183 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 185 Table 13.7 Adult support of education about condom use to prevent AIDS . 187 Table 13.8 Multiple sexual partners: Men . 189 Table 13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 191 Table 13.10 Payment for sexual intercourse . 192 Tables and Figures | xi Table 13.11.1 Coverage of prior HIV testing: Women . 194 Table 13.11.2 Coverage of prior HIV testing: Men . 195 Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 197 Table 13.13 Prevalence of medical injections . 199 Table 13.14 Comprehensive knowledge about AIDS and of a source of condoms among young people . 201 Table 13.15 Age at first sexual intercourse among young people . 202 Table 13.16 Premarital sexual intercourse and condom use during premarital sexual intercourse among young men . 204 Table 13.17 Multiple sexual partners in the past 12 months among young men . 205 Table 13.18 Age-mixing in sexual relationships among women and men age 15-19 . 206 Table 13.19 Recent HIV tests among young women . 207 Figure 13.1 Infections Spontaneously Identified by Survey Respondents as Sexually Transmitted. 196 Figure 13.2 Women and Men Seeking Advice or Treatment for STIs . 198 Figure 13.3 Trends in Age at First Sexual Intercourse . 203 CHAPTER 14 ACCESS TO AND UTILIZATION OF PRIMARY HEALTH CARE SERVICES Table 14.1.1 Primary doctor: Women . 211 Table 14.1.2 Primary doctor: Men . 212 Table 14.2 Utilization of Primary Health Care . 215 Table 14.3.1 Exposure to mass media health messages: Women . 218 Table 14.3.2 Exposure to mass media health messages: Men . 219 Figure 14.1 Family Doctor’s Background and Respondent’s Satisfaction with Services, Women and Men Age 15-49 . 213 Figure 14.2 Reasons for Not Seeking Care in a Polyclinic or an Ambulatory Facility . 216 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women and men . 222 Table 15.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings: Women . 223 Table 15.2.2 Control over men's cash earnings . 225 Table 15.3 Woman's control over her own earnings and over those of her husband . 226 Table 15.4.1 Ownership of assets: Women . 227 Table 15.4.2 Ownership of assets: Men . 228 Table 15.5 Participation in decision making . 229 Table 15.6.1 Women's participation in decision making by background characteristics . 230 Table 15.6.2 Men's participation in decision making by background characteristics . 232 Table 15.7.1 Attitude toward wife beating: Women . 234 Table 15.7.2 Attitude toward wife beating: Men . 235 Table 15.8 Indicators of women's empowerment . 236 Table 15.9 Current use of contraception by women's empowerment . 237 Figure 15.1 Number of Household Decisions in Which Currently Married Women Participate . 231 xii | Tables and Figures APPENDIX A SAMPLE DESIGN FOR THE 2010 ARMENIA DHS (2010 ADHS) Table A.1 Sample allocation of clusters and households . 244 Table A.2 Sample allocation of completed interviews with women and men . 244 Table A.3 Sample implementation: Women . 247 Table A.4 Sample implementation: Men . 248 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 251 Table B.2 Sampling errors for National sample . 252 Table B.3 Sampling errors for Urban sample . 253 Table B.4 Sampling errors for Rural sample . 254 Table B.5 Sampling errors for Yerevan sample . 255 Table B.6 Sampling errors for Aragatsotn sample . 256 Table B.7 Sampling errors for Ararat sample. 257 Table B.8 Sampling errors for Gegharkunik sample . 258 Table B.9 Sampling errors for Armavir sample . 259 Table B.10 Sampling errors for Lori sample . 260 Table B.11 Sampling errors for Kotayk sample . 261 Table B.12 Sampling errors for Shirak sample . 262 Table B.13 Sampling errors for Syunik sample . 263 Table B.14 Sampling errors for Vayots Dzor sample . 264 Table B.15 Sampling errors for Tavush sample . 265 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 . 269 Table C.5 Reporting of age at death in days . 270 Table C.6 Reporting of age at death in months . 271 Table C.7 Nutritional status of children based on NCHS/CDC/WHO International Reference Population . 272 Preface | xiii PREFACE The 2010 Armenia Demographic and Health Survey (ADHS) is 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 (NSS) and the Ministry of Health (MOH) of the Republic of Armenia from October 2010 through December 2010. ICF International 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. The United Nations Children’s Fund (UNICEF)/Armenia, United Nations Population Fund (UNFPA)/Armenia, and Joint United Nations Program on HIV/AIDS (UNAIDS)/Armenia supported the survey through in-kind contributions. The purpose of the 2010 ADHS was to collect national and regional 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 first reported in the 2000 ADHS (NSS, MOH, and ORC Macro, 2001) and the 2005 ADHS (NSS, MOH, and ORC Macro, 2006). 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. When possible, the 2010 ADHS data are compared with the 2005 and 2000 ADHS data. The survey findings provide estimates for a variety of demographic indicators. The 2010 ADHS results are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving health and health services for the people of Armenia. The 2010 ADHS also contributes to the growing international database on demographic and health-related indicators. Acknowledgments | xv 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 2010 Armenia Demographic and Health Survey (2010 ADHS) 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 2010 ADHS. • ICF International for providing technical support, training for fieldwork staff, consultations, recommendations, and analyses of the data collected. • United Nations Children’s Fund (UNICEF)/Armenia, Joint United Nations Programme on HIV/AIDS (UNAIDS)/Armenia, and United Nations Population Fund (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. • Finally, to 6,700 households, 5,922 women, and 1,584 men, whose honest participation made it possible to obtain the reliable information collected in the 2010 ADHS. Mr. Gagik Gevorgyan National Director, ADHS Member of the State Council on Statistics of RA Mr. Sergey Khachatryan National Director for Medical Affairs, ADHS Deputy Minister of Health Summary of Findings | xvii SUMMARY OF FINDINGS The 2010 Armenia Demographic and Health Survey (2010 ADHS) is a nationally representa- tive survey of 5,922 women and 1,584 men age 15-49. The 2010 ADHS is the third in a series of DHS surveys conducted in Armenia. The 2010 ADHS was undertaken to provide estimates for key population indicators and trends including fertility; abortion; nuptiality; awareness and use of family planning methods; sexual activity; infant and child mortality; childhood immuniza- tion levels; maternal and child health; infant and young children feeding practices; nutritional status of young children; and awareness and behavior regarding HIV/AIDS and other sexual- ly transmitted infections. The 2010 ADHS also collected information on a number of health topics related to access and utilization of primary health care services; health care costs; and health insurance coverage for women and men age 15- 49. Additionally, in all surveyed households the 2010 ADHS collected information about child labor for children age 5-17 and about child dis- cipline for one randomly selected child age 2-14. Fieldwork for the 2010 ADHS was conducted from October to December 2010. Height and weight measurements were collected for children under age 5 in all households in the survey. The 2010 ADHS was conducted by the Na- tional Statistical Service and the Ministry of Health (MOH) of the republic of Armenia. ICF International provided technical support for the survey through the USAID-sponsored MEAS- URE DHS Project. The U.S. Agency for Interna- tional Development (USAID)/Armenia provided funding, and the United Nations Children’s Fund (UNICEF)/Armenia, the Joint United Nations Programme on HIV/AIDS (UNAIDS)/Armenia, and the UN Population Fund (UNFPA)/Armenia supported the survey through in-kind contribu- tions. CHARACTERISTICS OF RESPONDENTS More than 60 percent of Armenians live in urban areas. Yerevan, the capital, accounts for more than one-third of all respondents. All households in Armenia have electricity and the vast majority of households have water piped into the dwelling/yard/plot, a flush toilet, a fin- ished floor, and a color television. Household ownership of most durable goods has increased during the past five years; in particular, the own- ership of computers and mobile phones has in- creased dramatically. Twenty-nine percent of households had computers in 2010 compared with 9 percent in 2005, and 87 percent of house- holds used mobile phones in 2010 compared with 33 percent in 2005. The proportion of households using natural gas for cooking has nearly doubled during the past five years; eight in ten households relied on natural gas for cook- ing in 2010 compared with four in ten in 2005. All but a handful of women and men age 15- 49 in the sample have attended school. Approx- imately four in ten women and five in ten men have reached only secondary school, 28 percent of women and 19 percent of men have reached secondary-special school, and 30 percent each of women and men have attended university. Yere- van residents have a clear educational advantage over the rest of the country: nearly half of wom- en and men in Yerevan have some university education. Thirty-five percent of women and 74 percent of men were employed in the 12 months prior to the survey. FERTILITY Fertility rates. A useful index of the level of fertility in a country is the total fertility rate (TFR), which indicates the number of children a woman would have if she passed through the childbearing years at the current age-specific fertility rates. The TFR was 1.7 children per woman for the three years preceding the 2010 ADHS. This is below replacement level. The TFR is only slightly lower in urban are- as (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 and the 2005 ADHS for the three years preceding that survey, indicating no recent change has occurred in overall fertility levels. xviii * Summary of Findings Age at first birth. Research has shown that childbearing in the teenage years is associated with increased social and health problems for both mother and child. The survey found that only 4 percent of women age 15-19 had given birth. Almost all births to teenage women oc- curred at ages 18 and 19. The median age at first birth among women age 25-49 is 22.5 years, slightly higher than 22.1 years in 2005 and 21.8 years in 2000; moreover, it seems to be increas- ing among younger women age 25-29 (24.1 years for this age group in 2010 compared with 22.5 years in 2005 and 21.4 years in 2000). Birth intervals. Research has shown that children born soon after a previous birth, espe- cially those born within two years of the previ- ous birth, have an increased risk of morbidity and mortality. In Armenia, 28 percent of second and higher order births occur after a birth inter- val of less than two years. The proportion of closely spaced births declines as education of the mother increases. Fertility preferences. Among currently married women in the 2010 ADHS, 58 percent reported that they either wanted no more chil- dren or were sterilized compared with 71 percent in the 2005 ADHS. Another 25 percent wanted another child, 8 percent were infecund (unable to conceive), and 9 percent were undecided about having another child. CONTRACEPTION Knowledge. Knowledge of contraception is widespread in Armenia. Among married women and men, knowledge of at least one method is universal (100 percent). On average, married women reported knowing eight and married men reported knowing seven methods of contracep- tion. Current use. Over half (55 percent) of mar- ried women reported that they were currently using a contraceptive method: 27 percent were using modern methods, and 28 percent were using traditional methods. The most widely used method among currently married women is, by far, withdrawal (25 percent), followed by the male condom (15 percent) and the IUD (10 per- cent). The difference in the overall use of contra- ception among married women in urban and rural areas is not large (58 percent and 51 per- cent, respectively). Nevertheless, urban women and women with more education show distinc- tive behavior patterns by relying more on mod- ern methods (in particular, the condom) and less on traditional methods (in particular, withdraw- al). There is considerable variation in contracep- tive use by region. Yerevan and Lori have the highest rates of use of modern methods (42 per- cent and 36 percent, respectively) compared with 10 to 11 percent in Tavush and Vayots Dzor. As expected, contraceptive use, especially the use of modern methods, increases with edu- cational attainment. Women with higher levels of education are twice as likely to use a modern method as women with only secondary or basic education (39 percent compared with 20 to 21 percent). This difference is mainly due to the increased use of the IUD and male condom. Wealth also correlates positively with women’s contraceptive use; modern contraceptive use increases markedly as household wealth increas- es, from 21 percent among married women in the lowest wealth quintile to 38 percent among those in the highest wealth quintile. Trends in current use. There has been a slight decrease in the use of any method of con- traception by currently married women since the 2000 ADHS, when 61 percent of currently mar- ried women reported using a contraceptive method compared with 55 percent in 2010. Use of modern contraceptive methods has increased from 22 percent in 2000 to 27 percent in 2010. In particular, the percentage of women using male condoms has increased from 7 percent in 2000 to 15 percent in 2010. The use of tradition- al methods has decreased over the past 10 years (from 38 percent in 2000 down to 28 percent in 2010). This is particularly true of the use of withdrawal (32 percent in 2000 to 25 percent in 2010). Method failure. A key concern for the fami- ly planning program is the rate at which users discontinue use of contraception and their rea- sons for stopping. Overall, 23 percent of all women who started using a contraceptive meth- od in the past five years discontinued use within 12 months of adopting the method; 3 percent switched to another method. The first-year dis- continuation rate is lowest among users of the IUD (4 percent) and highest among users of withdrawal (28 percent). Approximately 15 per- cent of users of condoms discontinued using the method during the first year of use. With regard Summary of Findings | xix to the reasons for stopping use, users were more likely to discontinue during the first year of use because of method failure, i.e., becoming preg- nant while using a method. Reasons for using traditional methods. As mentioned earlier, traditional methods account for about half of all contraceptive use and have high failure rates. The most common reason, given by 60 percent of women, was that the tra- ditional method is the husband’s or partner’s choice, the same percentage as reported in 2005 (59 percent). However, in 2010, 31 percent say that fear of or experience with side effects was a concern, and 20 percent say that the cost of modern methods was a factor in their choice. Fewer women cite these reasons than in 2005 when 47 and 37 percent of women reported fear of side effects or cost, respectively. Similarly, fewer women in 2010 feel that they lack knowledge about modern methods (10 percent) or that they are difficult to find or are not readily available (11 percent), than in 2005 when 20 and 26 percent, respectively, gave these reasons for using a traditional method. Future use. Among married women who were not using contraception, 23 percent report- ed that they intended use in the future, a de- crease from 29 percent in the 2005 ADHS and 36 percent in the 2000 ADHS. Source of supply. Most modern method us- ers obtained their methods from the private sec- tor (61 percent), primarily pharmacies (59 per- cent). Only one-third of users in 2010 (37 per- cent) received their method from the public sec- tor compared with 53 percent in 2005. However, the public sector is still the primary source for almost all users of the IUD (96 percent), the second most common modern method after the male condom. Among condom and pill users, the vast majority reported obtaining their most re- cent supply from a pharmacy (96 and 94 percent, respectively). 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 wom- an 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 0.8 abortions during her lifetime. This rate is considerably lower than the comparable rates of 1.8 in the 2005 ADHS and 2.6 in the 2000 ADHS. The proportion of preg- nancies ending in induced abortion has declined over the past ten years, from 55 percent in 2000 to 45 percent in 2005 and to 29 percent in 2010. Abortion differentials. In 2010, the TAR for rural women was almost the same as that for urban women (0.9 versus 0.8), while in 2005, the rates were 2.2 and 1.5, respectively. 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. Almost half (48 percent) of all abortions are to women who use contraception but experience method failure, a large proportion of whom are using withdrawal. Greater access to and use of more reliable methods would reduce the inci- dence of abortion. CHILDHOOD MORTALITY Trends in childhood mortality. Data from the 2010 ADHS indicate that childhood mortali- ty has declined over the past ten years. For ex- ample, infant mortality has declined from 24 deaths for the period 2001-2005 to 13 deaths for the period 2006-2010. There has been a similar decline in under-5 mortality, from 27 deaths to 16 deaths per 1,000 births. However, the data show that there was very little change in infant and under-5 mortality rates during the 10-15- year period prior to the survey. Differentials in infant mortality. The sur- vey found levels of infant mortality to be higher in rural areas than in urban areas. Infant mortali- ty levels are also higher among children of women with lower levels of education than among children of women with higher than sec- ondary-special education. MATERNAL AND CHILD HEALTH AND NUTRITION Antenatal care. Armenia has a well- developed health care system with an extensive infrastructure of facilities that provide maternal xx * Summary of Findings care services. Overall, the levels of antenatal care and delivery assistance are high. Ninety- nine percent of mothers receive antenatal care from professional health providers, mostly gyne- cologists. There is very little urban-rural distinc- tion in antenatal care received from doctors. Ninety-three percent of pregnant women make four or more antenatal care visits, which is a much higher percentage than that recorded in the 2005 ADHS (71 percent) and in the 2000 ADHS (65 percent). Although there is some urban-rural differential in the percentage of women making four or more ANC visits in 2010 (96 and 89 percent, respectively), the gap is much smaller than that reported in the 2005 ADHS (82 and 53 percent, respectively) and in the 2000 ADHS (82 and 45 percent, respectively). In terms of content of care, all women (100 percent) said they were weighed, had their blood pressure tested, and gave blood and urine speci- mens. Two-thirds of women had their blood taken for HIV testing (67 percent). However, the provision of information about danger signs that women may experience during pregnancy is lagging (57 percent). Delivery care. All births are delivered under the supervision of a trained medical professional, and 99 percent of births occur at health facilities. Home deliveries are somewhat more common in Gegharkunik region (2 percent). Childhood vaccinations. The health cards maintained at the health facilities are the primary source of vaccination data. Almost all children age 18-29 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. Overall, 92 percent of children age 18-29 months have received all basic WHO- recommended vaccinations (BCG, measles, and three doses each of DPT and polio). The results of the 2010 ADHS indicate that, in the past five years, there has been a substantial increase in vaccination coverage with all basic WHO- recommended vaccinations. The increase is no- table among children age 18-29 months, who were only 78 percent fully immunized by the date of the interview in 2005 but 92 percent immunized by 2010. The same is true for vac- cinations recommended by the Ministry of Health (MOH) (all basic vaccinations and three doses of the hepatitis B vaccine): although 74 percent of those age 18-29 months were fully vaccinated by the date of the interview in 2005, this compares with 87 percent in 2010. Treatment of diarrhea. The 2010 ADHS asked about the treatment of children who suf- fered from diarrhea during the two weeks pre- ceding the survey. Overall, 90 percent of chil- dren under age 5 with diarrhea in the two weeks before the survey were given either oral rehydra- tion salts or increased fluids (oral rehydration therapy). For only 4 percent of children with diarrhea, mothers reported that they engaged in the harmful practice of curtailing fluid intake. Food intake is curtailed more than fluid intake during episodes of diarrhea: 29 percent of chil- dren with diarrhea were given somewhat less food than usual, and 15 percent were given much less food than usual. The proportion of children with diarrhea who received more to drink than usual has increased substantially in the past five years, from 43 percent in the 2005 ADHS to 65 percent in the 2010 ADHS. Knowledge of ORS packets has increased, from 70 percent in the 2005 ADHS to 75 percent in 2010. The greatest increase is seen among rural mothers (64 percent of rural mothers knew of ORS in 2005, com- pared with 76 percent in 2010). 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 10.9 months, the durations of exclusive and predomi- nant breastfeeding (breastfeeding plus plain water) are short (1.8 months and 4.2 months, respectively). Nutritional status. In the 2010 ADHS, the height and weight of children under age 5 were measured. The 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; wast- ing 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 only slightly more than 2 per- cent of children will be stunted or wasted. In Armenia, however, 19 percent of children under age 5 are stunted, and 4 percent are wasted. Overall, 5 percent of children are underweight. Summary of Findings | xxi Conversely, 15 percent of children are overweight (weight-for-height above +2 SD), which is about seven times more than what one would expect in a normally distributed popula- tion. Overall, there has been a slight increase in the percentage of children who are stunted and underweight since 2000.1 The percentage of children under 5 who are stunted has increased from 17 percent in 2000 to 18 percent in 2005 and then to 19 percent in 2010. The proportion of children under age 5 who are underweight has also increased; from 2 percent in 2000 to 5 per- cent in 2010. The proportion of children who are wasted went up to 5 percent in 2005 but has dropped, to 4 percent, in 2010. The proportion of children who are overweight has increased in the past five years, from 11 percent in 2005 to 15 percent in 2010. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS The currently low level of HIV infection in Armenia provides a unique window of oppor- tunity for early targeted interventions to prevent further spread of the disease. Knowledge and attitudes. Almost all re- spondents reported that they have heard of HIV/AIDS. Roughly 70 to 80 percent of women and 80 to 87 percent of men know about the three main ways to reduce its transmission: ab- stinence, being faithful to one uninfected part- ner, and using condoms. Nevertheless, only one in five women (20 percent) and one in six men (16 percent) 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 kissing someone infected with the AIDS virus. Over the past five years, the per- centage of women who have comprehensive knowledge about HIV/AIDS has decreased from 26 percent in 2005 to 20 percent in 2010, and the percentage among men has decreased from 24 to 16 percent over the same period. 1 For comparison purposes, data from the 2000, 2005, and 2010 ADHS surveys were all re-calculated ac- cording to the new 2006 WHO Child Growth refer- ence standards, but restricted to children born to women interviewed with the Woman’s Questionnaire and living with the mother. Stigma surrounding AIDS is widespread in Armenia. Both women and men tend to express somewhat more accepting attitudes toward HIV- infected relatives than non-relatives. Fewer than three in ten women (29 percent) and 41 percent of men say that they would not want to keep secret a family member’s infection with the AIDS virus, and about half of respondents (49 percent of women and 54 percent of men) say they would be willing to care for a family mem- ber with the AIDS virus in their home. Only around one-fifth of respondents say that an HIV- positive teacher should be allowed to continue teaching and only 14 percent of women and 16 percent of men would buy fresh food from a shopkeeper with AIDS. The percentage express- ing accepting attitudes on all four measures is low, 1 percent among women and less than 5 percent among men. Sexual behavior. Only 15 percent of men and a negligible fraction of women reported having had more than one sexual partner in the 12 months before the survey. Among men who had multiple partners during the past 12 months, more than half (53 percent) had concurrent sexu- al partners during the same period. Sexually active men report having an average of 5.8 life- time sexual partners, about five times the aver- age number of lifetime sexual partners reported by sexually active women (1.0 partner). Condom use. Seven in ten men who had more than one sexual partner in the 12 months preceding the survey reported using a condom at the most recent sexual encounter (72 percent). More than seven in ten young women (72 per- cent) and more than nine in ten young men (93 percent) know a place where a person can get condoms. The percentage of youth who know a condom source has increased slightly, from 69 to 72 percent among women and has increased substantially, from 62 to 93 percent, among men since 2005. OTHER HEALTH ISSUES AND PRIMARY HEALTH CARE Primary doctor. In the 2010 ADHS, all re- spondents age 15-49 were asked whether they have chosen a primary doctor. Overall, more than half of women (58 percent) and more than one-third of men (38 percent) have chosen a primary doctor. Among respondents who have a primary doctor, 70 percent of women and 60 percent of men said that their primary doctor xxii * Summary of Findings specialized in internal and general medicine (a therapevt in old Soviet terminology). Fifteen percent of women and 17 percent of men have chosen a family doctor as their primary doctor, with smaller percentages of both women and men choosing a pediatrician or other type of doctor. Nine in ten respondents who had a fami- ly doctor as their primary doctor stated that their family doctor worked at an outpatient health facility serving the population from their area of residence. In general, both women and men were satisfied with the services they have received from their family doctor during their most recent visit (97 percent and 99 percent, respectively). Visits to a polyclinic or an ambulatory fa- cility. All respondents age 15-49 were asked about their experiences utilizing primary health care services in the two months preceding the survey. Data show that 76 percent of female respondents and 85 percent of male respondents report that they had no perceived health need that required a visit to a polyclinic or an ambula- tory facility in the two months preceding the survey. Only 14 percent of women and 10 per- cent of men had a perceived health need and went to a polyclinic or an ambulatory facility. The remaining 10 percent of women and 6 per- cent of men had a perceived health need, but did not go to these facilities. Fifty percent of women and 41 percent of men who had a perceived need but who did not seek care, said that the care was too expensive. Smoking. The proportion of current ciga- rette smokers among women and men has not changed much in the past five years. For women, the proportion who are current cigarette smokers has remained at 2 percent since 2005. Among men, the proportion of current cigarette smokers is nearly the same as in 2005 (61 percent in 2005 and 63 percent in 2010) but lower than in 2000 (68 percent). Breast examinations. Seventy-eight percent of Armenian women do not know about breast self-examinations (BSE) according to the current survey; this compares with 81 percent in 2005 and 85 percent in 2000. At the same time, only 3 percent of women in 2000 performed BSEs in the three months before the survey, compared with 10 percent in 2005 and 11 percent in 2010. One in six women age 15-49 (15 percent) re- ported that a health care provider had given them a breast examination (10 percent were given a manual breast examination, 4 percent received a mammogram, and 1 percent a sonogram). Pap smear testing. Coverage is very low. Fewer than one in ten Armenian women age 15- 49 (9 percent) ever had a Pap smear, and 7 per- cent had the test in the three months preceding the survey. These estimates are only slightly higher among women age 30-49 who are rec- ommended under the MOH regulations to under- take a Pap smear test on a regular basis: 13 per- cent have ever had the test, and 9 percent had the test in the past three months. CHILD PROTECTION In 2003, the government of Armenia adopt- ed the National Plan of Action for Protection of Children’s Rights, which is an integral part of the country’s child welfare reforms. The 2010 ADHS Household Questionnaire asked a number of questions to obtain information about child discipline and the prevalence of child labor in Armenia. Child Discipline. The manner in which par- ents and caretakers discipline children can have long-term consequences for their physical and psychological development and well-being. In an effort to identify the types of child discipline methods used in Armenia, the 2010 ADHS in- cluded questions on this topic. The questions on child discipline were asked about one randomly selected child age 2-14 in each household. Data show that seven in ten children age 2- 14 experienced some form of psychological or physical punishment during the 30 days preced- ing the survey. Approximately one-fifth of chil- dren (22 percent) experienced only non-violent discipline, and two-thirds of children (66 per- cent) experienced psychological aggression. Forty-two percent of children experienced any physical punishment and 4 percent experienced severe physical punishment. Despite the fact that physical punishment is common, overall, only 3 percent of Armenian mothers or the most knowl- edgeable caretakers interviewed in the ADHS believe that in order to bring up a child properly, the child needs to be physically punished. Child Labor. The 2010 ADHS Household Questionnaire asked a set of questions to obtain information about the prevalence of child labor in Armenia. Child labor is defined as the in- volvement of children age 5-14 in labor activi- Summary of Findings | xxiii ties: (1) children age 5-11 who during the past week did at least one hour of economic activity or at least 28 hours of domestic chores and (2) children age 12-14 who during the past week did at least 14 hours of economic activity or at least 28 hours of domestic chores. Overall, 4 percent of Armenian children age 5-14 are involved in child labor. Most of these children work in fami- ly businesses; overall, 3 percent of children age 5-14 worked for a family business during the week preceding the survey. Children living in Aragatsotn and Shirak were more likely to be involved in child labor during the reference peri- od than children in any other region (8 and 7 percent, respectively). Millennium Development Goal Indicators | xxv MILLENNIUM DEVELOPMENT GOAL INDICATORS Goals and Indicators Value Male Female Total 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age 51 4.3 5.1 4.7 2. Achieve universal primary education 2.1 Net enrollment ratio in primary education2 97.3 97.0 97.2 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 1.2 3.1c Ratio of girls to boys in tertiary education3 na na 1.0 4. Reduce child mortality 4.1 Under-5 mortality rate (per 1000 live births)4 21 22 16 4.2 Infant mortality rate (per 1000 live births)4 17 20 13 4.3 Proportion of 1-year-old children immunized against measles5 86.5 93.1 89.8 5. Improve maternal health 5.2 Proportion of births attended by skilled health personnel6 na na 99.5 5.3 Contraceptive prevalence rate7 na 54.9 na 5.4 Adolescent birth rate8 na 27.8 na 5.5a Antenatal care coverage: at least one visit by skilled health professional na 99.1 na 5.5b Antenatal care coverage: at least four visits by any provider na 92.8 na 5.6 Unmet need for family planning na 21.3 na 6. Combat HIV/AIDS, malaria and other diseases 6.2 Condom use at last high-risk sex: youth age 15-249 87.1 * na 6.3 Percentage of population age 15-24 with comprehensive knowledge of HIV/AIDS10 8.9 15.8 na 6.4 Ratio of school attendance of orphans to school attendance of non- orphans age 10-1411 1.0 nc11 1.0 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source12 98.7 88.1 94.6 7.9 Percentage of population with access to improved sanitation13 97.0 49.4 78.9 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Proportion of children age 0-59 months who are below -2 standard deviations (SD) from the median of the WHO Child Growth Standards in weight-for-age 2 Based on reported attendance, not enrollment 3 Based on reported net attendance, not gross enrollment 4 Expressed in terms of deaths per 1,000 live births. Mortality rates by sex refer to a 10-year period before the survey. Total mortality rates refer to a 5-year period before the survey. 5 In Armenia, the measles vaccinations are given at the age of 12 months. The values presented in the table are for children age 12-23 months who have been vaccinated at any time before the survey against measles. 6 Among births in the 5-year period before the survey 7 Use of any contraceptive method among married or in-union women age 15-49 8 Age-specific fertility rates for women age 15-19 corresponding to the 3-year period before the survey 9 High-risk sex is defined as sexual intercourse with a non-marital, non-cohabiting partner. It is expressed as a percentage of men and women age 15-24 who had high-risk sex in the past 12 months. 10 A person is considered to have comprehensive knowledge about HIV/AIDS when s/he knows that consistent use of a condom during sexual intercourse and having just one HIV-negative and faithful partner can reduce the chances of getting HIV, knows that a healthy-looking person can have HIV, and rejects the two most common misconceptions about HIV, i.e., that HIV can be transmitted by mosquito bites and that a person can get HIV by kissing someone who has HIV. 11 There are no cases of female orphans age 10-14. 12 Percentage of de-jure population whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, or rainwater collection 13 Percentage of de-jure population with access to flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet xxvi | Map of Armenia Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY, POPULATION, HISTORY, AND ECONOMY Geography The republic of Armenia is a small, landlocked mountainous country located in the southern Caucasus Mountains in southwestern Asia. The country borders on Turkey to the west, Georgia to the north, Azerbaijan to the east, and Iran to the south. The area of the country is 29,743 square km, approximately 71 percent of which is agricultural land, 12 percent is forested, 8 percent is special protected territories, and 9 percent is uncategorized. In Armenia, the largest lake is Lake Sevan, which has a surface area of 1,271 square km. The longest rivers are the Akhuryan (186 km) and the Araks (158 km). The highest point in the country is the peak of Aragats (4,090 meters); the lowest point is the Debet River (375 m). The longest distance between the northwest and the southeast is 360 km, and the longest distance between west and east is 200 km. Armenia has a highland continental climate with cold winters and hot summers. The country is subdivided into 11 regions (marz), including the region of Yerevan, which is the capital city of Armenia (NSS, 2011c). Population The 2001 population census was the most recent official census to be conducted prior to the 2010 Armenia Demographic and Health Survey; it revealed a population of 3,212,900. The second census in Armenia took place after independence was implemented in October 2011, and data is currently being analyzed. Based on the 2001 population census quarterly updates, the current estimate of the de jure (resident) population as of the end of 2010 was 3,262,600, with an annual growth rate of 0.4 percent in 2009-2010. In 2010, 51.5 percent of the population was female, and 48.5 percent was male. The proportion of the population that lives in urban areas is 64 percent. The population density in the country as a whole is 110 people per sq km, with approximately 1.1 million inhabitants living in Yerevan. In 2010, life expectancy at birth was 77.2 years for females and 70.6 years for males. According to the National Statistical Service (NSS) of Armenia, in 2010 the average size of the Armenian household was 4.1 persons for the de jure population and 3.8 persons for the de facto (current) population. Literacy among women and men age 15-49 is universal, and 21 percent of males and 23 percent of females age 25-49 have attained higher education. Approximately one-third of the Armenian population lives below the poverty line. The global economic crisis had a serious impact on poverty incidence in Armenia; according to the NSS, poverty increased in Armenia from 28 percent of the population in 2008 to 34 percent in 2009 and 36 percent in 2010 (NSS, 2011b, and NSS, 2011c). An Armenian diaspora has existed throughout the nation's history, with approximately two- thirds of ethnic Armenians living outside the country. The exodus of Armenians began during World War I, when the territory of Armenia was divided between the warring Ottoman and Russian Empires. The most recent large-scale migrations occurred as a result of interethnic fighting, the Karabakh crisis, a devastating earthquake centerd in the north of the country, and post-Soviet political, social, and economic transitions. Since 2007, about 11 percent of household members age 15 and older have been internal or external migrants. The main reasons for leaving the country have been work related. Since 2007, nearly three quarters of household outmigrants age 15 and older have left for the Russian Federation. In recent years, however, large-scale labor emigration has declined. By 2010, the net migration rates had declined by more than 4 times compared with the 2000 rates and had declined by 33 percent compared with the 2009 rates (NSS, 2011b). 2 | Introduction History The republic of Armenia lies in the Armenian highlands surrounding the biblical Mount Ararat. Although currently located in Turkey, the snow-covered peak of Ararat dominates the skyline of Yerevan, the capital city of Armenia. Ararat is regarded as a symbol of Armenia and is a centerpiece of the Armenian Coat of Arms. The Armenian nation is one of the oldest in the world and has long been famous for its cultural and spiritual heritage. Its history dates back almost 5,000 years. The original Armenian name for the country was Hayk, currently Hayastan. In the ninth through the sixth centuries B.C., the Urartu (Ararat) Kingdom flourished in the Armenian highlands. At its height, under Tigran the Great (95-55 BC), Armenia extended its rule from “sea to sea” (the Caspian to the Mediterranean Seas). In AD 301, Armenia became the first country to adopt Christianity as a state religion. Throughout history, Armenia changed its territorial size many times, and between the 4th and 19th centuries it passed under the rule of Greeks, Romans, Persians, Byzantines, Mongols, Arabs, Ottoman Turks, and Russians. After World War I, the independent Democratic Republic of Armenia was established on May 28, 1918. That republic, which endured only two and a half years, was annexed by the Red Army on November 29, 1920. In 1922, the newly proclaimed Armenian Soviet Socialist Republic became part of the Soviet Union as one of three republics comprising the Trans-Caucasian Soviet Federative Socialist Republic. In 1936, after reorganization, the Armenian Soviet Socialist Republic became a separate constituent republic of the Soviet Union. On September 21, 1991, the Supreme Council of the Republic of Armenia declared independence from the Soviet Union. Armenia is a sovereign, democratic country. The new constitution was approved in the July 1995 referendum, and the most recent amendments were made in November 2005. The president of Armenia is the head of state and is elected by the citizens for a five-year term of office. The most recent presidential election was held in 2008, and the next election is scheduled for 2013. State authority is implemented according to the constitution and laws and is based on the principle of distinguishing the legislative, administrative, and judicial authorities. Economy Since 2000, and particularly during 2001-2008, Armenia has experienced rapid economic growth (13 percent, on average), and its gross domestic product (GDP) per capita has tripled. Armenia has a lower middle-income economy; however, the country’s economy still relies on foreign investment, targeted grants, and support from Armenians working abroad. Economic growth and prudent fiscal policies have translated to stable employment, an increase in nominal wages, an increase in spending in social sectors, and a reduction in poverty in the past decade. Almost all sectors of the economy have contributed to economic growth, but the growth in construction has been particularly strong; in 2007-2008 its share of the GDP reached 25 percent. However, the recent global economic crisis had a strong negative impact on economic growth in Armenia, with a 14 percent decline in GDP observed in 2009, followed by only a 2 percent growth in GDP in 2010; this contrasts with the double-digit average growth rates during the early 2000s (NSS, 2011b). The main economic activities in Armenia are manufacturing machinery of tools, chemicals, textiles, and jewellery; diamond processing; construction and mining (copper, gold, molybdenum, aluminium); agriculture; cognac (Armenian brandy) and wine factories; food processing; trade; sales; machinery repair; tourism and hospitality; real estate; and information technology. The structure of economic activities in Armenia recently has shifted from mostly heavy industrial production to other activities, particularly activities in the service and agricultural sectors that became substantial contributors to GDP and employment structures (NSS, 2011b). In 2010, the main items exported abroad were ores; ferrous metals; copper, aluminium, and articles made of them; precious and semiprecious stones; alcoholic and non-alcoholic beverages; bituminous substances; and mineral waxes. The amount of imported goods, however, considerably exceeds that of exported goods ($3.75 billion versus $1.04 billion). The main items imported in 2010 Introduction | 3 were nuclear reactors, boiler machinery and mechanical appliances, electrical machinery and equipment, vehicles, natural gas and other mineral fuels, mineral oils and products of its distillation, foodstuffs, chemicals, pharmaceuticals, and tobacco products. Major trade partners in 2010 were Russia, Bulgaria, Germany, Netherlands, USA, Iran, Belgium, Georgia, Turkey, Ukraine, UAE, China, and Canada (NSS, 2011c). Armenia is a member of more than 40 international organizations, including the United Nations, the Council of Europe, the Asian Development Bank, the Commonwealth of Independent States, the World Trade Organization, the World Customs Organization, the Organization of the Black Sea Economic Cooperation, and others. 1.2 SYSTEMS FOR COLLECTING DEMOGRAPHIC AND HEALTH DATA The NSS of Armenia is responsible for conducting censuses and for using data from the national registration system to provide information about the current population. The 2001 census results were published in 2002-2004. The 2011 census is currently being completed; the results will be published in 2012-2014. Births, deaths, marriages, and divorces are registered at the local administrative level by the civil registry departments of the Ministry of Justice, while population migration within the country and abroad is registered by the relevant subdivisions of the Armenian police, and aggregated statistics are forwarded through territorial offices of the Armenian police to the territorial statistical offices and then to the NSS. The NSS compiles and analyzes these data and issues annual reports entitled, Population of Armenia, Women and Men in Armenia, and Statistical Yearbook among others. Health information is collected by the Ministry of Health (MOH) through special forms provided by the health facilities. Collected information is passed directly to the NSS. The NSS compiles and analyzes data for the country as a whole and issues annual reports as well as various analyses. Based on compiled health data, the Ministry of Health issues annual thematic reports and a bi-annual report entitled Health Indicators of the Population and Usage of Health Care Resources in Armenia. The national data are available at the WHO Website as part of the Health for All Database. 1.3 HEALTH CARE SYSTEM UPDATES IN ARMENIA Armenia began to reform the health care sector soon after attaining independence. Recognizing health and health care as fundamental human rights, the country’s strategy identified the major components of health care reform: (1) a reorientation of health services towards a balanced partnership between primary and hospital care; (2) the promotion of health and prevention of disease through tackling the determinants of health; and (3) a shift from the narrow biomedical model towards a social, multiprofessional, and multisectoral approach to health and health care. The main directions of health sector development in Armenia arose from the basic provisions of the government’s Action Plan and the document Health for All in the 21st Century, which was adopted by the World Health Organization. The main tasks of the health system reforms are—given available resources and potential—to ensure citizens’ constitutional right to health care, to improve access to state-guaranteed free medical care; and to initiate targeted balancing of the social and market values. The government of Armenia approved the first strategy for primary health care (PHC) development in 1997. It identified PHC service delivery in Armenia as inefficient and poor in quality. As a result, the government decided to reorient the health care system towards PHC and to introduce family medicine as a strategic component to improve the quality of and access to PHC services. The government approved the follow-up PHC development strategy to scale up and complete the PHC reforms. Long-term objectives include integration of outpatient specialist services with hospitals; implementation of polyclinic reform; and creation of new cadres of physicians trained in family medicine and nurses trained in family and community nursing. The strategy also recognizes the need 4 | Introduction for better integration of primary health care and social care services. It is estimated that 1,654 family doctors and 1,770 family nurses graduated by September 2011. To improve access to essential services in rural areas, the government has run a Primary Health Care Development Program that was built on the successful Armenia Social Investment Fund experience. By mobilizing communities to develop their plans to improve local health care and to raise their own revenues to share service improvement costs, the program has improved PHC infrastructure in the villages. The program was closely linked with PHC training programs to ensure that the outfitted rural facilities were staffed with qualified individuals. In January 2006, free access to polyclinic services for all Armenians was introduced. In 2007, the principle of free enrollment was incorporated into primary care. Also, regulations on establishment of independent solo and group family medicine practices were adopted by government decree. Criteria for conducting preventive health care visits by PHC doctors were developed and adopted by the government. On July 1, 2008, the government introduced vouchers that entitled pregnant women to receive free delivery care services. Additional financial resources from the government allowed the salaries of medical personnel to be increased. The health care delivery system is divided between outpatient and inpatient care. Inpatient care is provided by multi- and single-service hospitals. There are separate hospitals for maternity care and for children’s care. Outpatient care is provided by urban polyclinics, rural health centers/ambulatories, and feldsher-accoucher health posts.1 At the end of 2010, there were about 140 ambulatory-polyclinic facilities in urban areas, 255 rural ambulatories, and 617 health posts in Armenia. Polyclinics provide primary care services through district internists and pediatricians, as well as outpatient specialist services, resulting in no clear separation between primary and secondary care services. The prioritized rights of mother and child are set forth in the constitution of Armenia as well as in other laws. In particular, maternal and child health issues and future strategies of the main provisions were established in Maternal and Child Health Strategy:2003-2015. In addition, in the main strategic planning document of the country (known as the Program of Sustainable Development), maternal and child health represents a priority program area. During recent years, mother and child health issues have become a priority for the government of Armenia. For example, the government has approved National Strategy, Program and Actions Timeframe on Reproductive Health Improvement for 2007-2015, as well as National Strategy for Child and Adolescent Health and Development and Thereof Plan of Actions for 2010-2015. These documents reflect reproductive, maternal, and child health problems associated with the current situation in the country and define goals and strategies aimed at improving women's and children's health and nutrition while reducing infant and maternal mortality. The maternal and child health protection plans of action are high priorities of the MOH. 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 from international sources. The main local sources are the state budget and direct out-of-pocket payments by the population. International financing sources are general humanitarian donations and project-specific support. Grants and credit projects financed by foreign governments and international and multilateral organizations are now the most substantial form of external support in areas of immunization, 1 A feldsher is a health professional trained in nursing and midwifery with extended training in clinical diagnosis and pharmacology. Feldshers are authorized to provide basic treatment and to prescribe a restricted number of drugs at feldsher-accoucher posts (FAPs) with no assigned doctor. Introduction | 5 maternal and child health, reproductive health, adolescent health, iodine deficiency, and HIV/AIDS prevention (with emphasis on prevention of mother-to-child transmission of HIV). The state budget remains the main formal source of financing. State funds are derived from general tax revenues. State expenditures for health care are not sufficient to support the core system and to meet the health needs of the population. Each year Armenia increases its donations to the health sector. In coming years, the government’s most valuable and important project will be obligatory health insurance, which will improve the quality of health services as well as the health of the population. 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. Currently, abortion is legal during the first 12 weeks of pregnancy. In some cases, an abortion may be performed until 22 weeks of gestation if there is a medical or social justification. In the programs related to the improvement of reproductive health, contraceptive methods are provided free of charge, but before 2006, there was a fee for the necessary examinations. After implementing PHC in 2006, the gynecological services were included among the free services. For many years, oral contraceptives were not commonly available in Armenia due to an directive titled “Side Effects and Complications of Oral Contraceptives,” enacted by the MOH of the former Soviet Union in 1974. Today, in Armenia there is no barrier to contraceptive use because in 2002, a new law allowed oral contraceptive use. Moreover, in 2005, the government of Armenia adopted new regulations for performing abortions. 1.4 OBJECTIVES AND ORGANIZATION OF THE SURVEY The 2010 Armenia Demographic and Health Survey (2010 ADHS) is the third in a series of nationally representative sample surveys designed to provide information on population and health issues. It is conducted in Armenia under the worldwide Demographic and Health Surveys program. Specifically, the 2010 ADHS has a primary objective of providing current and reliable information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of young children, childhood mortality, maternal and child health, and awareness and behavior regarding AIDS and other sexually transmitted infections (STIs). The survey obtained detailed information on these issues from women of reproductive age and, for certain topics, from men as well. The 2010 ADHS results are intended to provide information needed to evaluate existing social programs and to design new strategies to improve health of and health services for the people of Armenia. Data are presented by region (marz) wherever sample size permits. The information collected in the 2010 ADHS will provide updated estimates of basic demographic and health indicators covered in the 2000 and 2005 surveys. The long-term objective of the survey includes strengthening the technical capacity of major government institutions, including the NSS. The 2010 ADHS also provides comparable data for long- term trend analysis in Armenia because the 2000, 2005, and 2010 surveys were implemented by the same organisation and used similar data collection procedures. It also adds to the international database of demographic and health–related information for research purposes. The 2010 ADHS was conducted by the National Statistical Service (NSS) and the MOH of Armenia from October 5 through December 25, 2010. ICF International provided technical support for the survey through the MEASURE DHS project. MEASURE DHS is a worldwide project, 6 | Introduction 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, the Joint United Nations Programme on AIDS (UNAIDS)/Armenia, and the United Nations Population Fund (UNFPA)/Armenia supported the survey through in-kind contributions. Sample Design and Implementation The sample was designed to permit detailed analysis—including the estimation of rates of fertility, infant/child mortality, and abortion—at 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 7,580 households was selected for the 2010 ADHS sample. The sample was selected in two stages. In the first stage, 308 clusters were selected from a list of enumeration areas in a subsample of a master sample derived from the 2001 Population Census frame. In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected for participation in the survey. All women age 15-49 who were either permanent residents of the households in the 2010 ADHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. Interviews were completed with 5,922 women. In addition, in a subsample of one-third of all of the households selected for the survey, all men age 15-49 were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. Interviews were completed with 1,584 men. Appendix A provides additional information on the sample design of the 2010 Armenia DHS. Questionnaires Three questionnaires were used in the ADHS: a Household Questionnaire, a Woman’s Questionnaire, and a Man’s Questionnaire. The Household Questionnaire and the individual questionnaires were based on model survey instruments developed in the MEASURE DHS program and questionnaires used in the previous 2005 ADHS. The model questionnaires were adapted for use by NSS and MOH. Suggestions were also sought from a number of nongovernmental organizations (NGOs). The questionnaires were developed in English and translated into Armenian. They were pretested in July 2010. 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 for each household member or visitor information on their age, sex, educational attainment, and relationship to the head of household. This information provided basic demographic data for Armenian households. It also was used to identify the women and men who were eligible for an 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., the flooring material, the source of water, and the type of toilet facilities), on ownership of a variety of consumer goods, and on other aspects of the socioeconomic status of the household. In addition, the Household Questionnaire was used to obtain information on each child’s birth registration, ask questions about child discipline and child labor, and record height and weight measurements of children under age 5. The Woman’s Questionnaire obtained information from women age 15-49 on the following topics: • Background characteristics • Pregnancy history • Antenatal, delivery, and postnatal care • Knowledge, attitudes, and use of contraception Introduction | 7 • Reproductive and adult health • Childhood mortality • Health and health care utilization • Vaccinations of children under age 5 • Episodes of diarrhea and respiratory illness of children under age 5 • Breastfeeding and weaning practices • Marriage and recent sexual activity • Fertility preferences • Knowledge of and attitudes toward AIDS and other sexually transmitted diseases • Woman’s work and husband’s background characteristics The Man’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 attitudes toward AIDS and other sexually transmitted diseases • Attitudes toward women’s status Training of Field Staff The main survey training, which was conducted by NSS, MOH, and ICF International staff, was held during a three-week period in September and was attended by all supervisors, field editors, interviewers, and quality control personnel, a total of 104 people (83 females and 21 males). The training included lectures, demonstrations, practice interviews in small groups, and examinations. All field staff received training in anthropometric measurement and participated in two 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. Fieldwork began in early October 2010 and was completed by December 25, 2010. Senior ADHS technical staff visited teams regularly to review the work and monitor data quality. MOH, UNICEF/Armenia, UNFPA/Armenia, and USAID/Armenia representatives also visited teams to monitor data collection on child discipline and child labor modules and to observe the height and weight measurements of children under age 5. The processing of the ADHS results began shortly after fieldwork commenced. Completed 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 was received), several office editors, 12 data entry operators, and a secondary editor. The concurrent processing of the data was an advantage because the senior DHS 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 March 2011. 8 | Introduction 1.5 RESPONSE RATES Table 1.1 shows response rates for the 2010 ADHS. A total of 7,580 households were selected in the sample, of which 7,043 were occupied at the time of the 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. The number of occupied households successfully interviewed was 6,700, yielding a household response rate of 95 percent. The household response rate in urban areas (94 percent) was slightly lower than in rural areas (97 percent). In these households, a total of 6,059 eligible women were identified; interviews were completed with 5,922 of these women, yielding a response rate of 98 percent. In one-third of the households, a total of 1,641 eligible men were identified, and interviews were completed with 1,584 of these men, yielding a response rate of 97 percent. Response rates are slightly lower in urban areas (97 percent for women and 96 percent for men) than in rural areas where rates were 99 and 97 percent, respectively. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Armenia 2010 Residence Result Urban Rural Total Household interviews Households selected 5,461 2,119 7,580 Households occupied 5,033 2,010 7,043 Households interviewed 4,753 1,947 6,700 Household response rate1 94.4 96.9 95.1 Interviews with women age 15-49 Number of eligible women 4,073 1,986 6,059 Number of eligible women interviewed 3,966 1,956 5,922 Eligible women response rate2 97.4 98.5 97.7 Interviews with men age 15-49 Number of eligible men 1,105 536 1,641 Number of eligible men interviewed 1,063 521 1,584 Eligible men response rate2 96.2 97.2 96.5 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population | 9 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 This chapter summarizes the demographic and socioeconomic characteristics of the household population in the 2010 ADHS, including age, sex, place of residence, educational status, and household characteristics. Information on child birth registration, child labor, and child discipline is also presented. Knowledge about he characteristics of respondents and their households helps in understanding and interpreting the findings of the survey and also indicates 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 on 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 2010 ADHS distinguishes between the de jure population (persons who usually live in the household) and the de facto population (persons who stayed the night before the interview in the household). According to the 2010 ADHS data, the differences between these populations are small. Tabulations for the household data presented in this chapter are based primarily on the de facto population. Because of the way the sample was designed, the number of cases in some regions may appear small; this is 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 unweighted cases are suppressed. 2.1 HOUSING CHARACTERISTICS There is a strong correlation between the socioeconomic condition of a household and the vulnerability of its members, especially children, to common diseases. The amenities and assets available to households are important in determining the general socioeconomic status of the population. To assess the socioeconomic conditions under which the population lives, respondents were asked to give specific information about their household environment. The 2010 ADHS included questions about the household’s access to electricity, type of water source, sanitation facilities, floor material, and ownership of durable goods. Tables 2.1 through 2.6 present major housing characteristics by urban-rural residence. Drinking Water The source of drinking water is an indicator of whether it is suitable for drinking. Table 2.1 provides information on the source of drinking water, the amount of time it takes to obtain the water, and the type of 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 households. Nine in ten households in Armenia have their drinking water piped directly into the dwelling, yard, or plot (Table 2.1). Urban households are more likely than rural households to have piped water in their house, yard, or plot (97 percent compared with 80 percent). In rural areas, about 3 percent of households have a public tap or standpipe and 4 percent obtain water from a protected spring. Overall, 95 percent of Armenian households have access to an improved source of drinking water. The majority of households use water that is available on the premises; therefore, only 6 percent of Armenian households have to go outside to get drinking water. In households with no water in the house, 13 percent of rural households spent less than 30 minutes on a trip to obtain water and 1 percent of rural households spent 30 minutes or longer to fetch water. 10 | Housing Characteristics and Household Population Because households may use more than one method to treat water to make it safer to drink, water treatment is given as the percentage 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 2.1 show that water is not treated in 91 percent of households. The most frequently used treatment for water is boiling (6 percent). Overall, 8 percent of households use an appropriate treatment method, i.e., boiling, bleaching, straining, filtering or solar disinfecting. Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Armenia 2010 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source Piped water into dwelling/yard/plot 97.1 79.8 91.0 97.3 79.5 90.5 Public tap/standpipe 0.8 2.9 1.5 0.5 2.9 1.4 Pipe into dwelling (own artesian) 0.0 0.8 0.3 0.0 1.0 0.4 Tubewell/ borehole 0.3 0.5 0.4 0.3 0.4 0.4 Protected dug well 0.1 0.8 0.3 0.1 0.9 0.4 Protected spring 0.3 3.5 1.5 0.3 3.3 1.5 Bottled water 0.2 0.0 0.1 0.1 0.0 0.1 Non-improved source Unprotected spring 0.0 0.7 0.2 0.0 0.6 0.2 Tanker truck/cart with drum 1.2 10.4 4.4 1.2 10.7 4.9 Surface water 0.0 0.0 0.0 0.0 0.0 0.0 Other sources 0.0 0.3 0.1 0.0 0.4 0.1 Missing 0.1 0.2 0.1 0.0 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 98.7 88.4 95.1 98.7 88.1 94.6 Time to obtain drinking water (round trip) Water on premises 98.2 86.2 94.0 98.2 86.3 93.7 Less than 30 minutes 1.5 12.6 5.4 1.5 12.4 5.6 30 minutes or longer 0.2 0.9 0.4 0.2 0.9 0.4 Don't know/missing 0.1 0.3 0.2 0.1 0.4 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 7.2 3.1 5.7 8.4 3.7 6.6 Strained through cloth 0.3 0.6 0.4 0.3 0.5 0.4 Ceramic, sand or other filter 2.1 0.6 1.6 2.3 0.6 1.7 Other 1.0 0.9 0.9 1.0 1.0 1.0 No treatment 89.5 94.7 91.3 88.1 94.2 90.4 Percentage using an appropriate treatment method2 9.5 4.1 7.6 11.0 4.6 8.5 Number 4,341 2,359 6,700 14,721 9,065 23,787 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Sanitation Facility A household’s toilet/latrine facility is classified as hygienic if it is used only by household members (i.e., not shared) and if 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 system/septic tank/pit latrine, and pit latrine with a slab. 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. Table 2.2 shows the proportion of households and of the de jure Housing Characteristics and Household Population | 11 population with access to hygienic sanitation facilities (that is, those with access to improved, unshared facilities), shared facilities and non-improved facilities. Most households in Armenia use improved sanitation facilities that are not shared with another household (Table 2.2). Seven in ten households in Armenia use a flush toilet connected to piped sewer system, and 8 percent of households use a pit latrine with a slab. Flush toilets are widespread in urban areas, while pit latrines with a slab are more prevalent in rural areas. It should be noted that the 2010 ADHS questionnaire categorized sanitation facilities differently than the 2005 ADHS questionnaire, and thus it is difficult to compare data from the two surveys. Two in ten households use a non-improved source. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Armenia 2010 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 96.7 47.8 79.5 97.0 49.3 78.9 Flush/pour flush to piped sewer system 94.7 22.8 69.4 94.9 24.6 68.1 Flush/pour flush to septic tank 0.1 1.2 0.5 0.1 1.3 0.6 Flush/pour flush to a pit latrine 0.6 4.4 1.9 0.6 4.4 2.1 Pit latrine with a slab 1.3 19.4 7.7 1.4 19.0 8.1 Shared facility1 0.9 1.3 1.1 1.1 0.8 0.9 Flush/pour flush to piped sewer system 0.7 0.1 0.5 0.9 0.0 0.5 Flush/pour flush to a pit latrine 0.1 0.1 0.1 0.1 0.1 0.1 Pit latrine with a slab 0.1 1.1 0.5 0.1 0.7 0.3 Non-improved facility 2.2 50.8 19.5 2.0 49.7 20.2 Flush/pour flush not to sewer/septic tank/pit latrine 0.3 0.2 0.3 0.3 0.1 0.2 Pit latrine without slab/open pit 1.7 50.4 18.8 1.5 49.6 19.8 Bucket 0.1 0.0 0.1 0.1 0.0 0.1 Public toilet 0.0 0.1 0.1 0.0 0.0 0.0 No facility/bush/field 0.0 0.1 0.1 0.0 0.0 0.0 Missing 0.1 0.0 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,341 2,359 6,700 14,721 9,065 23,787 1 Shared facility of an otherwise improved type Hand Washing Washing hands with soap and water is the most hygienic practice. However, hand washing with a non-soap cleaning agent such as ash or sand is an improvement over not using any cleansing agent. In the 2010 ADHS all household respondents were asked to show the interviewer where household members wash their hands. Table 2.3 shows the proportion of households where the interviewer observed the hand washing station in the house for availability of water, soap, and a non- soap cleaning agent. A hand washing station was observed in 88 percent of households in Armenia (Table 2.3). The proportion of households with an observed hand washing station varies according to household residence, region, and wealth quintile. Urban households were more likely than rural households to have a place where hand washing was observed (94 percent and 78 percent, respectively). Households in Aragatsotn and those from the lowest wealth quintile are the least likely to have their hand washing stations observed (57 percent and 63 percent) compared with households from other regions and wealth status. 12 | Housing Characteristics and Household Population Table 2.3 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Armenia 2010 Background characteristic Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed Total Number of households with place for hand washing observed Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Residence Urban 94.3 4,341 96.5 0.1 0.6 2.5 0.0 0.3 100.0 4,095 Rural 77.6 2,359 93.4 0.1 1.9 3.3 0.0 1.3 100.0 1,830 Region Yerevan 94.3 2,444 95.3 0.1 0.5 3.7 0.0 0.4 100.0 2,306 Aragatsotn 57.1 259 97.4 0.0 0.0 2.5 0.0 0.0 100.0 148 Ararat 86.0 543 93.6 0.0 1.5 1.2 0.0 3.7 100.0 468 Armavir 75.5 539 95.5 0.5 1.3 2.6 0.0 0.0 100.0 407 Gegharkunik 97.5 447 99.8 0.0 0.1 0.1 0.0 0.0 100.0 436 Lori 87.2 611 99.0 0.0 0.4 0.6 0.0 0.0 100.0 533 Kotayk 94.2 537 93.4 0.2 4.6 1.3 0.0 0.5 100.0 506 Shirak 80.0 553 95.1 0.2 0.4 3.1 0.3 0.8 100.0 442 Syunik 100.0 317 96.8 0.0 0.1 3.0 0.0 0.0 100.0 317 Vayots Dzor 84.3 142 81.4 0.0 1.4 15.2 0.0 1.9 100.0 120 Tavush 79.1 308 95.5 0.0 1.1 3.3 0.0 0.1 100.0 244 Wealth quintile Lowest 62.9 1,326 86.0 0.1 3.9 7.1 0.0 2.9 100.0 834 Second 90.7 1,346 96.0 0.2 0.8 2.3 0.0 0.6 100.0 1,220 Middle 95.8 1,427 95.9 0.1 0.4 3.5 0.1 0.0 100.0 1,367 Fourth 95.7 1,327 97.8 0.0 0.3 1.7 0.0 0.2 100.0 1,270 Highest 96.8 1,274 99.0 0.0 0.4 0.6 0.0 0.0 100.0 1,233 Total 88.4 6,700 95.6 0.1 1.0 2.8 0.0 0.6 100.0 5,925 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent Among households where a place for hand washing was observed, 96 percent had soap and water available at the time of interview. Availability of soap and water is somewhat lower in Vayots Dzor region (81 percent) and in households from the lowest wealth quintile (86 percent) compared with 93 percent or higher in households from other regions and wealth status. Only 3 percent of households in Armenia had soap alone, and less than 1 percent had no water, no soap, and no other cleansing agent available. In contrast, in Vayots Dzor, 15 percent of observed households had soap but no water available. In Ararat, about 4 percent of observed households had no water, no soap, and no other cleansing agent available at the time of the interview. Household Characteristics Table 2.4 presents the distribution of households by household characteristics, according to residence. All households in Armenia have electricity (Table 2.4). The majority of households have a finished floor, use natural gas for cooking, and have a specific place for cooking inside the house. Parquet or polished wood floors are most common in urban areas (71 percent). In rural areas, 49 percent of households have wooden plank floors, 36 percent have parquet or polished wood floors, and 8 percent of households have a cement floor. Almost half of all households (45 percent) have two rooms used for sleeping. Most rural households (93 percent) and half of urban households (52 percent) have stone walls with lime or cement. Forty-one percent of urban households have cement blocks for walls. Shingles are the preferred roofing material in both urban and rural areas (52 and 79 percent, respectively), while taule roofing is used only in urban areas (29 percent). Urban and rural households show a similar preference for metal roofing (17 and 20 percent, respectively). Housing Characteristics and Household Population | 13 Cooking fuel appears to have changed dramatically since 2000. Natural gas is, by far, the most often used fuel: eight in ten households in Armenia rely on natural gas for cooking in 2010 compared with four in ten in 2005. The proportion of households using electricity for cooking has declined from 37 percent in 2000 to 16 percent in 2005 to 5 percent in 2010. Use of LPG has also declined; for example, in 2005, more than one-third of households relied on LPG (37 percent) compared with only 13 percent in 2010. Conversely, use of natural gas has nearly doubled in the same time period, with a more rapid increase having occurred in urban areas (43 percent in 2005 and 85 percent in 2010) than in rural areas (41 percent in 2005 and 70 percent in 2010). Less than 2 percent of households use solid fuel for cooking in 2010 compared with 5 percent in 2005. Expanded access could account for some of the apparent shifts. For example, according to NSS, just a few regions in Armenia had access to natural gas in 2000, while in 2010 the gas system network covered 92 percent of urban areas and 55 percent of rural areas (NSS, 2011a). Secondhand Smoke Exposure Secondhand smoke (SHS) causes health risks in children and adults who do not smoke. Pregnant women exposed to SHS have a higher risk of giving birth to a low-birth weight baby (Windham et al., 1999). Children who are exposed to SHS are at increased risk for respiratory and ear infections and poor lung development (US Department of Health and Human Services, 2006). The 2010 ADHS collected information on smoking inside the home to assess the percentage of households in which there is exposure to secondhand smoke. The last panel in Table 2.4 shows percent distribution of households by frequency of smoking inside the home. A high proportion of households in Armenia are exposing their members to secondhand smoke. In over half of the households in Armenia (55 percent), a household member smokes inside the house on a daily basis, compared with 38 percent of households where household members never smoke inside their house. Members of rural households (59 percent) are slightly more likely to smoke inside the house on a daily basis and less likely to never smoke inside the house (34 percent) than those in urban households (53 and 40 percent, respectively). 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 Table 2.4 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking; and percent distribution by frequency of smoking in the home, according to residence, Armenia 2010 Housing characteristic Residence Total Urban Rural Electricity Yes 99.7 99.8 99.8 No 0.2 0.2 0.2 Total 100.0 100.0 100.0 Flooring material Earth, sand 0.2 0.3 0.2 Wood planks 14.8 49.4 27.0 Parquet, polished wood/ laminate 70.5 36.2 58.4 Vinyl or linoleum 5.0 2.5 4.1 Ceramic/marble tiles 3.3 2.3 2.9 Cement 2.7 7.7 4.5 Carpet 2.6 0.1 1.7 Other 0.8 1.6 1.1 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Wall material Stone with mud 0.4 1.0 0.6 Cement 2.7 0.3 1.8 Stone with lime/cement 51.5 92.7 66.0 Bricks 3.1 4.1 3.5 Cement blocks 41.1 0.5 26.8 Other 1.1 1.5 1.2 Missing 0.2 0.0 0.1 Total 100.0 100.0 100.0 Roof material Metal 17.3 19.9 18.2 Roofing shingles 51.8 79.4 61.6 Taule (tarred roofing paper) 29.2 0.1 19.0 Other 1.5 0.6 1.2 Missing 0.2 0.0 0.1 Total 100.0 100.0 100.0 Rooms used for sleeping One 34.0 26.5 31.3 Two 45.8 42.0 44.5 Three or more 19.6 31.3 23.7 Missing 0.6 0.2 0.4 Total 100.0 100.0 100.0 Place for cooking In the house 99.1 95.6 97.9 In a separate building 0.6 3.7 1.7 Outdoors 0.0 0.6 0.2 Other 0.0 0.0 0.0 Missing 0.2 0.0 0.2 Total 100.0 100.0 100.0 Cooking fuel Electricity 5.1 6.0 5.4 LPG 9.3 20.2 13.1 Natural gas 85.4 69.5 79.8 Kerosene 0.0 0.0 0.0 Charcoal 0.0 0.0 0.0 Wood 0.0 3.7 1.3 Animal dung 0.0 0.6 0.2 No food cooked in house 0.1 0.0 0.1 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 0.1 4.3 1.5 Frequency of smoking in the home Daily 52.6 58.7 54.8 Weekly 4.0 3.1 3.7 Monthly 0.7 0.6 0.7 Less than monthly 2.3 3.8 2.8 Never 40.2 33.8 37.9 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Number 4,341 2,359 6,700 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood, and animal dung 14 | Housing Characteristics and Household Population household 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 2.5 provides information on household ownership of durable goods (e.g., radios, televisions, telephones, computers, refrigerators) and means of transportation (e.g., bicycles, motorcycles, automobiles). Table 2.5 shows that urban households are more likely than rural households to own durable and electronic goods, while rural households are slightly more likely to own a means of transportation. Overall, 98 percent of Armenian households have color televisions, 92 percent have refrigerators, and 81 percent have a washing machine. Eighty-seven percent of households have a mobile telephone, and 78 percent have a land line (non-mobile) telephone. Household ownership of most durable goods has increased during the past five years; in particular the ownership of computers and mobile phones has increased dramatically since 2005. Twenty-nine percent of households have computers in 2010 compared with 9 percent in 2005. Computers are much more common in urban than in rural areas (38 percent and 12 percent, respectively). The proportion of households using mobile phones has increased from 33 percent in 2005 to 87 percent in 2010, with little difference seen by residence. Non- mobile telephones are still much more common in urban areas than in rural areas. Although 90 percent of urban households have a non-mobile telephone, the corresponding proportion in the rural areas is 56 percent. Conversely, the proportions owning radios or black and white televisions have declined in the same time period. Two percent of households own a black and white television and just 12 percent have radios in 2010; this compares with 14 percent and 29 percent, respectively in 2005. Thirty percent of households in Armenia have a car or truck, while only 4 percent have a bicycle. Rural households are slightly more likely than urban households to own a car or truck (33 percent and 27 percent, respectively). Bicycles are also more common in rural areas than in urban areas (7 percent and 2 percent, respectively). Forty-two percent of Armenian households own agricultural land; as expected, the proportion is higher in rural than urban areas (90 percent versus 16 percent). Twenty-two percent of Armenian households own farm animals, which, similar to ownership of agricultural land, is higher in rural than urban areas. 2.2 WEALTH QUINTILES The wealth index is a 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 et al., 2000, Rutstein and Johnston, 2004). 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 Table 2.5 Household possessions Percentage of households possessing various household effects, agricultural land, and livestock/farm animals by residence, Armenia 2010 Possession Residence Total Urban Rural Household effects Radio 15.5 5.2 11.8 Black and white television 2.2 2.0 2.2 Color television 97.9 97.3 97.7 Washing machine 84.2 76.1 81.4 Vacuum cleaner 75.5 50.3 66.6 Computer 37.8 11.7 28.6 Mobile telephone 87.6 85.7 86.9 Non-mobile telephone 89.9 55.9 77.9 Refrigerator 93.7 88.0 91.7 Digital camera 37.9 20.5 31.8 Video camera/camcorder 16.4 5.4 12.5 Table 99.4 99.8 99.5 Chair 99.6 99.7 99.6 Sofa/divan 98.3 96.5 97.7 Bed 99.4 99.7 99.5 Buffet/curio cabinet/wall unit 93.6 94.3 93.8 Air conditioner 8.0 2.9 6.2 DVD player 60.2 52.0 57.3 Satellite antenna/dish 16.1 19.9 17.5 Freezer 5.0 3.1 4.3 Electric fan 70.3 53.5 64.4 Sewing machine 50.6 48.4 49.8 Carpet 90.0 88.6 89.5 Means of transport Bicycle 2.4 6.9 4.0 Animal drawn cart 0.1 0.2 0.1 Motorcycle/scooter 0.2 0.3 0.2 Car/truck 27.4 33.3 29.5 Boat with a motor 0.4 0.3 0.4 Ownership of agricultural land 16.2 90.4 42.3 Ownership of farm animals1 3.8 56.1 22.2 Number 4,341 2,359 6,700 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, pigs, rabbits, fur animals, chickens, or bees Housing Characteristics and Household Population | 15 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 2.6 shows the distribution of the population across the five wealth quintiles, by urban and rural areas and by region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. For example, 81 percent of the rural population is in the lowest and second-lowest wealth quintiles. In comparison, approximately six in ten urban residents (60 percent) are in the two highest wealth quintiles. Table 2.6 also shows the Gini coefficient of wealth in Armenia, which indicates the concentration of wealth, with 0 representing an exactly equal distribution (everyone having the same amount of wealth) and 1 representing a totally unequal distribution (one person having all the wealth). The overall Gini coefficient is 0.22. It is much lower in urban areas (0.06) than in rural areas (0.32), indicating a more unequal distribution of wealth in the rural population than in the urban population. The lowest Gini coefficient is seen in Yerevan (0.02) where nearly half of the population (46 percent) is in the highest wealth quintile. The highest Gini coefficients—that is, the least equitable distributions of wealth—are observed in Aragatsotn (0.46) and Vayots Dzor (0.38). Table 2.6 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Armenia 2010 Residence/region Wealth quintile Total Number of population Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 2.4 12.2 25.0 28.7 31.7 100.0 14,721 0.06 Rural 48.7 32.7 11.9 5.5 1.2 100.0 9,065 0.32 Region Yerevan 0.5 6.6 18.3 28.8 45.7 100.0 8,321 0.02 Aragatsotn 61.1 23.2 10.8 4.3 0.7 100.0 954 0.46 Ararat 44.5 24.2 9.5 11.0 10.7 100.0 1,904 0.32 Armavir 46.8 29.3 11.7 9.3 2.8 100.0 2,104 0.33 Gegharkunik 24.4 42.9 20.2 10.9 1.6 100.0 1,608 0.23 Lori 13.6 22.8 34.4 20.3 8.9 100.0 2,074 0.16 Kotayk 11.0 27.2 21.7 25.1 15.0 100.0 2,069 0.15 Shirak 28.8 24.3 30.1 15.2 1.6 100.0 2,120 0.26 Syunik 13.6 20.5 30.8 26.1 9.0 100.0 967 0.17 Vayots Dzor 46.5 21.8 14.8 10.8 6.1 100.0 546 0.38 Tavush 36.1 31.0 17.6 12.5 2.8 100.0 1,120 0.28 Total 20.0 20.0 20.0 19.9 20.1 100.0 23,787 0.22 2.3 HOUSEHOLD POPULATION BY AGE AND SEX 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 2.7 and Figure 2.1 present the distribution of the de facto household population in the 2010 ADHS by five-year age groups, according to urban-rural residence and sex. The total de facto population was 23,672. 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 (82 and 90 men per 100 women, respectively). Among the youngest age groups, however, there are more males than females. It is not until the 15-19 age cohort that women outnumber men in rural areas and not until the 40-44 age cohort that they outnumber men in urban areas. Overall, this imbalance in the sex ratio among the working age population suggests that the outmigration from Armenia has been primarily composed of men. 16 | Housing Characteristics and Household Population Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Armenia 2010 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 6.7 5.2 5.9 7.6 6.1 6.8 7.1 5.5 6.3 5-9 6.6 4.9 5.6 7.2 4.4 5.7 6.8 4.7 5.7 10-14 7.2 5.1 6.0 8.4 6.5 7.4 7.7 5.6 6.6 15-19 7.1 6.7 6.9 7.7 7.7 7.7 7.3 7.0 7.2 20-24 8.5 7.4 7.9 9.4 10.0 9.7 8.8 8.4 8.6 25-29 8.7 7.8 8.2 8.9 7.3 8.1 8.8 7.6 8.1 30-34 7.5 7.3 7.4 6.1 6.0 6.0 6.9 6.8 6.9 35-39 5.6 5.5 5.6 4.4 4.8 4.6 5.1 5.3 5.2 40-44 5.3 5.9 5.7 4.9 6.6 5.8 5.2 6.2 5.7 45-49 6.3 6.7 6.5 7.7 7.8 7.7 6.8 7.1 7.0 50-54 8.1 9.9 9.1 8.5 9.3 8.9 8.2 9.7 9.0 55-59 6.6 7.9 7.3 5.1 5.4 5.2 6.0 7.0 6.5 60-64 5.4 6.7 6.1 3.4 3.7 3.5 4.6 5.6 5.1 65-69 3.0 2.5 2.7 1.9 2.4 2.1 2.5 2.5 2.5 70-74 3.5 4.6 4.1 3.1 4.7 4.0 3.3 4.7 4.1 75-79 2.4 2.8 2.6 3.0 3.2 3.1 2.6 3.0 2.8 80 + 1.6 2.9 2.3 2.8 4.1 3.5 2.1 3.3 2.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,598 8,015 14,613 4,287 4,773 9,060 10,885 12,787 23,672 The age structure is typical of an older population characterized by low fertility. Over 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 slightly higher in urban areas (71 percent) than in rural areas (67 percent). This difference may be largely attributed to high levels of rural-urban migration for work among the 30-39, 55-59, and 60-64-year-old cohorts. The disproportionately low percentage of the population in the 65-69 age group is probably due to low levels of fertility during World War II (Figure 2.1). Figure 2.1 Population Pyramid 80 + 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 <5 0246 0 2 4 6 ADHS 2010 Male Percent Female Age The data further indicate that 19 percent of the population is under 15 years of age. The proportion under 15 is slightly larger in the rural areas than in the urban areas (20 and18 percent, respectively). This is evidence of higher fertility in rural areas (see Chapter 5). The percentages of the 15-19 and 20-24 year-old cohorts are larger than younger age cohorts, which may largely be due to the fertility peaks following the earthquake of 1988. The percentages of the 45-49 and 50-54 year-old Housing Characteristics and Household Population | 17 cohorts are also larger than younger age cohorts, which may be attributed to the fertility peaks of the post World War II baby boom that lasted through the mid 1960s. 2.4 HOUSEHOLD COMPOSITION Table 2.8 presents the percent distribution of households in the 2010 ADHS sample by sex of the head of the household and by mean household size. These characteristics are important because they are often associated with differences in household socioeconomic 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 individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. In general, households in Armenia are headed by males (63 percent), while over one-third (37 percent) are headed by females. The percentage of male-headed households is lower than that recorded in the 2000 ADHS (71 percent) but is similar to that in the 2005 ADHS (64 percent). Households in urban areas are more likely than those in rural areas to be headed by a woman (39 percent compared with 33 percent). The average household size in Armenia is 3.6 persons, compared with 3.8 persons in 2005 and 4.3 persons in 2000. The average household size in rural areas is slightly larger than in urban areas (3.8 compared with 3.4 members). The decrease in household size over time is more noticeable in rural areas where it has declined from 4.7 persons in 2000, to 4.2 in 2005, and to 3.8 members in 2010. The average household size in urban areas has also gotten smaller, with the main decline occurring between 2000 and 2005 (from 4.1 to 3.5 persons). There has been virtually no change in the past five years (3.5 versus 3.4 members). The increase over time in the proportion of female- headed households and the decrease in the average household size are consistent with continued outmigration, particularly of men. Birth Registration In Armenia, birth registration is recognized as a child’s right. 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 certificate is issued at the time of registration or later as proof of the registration of the birth. In the 2010 ADHS, for all children age 0-4 years, mothers were asked if their child had been registered. Table 2.9 gives the percentage of children under age 5 whose births were officially registered and the percentage who had a birth certificate at the time of the survey. Not all children who are registered 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. Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18 years of age, according to residence, Armenia 2010 Residence Characteristic Urban Rural Total Household headship Male 60.7 66.7 62.9 Female 39.3 33.3 37.1 Total 100.0 100.0 100.0 Number of usual members 0 0.2 0.3 0.2 1 16.2 13.5 15.2 2 19.9 16.5 18.7 3 18.0 14.1 16.6 4 19.8 17.6 19.0 5 13.3 16.9 14.6 6 8.1 11.9 9.5 7 2.9 6.2 4.1 8 0.9 1.5 1.1 9+ 0.7 1.4 1.0 Total 100.0 100.0 100.0 Mean size of households 3.4 3.8 3.6 Percentage of households with orphans and foster children under 18 years of age Foster children1 1.0 1.0 1.0 Double orphans 0.0 0.0 0.0 Single orphans2 1.5 2.2 1.7 Foster and/or orphan children 2.3 3.0 2.5 Number of households 4,341 2,359 6,700 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under 18 years of age living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent. 18 | Housing Characteristics and Household Population Birth registration is universal in Armenia, with 100 percent of births in the five years preceding the survey registered, with practically all of these births having a certificate. Small variations are found across subgroups of children; in particular, children in Lori region are somewhat less likely to have a birth certificate (97 percent) compared with children from all other regions. Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Armenia 2010 Children whose births are registered Background characteristic Percentage who had birth certificate Percentage who did not have birth certificate Percentage registered Number of children Age <2 99.1 0.3 99.5 638 2-4 99.6 0.1 99.7 842 Sex Male 99.9 0.1 100.0 773 Female 98.8 0.3 99.1 706 Residence Urban 99.3 0.0 99.3 863 Rural 99.5 0.5 100.0 616 Region Yerevan 100.0 0.0 100.0 472 Aragatsotn 100.0 0.0 100.0 59 Ararat 100.0 0.0 100.0 106 Armavir 99.4 0.0 99.4 140 Gegharkunik 100.0 0.0 100.0 115 Lori 96.9 1.6 98.6 115 Kotayk 98.5 0.0 98.5 150 Shirak 98.5 0.7 99.3 160 Syunik 100.0 0.0 100.0 53 Vayots Dzor 100.0 0.0 100.0 42 Tavush 99.6 0.0 99.6 69 Wealth quintile Lowest 99.6 0.4 100.0 295 Second 99.7 0.3 100.0 308 Middle 99.0 0.0 99.0 300 Fourth 99.0 0.3 99.3 298 Highest 99.6 0.0 99.6 277 Total 99.4 0.2 99.6 1,479 Children’s Living Arrangements and Orphanhood Information on households with foster children and orphans was collected in the 2010 ADHS. Foster children are defined here as children under age 18 living in households with neither their mother nor their father present; orphans are children with one or both parents dead. Table 2.10 shows the distribution of children under 18 years of age by living arrangements and orphanhood status, according to background characteristics. Of the 5,402 children under age 18 recorded in the 2010 ADHS, four in five live with both parents, 15 percent live with their mother only, 1 percent live with their father only, and 1 percent live with neither of their biological parents. Housing Characteristics and Household Population | 19 Table 2.10 Children's living arrangements and orphanhood Percent distribution of de jure children under 18 years of age by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Armenia 2010 Background characteristic Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percentage not living with a biological parent Percentage with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing information on father/ mother Age 0-4 88.3 10.8 0.3 0.3 0.1 0.1 0.0 0.0 0.0 0.0 100.0 0.1 0.4 1,479 <2 89.2 10.4 0.0 0.2 0.0 0.1 0.0 0.0 0.0 0.0 100.0 0.1 0.0 638 2-4 87.6 11.2 0.5 0.4 0.2 0.1 0.0 0.0 0.0 0.1 100.0 0.1 0.6 842 5-9 85.9 10.5 1.9 0.9 0.2 0.5 0.1 0.0 0.0 0.1 100.0 0.6 2.1 1,345 10-14 79.3 13.9 3.2 0.7 0.7 1.1 0.1 0.2 0.1 0.7 100.0 1.4 4.3 1,553 15-17 74.8 15.1 4.7 0.3 1.1 2.8 0.3 0.3 0.0 0.7 100.0 3.4 6.4 1,025 Sex Male 83.1 11.9 2.4 0.7 0.4 0.9 0.1 0.2 0.0 0.3 100.0 1.2 3.1 2,929 Female 81.9 13.1 2.3 0.4 0.6 1.1 0.1 0.1 0.0 0.5 100.0 1.3 3.0 2,473 Residence Urban 84.0 11.2 2.1 0.5 0.4 1.2 0.0 0.2 0.0 0.4 100.0 1.4 2.8 3,149 Rural 80.6 14.3 2.7 0.6 0.6 0.8 0.2 0.0 0.0 0.2 100.0 1.0 3.5 2,253 Region Yerevan 85.5 10.1 1.7 0.6 0.5 1.1 0.0 0.2 0.0 0.5 100.0 1.2 2.3 1,753 Aragatsotn 85.7 11.3 1.5 0.2 0.0 0.1 1.2 0.0 0.0 0.0 100.0 1.3 2.7 229 Ararat 83.2 7.9 5.1 0.2 2.3 1.0 0.0 0.2 0.0 0.0 100.0 1.2 7.6 406 Armavir 84.4 10.8 2.6 0.1 0.0 1.3 0.0 0.0 0.0 0.7 100.0 1.3 2.6 518 Gegharkunik 76.4 18.4 2.1 0.7 1.0 0.7 0.6 0.0 0.0 0.1 100.0 1.3 3.7 427 Lori 79.3 15.3 2.2 0.0 0.2 1.0 0.1 0.5 0.3 1.2 100.0 1.8 3.2 478 Kotayk 85.7 10.1 2.1 1.7 0.2 0.3 0.0 0.0 0.0 0.0 100.0 0.3 2.3 481 Shirak 66.8 28.3 2.5 0.5 0.0 1.8 0.0 0.0 0.0 0.0 100.0 1.8 2.5 544 Syunik 92.6 2.0 2.6 0.0 0.7 1.9 0.0 0.0 0.0 0.3 100.0 1.9 3.6 181 Vayots Dzor 82.5 12.5 2.9 1.3 0.1 0.7 0.0 0.0 0.0 0.0 100.0 0.7 3.0 130 Tavush 92.0 3.4 3.0 0.5 0.4 0.6 0.0 0.0 0.0 0.1 100.0 0.6 3.4 254 Wealth quintile Lowest 80.8 12.7 4.0 0.2 0.7 0.8 0.4 0.1 0.0 0.4 100.0 1.3 5.2 1,199 Second 78.9 17.1 2.4 0.5 0.1 0.5 0.0 0.2 0.1 0.1 100.0 0.8 2.8 1,113 Middle 79.1 15.5 2.1 0.4 0.5 1.9 0.1 0.0 0.0 0.4 100.0 1.9 2.7 1,076 Fourth 85.4 9.8 1.9 0.4 1.0 1.1 0.0 0.0 0.0 0.3 100.0 1.1 2.9 977 Highest 89.4 6.5 1.0 1.2 0.1 0.9 0.0 0.3 0.0 0.6 100.0 1.2 1.4 1,038 Total <15 84.4 11.8 1.8 0.6 0.3 0.6 0.1 0.1 0.0 0.3 100.0 0.8 2.3 4,377 Total <18 82.6 12.5 2.3 0.5 0.5 1.0 0.1 0.1 0.0 0.4 100.0 1.3 3.1 5,402 Note: Table is based on de jure members, i.e., usual residents 1 Includes children with father dead, mother dead, both dead, and one parent dead but information missing on survival status of the other parent 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 age 18 have lost one or both parents. Two percent of children under age 18 have lost their fathers and less than 1 percent have lost their mothers. Extremely few children under age 18 are reported to have lost both parents. Differentials in fosterhood and orphanhood by background characteristics are not large. As expected, older children are more likely than younger children to be fostered and orphaned. For example, older children are less likely than younger children to live with both parents and are more likely than younger children to have lost one or both parents. Small differences in living arrangements are found between rural and urban children. Syunik and Tavush have found the highest proportions of children living with both parents (93 percent and 92 percent, respectively), while Shirak has the lowest (67 percent). Shirak also reports the highest proportion of children who live only with their mothers but whose fathers are alive (28 percent) compared with the national average of 13 percent for children under age 18. This is possibly due to high levels of male migration away from home in search of employment. Table 2.10 shows that children from the two highest wealth quintiles are more likely to live with both parents, although the difference between wealth quintiles is not large. The proportion of orphanhood among children under age 15 can be compared with data from the 2000 ADHS at national level. Overall, the proportion of children under age 15 living with both parents has declined from 90 percent in 2000 to 84 percent in 2010. 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 in 2000 to 12 percent in 2010). 20 | Housing Characteristics and Household Population Regional level comparisons between the surveys in Figure 2.2 show that over the past ten years, among children under age 15, there has been a steady increase in the proportion of children who live only with their mothers but whose fathers are alive in Shirak (28 percent in 2010 versus 23 percent in 2005 and 6 percent in 2000) and in Aragatsotn (10 percent in 2010 compared with 6 percent in 2005 and 1 percent in 2000). The opposite trend is noticeable in Gegharkunik, Syunik, Yerevan, Tavush, Ararat, and Kotayk where the proportion of children under age 15 who live only with their mothers, but whose fathers are alive, has declined during the past five years (Figure 2.2). 6 1 2 4 3 10 6 6 5 4 4 14 6 9 10 31 9 10 23 7 3 16 9 10 7 10 20 16 8 28 2 11 3 Yerevan Aragatsotn Ararat Armavir Gegharkunik Lori Kotayk Shirak Syunik Vayots Dzor Tavush 0 10 20 30 Percent 2000 ADHS 2005 ADHS 2010 ADHS Figure 2.2 Percentage of Children under Age 15 Who Live Only with Their Mother but Whose Father is Alive, Armenia 2000, 2005, and 2010 2.5 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Education is important because it helps individuals make informed decisions that impact their health and well-being. Armenia’s educational system has undergone several stages of restructuring over the past five years, making the analysis of education data across a wide range of ages challenging.1 The current school system in Armenia has been in place since 2007, when definition of basic school changed from grades 1-8 to grades 1-9 and definition of high school changed from grades 9-10 to grades 10-12. The current school system consists of primary school (grades 1 through 4 for students’ age 6-10), middle school (grades 5 through 9 for students’ age 10-14), and high school (grades 10 through 12 for student’s age 15-17). Primary and middle school (grades 1 through 9) together constitute what is referred to as basic education. In the constitution of Armenia basic education is declared to be mandatory. Primary, middle, and high school together (or grades 1 through 12) constitute what is referred to as a standard school or secondary education. In this report, respondents who have attended or completed grades 1 through 9 are presented as having attained basic education, and those who in addition to basic school have attended or completed high school are presented as having attained secondary education. Students who have completed a minimum of nine grades may enroll in specialized secondary education, which provides training for careers that require mid-level qualifications, such as nurses, 1 The Armenian educational system in 2000-2005 consisted of primary school (grades 1-3, age 7-9), middle school (grades 4-8, age 10-14), and high school (grades 9-10, ages 15-16). Education of at least 8 grades was compulsory. Students who had completed at least 8 grades were eligible for secondary-special education. Since 2005, age 6 years and 6 months has become the mandatory age of school enrollment. Before 2005, children were allowed to enter school at age 6 or 7; the majority of children would start school at age 7. Housing Characteristics and Household Population | 21 midwives, musicians, technicians, and others. The course of study for specialized secondary education can be completed in one to three years depending on the number of grades completed by a student. Upon graduation students receive a secondary-special education degree, a level that is somewhat higher than secondary education but lower than higher education. University and postgraduate education provides training for a higher level of specialists. Students who have completed secondary education or secondary-special education may enroll in a university. Tables 2.11 and 2.12 present information on the educational attainment of the Armenian population age 6 and older. Virtually all Armenians have gone to school. The median number of years of schooling by sex is 9.9 years for women and 9.6 years for men. The proportions of the female and male populations with no education are low (less than 1 percent each), with the highest levels being among those age 6 to 9 (reflecting some who have not yet started school) and those age 65 and older. Individuals residing in urban areas have substantially higher levels of secondary-special and higher education than those in rural areas. One in three respondents living in the capital city of Yerevan has higher education compared with one in ten in Aragatsotn, Ararart, or Gegharkunik. Wealth status has a strong positive relationship with education; 40 percent of women in the highest wealth quintile have at least some higher education compared with 8 percent of women in the lowest quintile. The corresponding proportions for men are 37 percent and 6 percent, respectively. Table 2.11 Educational attainment of the female household population Percent distribution of the de facto female household populations age 6 and older by highest level of schooling attended or completed and median years completed, according to background characteristics, Armenia 2010 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Total Number Median years completed Age 6-9 5.2 92.9 1.8 0.0 0.0 0.0 0.0 100.0 488 0.9 10-14 0.0 5.7 9.2 84.2 0.0 0.3 0.4 100.0 719 5.5 15-19 0.2 0.0 0.0 30.0 21.7 15.5 32.6 100.0 899 9.6 20-24 0.2 0.0 0.0 3.7 31.5 24.9 39.7 100.0 1,076 12.1 25-29 0.4 0.0 0.0 4.6 34.2 28.3 32.5 100.0 975 11.8 30-34 0.5 0.0 0.0 6.7 32.5 31.4 28.9 100.0 873 11.7 35-39 0.4 0.0 0.0 3.8 36.0 34.5 25.4 100.0 674 11.4 40-44 0.1 0.1 0.0 3.2 40.8 33.4 22.3 100.0 792 11.1 45-49 0.1 0.0 0.2 3.4 41.5 34.1 20.8 100.0 910 11.2 50-54 0.0 0.2 0.2 4.9 43.7 30.8 20.1 100.0 1,239 10.2 55-59 0.2 0.0 0.0 5.6 37.6 33.8 22.8 100.0 893 11.3 60-64 0.1 0.4 0.2 9.4 32.8 27.5 29.6 100.0 710 11.6 65+ 2.3 4.4 6.4 31.6 28.1 14.6 12.6 100.0 1,722 9.2 Residence Urban 0.5 4.6 0.9 12.7 24.5 27.2 29.7 100.0 7,520 11.2 Rural 1.1 5.2 2.8 19.6 41.5 19.1 10.7 100.0 4,448 9.5 Region Yerevan 0.3 4.3 0.7 10.9 20.5 26.3 36.9 100.0 4,280 11.7 Aragatsotn 0.1 4.9 1.5 14.4 54.2 13.4 11.6 100.0 461 9.5 Ararat 0.8 6.7 2.2 18.5 44.6 16.2 11.0 100.0 928 9.5 Armavir 1.8 4.1 1.2 19.5 33.8 25.4 14.2 100.0 1,016 9.7 Gegharkunik 1.7 5.9 3.4 18.3 43.2 16.6 10.8 100.0 842 9.5 Lori 0.7 3.8 2.0 15.6 37.7 22.7 17.5 100.0 1,026 9.7 Kotayk 0.8 6.3 1.7 16.7 30.8 25.1 18.6 100.0 1,026 9.8 Shirak 0.8 4.7 1.6 18.9 30.5 27.8 15.6 100.0 1,104 9.8 Syunik 0.2 2.8 2.0 16.5 29.3 32.2 17.0 100.0 469 10.0 Vayots Dzor 0.4 5.9 3.3 12.2 40.3 24.8 13.1 100.0 270 9.7 Tavush 0.9 5.9 3.1 21.0 28.3 26.0 14.7 100.0 545 9.7 Wealth quintile Lowest 1.5 4.9 3.2 21.9 44.6 16.1 7.9 100.0 2,340 9.4 Second 0.8 5.4 2.1 20.1 37.3 21.6 12.7 100.0 2,443 9.6 Middle 0.6 5.0 1.1 14.8 29.8 27.9 20.6 100.0 2,432 9.9 Fourth 0.5 3.8 0.9 10.6 24.5 28.0 31.6 100.0 2,381 11.4 Highest 0.1 4.9 0.7 8.8 17.9 27.2 40.4 100.0 2,373 12.1 Total 0.7 4.8 1.6 15.2 30.8 24.2 22.6 100.0 11,969 9.9 1 Completed grade 4 at the primary level 2 Completed grade 12 at the secondary level or completed grade 10 or grade 11 at the secondary level and has a secondary school diploma/attestat 22 | Housing Characteristics and Household Population Table 2.12 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and older by highest level of schooling attended or completed and median years completed, according to background characteristics, Armenia 2010 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Total Number Median years completed Age 6-9 3.3 94.1 2.2 0.3 0.0 0.0 0.0 100.0 593 0.8 10-14 0.1 3.6 8.5 86.0 0.0 1.7 0.0 100.0 834 5.3 15-19 0.7 0.0 0.0 43.0 19.3 12.8 24.2 100.0 800 9.2 20-24 0.2 0.0 0.2 11.4 41.1 14.3 32.6 100.0 961 9.9 25-29 0.8 0.7 0.0 11.7 43.6 11.4 31.8 100.0 953 9.8 30-34 0.1 0.0 0.5 12.8 45.9 15.0 25.6 100.0 756 9.8 35-39 0.0 0.1 0.2 7.7 43.3 20.1 28.6 100.0 560 10.0 40-44 0.4 0.2 0.0 6.6 36.2 31.3 25.3 100.0 561 11.1 45-49 0.1 0.0 0.0 6.4 41.5 28.7 23.3 100.0 744 10.4 50-54 0.2 0.3 0.0 8.2 42.2 28.1 21.1 100.0 897 10.0 55-59 0.2 0.6 0.0 7.8 35.1 33.8 22.5 100.0 651 11.3 60-64 0.0 0.0 0.0 9.4 29.7 31.8 29.1 100.0 500 11.5 65+ 1.6 3.5 5.3 27.1 29.9 15.2 17.4 100.0 1,153 9.5 Residence Urban 0.4 5.9 1.1 16.9 26.4 20.1 29.2 100.0 6,062 9.9 Rural 1.0 7.3 2.1 24.8 40.2 14.5 10.1 100.0 3,901 9.4 Region Yerevan 0.4 6.1 1.1 14.8 22.1 19.4 35.9 100.0 3,381 10.8 Aragatsotn 1.2 7.3 1.0 18.1 55.3 6.9 10.3 100.0 426 9.4 Ararat 0.5 7.0 1.2 20.7 48.4 11.4 10.8 100.0 850 9.4 Armavir 1.4 6.2 2.3 25.1 31.0 19.2 14.8 100.0 923 9.5 Gegharkunik 1.2 8.9 2.0 22.8 43.0 12.9 9.3 100.0 651 9.3 Lori 0.3 5.8 1.7 25.2 37.1 15.0 14.7 100.0 902 9.5 Kotayk 0.5 5.7 1.3 23.0 30.7 21.5 17.2 100.0 859 9.6 Shirak 0.4 7.0 1.9 22.5 27.9 21.6 18.8 100.0 830 9.6 Syunik 0.8 5.3 1.8 17.6 31.8 25.0 17.7 100.0 440 9.8 Vayots Dzor 0.5 6.3 2.8 14.6 38.7 23.7 13.3 100.0 223 9.7 Tavush 0.4 7.2 2.1 28.7 31.1 16.1 14.3 100.0 479 9.4 Wealth quintile Lowest 1.3 7.2 2.5 28.5 41.8 12.3 6.4 100.0 2,056 9.3 Second 0.8 7.1 1.8 24.6 38.8 16.6 10.5 100.0 1,937 9.4 Middle 0.5 7.1 1.7 20.5 31.4 19.7 19.2 100.0 1,985 9.6 Fourth 0.3 4.9 1.0 13.9 24.1 20.0 35.8 100.0 1,974 10.8 Highest 0.1 6.0 0.7 12.4 22.8 21.1 36.7 100.0 2,011 11.2 Total 0.6 6.5 1.5 20.0 31.8 17.9 21.7 100.0 9,963 9.6 1 Completed grade 4 at the primary level 2 Completed grade 12 at the secondary level or completed grade 10 or grade 11 at the secondary level and has a secondary school diploma/attestat Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex, residence, region, and wealth quintile are shown in Table 2.13. The NAR indicates participation in basic education (primary and middle school) for the population age 6-14 and high school for the population age 15-17. 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. 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. Housing Characteristics and Household Population | 23 Table 2.13 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Armenia 2010 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 BASIC SCHOOL Residence Urban 91.6 93.5 92.5 1.02 94.4 94.3 94.4 1.00 Rural 91.6 91.5 91.6 1.00 93.7 94.0 93.8 1.00 Region Yerevan 91.4 94.2 92.7 1.03 95.8 94.7 95.3 0.99 Aragatsotn 93.8 96.1 94.7 1.02 93.8 96.3 94.9 1.03 Ararat 83.9 83.1 83.5 0.99 85.7 83.4 84.6 0.97 Armavir 94.3 91.9 93.3 0.97 96.6 95.6 96.2 0.99 Gegharkunik 93.2 93.4 93.3 1.00 93.8 99.3 96.3 1.06 Lori 92.3 90.1 91.5 0.98 96.4 95.4 96.0 0.99 Kotayk 88.8 94.4 91.7 1.06 89.3 94.4 91.9 1.06 Shirak 94.5 93.9 94.2 0.99 95.3 93.9 94.7 0.99 Syunik 92.2 95.3 93.6 1.03 95.3 95.3 95.3 1.00 Vayots Dzor 94.8 98.7 96.8 1.04 94.8 100.2 97.6 1.06 Tavush 90.7 89.9 90.3 0.99 93.0 90.3 91.8 0.97 Wealth quintile Lowest 90.6 91.7 91.1 1.01 92.9 94.4 93.6 1.02 Second 95.1 92.1 93.7 0.97 96.3 93.9 95.2 0.97 Middle 92.1 93.6 92.7 1.02 95.7 94.9 95.3 0.99 Fourth 86.2 93.6 89.8 1.09 89.9 93.8 91.8 1.04 Highest 92.9 92.9 92.9 1.00 95.1 93.7 94.5 0.99 Total 91.6 92.7 92.1 1.01 94.1 94.2 94.1 1.00 HIGH SCHOOL Residence Urban 35.4 47.1 40.7 1.33 51.8 57.3 54.3 1.10 Rural 50.4 52.3 51.2 1.04 63.0 66.8 64.6 1.06 Region Yerevan 30.4 44.7 36.8 1.47 46.0 52.1 48.7 1.13 Aragatsotn 66.2 72.2 68.3 1.09 67.2 80.3 71.9 1.20 Ararat 61.0 45.9 54.1 0.75 99.9 76.0 88.9 0.76 Armavir 39.2 48.4 42.3 1.23 45.9 65.8 52.4 1.43 Gegharkunik 42.2 38.7 40.5 0.92 64.3 44.3 54.2 0.69 Lori 41.1 50.6 45.3 1.23 52.7 64.5 57.9 1.22 Kotayk 37.4 49.0 42.7 1.31 49.3 58.4 53.5 1.18 Shirak 51.0 57.5 54.2 1.13 64.1 67.7 65.9 1.06 Syunik 54.9 70.5 60.6 1.28 64.3 80.8 70.4 1.26 Vayots Dzor 52.1 63.0 57.5 1.21 66.1 68.5 67.3 1.04 Tavush 54.3 45.5 50.1 0.84 84.1 76.3 80.4 0.91 Wealth quintile Lowest 44.0 46.9 45.1 1.07 56.2 60.0 57.7 1.07 Second 47.9 51.1 49.4 1.07 56.7 62.8 59.6 1.11 Middle 38.3 53.9 44.1 1.41 53.7 65.9 58.3 1.23 Fourth 40.8 57.5 48.6 1.41 63.9 69.5 66.5 1.09 Highest 38.0 38.4 38.2 1.01 54.8 49.2 52.0 0.90 Total 42.2 49.3 45.3 1.17 56.9 61.2 58.8 1.08 1 The NAR for basic school is the percentage of the basic school age (6-14 years) population that is attending basic school (primary and middle school, grades 1-9). The NAR for high school is the percentage of the high-school age (15-17 years) population that is attending high school, grades 10-12. By definition the NAR cannot exceed 100 percent. 2 The GAR for basic school is the total number of basic school students, expressed as a percentage of the official 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 overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for basic school is the ratio of the basic school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for high school is the ratio of the high school NAR (GAR) for females to the NAR (GAR) for males. In Armenia, school attendance among school-age household members is high. The overall NAR for basic education is 92 and the GAR is 94. This means that among children who should be attending basic education, 92 percent are currently doing so. A comparison of the NAR and GAR indicates that approximately 2 percent of students are either under age or over age for their grade level. With the exception of the Ararat region, attendance ratios are greater than 90 percent by sex, region, and urban-rural residence. In the past five years the NAR has decreased by two percentage points, 94 percent of children who should have been attending basic education were doing so in 2005. 24 | Housing Characteristics and Household Population The NAR and GAR are much lower at the high school level: only 45 percent of students age 15-17 who should be attending high school are in school (NAR). The GAR for high school is 59 percent. A comparison of the NAR and GAR indicates that approximately 14 percent of students are either under age or over age for their grade level. Attendance ratios for high school are slightly higher among females than males. Surprisingly, both the NAR and GAR at the high school level are higher among students living in rural areas than among those living in urban areas. The NAR and GAR are much lower in Yerevan (37 and 49 percent, respectively) compared with high-school-age students from other regions. A comparison of the NAR and GAR indicates that Ararat and Tavush have the highest proportions of high school age students who are either under age or over age for their grade level (35 percent in Ararat and 30 percent in Tavush). The gender parity index (GPI), or the ratio of the female to the male NAR or GAR at the basic and high school levels, is an indicator of the magnitude of the gender gap in attendance ratios. If there is no gender difference, the GPI will equal one. The 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 2.13 shows the GAR GPI is 1.00 for the basic level and 1.08 for the high school level, which indicates that there is no gender gap at the basic level, while there is a gender gap in favor of females at the high school level. In Ararat, Gegharkunik, and Tavush, the disparity is in favor of males: the gender parity indexes at the high school level for the NAR are 0.75, 0.92, and 0.84 respectively; and for the GAR are 0.76, 0.69 and 0.91, respectively. Figure 2.3 presents the age-specific attendance rates (ASAR) for the population age 5-24, by sex. The ASAR indicates that almost all youths of basic school age (6-14) attend school, with no significant differences by gender. Among the high-school-age population (15-17), attendance ratios begin to decline, particularly among males. It should be noted that among young people age 17, a considerably higher proportion of females than males are attending school. One possible explanation is that a substantial proportion of young men age 15-19 temporarily join the labor force (particularly in the agricultural sector) after completing compulsory basic education and before they are required to serve in the military at age 18. For example, 53 percent of men age 15-19 work in agriculture compared with 33 percent of the same-age women (see Chapter 3, Tables 3.5.1 and 3.5.2). Figure 2.3 Age-specific Attendance Rates of the De Facto Population 5 to 24 Years 5 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 Percent Male Female ADHS 2010 Housing Characteristics and Household Population | 25 2.6 CHILD PROTECTION The prevention of exploitation, abuse, and violence against children is a high priority for Armenia and many other international organizations. According to UNICEF, in 2006 an estimated 158 million children age 5 to 14 were engaged in child labor; and between 500 million and 1.5 billion children worldwide experience violence on an annual basis (UNICEF, 2011). In 1989 Armenia became a signatory to the Convention on the Rights of the Child, a document that recognizes that all children have the right to be protected from any harm, including abuse, neglect, and economic exploitation (UN, 1989). Armenia ratified the Convention on the Rights of the Child in 1992. In 2003, the Armenia adopted the National Plan of Action for Protection of Children’s Rights, which is an integral part of the country’s child welfare reforms. The 2010 ADHS Household Questionnaire asked a number of questions to obtain information about child discipline and the prevalence of child labor in Armenia. Child Discipline The manner in which parents and caretakers discipline children can have long-term consequences on their physical and psychological development and well-being. In an effort to identify the types of child discipline methods used in Armenia, the 2010 ADHS included questions on this topic. The questions on child discipline were asked about one randomly selected child age 2-14 in each household.3 The questions were asked to the mother/caretaker of the child, and in instances where the mother/caretaker was not present, to the most knowledgeable adult. Questions asked referred to practices that may have been used to discipline the child during the 30 days prior to the interview. Specifically, questions were asked about whether anyone in the household had taken away the child’s privileges; forbade something the child liked, or did not allow the child to leave the house; explained why some behavior was wrong; shook the child; shouted, yelled, or screamed at the child; gave the child something else to do; spanked, hit, or slapped on the bottom with a bare hand; hit on the bottom or elsewhere on the body with something like a belt, hairbrush, or stick; called the child dumb, lazy, or a similar name; hit or slapped on the face, head, or ears; hit or slapped on the hand, arm, or leg; or beat the child with an implement. Finally, caretakers were directly asked if they believe that in order to bring up the child properly, they need to physically punish him/her. Table 2.14 shows that seven in ten children age 2-14 experienced some form of psychological or physical punishment during the 30 days preceding the survey. Approximately one-fifth of children (22 percent) experienced only non-violent discipline,4 and two-thirds of children (66 percent) experienced psychological aggression.5 Forty-two percent of children experienced physical punishment, and 4 percent experienced severe physical punishment. Boys tend to experience violence more often than girls. Urban children (46 percent) are more likely than rural children (38 percent) to experience any physical punishment. Children from Syunik are the least likely to have experienced physical punishment or any violent disciplinary method compared with other children. In contrast, over half of the children in Shirak, Armavir, and Yerevan have experienced any physical punishment. The highest proportions of children that have experienced severe physical punishment are from Shirak (8 percent), Tavush (6 percent), Kotayk, and Armavir (5 percent each). 3 If several children age 2-14 were listed in the household schedule, only one child per household was randomly selected for administration of the questions on child discipline. If one child age 2-14 was listed in the household schedule, the questions on child discipline were administered about this child. If none of the children listed in the household schedule were age 2-14, the questions on child discipline were not administered. 4 Only non-violent discipline: 1) providing an affirmative answer for the following: took away child’s privileges, forbade something the child liked, did not allow the child to leave the house or explained why some behavior was wrong, or gave the child something else to do; and 2) providing a negative answer to: shook the child, shouted, yelled, or screamed at the child; spanked, hit, or slapped on the bottom with a bare hand; hit on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other; called the child dumb, lazy, or similar name; hit or slapped the child on the face, head, or ears; hit or slapped the child on the hand, arm, or leg; beat the child with an implement. 5 Psychological aggression: an affirmative answer for the following: shouted, yelled, or screamed at the child or called the child dumb, lazy, or similar name. 26 | Housing Characteristics and Household Population Table 2.14 Child discipline Percentage of children age 2-14 according to method of disciplining the child, by background characteristics, Armenia 2010 Background characteristic Percentage of children 2-14 years of age who experience Respondent believes that the child needs to be physically punished Respondents to the child discipline module Only non- violent discipline1 Psychological aggression2 Physical punishment Any violent discipline method4 Number of children age 12-14 years5 Any Severe3 Age 2-4 22.2 61.8 48.1 3.9 67.2 830 3.6 537 5-9 20.5 68.7 47.3 3.4 72.8 1,346 2.9 745 10-14 23.4 65.3 35.0 4.0 68.1 1,548 3.6 998 Sex Male 19.8 68.2 45.0 3.9 72.0 1,988 3.8 1,190 Female 24.7 62.9 39.3 3.6 66.9 1,736 2.9 1,089 Residence Urban 21.9 64.7 45.5 4.4 69.9 2,202 2.8 1,384 Rural 22.4 67.2 37.8 2.8 69.2 1,522 4.3 896 Region Yerevan 21.7 66.8 51.4 4.2 72.1 1,233 3.0 769 Aragatsotn 45.8 47.9 21.2 0.5 49.8 147 3.4 94 Ararat 13.6 73.4 33.1 1.4 74.1 287 1.8 175 Armavir 21.3 70.4 51.0 5.0 71.6 349 2.8 216 Gegharkunik 14.6 70.1 36.6 1.0 72.2 301 3.3 168 Lori 39.9 48.2 23.1 1.8 52.9 306 1.1 193 Kotayk 17.8 74.6 37.4 4.7 77.4 335 6.1 207 Shirak 16.4 71.6 56.5 8.0 80.1 361 3.9 214 Syunik 39.8 11.9 7.1 0.4 15.0 128 5.2 83 Vayots Dzor 6.8 78.8 48.1 2.3 79.8 95 5.4 55 Tavush 18.2 77.1 41.0 5.7 79.9 183 5.5 107 Mother's education Basic 23.7 66.3 38.7 6.8 67.9 242 4.1 128 Secondary 17.6 69.4 43.6 4.3 73.3 1,528 4.0 898 Secondary special 24.0 63.9 42.8 3.6 68.6 1,148 2.7 726 Higher 27.4 61.2 40.5 2.0 64.7 806 3.0 528 Wealth quintile Lowest 22.3 68.3 40.0 4.3 70.5 815 4.6 469 Second 16.9 69.7 38.8 4.5 72.6 739 3.6 449 Middle 24.4 62.5 42.1 4.0 67.2 785 2.5 491 Fourth 21.6 63.0 41.9 2.4 67.7 646 3.6 410 Highest 25.0 64.8 49.2 3.5 69.8 739 2.7 460 Total 22.1 65.7 42.4 3.8 69.6 3,724 3.4 2,279 1 Only non-violent discipline: (1) providing an affirmative answer for the following: took away child’s privileges, forbade something the child liked, did not allow the child to leave the house or explained why some behavior was wrong , or gave the child something else to do; and (2) providing a negative answer to the following: shook the child; shouted, yelled, or screamed at the child; spanked, hit, or slapped on the bottom with bare hand; hit on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other; called the child dumb, lazy, or a similar name; hit or slapped the child on the face, head, or ears; hit or slapped the child on the hand, arm, or leg; beat the child with an implement. 2 Psychological aggression: providing an affirmative answer for the following: shouted, yelled, or screamed at the child or called the child dumb, lazy, or a similar name. 3 Hit or slapped on the face, head, or ears or beaten with an implement during the past 30 days 4 MICS IV 8.5 indicator; MICS III indicator 74 (Any psychological or physical punishment) 5 Table is based on children age 2-14 years randomly selected during fieldwork (one child selected per household, if any children in the age range) about whom the questions on child discipline were administered Lack of education tends to be positively associated with severe physical punishment, although the differences are small. Seven percent of children whose mothers had only a basic education were severely physically punished during the month before the survey compared with 2 percent of children whose mothers had a higher education. Children of better educated and wealthier parents and those from Aragatsotn, Lori, and Syunik are more likely to receive only non-violent discipline compared with other children. Overall, only 3 percent of the respondents to the child discipline module (i.e., the child’s mother or the most knowledgeable caretaker) believe that in order to bring up a child properly, the child needs to be physically punished. Housing Characteristics and Household Population | 27 Child Labor The ADHS Household Questionnaire asked a set of questions (based on the questions asked about child labor in the UNICEF MICS III survey) to obtain information about the prevalence of child labor in Armenia. Child labor is defined as the involvement of children age 5-14 in labor activities.6 In this report, a child is considered to be involved in child labor activities if he or she meets the following criteria: • Children age 5-11: at least one hour of economic work or 28 hours of domestic work during the week preceding the survey • Children age 12-14: at least 14 hours of economic work or 28 hours of domestic work during the week preceding the survey These definitions are consistent with UNICEF MICS–III child labor indicators, which make it possible to differentiate child labor from child work, which in turn allows organizations working in child protection to identify and advocate for the types of work that should be eliminated if the rights of the children are to be preserved. The discussion below provides a minimum estimate of the prevalence of child labor in Armenia. It is important to remember that some children may be involved in other labor activities that constitute child labor for a smaller number of hours than the criteria specified above and so will not be represented in the prevalence estimate. Table 2.15 shows that 4 percent of children age 5-14 are involved in child labor. Of these children, none of those who worked outside of their household in the past week received payment for their work. Overall, 3 percent of children worked for a family business during the week preceding the survey. No children age 5-14 were reported to be involved in domestic work for 28 hours or longer during the week preceding the survey (data not shown separately). The small number of children involved in child labor makes analysis by background characteristics challenging. Nevertheless, small variations in child labor activities are observed by age, sex, urban-rural residence, regions, school attendance, and wealth index. Surprisingly, children age 5-11 are more likely than children age 12-14 to be involved in child labor (5 and 2 percent, respectively). Children living in Aragatsotn and Shirak were more likely to be involved in child labor during the reference period than any other regions (8 and 7 percent, respectively). Children from the wealthier households and children whose mothers have higher education are the least likely to be involved in child labor. Differences by sex and orphanhood are negligible. 6 Legislation in Armenia permits children age 16 and older to work, and in certain cases, with the agreement of the parent/guardian, children age 14 are allowed to work. 28 | Housing Characteristics and Household Population Table 2.15 Child labor Percentage of children age 5-14 years who were involved in child labor activities in the past week, by type of work, Armenia 2010 Background characteristic Worked outside household in the past week1 Worked for family business in the past week1 Total child labor2 Number of children age 5-14 Paid work Unpaid work Age 5-11 0.0 1.1 4.0 4.9 1,917 12-14 0.1 0.0 1.8 1.8 978 Sex Male 0.1 0.7 4.0 4.7 1,578 Female 0.0 0.7 2.4 2.9 1,317 Residence Urban 0.0 1.0 1.6 2.4 1,704 Rural 0.1 0.3 5.6 6.0 1,191 Region Yerevan 0.0 1.7 2.0 3.3 949 Aragatsotn 0.0 0.0 7.7 7.7 115 Ararat 0.0 0.2 2.9 3.1 229 Armavir 0.0 0.8 5.1 5.9 259 Gegharkunik 0.0 0.0 1.8 1.8 238 Lori 0.0 1.3 0.7 1.9 248 Kotayk 0.3 0.0 5.2 5.5 262 Shirak 0.0 0.0 7.0 7.0 276 Syunik 0.0 0.0 2.5 2.5 99 Vayots Dzor 0.0 0.0 0.0 0.0 73 Tavush 0.0 0.0 3.3 3.3 146 Orphan (mother and/or father deceased) Yes 0.0 0.0 4.4 4.4 96 No 0.0 0.8 3.2 3.9 2,799 School participation Yes 0.0 0.7 3.6 4.2 2,601 No 0.0 0.7 0.5 1.1 294 Mother's education Basic 0.0 0.0 3.5 3.5 170 Secondary 0.1 0.9 4.6 5.5 1,174 Secondary special 0.0 1.3 2.6 3.5 865 Higher 0.0 0.0 1.9 1.9 612 Mother not in household 0.0 0.0 0.5 0.5 74 Wealth quintile Lowest 0.0 0.0 6.9 6.9 648 Second 0.1 0.3 3.6 4.1 578 Middle 0.0 1.0 2.1 3.2 591 Fourth 0.0 1.7 1.4 2.4 500 Highest 0.0 0.8 1.6 2.4 578 Total 0.0 0.7 3.2 3.9 2,895 1 Defined as any such work for children age 5-11 and 14 hours or more of such work for those age 12-14 2 Equivalent to UNICEF MICS III Indicator 71.The numerator for the child labor estimate includes: (a) children age 5-11 who during the past week did at least 1 hour of economic activity or at least 28 hours of domestic chores and (b) children age 12-14 who during the past week did at least 14 hours of economic activity or at least 28 hours of domestic chores. One of the negative consequences of child labor is its effect on a child’s schooling. Table 2.16 shows the percentage of children who are involved in child labor, the percentage of children who are attending school, and the percentage of children who are both attending school and also involved in child labor. Among those children who are involved in child labor, 97 percent are attending school. Among children age 5-14 who are attending school, 4 percent are involved in child labor. Housing Characteristics and Household Population | 29 Table 2.16 Child labor and school attendance Among children age 5-14, the percentage of children who are involved in child labor and the percentage of children who are attending school; among children age 5-14 involved in child labor, the percentage of child laborers who are attending school; and among children age 5-14 attending school, the percentage who are involved in child labor, according to background characteristics, Armenia 2010 Background characteristic Percentage of children involved in child labor1 Percentage of children attending school2 Number of children 5-14 years of age Percentage of child laborers who are attending school3 Number of children aged 5-14 involved in child labor Percentage of children attending school who are involved in child labor4 Number of children age 5-14 attending school Age 5-11 4.9 85.1 1,917 96.5 95 5.6 1,631 12-14 1.8 99.2 978 * 18 1.8 970 Sex Male 4.7 89.7 1,578 95.5 74.9 5.1 1,416 Female 2.9 90.0 1,317 100.0 37.6 3.2 1,185 Residence Urban 2.4 89.6 1,704 (93.8) 41 2.5 1,526 Rural 6.0 90.3 1,191 98.9 72 6.6 1,075 Region Yerevan 3.3 88.1 949 * 31 3.5 836 Aragatsotn 7.7 90.0 115 * 9 8.5 104 Ararat 3.1 88.8 229 * 7 3.5 204 Armavir 5.9 92.2 259 * 15 6.4 238 Gegharkunik 1.8 90.5 238 * 4 2.0 215 Lori 1.9 90.1 248 * 5 1.9 224 Kotayk 5.5 90.4 262 * 15 5.8 237 Shirak 7.0 91.2 276 * 19 7.6 252 Syunik 2.5 93.1 99 * 2 2.7 92 Vayots Dzor 0.0 88.9 73 * 0 0.0 65 Tavush 3.3 92.3 146 * 5 3.6 135 Orphan (mother and/or father deceased) Yes 4.4 100.0 96 * 4 4.4 96 No 3.9 89.5 2,799 96.9 108 4.2 2,506 Mother's education Basic 3.5 91.1 170 * 5 3.8 155 Secondary 5.5 88.7 1,174 94.9 65 5.9 1,041 Secondary special 3.5 89.3 865 (100.0) 30 3.9 772 Higher 1.9 91.7 612 * 11 2.0 562 Mother not in household 0.5 96.2 74 * 0 0.5 71 Wealth quintile Lowest 6.9 89.9 648 (98.2) 45 7.5 582 Second 4.1 93.1 578 * 23 4.4 538 Middle 3.2 87.6 591 * 19 3.1 518 Fourth 2.4 88.2 500 * 12 2.7 441 Highest 2.4 90.3 578 * 14 2.7 521 Total 3.9 89.9 2,895 97.0 112 4.2 2,601 Note: 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 table is based on the responses to a series of questions in the child labor module which is administered to the caretaker of each child in the household 5-14 years of age. The numerator to estimate the child labor percentage includes: (a) children 5-11 years of age that during the week preceding the survey did at least one hour of economic activity or at least 28 hours of domestic chores, and (b) children 12-14 years of age that during the week preceding the survey did at least 14 hours of economic activity or at least 28 hours of domestic chores. 2 Percentage of children 5-14 years of age attending school 3 MICS-III indicator 72. Laborer students: Number of children 5-14 years of age involved in child labor activities that are also attending school divided by the total number of children 5-14 years of age involved in child labor activities. 4 MICS-III indicator 73. Student laborers: Number of children 5-14 years of age attending school that are also involved in child labor activities divided by the total number of children 5-14 attending school Since 2004 a few surveys on child labor have been conducted in Armenia, among them the 2004 Labor Force and Child Labor Survey conducted by the National Statistical Service (NSS, 2005) and the 2008 Child Labor survey conducted by the “Harmonic Society” Social Workers’ Association, an NGO funded by UNICEF (UNICEF, 2008).According to the NSS survey, 5 percent of children age 7-17 worked in the three years preceding the survey. According to the 2008 UNICEF survey, 5 percent of children age 7-18 were working last year. 30 | Housing Characteristics and Household Population It should be noted that data on child labor in the 2010 ADHS are not directly comparable to the data collected in the 2004 NSS and the 2008 UNICEF surveys for a number of reasons. For example, there are differences in sampling and survey methodology, the survey population, and the wording of questions and the time frame references in all three surveys. Moreover, definitions of child labor employed for data analysis differ in each of the three surveys. Background Characteristics of Respondents | 31 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 This chapter gives a demographic and socioeconomic profile of respondents in the 2010 ADHS sample. Information on the basic characteristics of women and men interviewed in the survey is essential to interpret findings within the context of reproduction, health, and women’s status. The percent distribution of respondents by the various demographic and socioeconomic characteristics can be used as an approximate indicator of the representativeness of the survey sample to the general population. The main background characteristics, described in detail here and used in subsequent chapters on reproduction and health, are as follows: age at the time of the survey, marital status, residence, education, and wealth quintile. This chapter also includes information on exposure to mass media, employment and earnings, employment abroad, and use of tobacco. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 presents the distribution of interviewed women and men age 15-49 by selected background characteristics that include 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 2010 ADHS. Men age 15-49 were interviewed in every third household.1 In order not to double count respondents, the tables in this report in most cases are based on the de facto population, that is, those who stayed in the household the previous night. The age distribution shows that around half of the women (48 percent) and men (51 percent) are under age 30. In general, there are higher proportions of women and men in their twenties, and lower proportions of women and men in their late thirties and early forties, compared with older and younger age groups. This distribution likely reflects higher rates of emigration among the working age population in Armenia. Nearly two-thirds of the women (61 percent) and more than half of the men (54 percent) are married or living together. Because men tend to marry later in life than women, more men age 15-49 (45 percent) have never married compared with women age 15-49 (32 percent). Seven percent of women are divorced, separated, or widowed as opposed to 1 percent of men. The proportion of women who are married or living together has changed little over the past 10 years (64 percent in 2000 and 61 percent in 2010), while the proportion of men who are married or living together has declined considerably (from 68 percent in 2000 down to 54 percent in 2010). Consequently, the proportion of never-married men has increased considerably over the past ten years, from 31 percent in 2000 to 45 percent in 2010. Corresponding proportions of never-married women are 29 and 32 percent, respectively. There are few, if any, differences observed in the past five years. Three-fifths of the population lives in urban areas, with the majority of people living in Yerevan. Outside of Yerevan, the distribution by region shows that around two in five respondents are from the Kotayk, Shirak, Armavir, and Lori regions. The regions with the smallest proportions of respondents are the Syunik, Tavush, Vayots Dzor, and Aragatsotn regions. Women and men in Armenia are universally well educated, with 94 percent of women and 88 percent of men having at least some secondary education. Thirty percent each of women and men have some higher education. 1 In the 2000 ADHS, men age 15-54 in every third household were included in the survey. 32 | Background Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Armenia 2010 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 14.5 861 844 14.4 229 237 20-24 17.4 1,032 1,054 18.8 298 299 25-29 16.0 950 927 18.0 285 279 30-34 14.1 838 801 14.5 229 226 35-39 10.9 643 662 10.2 162 164 40-44 12.5 742 739 10.3 164 170 45-49 14.5 857 895 13.7 217 209 Marital status Never married 32.3 1,911 1,831 44.7 707 701 Married 60.7 3,597 3,679 51.1 809 811 Living together 0.5 28 27 2.9 46 47 Divorced/separated 4.0 236 221 1.2 19 22 Widowed 2.5 149 164 0.2 3 3 Residence Urban 61.5 3,641 3,966 62.1 984 1,063 Rural 38.5 2,281 1,956 37.9 600 521 Region Yerevan 34.9 2,069 987 37.5 593 283 Aragatsotn 4.4 260 485 4.4 70 148 Ararat 6.4 379 476 7.9 125 136 Armavir 9.0 535 504 9.3 148 145 Gegharkunik 7.7 459 564 5.3 83 134 Lori 8.7 513 453 8.2 130 107 Kotayk 9.2 543 584 9.4 148 158 Shirak 10.1 598 632 8.3 131 135 Syunik 3.3 198 379 4.0 63 123 Vayots Dzor 2.2 131 397 1.5 24 87 Tavush 4.0 238 461 4.3 68 128 Education Basic 5.9 347 346 11.9 188 179 Secondary 36.1 2,137 2,228 39.0 619 660 Secondary special 28.4 1,681 1,749 19.0 301 300 Higher 29.7 1,757 1,599 30.1 477 445 Wealth quintile Lowest 19.4 1,151 1,066 21.0 332 312 Second 20.5 1,211 1,305 18.0 285 314 Middle 19.2 1,139 1,332 19.7 312 346 Fourth 19.3 1,146 1,284 21.0 332 362 Highest 21.5 1,275 935 20.4 323 250 Total 100.0 5,922 5,922 100.0 1,584 1,584 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 3.2 EDUCATIONAL ATTAINMENT OF RESPONDENTS Education provides people with the knowledge and skills that can lead to a better quality of life. Level of education has been found to be closely associated with the health of women and children as well as with the reproductive health behaviors of women and men. As discussed in Chapter 2, Armenia’s educational system has undergone several stages of restructuring over the past five years.2 Tables 3.2.1 and 3.2.2 show the distribution of women and men by highest level of schooling attended or completed and the median number of years of schooling, according to background characteristics. 2 Basic education consists of grades 1-9 instead of grades 1-8 as in the previous system; high school consists of grades 10-12 instead of grades 9-10 as in the previous system. The two levels together (basic education and high school) are referred to as secondary education (grades 1 through 12 in the new system versus grades 1 through 10 in the old system). All other categories are similar to those in the 2005 ADHS. Background Characteristics of Respondents | 33 Education has been almost universal in Armenia for some time; the median number of years of schooling completed for women is 11.2 years (Table 3.2.1) and for men is 9.9 years (Table 3.2.2). Women age 15-19, those in the poorest households, and those in rural areas have less education than other women. Women in Yerevan and Syunik are better educated than women in other regions; the median years of schooling completed for women in these regions are 12.3 and 12.1 years, respectively. Women from the wealthiest households have, on average, an additional 2.8 years of schooling compared with women from the poorest households (12.5 years versus 9.7 years). Although virtually all female respondents have attended secondary school, differences are seen in attendance at higher levels of education. For example, 39 percent of urban women have some higher education compared with only 15 percent of rural women. There also is considerable variation by region: the largest proportion of highly educated women lives in Yerevan (47 percent), and the smallest proportions live in Gegharkunik (14 percent), Ararat (15 percent), and Aragatsotn (16 percent). Attainment of higher education is closely related to wealth status; half of the women in the highest wealth quintile have some university education compared with one in ten women in the lowest quintile. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Armenia 2010 Highest level of schooling Median years completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Total Number of women Age 15-24 0.1 0.0 0.0 15.1 27.6 21.1 36.2 100.0 10.1 1,893 15-19 0.0 0.0 0.0 28.7 22.7 15.9 32.7 100.0 9.6 861 20-24 0.1 0.0 0.0 3.7 31.7 25.3 39.1 100.0 12.1 1,032 25-29 0.1 0.0 0.0 4.7 34.0 28.0 33.2 100.0 11.9 950 30-34 0.0 0.0 0.0 6.8 32.5 32.1 28.6 100.0 11.7 838 35-39 0.4 0.0 0.0 3.6 36.1 35.0 24.9 100.0 11.4 643 40-44 0.0 0.1 0.0 3.7 41.8 31.8 22.6 100.0 11.1 742 45-49 0.0 0.1 0.0 3.5 40.9 33.4 22.1 100.0 11.2 857 Residence Urban 0.1 0.0 0.0 6.2 23.9 30.9 38.9 100.0 11.9 3,641 Rural 0.1 0.1 0.0 10.6 50.0 24.3 14.9 100.0 9.8 2,281 Region Yerevan 0.1 0.0 0.0 5.5 18.7 28.3 47.3 100.0 12.3 2,069 Aragatsotn 0.0 0.0 0.0 5.3 65.4 13.6 15.7 100.0 9.7 260 Ararat 0.0 0.0 0.0 8.9 52.3 23.9 14.9 100.0 9.8 379 Armavir 0.0 0.0 0.0 10.9 38.3 31.6 19.2 100.0 10.0 535 Gegharkunik 0.0 0.3 0.0 12.0 51.7 22.2 13.9 100.0 9.7 459 Lori 0.0 0.2 0.0 9.0 43.6 25.3 22.0 100.0 9.9 513 Kotayk 0.0 0.0 0.0 9.2 35.1 30.3 25.4 100.0 10.8 543 Shirak 0.2 0.0 0.0 8.1 34.5 35.1 22.1 100.0 11.0 598 Syunik 0.0 0.0 0.0 6.6 27.8 39.9 25.7 100.0 12.1 198 Vayots Dzor 0.4 0.0 0.0 7.1 45.0 29.3 18.2 100.0 9.9 131 Tavush 0.1 0.0 0.0 11.0 33.2 32.5 23.2 100.0 11.1 238 Wealth quintile Lowest 0.2 0.0 0.0 12.9 54.2 21.9 10.8 100.0 9.7 1,151 Second 0.0 0.1 0.0 9.9 44.8 28.3 16.9 100.0 9.8 1,211 Middle 0.0 0.1 0.0 7.9 31.5 33.2 27.3 100.0 11.3 1,139 Fourth 0.2 0.0 0.0 5.4 22.5 31.0 41.0 100.0 12.1 1,146 Highest 0.0 0.0 0.0 3.8 17.8 27.6 50.8 100.0 12.5 1,275 Total 0.1 0.0 0.0 7.9 33.9 28.4 29.7 100.0 11.2 5,922 1 Completed grade 4 at the primary level 2 Completed grade 12 at the secondary level or completed grade 10-11 at secondary level and has a secondary school diploma/attestat 34 | Background Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Armenia 2010 Highest level of schooling Median years completed Background characteristic Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Total Number of men Age 15-24 0.0 0.4 22.7 31.7 14.8 30.5 100.0 9.7 527 15-19 0.0 0.0 38.9 19.9 16.3 24.9 100.0 9.3 229 20-24 0.0 0.6 10.3 40.7 13.6 34.8 100.0 9.9 298 25-29 1.4 0.0 13.7 41.2 12.7 30.9 100.0 9.8 285 30-34 0.0 0.9 13.5 44.1 17.1 24.5 100.0 9.8 229 35-39 0.3 0.0 6.6 35.6 25.2 32.3 100.0 10.9 162 40-44 0.2 0.0 3.6 35.4 27.5 33.3 100.0 11.2 164 45-49 0.0 0.0 6.0 35.5 28.5 30.0 100.0 11.2 217 Residence Urban 0.4 0.2 9.4 27.8 20.8 41.4 100.0 10.9 984 Rural 0.2 0.3 21.2 50.7 16.1 11.5 100.0 9.5 600 Region Yerevan 0.5 0.3 8.6 22.0 19.3 49.3 100.0 11.5 593 Aragatsotn 1.4 0.0 14.4 64.3 7.9 12.0 100.0 9.5 70 Ararat 0.0 0.0 12.9 63.1 14.2 9.7 100.0 9.6 125 Armavir 0.0 0.0 23.0 41.6 18.4 17.0 100.0 9.6 148 Gegharkunik 0.3 0.0 12.1 56.5 22.9 8.1 100.0 9.6 83 Lori 0.0 0.0 22.4 38.2 20.3 19.1 100.0 9.7 130 Kotayk 0.0 0.0 24.2 33.5 24.6 17.8 100.0 9.8 148 Shirak 0.0 0.9 10.7 36.7 23.0 28.6 100.0 9.9 131 Syunik 0.8 0.0 12.6 34.7 21.5 30.5 100.0 9.9 63 Vayots Dzor 0.0 0.0 7.2 48.5 17.6 26.7 100.0 9.8 24 Tavush 0.0 1.0 14.0 50.1 8.9 26.1 100.0 9.7 68 Wealth quintile Lowest 0.3 0.6 21.2 55.3 14.2 8.4 100.0 9.5 332 Second 1.1 0.0 21.1 48.3 18.9 10.5 100.0 9.6 285 Middle 0.0 0.6 11.4 34.4 25.2 28.3 100.0 9.9 312 Fourth 0.1 0.0 9.7 23.8 17.8 48.7 100.0 11.5 332 Highest 0.1 0.0 6.5 21.9 19.2 52.2 100.0 11.8 323 Total 0.3 0.2 13.9 36.5 19.0 30.1 100.0 9.9 1,584 1 Completed grade 4 at the primary level 2 Completed grade 12 at the secondary level or completed grade 10-11 at secondary level and has a secondary school diploma/attestat The pattern of educational attainment among men is similar to that of women (Table 3.2.2). Younger men and men in rural areas generally have lower levels of education compared with their counterparts. Forty-one percent of urban men have some higher education compared with 12 percent of rural men. As with women, there is considerable variation by region. Yerevan residents have a clear educational advantage over the rest of the country: nearly half of the men in Yerevan (49 percent) have some university education compared with 10 percent or less of the men in Ararat and Gegharkunik. Wealth status is positively associated with education; 52 percent of men in the highest wealth quintile have some higher education compared with 8 percent of men in the lowest wealth quintile. The proportion of respondents with some higher education has substantially increased in the past ten years, from 19 percent of women and 22 percent of men in the 2000 ADHS to 24 percent each in the 2005 ADHS to 30 percent of women and men in the 2010 ADHS. 3.3 EXPOSURE TO MASS MEDIA Access to information is essential to increase people’s knowledge and awareness of what is taking place around them. In the 2010 ADHS, information was collected on respondents’ exposure to both broadcast and print media. This information is important because it can help program managers plan the dissemination of information on health, family planning, nutrition, and other programs. In the survey, exposure to media was assessed by asking how often a respondent reads a newspaper, watches television, or listens to the radio. The results are presented in Tables 3.3.1 and 3.3.2. Background Characteristics of Respondents | 35 At least once a week, 93 percent of Armenian women watch television, nearly half (45 percent) read a newspaper, and one-fifth (20 percent) listen to the radio (Table 3.3.1). Sixteen percent of women access all three media at least once a week, while 6 percent are not regularly exposed to any mass media. Younger women are more likely than older women to listen to the radio and access the three types of media at least once a week. Exposure to media has a strong positive association with education and wealth. For example, while 22 percent of women in the highest wealth quintile access all three media at least once a week, the corresponding proportion for women in the lowest wealth quintile is only 7 percent. Urban women are about twice as likely to be exposed to mass media as their rural counterparts (20 percent compared with 9 percent). Overall, women from Shirak and Yerevan are the most likely to be exposed to all three media at least once a week (40 percent and 23 percent, respectively). Aragatsotn, Syunik, and Vayots Dzor regions have the lowest proportions of women who access all three media at least once a week. 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 characteristics, Armenia 2010 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 48.4 91.1 24.6 17.5 8.4 861 20-24 47.0 94.0 21.8 17.5 5.6 1,032 25-29 46.2 91.2 21.7 14.9 6.7 950 30-34 45.8 94.0 21.0 17.2 4.1 838 35-39 48.9 93.5 19.4 14.9 5.6 643 40-44 39.1 90.7 14.3 12.7 8.2 742 45-49 41.2 93.2 17.8 13.3 6.2 857 Residence Urban 52.6 90.9 26.1 19.7 7.6 3,641 Rural 33.7 95.2 10.9 8.9 4.4 2,281 Region Yerevan 53.0 88.0 31.8 23.4 9.9 2,069 Aragatsotn 11.0 99.9 2.3 1.4 0.0 260 Ararat 34.8 99.8 13.5 13.0 0.1 379 Armavir 16.4 76.5 6.1 3.8 23.4 535 Gegharkunik 28.8 99.6 3.2 2.1 0.4 459 Lori 63.9 98.5 10.1 8.5 1.3 513 Kotayk 36.3 97.3 13.6 11.4 2.0 543 Shirak 59.6 93.9 50.4 39.9 4.0 598 Syunik 68.4 98.5 1.4 1.4 1.3 198 Vayots Dzor 48.3 99.6 1.9 1.5 0.3 131 Tavush 52.1 98.9 2.1 2.1 0.9 238 Education Basic 16.2 86.7 7.2 2.7 12.6 347 Secondary 30.1 93.9 12.0 8.3 4.8 2,137 Secondary special 46.5 92.0 21.7 15.5 6.8 1,681 Higher 68.4 92.5 31.6 26.9 6.7 1,757 Wealth quintile Lowest 27.2 92.5 9.7 7.2 6.9 1,151 Second 37.1 94.9 12.9 10.6 4.6 1,211 Middle 49.5 94.9 21.9 17.3 3.8 1,139 Fourth 56.9 93.5 26.8 19.9 5.7 1,146 Highest 55.1 87.5 29.5 22.2 10.6 1,275 Total 45.3 92.5 20.3 15.5 6.4 5,922 There has been a noticeable decrease in the past five years in the proportion of women exposed to each specific medium at least once a week: reading a newspaper has decreased from 53 percent in 2005 to 45 percent in 2010, television watching has decreased from 97 percent in 2005 to 93 percent in 2010, and listening to the radio has decreased from 33 percent in 2005 to 20 percent in 2010. Overall, the proportion of women exposed to all three media is smaller in 2010 than that observed in 2005 (16 and 23 percent, respectively). Slight changes in the wording of the questions between the two surveys may account for some of the trends. Dramatic increases in ownership of home computers and decreases in radio ownership over the past five years may also have contributed 36 | Background Characteristics of Respondents to this decline. Ownership of computers has tripled in Armenia in the past five years (growing from 9 to 29 percent), while ownership of radios has decreased by more than half its level during the same time period (from 29 percent in 2005 to 12 percent in 2010) (NSS et al., 2006; chapter 2, Table 2.5). In general, men report a lower level of exposure to all types of media than women (Table 3.3.2). Almost all men (96 percent) watch television, 30 percent read a newspaper, and 18 percent listen to the radio at least once a week. Less than 10 percent are exposed to all three types of media on a weekly basis. Three percent of men are not regularly exposed to any of the three media types. Table 3.3.2 shows that, for men, the relationships between exposure to mass media and background characteristics are generally similar to those observed among women. However, media exposure by age differs among men; younger men are less likely than older men to be exposed to all three media at least once a week. At the regional level, exposure to the three media at least once a week ranges from 16 percent in Yerevan to 1 percent or less for men in Gegharkunik, Ararat, Lori, and Syunik. In fact, in Syunik, no men reported accessing all three media at least once a week, an observation attributable to the fact that only 1 percent of men in Syunik report listening to the radio at least once a week. As with women, the proportion of men with access to all three media at least once a week has decreased over the past five years, declining from 22 percent in 2005 to 9 percent in 2010). 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 characteristics, Armenia 2010 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 20.6 94.2 15.3 7.2 5.8 229 20-24 35.2 98.3 16.9 9.1 0.9 298 25-29 28.1 96.2 16.8 6.7 3.7 285 30-34 30.5 96.0 18.0 10.5 3.4 229 35-39 29.4 96.1 26.0 11.1 1.6 162 40-44 37.0 93.5 21.8 15.9 5.1 164 45-49 29.6 95.6 13.6 6.8 4.4 217 Residence Urban 39.6 94.7 23.1 13.1 4.5 984 Rural 14.2 97.9 9.1 2.8 1.7 600 Region Yerevan 40.7 92.8 28.9 16.2 6.4 593 Aragatsotn 8.1 95.5 9.7 7.0 4.5 70 Ararat 4.4 98.2 3.2 0.5 1.8 125 Armavir 7.1 100.0 23.9 3.6 0.0 148 Gegharkunik 3.2 99.2 7.7 1.2 0.4 83 Lori 63.3 99.0 0.8 0.8 1.0 130 Kotayk 26.5 99.2 15.3 8.6 0.8 148 Shirak 37.8 93.2 12.7 10.2 4.8 131 Syunik 32.0 97.0 1.0 0.0 1.3 63 Vayots Dzor 16.1 94.6 16.7 11.1 5.0 24 Tavush 19.7 98.2 18.8 11.0 0.0 68 Education Basic 7.4 94.0 6.5 2.4 6.0 188 Secondary 17.8 97.6 12.6 4.7 2.0 619 Secondary special 32.0 96.8 20.9 8.5 1.8 301 Higher 53.4 93.9 27.0 18.2 5.3 477 Wealth quintile Lowest 8.9 98.3 7.7 1.5 1.6 332 Second 16.5 94.9 12.2 4.0 4.7 285 Middle 38.7 96.5 19.0 9.4 2.3 312 Fourth 41.5 95.5 22.0 13.4 3.8 332 Highest 43.2 94.2 27.7 17.1 5.0 323 Total 30.0 95.9 17.8 9.2 3.4 1,584 Background Characteristics of Respondents | 37 3.4 EMPLOYMENT As with education, employment can be a source of empowerment for women. In the 2010 ADHS, respondents were asked a number of questions to determine their employment status at the time of the survey as well as 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, especially 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 employment, respondents were asked several questions to probe for their employment status and to ensure complete coverage of employment in both the formal and informal sectors. Respondents are considered “employed” if they are currently working (i.e., if they have worked in the past seven days) or if they have worked at any time during the 12 months preceding the survey. Additional information is obtained on the type of work women are doing, whether they worked continuously throughout the year, who they worked for, and the form in which they received their earnings (in cash or in kind). Tables 3.4.1 and 3.4.2 show the percent distribution of female and male respondents by employment status, according to background characteristics. Thirty-two percent of women reported being currently employed, 3 percent were employed in the 12 months preceding the survey but not working at the time of the survey, and 65 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 (66 percent versus 32 percent). Nonetheless, more than one-quarter of men (27 percent) reported that they were not employed during the 12 months preceding the survey. Divorced, separated, or widowed women were substantially more likely than other women to be employed at the time of the survey. Among men, those who were formerly or currently married were more likely to be employed than never-married men. Current employment among women and men generally increases with age, education, and wealth quintile. Differences in current employment between rural and urban residents are not significant; however, among those employed in the 12 months preceding the survey, rural men are more likely not to be currently employed at the time of the survey than urban men (13 percent versus Figure 3.1 Women's and Men's Employment Status in the Past 12 Months ADHS 2010 Currently employed 32% Did not work in past 12 months 65% Not currently employed but worked in past 12 months 3% Not currently employed but worked in past 12 months 8% Did not work in past 12 months 27% Currently employed 66% 38 | Background Characteristics of Respondents 4 percent, respectively). Current employment among women is highest in Gegharkunik and Syunik (47 and 46 percent, respectively), while in Lori the proportion is only 19 percent. For men, current employment rates range from 75 percent in Armavir to 47 percent in Gegharkunik. Among men employed in the 12 months preceding the survey, men in Gegharkunik (31 percent) are substantially more likely not to be currently employed but to have worked in the 12 months preceding the survey compared with men from other regions. Men with lower levels of education and men living in households in the three lowest wealth quintiles are far more likely to have worked recently but not to be currently employed compared with more educated and wealthier men. Table 3.4.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Armenia 2010 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Total Number of women Age 15-19 7.1 0.8 92.1 100.0 861 20-24 18.2 2.9 78.8 100.0 1,032 25-29 27.2 3.4 69.5 100.0 950 30-34 38.4 5.0 56.5 100.0 838 35-39 43.4 4.7 52.0 100.0 643 40-44 47.5 3.0 49.4 100.0 742 45-49 48.4 3.9 47.8 100.0 857 Marital status Never married 25.1 3.0 71.8 100.0 1,911 Married or living together 32.6 3.1 64.3 100.0 3,626 Divorced/separated/widowed 55.1 6.9 38.0 100.0 385 Number of living children 0 26.7 3.0 70.3 100.0 2,233 1-2 32.5 3.8 63.7 100.0 2,690 3-4 41.3 2.8 55.9 100.0 964 5+ (23.5) (0.0) (76.5) 100.0 36 Residence Urban 32.1 4.4 63.5 100.0 3,641 Rural 31.0 1.6 67.4 100.0 2,281 Region Yerevan 34.5 6.1 59.4 100.0 2,069 Aragatsotn 30.8 1.4 67.8 100.0 260 Ararat 34.5 2.9 62.6 100.0 379 Armavir 29.8 1.8 68.4 100.0 535 Gegharkunik 47.0 0.8 52.2 100.0 459 Lori 18.7 2.6 78.7 100.0 513 Kotayk 28.8 2.1 69.2 100.0 543 Shirak 22.0 1.8 76.2 100.0 598 Syunik 45.9 3.6 50.5 100.0 198 Vayots Dzor 21.8 0.0 78.2 100.0 131 Tavush 30.2 0.2 69.7 100.0 238 Education Basic 22.1 5.1 72.8 100.0 347 Secondary 26.3 2.3 71.5 100.0 2,137 Secondary special 32.0 3.5 64.5 100.0 1,681 Higher 39.8 4.0 56.1 100.0 1,757 Wealth quintile Lowest 29.0 1.9 69.1 100.0 1,151 Second 30.7 2.4 66.8 100.0 1,211 Middle 28.3 3.4 68.3 100.0 1,139 Fourth 34.2 3.8 62.0 100.0 1,146 Highest 35.7 4.9 59.4 100.0 1,275 Total 31.7 3.3 65.0 100.0 5,922 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 "Currently employed" is defined as having done work in the past seven days. 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 | 39 Table 3.4.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Armenia 2010 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Total Number of men Age 15-19 11.9 3.9 83.9 100.0 229 20-24 50.6 10.0 39.4 100.0 298 25-29 72.9 10.8 16.2 100.0 285 30-34 85.1 8.7 6.2 100.0 229 35-39 85.0 6.7 8.2 100.0 162 40-44 90.4 2.2 7.4 100.0 164 45-49 80.6 8.0 11.4 100.0 217 Marital status Never married 41.9 8.5 49.5 100.0 707 Married or living together 84.8 7.2 8.0 100.0 855 Divorced/separated/widowed (91.4) (0.0) (8.6) 100.0 22 Number of living children 0 45.8 8.7 45.4 100.0 787 1-2 86.1 5.6 8.3 100.0 616 3-4 83.1 10.1 6.9 100.0 169 5+ * * * 100.0 11 Residence Urban 66.6 4.4 28.9 100.0 984 Rural 64.4 13.0 22.6 100.0 600 Region Yerevan 66.6 2.9 30.4 100.0 593 Aragatsotn 67.0 3.8 29.1 100.0 70 Ararat 58.4 11.8 29.9 100.0 125 Armavir 74.6 4.6 20.8 100.0 148 Gegharkunik 47.3 31.0 21.7 100.0 83 Lori 55.8 12.3 31.9 100.0 130 Kotayk 73.0 8.2 18.7 100.0 148 Shirak 72.5 9.3 17.7 100.0 131 Syunik 71.8 0.0 28.2 100.0 63 Vayots Dzor 66.7 19.1 14.3 100.0 24 Tavush 57.9 13.3 28.8 100.0 68 Education Basic 50.3 11.8 37.9 100.0 188 Secondary 65.1 11.2 23.6 100.0 619 Secondary special 74.9 4.3 20.8 100.0 301 Higher 67.0 3.6 29.5 100.0 477 Wealth quintile Lowest 65.1 12.5 22.4 100.0 332 Second 63.2 11.6 25.2 100.0 285 Middle 60.5 9.9 29.4 100.0 312 Fourth 68.2 3.5 28.3 100.0 332 Highest 71.3 1.4 27.2 100.0 323 Total 65.8 7.7 26.5 100.0 1,584 Note: 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 "Currently employed" is defined as having done work in the past seven days. 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. Trends in current employment among women and men are shown in Figure 3.2. Among men, the percentage currently employed has increased over the past decade, with the most dramatic increase occurring in the past five years (from 50 percent in 2005 to 66 percent in 2010). The difference in the percentage of men currently employed between 2000 and 2005 is considerably smaller (47 and 50 percent, respectively). It should be noted that slight changes in the wording of the questions and changes in the definition of “currently employed” between the 2000 and 2005 ADHS may account for some of the trends. In the 2000 ADHS women were asked, “Aside from your own housework, are you currently working?” But in 2005 and 2010 women were asked, “Aside from your 40 | Background Characteristics of Respondents own housework, have you done any work in the last seven days?” Thus, for women, being “currently employed” in 2005 and 2010 was defined as having done work in the past seven days, while in the 2000 ADHS, currently employed was defined as currently working. The current employment question for men also varied across the three surveys. In the 2000 and 2005 surveys, men were asked, “Are you currently working?” In the 2010 ADHS, the current employment question was modified to focus on work in the week preceding the survey (“Have you done any work in the past 7 days?”). Thus, in 2010, current employment included men who reported that they had worked in the week before the interview while, in 2000 and 2005, it included men who reported themselves as currently working without a specified time frame. 32 2 66 27 2 71 32 3 65 0 20 40 60 80 Percent 2000 2005 2010 Figure 3.2 Trends in Employment Status, Armenia 2000-2010 Women Men 46 45 44 50 16 34 66 8 27 0 20 40 60 80 Percent 1 “Currently employed” in the 2010 ADHS and in 2005 ADHS is defined as having done work in the past 7 days. In the 2000 ADHS, “currently employed” is defined as working at the time of interview. Currrently employed1 Currrently employed2 Not currently employed but worked in past 12 months Not currently employed but worked in past 12 months Did not work in past 12 months Did not work in past 12 months 2 “Currently employed” in the 2010 ADHS is defined as having done work in the past 7 days. In the 2000 ADHS and the 2005 ADHS, “currently employed” is defined as working at the time of interview. 3.5 OCCUPATION Respondents who indicated that they were currently working were asked about the kind of work that they did. Their responses were recorded verbatim and then coded into occupation groups after questionnaires were sent to 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 for 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 positions, 29 percent are employed in sales and services, and 15 percent work in agriculture. Women with specialized secondary or higher education, women living in households in the two highest wealth quintiles, and urban women are more likely to hold professional, technical, or managerial jobs. The opposite is true for women working in the agricultural sector. Women with lower levels of education, women living in households in the two poorest wealth quintiles, and women living in rural areas are more likely to work in agriculture. An agricultural occupation is also more likely as a woman has more children. Professional, technical, or managerial jobs are most common in Gegharkunik, where two-thirds of employed women work in professional positions (66 percent). In regions where agricultural work is scarce, such as Yerevan and Vayots Dzor, about eight in ten employed women work in professional positions or in sales and services. Agricultural jobs are most common in Ararat and Aragatsotn (42 percent and 55 percent, respectively). Background Characteristics of Respondents | 41 Table 3.5.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Armenia 2010 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 21.1 4.9 26.4 0.0 6.2 32.8 8.7 100.0 68 20-24 34.5 3.3 38.7 7.0 4.3 9.5 2.7 100.0 218 25-29 50.9 5.4 25.7 4.6 5.8 7.6 0.0 100.0 290 30-34 49.1 3.6 27.7 3.5 3.7 11.6 0.8 100.0 364 35-39 50.2 0.6 25.3 1.7 2.3 18.7 1.2 100.0 309 40-44 45.4 1.1 30.3 3.0 4.0 15.8 0.2 100.0 375 45-49 44.3 1.3 28.5 1.4 5.1 19.2 0.3 100.0 448 Marital status Never married 43.4 7.2 30.9 4.1 4.5 8.2 1.7 100.0 539 Married or living together 48.6 0.6 25.5 2.4 3.6 18.4 0.9 100.0 1,295 Divorced/separated/widowed 32.3 1.8 42.3 4.8 7.5 11.3 0.0 100.0 239 Number of living children 0 42.9 6.5 31.2 5.1 4.7 7.8 1.8 100.0 663 1-2 48.7 0.7 30.0 2.9 4.5 12.8 0.4 100.0 976 3-4 42.0 0.3 22.5 0.4 3.2 30.5 1.1 100.0 425 5+ * * * * * * * 100.0 8 Residence Urban 48.4 3.1 36.1 4.3 5.8 1.3 1.0 100.0 1,328 Rural 40.0 1.3 15.8 1.0 1.6 39.5 0.9 100.0 744 Region Yerevan 47.9 4.1 35.6 4.5 6.8 0.4 0.7 100.0 841 Aragatsotn 33.3 0.9 8.9 0.7 0.2 54.6 1.4 100.0 84 Ararat 20.7 1.7 30.2 1.7 3.4 42.4 0.0 100.0 142 Armavir 39.6 2.1 25.0 0.3 3.3 28.9 0.8 100.0 169 Gegharkunik 65.7 0.2 6.9 1.0 0.2 25.4 0.7 100.0 219 Lori 30.7 2.4 44.1 6.3 5.3 8.6 2.6 100.0 109 Kotayk 45.2 0.0 33.2 4.0 6.2 10.9 0.5 100.0 167 Shirak 48.6 0.8 22.8 1.8 0.6 21.3 4.2 100.0 142 Syunik 38.8 1.8 31.4 2.2 0.6 24.6 0.5 100.0 98 Vayots Dzor 60.3 3.3 22.2 2.7 10.4 1.1 0.0 100.0 28 Tavush 49.0 4.8 24.8 1.8 0.0 19.3 0.3 100.0 72 Education Basic 23.4 0.0 26.2 0.0 4.7 42.5 3.1 100.0 94 Secondary 18.0 0.5 38.1 1.5 8.3 32.9 0.7 100.0 610 Secondary special 48.3 2.0 33.3 3.1 2.8 10.5 0.1 100.0 597 Higher 67.4 4.7 18.4 4.8 2.2 0.9 1.5 100.0 771 Wealth quintile Lowest 31.2 1.3 17.1 0.0 1.2 47.9 1.3 100.0 356 Second 40.0 2.4 24.5 1.5 5.4 25.5 0.7 100.0 402 Middle 42.3 1.9 38.7 3.1 5.4 6.7 1.9 100.0 361 Fourth 52.2 2.5 33.4 4.6 4.3 1.7 1.3 100.0 436 Highest 55.6 3.7 29.6 5.2 4.7 1.1 0.1 100.0 518 Total 45.4 2.5 28.8 3.1 4.3 15.0 1.0 100.0 2,072 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Table 3.5.2 shows that, among employed men, 21 percent hold professional, technical, or managerial jobs, 39 percent are in sales and services, 8 percent work as skilled manual laborers, 17 percent work as unskilled manual laborers, and 15 percent work in agriculture. Although employment in most sectors increases with age, those age 15-19 are more than three times as likely as men in other age groups to work in agriculture. Men in urban areas are more likely to be working in jobs that require skills (i.e., professional/technical/managerial and sales and services) than men living in rural areas. The converse is true for men in rural areas; they are substantially more likely to be working as an unskilled manual laborer or in agriculture than men in urban areas. Similar patterns by education and wealth are seen among men and women. 42 | Background Characteristics of Respondents Table 3.5.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Armenia 2010 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 6.1 0.0 19.4 1.9 17.3 53.4 2.0 100.0 36 20-24 12.3 0.1 40.8 9.9 22.5 13.7 0.7 100.0 181 25-29 21.7 0.4 38.0 7.8 17.2 14.8 0.0 100.0 239 30-34 17.5 0.0 41.5 8.1 19.2 12.3 1.3 100.0 215 35-39 23.6 0.0 41.3 8.6 16.0 10.5 0.0 100.0 148 40-44 28.4 0.0 39.0 7.4 11.0 14.2 0.0 100.0 151 45-49 27.7 0.8 36.9 8.2 12.1 14.2 0.0 100.0 192 Marital status Never married 16.7 0.5 37.3 6.0 22.4 16.5 0.6 100.0 357 Married or living together 23.5 0.0 39.0 9.1 14.0 14.1 0.4 100.0 786 Divorced/separated/widowed * * * * * * * 100.0 20 Number of living children 0 18.7 0.4 36.6 7.8 20.1 15.8 0.6 100.0 429 1-2 23.9 0.2 43.2 8.3 13.0 11.0 0.4 100.0 565 3-4 18.3 0.1 28.9 7.8 20.3 24.7 0.0 100.0 158 5+ * * * * * * * 100.0 11 Residence Urban 28.0 0.0 46.3 10.4 13.3 1.3 0.7 100.0 699 Rural 10.6 0.6 27.7 4.7 21.6 34.8 0.0 100.0 464 Region Yerevan 36.3 0.0 42.4 9.4 11.0 0.5 0.5 100.0 413 Aragatsotn 11.1 0.0 5.7 4.0 31.2 48.0 0.0 100.0 50 Ararat 6.5 0.0 32.8 5.9 12.3 42.5 0.0 100.0 87 Armavir 9.9 0.0 38.9 4.8 18.9 27.4 0.0 100.0 117 Gegharkunik 14.1 1.6 35.0 6.7 33.7 8.9 0.0 100.0 65 Lori 16.7 0.0 39.8 1.5 26.0 16.0 0.0 100.0 89 Kotayk 12.4 0.0 42.2 14.4 18.4 12.6 0.0 100.0 120 Shirak 16.1 0.0 34.8 11.5 13.2 21.8 2.5 100.0 108 Syunik 16.0 0.0 44.7 5.6 14.6 19.1 0.0 100.0 45 Vayots Dzor 12.5 3.9 46.1 7.1 13.1 16.8 0.5 100.0 21 Tavush 13.4 2.1 49.7 7.6 17.8 9.4 0.0 100.0 48 Education Basic 2.8 0.0 32.0 8.8 26.4 28.3 1.7 100.0 117 Secondary 4.1 0.0 39.9 4.3 29.7 21.8 0.2 100.0 472 Secondary special 14.5 0.0 51.0 17.6 6.4 10.3 0.3 100.0 238 Higher 55.9 0.9 31.2 6.5 2.0 3.0 0.4 100.0 336 Wealth quintile Lowest 7.5 0.6 23.9 4.4 24.4 39.3 0.0 100.0 257 Second 9.4 0.0 36.3 7.3 24.9 21.5 0.6 100.0 213 Middle 21.2 0.5 47.3 7.5 14.4 7.6 1.5 100.0 220 Fourth 31.1 0.0 41.4 14.1 10.8 2.5 0.0 100.0 238 Highest 36.4 0.0 47.1 7.5 8.6 0.4 0.0 100.0 235 Total 21.1 0.2 38.9 8.1 16.6 14.6 0.4 100.0 1,163 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 3.6 EMPLOYMENT CHARACTERISTICS Table 3.6 shows the percent distribution of women who were employed in the 12 months preceding the survey by type of earnings and employer, and continuity of employment, according to type of employment (agricultural or non-agricultural). Overall, 76 percent of employed women earn cash only, 8 percent are paid in cash and in kind, and 10 percent receive no payment. Men are more likely to receive compensation than women—87 percent receive cash, and only 5 percent receive no Background Characteristics of Respondents | 43 payment (data not shown). Four in ten women who work in agriculture do not receive payment, while 87 percent who work in nonagricultural jobs are paid in cash. The majority of women (72 percent) are employed by a nonrelative, 12 percent are employed by a family member, and 16 percent are self-employed. Self-employment has doubled over the past five years, increasing from 8 percent in 2005 to 16 percent in 2010. The increase is particularly noticeable in the agricultu

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