Armenia - Demographic and Health Survey - 2017

Publication date: 2017

Armenia Demographic and Health Survey 2015-16 A rm enia 2015-16 D em ographic and H ealth S urvey Armenia Demographic and Health Survey 2015-16 National Statistical Service Yerevan, Armenia Ministry of Health Yerevan, Armenia The DHS Program ICF Rockville, Maryland USA August 2017 The 2015-16 Armenia Demographic and Health Survey (2015-16 ADHS) was implemented by the National Statistical Service and the Ministry of Health from December 8, 2015, to April 5, 2016. The funding for the ADHS was provided by the United States Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Children’s Fund (UNICEF). ICF provided technical assistance through The DHS Program, a USAID- funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2015-16 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: 374-11-524-213; Fax: 374-11-521-921; E-mail: info@armstat.am; Internet: http://www.armstat.am. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Recommended citation: National Statistical Service [Armenia], Ministry of Health [Armenia], and ICF. 2017. Armenia Demographic and Health Survey 2015-16. Rockville, Maryland, USA: National Statistical Service, Ministry of Health, and ICF. Contents • iii CONTENTS TABLES AND FIGURES . ix PREFACE . xv ACKNOWLEDGEMENTS . xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xix SUSTAINABLE DEVELOPMENT GOAL INDICATORS . xxi MAP OF ARMENIA . xxii 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Geography and Population . 1 1.1.1 Geography . 1 1.1.2 Population . 1 1.2 Systems for Collecting Demographic and Health Data . 2 1.3 Health Care System Updates in Armenia . 2 1.4 Objectives and Organization of the Survey . 4 1.5 Sample Design and Implementation . 5 1.6 Questionnaires . 5 1.7 Anthropometry and Anemia Testing . 6 1.8 Pretest . 7 1.9 Training of Field Staff . 8 1.10 Fieldwork and Data Processing . 8 1.11 Response Rates . 9 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Housing Characteristics . 12 2.1.1 Drinking Water . 12 2.1.2 Sanitation Facility . 14 2.1.3 Household Characteristics . 15 2.2 Secondhand Smoke Exposure . 15 2.3 Household Possessions . 16 2.4 Wealth Quintiles . 16 2.5 Hand Washing . 17 2.6 Household Population by Age and Sex . 18 2.7 Household Size and Composition . 20 2.8 Children’s Living Arrangements and Orphanhood . 20 2.9 Educational Attainment of Household Members. 21 2.10 Child Protection . 25 2.10.1 Birth Registration . 26 2.10.2 Child Discipline . 26 2.11 Poverty Benefits . 29 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS . 31 3.1 Background Characteristics of Respondents . 31 3.2 Educational Attainment of Respondents . 32 3.3 Exposure to Mass Media and Internet . 34 3.3.1 Mass Media . 35 3.3.2 Internet Usage . 36 3.4 Employment . 38 iv • Contents 3.5 Occupation . 41 3.6 Women’s Employment Characteristics . 44 3.7 Employment Abroad . 45 4 MARRIAGE AND SEXUAL ACTIVITY . 47 4.1 Marital Status . 47 4.2 Age at First Marriage and Sexual Intercourse . 48 4.2 Age at First Sexual Intercourse . 50 4.3 Recent Sexual Activity . 51 5 FERTILITY . 55 5.1 Current Fertility . 55 5.2 Fertility Differentials by Background Characteristics . 56 5.3 Fertility Trends . 57 5.3.1 Retrospective Data . 57 5.3.2 Comparison with Prior ADHS Surveys . 58 5.4 Children Ever Born and Living . 58 5.5 Birth Intervals . 59 5.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 61 5.7 Menopause . 61 5.8 Age at First Birth . 62 5.9 Teenage Pregnancy and Motherhood . 63 6 FERTILITY PREFERENCES . 65 6.1 Fertility Preferences . 65 6.2 Ideal Number of Children . 68 6.3 Fertility Planning . 70 6.4 Wanted and Unwanted Fertility . 71 7 CONTRACEPTION . 73 7.1 Knowledge of Contraceptive Methods . 73 7.2 Current Use of Contraception . 75 7.3 Current Use by Background Characteristics . 76 7.4 Source of Family Planning . 78 7.5 Informed Choice . 79 7.6 Discontinuation within 12 Months of Use . 80 7.7 Knowledge of the Fertile Period . 82 7.8 Need for Family Planning . 83 7.9 Future Use of Contraception . 86 7.10 Exposure to Family Planning Messages in the Mass Media . 87 7.11 Contact of Nonusers with Family Planning Providers . 89 7.12 Exposure to Reproductive Health Messages . 90 8. ABORTION . 91 8.1 Pregnancy Outcomes . 92 8.2 Lifetime Experience with Induced Abortion . 94 8.3 Rates of Induced Abortion . 95 8.4 Trends in Induced Abortion . 97 8.5 Use of Contraceptive Methods before Abortion . 98 8.6 Reasons for Abortion . 99 Contents • v 9 REPRODUCTIVE HEALTH . 101 9.1 Antenatal Care . 102 9.1.1 Antenatal Care Provider . 102 9.1.2 Number and Timing of ANC Visits . 103 9.1.3 Folate and Iron Supplements . 103 9.1.4 Antenatal Care Content . 104 9.1.5 Ultrasound Tests . 105 9.2 Assistance and Medical Care at Delivery . 106 9.2.1 Place of Delivery. 106 9.2.2 Assistance at Delivery . 107 9.2.3 Caesarian Deliveries . 107 9.2.4 Payment for Delivery . 109 9.3 Postnatal Care for the Mother . 111 9.3.1 Timing of Postnatal Checkups for the Mother . 111 9.3.2 Type of Provider of Postnatal Checkups for the Mother . 112 9.4 Postnatal Care for the Newborn . 112 9.4.1 Timing of Postnatal Care for Newborns . 112 9.4.2 Type of Provider of Postnatal Care for Newborns . 114 9.4.3 Content of Postnatal Care for Newborns . 114 9.5 Problems in Accessing Health Care . 115 9.6 Travel to Nearest Health Clinic . 117 10 HEALTH INSURANCE, USE OF TOBACCO, KNOWLEDGE AND ATTITUDES ABOUT TUBERCULOSIS . 119 10.1 Health Insurance . 119 10.2 Use of Tobacco . 122 10.3 Tuberculosis . 124 10.3.1 Knowledge and Attitudes about Tuberculosis . 124 10.3.2 Knowledge of Tuberculosis Symptoms . 128 10.3.3 Knowledge of Organs Affected by Tuberculosis . 131 10.3.4 Misconceptions about How Tuberculosis is Spread . 132 11 CHILD HEALTH . 135 11.1 Child’s Weight and Size at Birth . 135 11.2 Vaccination Coverage. 137 11.3 Trends in Vaccination Coverage . 141 11.4 Acute Respiratory Infection . 142 11.5 Fever . 142 11.6 Diarrhea . 143 11.7 Knowledge of ORS Packets . 146 11.8 Disposal of Children’s Stools . 146 11.9 Childhood Mortality . 147 12 NUTRITION . 149 12.1 Nutritional Status of Children . 150 12.1.1 Measurement of Nutritional Status among Young Children . 150 12.1.2 Levels of Child Malnutrition . 151 12.1.3 Trends in Children’s Nutritional Status . 156 12.2 Breastfeeding and Supplementation . 157 12.2.1 Initiation of Breastfeeding . 157 12.2.2 Breastfeeding Status by Age . 159 12.2.3 Duration of Breastfeeding . 161 12.2.4 Types of Complementary Foods . 161 vi • Contents 12.3 Infant and Young Child Feeding (IYCF) Practices . 163 12.4 Household Iodized Salt Consumption . 166 12.5 Micronutrient Intake in Children . 167 12.6 Nutritional Status of Women . 169 12.7 Micronutrient Intake among Mothers . 171 12.8 Anemia . 173 12.8.1 Anemia Prevalence in Women . 174 12.8.2 Anemia Prevalence in Children . 176 12.8.3 Knowledge about Anemia . 178 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS . 189 13.1 Knowledge of HIV/AIDS and Methods of HIV Prevention . 190 13.2 Misconceptions about HIV Transmission and Comprehensive Knowledge of AIDS . 192 13.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 193 13.4 Discriminatory Attitudes towards People Living with HIV . 194 13.5 Higher-Risk Sex . 196 13.5.1 Multiple Partners and Higher-Risk Sexual Intercourse. 196 13.5.2 Transactional Sex . 198 13.6 Coverage of Prior HIV Testing . 199 13.7 Self-Reported Sexually Transmitted Infections . 202 13.8 Prevalence of Medical Injections. 204 13.9 HIV/AIDS-Related Knowledge and Behavior among Youth . 206 13.9.1 HIV/AIDS-Related Knowledge among Young Adults . 206 13.9.2 Age at First Sex among Youth . 206 13.9.3 Abstinence and Premarital Sex . 208 13.9.4 Multiple Sexual Partners and Condom Use among Young People . 208 13.9.5 Recent HIV Tests among Youth . 209 14 DOMESTIC VIOLENCE . 211 14.1 Measurement of Violence . 211 14.1.1 Use of Valid Measures of Violence . 211 14.1.2 Ethical Considerations . 213 14.2 Experience of Physical Violence . 213 14.3 Experience of Sexual Violence . 215 14.4 Experience of Different Forms of Violence . 215 14.5 Violence during Pregnancy . 216 14.6 Marital Control by Spouse . 216 14.7 Forms of Spousal Violence . 218 14.8 Spousal Violence by Background Characteristics . 219 14.9 Violence by Spousal Characteristics and Women’s Empowerment Indicators . 221 14.10 Recent Spousal Violence by Any Husband . 222 14.11 Onset of Spousal Violence . 224 14.12 Physical Consequences of Spousal Violence . 224 14.13 Violence by Women against Their Husband . 225 14.14 Help-seeking Behavior by Women Who Experience Violence . 227 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 229 15.1 Employment and Cash Earnings . 230 15.2 Control Over Cash Earnings and Relative Magnitude of Women’s Earnings . 231 15.3 Ownership of Assets, Bank Accounts, and Mobile Phones . 234 15.4 Women’s Participation in Decision Making . 243 Contents • vii 15.5 Attitudes toward Wife Beating . 246 15.6 Attitudes toward and Ability to Negotiate Safer Sex with Husbands . 249 15.7 Indicators of Women’s Empowerment . 251 15.8 Contraceptive Use by Women’s Status . 252 REFERENCES . 255 APPENDIX A SAMPLE DESIGN . 259 A.1 Introduction . 259 A.2 Sample Frame . 259 A.3 Sample Design and Implementation . 261 A.4 Sample Probabilities and Sample Weights . 262 A.5 Survey Implementation. 263 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 267 APPENDIX C DATA QUALITY TABLES . 285 APPENDIX D PERSONS INVOLVED IN THE 2015-16 ARMENIA DEMOGRAPHIC AND HEALTH SURVEY . 291 APPENDIX E QUESTIONNAIRES . 295 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 9 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1 Household drinking water . 13 Table 2.2 Availability of water . 13 Table 2.3 Household sanitation facilities . 14 Table 2.4 Household characteristics . 15 Table 2.5 Household possessions . 16 Table 2.6 Wealth quintiles . 17 Table 2.7 Hand washing . 18 Table 2.8 Household population by age, sex, and residence . 19 Table 2.9 Household composition . 20 Table 2.10 Children's living arrangements and orphanhood . 21 Table 2.11.1 Educational attainment of the female household population . 23 Table 2.11.2 Educational attainment of the male household population . 23 Table 2.12 School attendance ratios . 24 Table 2.13 Birth registration of children under age 5 . 26 Table 2.14 Child discipline . 28 Table 2.15 Poverty benefits . 29 Figure 2.1 Population pyramid . 19 Figure 2.2 Age-specific attendance rates in the de facto population age 5-24 . 25 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS . 31 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 Internet usage: Women . 37 Table 3.4.2 Internet usage: Men. 38 Table 3.5.1 Employment status: Women . 39 Table 3.5.2 Employment status: Men . 40 Table 3.6.1 Occupation: Women . 42 Table 3.6.2 Occupation: Men . 43 Table 3.7 Type of employment . 44 Table 3.8 Respondent’s employment abroad . 45 Figure 3.1 Employment status . 41 4 MARRIAGE AND SEXUAL ACTIVITY . 47 Table 4.1 Current marital status . 48 Table 4.2 Age at first marriage . 49 Table 4.3 Median age at first marriage by background characteristics . 49 Table 4.4 Age at first sexual intercourse . 50 Table 4.5 Median age at first sexual intercourse by background characteristics . 51 Table 4.6.1 Recent sexual activity: Women. 52 Table 4.6.2 Recent sexual activity: Men . 53 x • Tables and Figures 5 FERTILITY . 55 Table 5.1 Current fertility . 56 Table 5.2 Fertility by background characteristics . 57 Table 5.3 Trends in age-specific fertility rates . 57 Table 5.4 Trends in fertility . 58 Table 5.5 Children ever born and living . 59 Table 5.6 Birth intervals . 60 Table 5.7 Postpartum amenorrhea, abstinence and insusceptibility . 61 Table 5.8 Menopause . 61 Table 5.9 Age at first birth . 62 Table 5.10 Median age at first birth . 62 Table 5.11 Teenage pregnancy and motherhood . 63 Figure 5.1 Trends in age-specific fertility rates . 58 6 FERTILITY PREFERENCES . 65 Table 6.1 Fertility preferences according to number of living children . 66 Table 6.2.1 Desire to limit childbearing: Women . 67 Table 6.2.2 Desire to limit childbearing: Men . 67 Table 6.3 Ideal number of children according to number of living children . 69 Table 6.4 Mean ideal number of children according to background characteristics . 70 Table 6.5 Fertility planning status . 71 Table 6.6 Wanted fertility rates . 71 Figure 6.1 Trends in fertility desires among married women . 68 7 CONTRACEPTION . 73 Table 7.1 Knowledge of contraceptive methods . 74 Table 7.2 Current use of contraception according to age . 75 Table 7.3 Current use of contraception according to background characteristics . 76 Table 7.4 Trends in the current use of contraception . 77 Table 7.5 Source of modern contraception methods . 79 Table 7.6 Informed choice . 80 Table 7.7 Twelve-month contraceptive discontinuation rates . 81 Table 7.8 Reasons for discontinuation . 82 Table 7.9 Knowledge of fertile period . 82 Table 7.10 Need and demand for family planning among currently married women . 85 Table 7.11 Future use of contraception . 86 Table 7.12.1 Exposure to family planning messages: Women . 87 Table 7.12.2 Exposure to family planning messages: Men. 88 Table 7.13 Contact of nonusers with family planning providers . 89 Table 7.14 Exposure to reproductive health messages . 90 Figure 7.1 Trends in contraceptive use among currently married women . 78 Figure 7.2 Trends in unmet need for family planning . 86 8. ABORTION . 91 Table 8.1 Pregnancy outcome by background characteristics . 92 Table 8.2 Lifetime experience with induced abortion. 94 Table 8.3 Induced abortion rates . 95 Table 8.4 Induced abortion rates by background characteristics . 96 Table 8.5 Trends in age-specific abortion rates . 98 Table 8.6 Use of contraception before pregnancy. 98 Table 8.7 Reason for abortion . 99 Figure 8.1 Trends in induced abortion by urban-rural residence, Armenia 2000-2016 . 93 Figure 8.2 Age-specific fertility rates and abortion rates, 2015-16 . 96 Tables and Figures • xi Figure 8.3 Trends in age-specific abortion rates, 2000-2016 . 97 9 REPRODUCTIVE HEALTH . 101 Table 9.1 Antenatal care . 102 Table 9.2 Number of antenatal care visits and timing of first visit . 103 Table 9.3 Components of antenatal care . 104 Table 9.4 Ultrasound testing during antenatal care . 105 Table 9.5 Place of delivery . 106 Table 9.6 Assistance during delivery . 107 Table 9.7 Caesarean section . 108 Table 9.8 Access to free delivery services . 110 Table 9.9 Payment for delivery of the last birth . 110 Table 9.10 Timing of first postnatal checkup for the mother . 111 Table 9.11 Timing of first postnatal checkup for the newborn . 113 Table 9.12 Type of provider of first postnatal checkup for the newborn . 114 Table 9.13 Content of postnatal care for newborns . 115 Table 9.14 Problems in accessing health care . 116 Table 9.15 Travel to the nearest clinic . 117 Figure 9.1 Mother’s duration of stay in the health facility after giving birth . 109 Figure 9.2 Type of provider of postnatal care for the mother . 112 10 HEALTH INSURANCE, USE OF TOBACCO, KNOWLEDGE AND ATTITUDES ABOUT TUBERCULOSIS . 119 Table 10.1.1 Health insurance coverage: Women . 120 Table 10.1.2 Health insurance coverage: Men . 121 Table 10.2.1 Use of tobacco: Women . 122 Table 10.2.2 Use of tobacco: Men . 123 Table 10.3 Average number of cigarettes smoked daily: Men . 124 Table 10.4.1 Knowledge and attitudes concerning tuberculosis: Women . 126 Table 10.4.2 Knowledge and attitudes concerning tuberculosis: Men. 127 Table 10.5.1 Knowledge of symptoms of tuberculosis: Women . 129 Table 10.5.2 Knowledge of symptoms of tuberculosis: Men . 130 Table 10.6.1 Knowledge about organs that can be affected by tuberculosis: Women . 131 Table 10.6.2 Knowledge about organs that can be affected by tuberculosis: Men . 132 Table 10.7.1 Misconceptions about tuberculosis transmission: Women . 133 Table 10.7.2 Misconceptions about tuberculosis transmission: Men . 134 Figure 10.1 Knowledge of tuberculosis . 125 11 CHILD HEALTH . 135 Table 11.1 Child's size and weight at birth . 136 Table 11.2 Vaccinations by source of information . 138 Table 11.3 Vaccinations by background characteristics . 140 Table 11.4 Prevalence and treatment of symptoms of ARI . 142 Table 11.5 Prevalence and treatment of fever . 143 Table 11.6 Prevalence of diarrhea . 144 Table 11.7 Feeding practices during diarrhea . 144 Table 11.8 Diarrhea treatment . 145 Table 11.9 Knowledge of ORS packets . 146 Table 11.10 Disposal of children's stools. 147 Figure 11.1 Trends in vaccination coverage among children 18-29 months . 141 xii • Tables and Figures 12 NUTRITION . 149 Table 12.1 Nutritional status of children . 153 Table 12.2 Initial breastfeeding . 158 Table 12.3 Breastfeeding status according to age . 159 Table 12.4 Median duration of breastfeeding . 161 Table 12.5 Foods and liquids consumed by children in the day or night preceding the interview . 162 Table 12.6 Infant and young child feeding (IYCF) practices . 164 Table 12.7 Presence of iodized salt in household . 167 Table 12.8 Micronutrient intake among children . 168 Table 12.9 Nutritional status of women . 170 Table 12.10 Micronutrient intake among mothers . 172 Table 12.11 Folate or multivitamins intake among mothers . 173 Table 12.12 Prevalence of anemia in women . 175 Table 12.13 Prevalence of anemia in children . 177 Table 12.14 Knowledge of anemia . 179 Table 12.15.1 Knowledge of symptoms of anemia: Women . 181 Table 12.15.2 Knowledge of symptoms of anemia: Men . 182 Table 12.16.1 Knowledge about what may cause anemia: Women . 183 Table 12.16.2 Knowledge about what may cause anemia: Men . 184 Table 12.17.1 What person can eat or drink to prevent anemia: Women . 185 Table 12.17.2 What person can eat or drink to prevent anemia: Men . 186 Table 12.18 Attitudes about drinking tea or coffee during meal time in relation to anemia . 187 Figure 12.1 Nutritional status of children by age . 155 Figure 12.2 Trends in nutritional status of children under age 5, 2005-2016 . 157 Figure 12.3 Infant feeding practices by age . 160 Figure 12.4 IYCF Indicators on breastfeeding status . 161 Figure 12.5 IYCF indicators on minimum acceptable diet . 166 Figure 12.6 Trends in nutritional status of women age 15-49 . 171 Figure 12.7 Trends in anemia status among women age 15-49, 2000-2016 . 176 Figure 12.8 Trends in anemia status among children age 6-59 months, 2000-2016 . 178 13 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS . 189 Table 13.1 Knowledge of HIV or AIDS . 190 Table 13.2 Knowledge of HIV prevention methods . 191 Table 13.3 Comprehensive knowledge about HIV . 193 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 194 Table 13.5 Discriminatory attitudes towards people living with HIV . 195 Table 13.6 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men . 197 Table 13.7 Payment for sexual intercourse and condom use at last paid sexual intercourse . 198 Table 13.8.1 Coverage of prior HIV testing: Women . 200 Table 13.8.2 Coverage of prior HIV testing: Men . 201 Table 13.9 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 203 Table 13.10 Prevalence of medical injections. 205 Table 13.11 Comprehensive knowledge about HIV among young people . 206 Table 13.12 Age at first sexual intercourse among young people . 207 Table 13.13 Premarital sexual intercourse among young people . 208 Table 13.14 Recent HIV tests among young people . 209 Figure 13.1 Women seeking advice or treatment for STIs . 204 Figure 13.2 Trends in age at first sexual intercourse . 207 Figure 13.3 Multiple sexual partners and higher-risk sex among young people . 209 Tables and Figures • xiii 14 DOMESTIC VIOLENCE . 211 Table 14.1 Experience of physical violence . 214 Table 14.2 Experience of sexual violence. 215 Table 14.3 Experience of different forms of violence . 215 Table 14.4 Experience of violence during pregnancy . 216 Table 14.5 Marital control exercised by husbands . 217 Table 14.6 Forms of spousal violence . 218 Table 14.7 Spousal violence by background characteristics . 220 Table 14.8 Spousal violence by husband's characteristics and empowerment indicators . 221 Table 14.9 Frequency of physical or sexual violence . 223 Table 14.10 Experience of spousal violence by duration of marriage . 224 Table 14.11 Injuries to women due to spousal violence . 224 Table 14.12 Violence by women against their spouse . 225 Table 14.13 Violence by women against their husband according to the husband’s characteristics and empowerment indicators . 226 Table 14.14 Help seeking to stop violence . 228 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 229 Table 15.1 Employment and cash earnings of currently married women and men . 230 Table 15.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings . 232 Table 15.2.2 Control over men's cash earnings . 233 Table 15.3 omen's control over their own earnings and over those of their husbands . 234 Table 15.4.1 Ownership of assets: Women . 235 Table 15.4.2 Ownership of assets: Men . 236 Table 15.5.1 Ownership of title or deed for house: Women . 237 Table 15.5.2 Ownership of title or deed for house: Men . 238 Table 15.6.1 Ownership of title or deed for land: Women . 239 Table 15.6.2 Ownership of title or deed for land: Men . 240 Table 15.7.1 Ownership and use of bank accounts and mobile phones: Women . 241 Table 15.7.2 Ownership and use of bank accounts and mobile phones: Men. 242 Table 15.8 Participation in decision making . 243 Table 15.9.1 Women's participation in decision making by background characteristics . 244 Table 15.9.2 Men's participation in decision making by background characteristics . 246 Table 15.10.1 Attitude toward wife beating: Women . 247 Table 15.10.2 Attitude toward wife beating: Men . 248 Table 15.11 Attitudes toward negotiating safer sexual relations with husband . 250 Table 15.12 Ability to negotiate sexual relations with husband . 251 Table 15.13 Indicators of women's empowerment . 252 Table 15.14 Current use of contraception by women's empowerment . 253 Table 15.15 Ideal number of children and unmet need for family planning by women's empowerment . 254 Figure 15.1 Number of decisions in which currently married women participate . 245 APPENDIX A SAMPLE DESIGN . 259 Table A.1 Households . 260 Table A.2 Enumeration areas . 260 Table A.3 Sample allocation of enumeration areas and households . 261 Table A.4 Sample allocation of completed interviews with women and men . 262 Table A.5 Sample implementation: Women . 264 Table A.6 Sample implementation: Men . 265 xiv • Tables and Figures APPENDIX B ESTIMATES OF SAMPLING ERRORS . 267 Table B.1 List of selected indicators for sampling errors, Armenia 2015-16 . 269 Table B.2 Sampling errors: Total sample, Armenia 2015-16 . 270 Table B.3 Sampling errors: Urban sample, Armenia 2015-16 . 271 Table B.4 Sampling errors: Rural sample, Armenia 2015-16 . 272 Table B.5 Sampling errors: Yerevan sample, Armenia 2015-16 . 273 Table B.6 Sampling errors: Aragatsotn sample, Armenia 2015-16 . 274 Table B.7 Sampling errors: Ararat sample, Armenia 2015-16 . 275 Table B.8 Sampling errors: Armavir sample, Armenia 2015-16 . 276 Table B.9 Sampling errors: Gegharkunik sample, Armenia 2015-16. 277 Table B.10 Sampling errors: Lori sample, Armenia 2015-16 . 278 Table B.11 Sampling errors: Kotayk sample, Armenia 2015-16 . 279 Table B.12 Sampling errors: Shirak sample, Armenia 2015-16 . 280 Table B.13 Sampling errors: Syunik sample, Armenia 2015-16 . 281 Table B.14 Sampling errors: Vayots Dzor sample, Armenia 2015-16 . 282 Table B.15 Sampling errors: Tavush sample, Armenia 2015-16 . 283 APPENDIX C DATA QUALITY TABLES . 285 Table C.1 Household age distribution . 285 Table C.2.1 Age distribution of eligible and interviewed women . 286 Table C.2.2 Age distribution of eligible and interviewed men . 286 Table C.3 Completeness of reporting . 287 Table C.4 Births by calendar years . 287 Table C.5 Reporting of age at death in days . 288 Table C.6 Reporting of age at death in months . 288 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 289 Table C.8 Vaccinations by background characteristics for children age 18-29 months . 290 Preface • xv PREFACE he 2015-16 Armenia Demographic and Health Survey (2015-16 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 December 8, 2015, through April 5, 2016. ICF provided technical support for the survey through The DHS Program. The DHS Program is funded 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 primary objective of the 2015-16 ADHS project is to provide up-to-date estimates of key demographic and health indicators. Specifically, the ADHS collected information on fertility and abortion levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, maternal and child health, childhood mortality, domestic violence against women, child discipline, awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking, tuberculosis, and anemia. The 2015-16 ADHS is a follow- up survey to the 2000, 2005, and 2010 ADHS surveys and provides updated estimates of key demographic and health indicators. The 2015-16 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. They also contribute to the international database on demographic and health-related indicators. T Acknowledgments • xvii ACKNOWLEDGMENTS he 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 2015- 16 Armenia Demographic and Health Survey (2015-16 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 2015-16 ADHS.  ICF for providing technical support, training of fieldwork staff, consultations, recommendations, and analyses of the data collected.  United Nations Children’s Fund (UNICEF)/Armenia, Joint United Nations Program on HIV/AIDS (UNAIDS)/Armenia, and United Nations Population Fund (UNFPA)/Armenia for providing technical, financial, 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 7,893 households, 6,116 women, and 2,755 men, whose honest participation made it possible to obtain the reliable information collected in the 2015-16 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 T Millennium Development Goal Indicators • xix 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 3.2 2.0 2.6 2. Achieve universal primary education 2.1 Net enrollment ratio in primary education2 98.1 97.2 97.7 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education3 na na 0.99 3.1b Ratio of girls to boys in secondary education3 na na 1.29 3.1c Ratio of girls to boys in tertiary education3 na na 1.31 4. Reduce child mortality 4.3 Proportion of 1-year-old children immunized against measles4 94.2 91.3 92.8 5. Improve maternal health 5.2 Proportion of births attended by skilled health personnel5 na na 99.8 5.3 Contraceptive prevalence rate6 na 57.1 na 5.4 Adolescent birth rate7 na 24 na 5.5a Antenatal care coverage: at least one visit by skilled health professional na 99.6 na 5.5b Antenatal care coverage: at least four visits by any provider na 96.0 na 5.6 Unmet need for family planning na 12.5 na 6. Combat HIV/AIDS, malaria and other diseases 6.2 Condom use at last high-risk sex: youth age 15-248 86.3a 0.0 43.1b 6.3 Percentage of population age 15-24 with comprehensive knowledge of HIV/AIDS9 12.5a 20.2 16.4b 7. Ensure environmental sustainability Urban Rural Total 7.8 Percentage of population using an improved drinking water source10 98.9 97.0 98.1 7.9 Percentage of population with access to improved sanitation11 96.1 48.6 76.6 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, among 6-9-year-olds for primary, 10-17-year-olds for secondary, 18-24- year-olds for tertiary education 4 In Armenia, the measles vaccinations are given at the age of 12 months. The values presented in the table are for children age 24- 35 months who have been vaccinated at any time before the survey against measles. 5 Among births in the 5-year period before the survey 6 Use of any contraceptive method among married or in-union women age 15-49 7 Age-specific fertility rates for women age 15-19 corresponding to the 3-year period before the survey 8 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. 9 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. 10 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 11 Percentage of de-jure population with access to flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet and does not share its facility with other households a Restricted to men in sub-sample of households selected for the male interview b The total is calculated as the simple arithmetic mean of the percentages in the columns for male and females Sustainable Development Goal Indicators • xxi SUSTAINABLE DEVELOPMENT GOAL INDICATORS Sustainable Development Goal Indicators Armenia 2015-16 Indicator Sex Total Male Female 2. Zero hunger 2.2.1 Prevalence of stunting among children under 5 years of age 10.9 7.8 9.4 2.2.2 Prevalence of malnutrition among children under 5 years of age 18.1 17.7 17.8 a) Prevalence of wasting among children under 5 years of age 3.6 5 4.2 b) Prevalence of overweight among children under 5 years of age 14.5 12.7 13.6 3. Good health and well-being 3.1.2 Proportion of births attended by skilled health personnel na na 99.8 3.7.1 Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods na 40.2 na 3.7.2 Adolescent birth rates per 1,000 women a) Girls aged 10-14 years1 na na na b) Women aged 15-19 years2 na 24 na 3.a.1 Age-standardized prevalence of current tobacco use among persons aged 15 years and older3 61.4 1.2 31.3a 3.b.1 Proportion of the target population covered by all vaccines included in their national programme4 88.0 84.7 86.4 5. Gender equality 5.2.1 Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months5,6 a) Physical violence na 3.5 na b) Sexual violence na 0.3 na c) Psychological violence na na na 5.3.1 Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 a) before age 15 na 0.0 na b) before age 18 na 5.3 na 5.b.1 Proportion of individuals who own a mobile telephone7 98.8 96.7 97.8a Residence Total 6. Clean water and sanitation Urban Rural 6.1.1 Proportion of the population using safely managed drinking water services8 98.9 97 98.1 6.2.1 Proportion of population using safely managed sanitation services, including a handwashing facility with soap and water9 96.1 48.6 76.6 7. Affordable clean energy 7.1.1 Proportion of population with access to electricity10 100.0 100.0 100.0 7.1.2 Proportion of population with primary reliance on clean fuels and technology11 99.7 92.0 96.9 Sex Total 8. Decent work and economic growth Male Female 8.10.2 Proportion of adults (15 years and older) with an account at a bank or other financial institution or with a mobile-money-service provider7 20.7 19.3 20.0a 16. Peace, justice, and strong institutions 16.2.1 Percentage of children aged 1-17 years who experienced any physical punishment and/or psychological aggression by caregivers in the past month12 70.8 66.8 68.9 16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority 98.9 98.5 98.7 17. Partnerships for the goals 17.8.1 Proportion of individuals using the Internet7 88.9 85.3 87.1a na = Not applicable 1 Equivalent to the age-specific fertility rate for girls age 10-14 for the 3-year period preceding the survey, expressed in terms of births per 1,000 girls age 10-14 2 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 3 Data are not age-standardized and are available for women and men age 15-49 only. 4 Data are presented for children age 12-23 months who received all vaccinations appropriate for their age that are included in the national program: BCG, hepatitis B (birth dose), three doses of DPT-HEPB-HIB, three doses of oral polio vaccine, and two doses of rotavirus vaccine (excluding the recently introduced pneumococcal vaccine). 5 Data are available for women age 15-49 who have ever been in union only. 6 In the DHS, psychological violence is termed emotional violence. 7 Data are available for women and men age 15-49 who have used the internet in the past 12 months. 8 Measured as the percentage of population using an improved water source: the percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, protected spring, or rainwater collection. Households using bottled water for drinking are classified as using an improved or unimproved source according to their water source for cooking and handwashing. 9 Measured as the percentage of population using an improved sanitation facility: the percentage of de jure population whose household has a flush or pour flush toilet to a piped water system, septic tank or pit latrine; ventilated improved pit latrine; pit latrine with a slab; or composting toilet and does not share this facility with other households. 10 Measured as the percentage of households with access to electricity. 11 Measured as the percentage of the households using clean fuel for cooking. 12 Data are available for children age 1-14 only. a The total is calculated as the simple arithmetic mean of the percentages in the columns for males and females xxii • Map of Armenia Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2015-16 Armenia Demographic and Health Survey (ADHS) was implemented by the National Statistical Service (NSS) and Ministry of Health (MOH) of the Republic of Armenia. Data collection took place from 8 December 2015 to 5 April 2016. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers support and technical assistance for population and health surveys in countries worldwide. Other agencies and organizations that facilitated the successful implementation of the survey through technical or financial support were the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the Joint United Nations Programme on HIV/AIDS (UNAIDS). 1.1 GEOGRAPHY AND POPULATION 1.1.1 Geography The Republic of Armenia (RA) is situated in the western part of Asia and occupies the northeastern part of the Armenian plateau between the Caucasus and Nearest Asia (the inter-river territory between the middle flows of the rivers Kur and Araxes). The country borders with Georgia in the north, with Azerbaijan in the east, with Iran in the south, and with Turkey in the west and southwest. The area of the country is 29,743 square km, 68.8 percent of which is agricultural, 11.2 percent is forest, 11.3 percent is protected territory, and 8.7 percent is other types of land. The highest elevation in the country is the peak of Mt. Aragats (4,090 m), the lowest point is the underflow region of the Debed River (375 m). The largest lake is Lake Sevan, which is located 1,900 m above sea level. The surface of the lake is 1,276 square km. The longest rivers are the Araxes (192 km in the territory of RA, with a total length of 1,072 km) and the Akhuryan (186 km). The climate in Armenia is dry and continental, with cold winters and hot summers. The country is subdivided into 10 regions (marz), and the capital city of Yerevan (NSS 2016a). 1.1.2 Population The First National Population Census of the Republic of Armenia after independence took place from 10-19 October 2001. As of 10 October 2001, the de facto population number in Armenia was 3,002,594 and the de jure population was 3,213,011 (NSS 2013). The most recent census prior to ADHS 2015-16 was conducted from 12-21 October 2011. According to the 2011 Census results, the de facto population in Armenia was 2,871,771 and the de jure population was 3,018,854 (NSS 2013). The de jure population of RA as of 1 April 2016, is 2,994,400, with 1,904,700 urban and 1,089,700 rural (NSS 2016b). More than half of the urban population (1,073,400) was living in the capital city, Yerevan. Men and women comprised 47.7 percent and 52.3 percent, respectively, of the permanent population in Armenia in 2016. The average age of the population was 36.1; it was 34.2 for men and 37.8 for women (NSS 2016d). As of early 2016, 20.8 percent of the permanent population was age 15 or younger, 66.3 percent was age 16-62, and 12.9 percent was age 63 or older. One of the existing problems of the demographic distribution is the ageing of the population, a process that greatly accelerated in Armenia during the post-Soviet period. Population ageing or demographic ageing is the result of long-lasting demographic changes, mainly changes in population reproduction, fertility, mortality, and their correlates and also partially the result of migration as well. By the demographic ageing scale set by the UN, if the share of the population age 65 is more than 7 percent, then this population is considered to be ageing. In early 2016, the share of the RA population age 65 and older was 11.0 percent. T 2 • Introduction and Survey Methodology 1.2 SYSTEMS FOR COLLECTING DEMOGRAPHIC AND HEALTH DATA The National Statistical Service (NSS) of RA is responsible for conducting a nationwide census every 10 years and for providing information about the current population using data from the national registration system. The 2001 census results were published during 2002-2004, and the 2011 census results during 2012-2014. Data on births, deaths, marriages, and divorces are provided by the Civil Status Acts Registration offices of the Ministry of Justice. Administrative data on internal and external migration of the population are provided by the Passport and Visa Department of RA police, and are based on the data from an electronic database, which is, in turn, based on the administrative records of registration of residency. The NSS handles statistical processing and analysis of the obtained administrative data, and publishes the preliminary data in the monthly report “Socio-Economic Situation of RA,” while final data by specific characteristics are published in a number of different annual reports of RA, including “The Demographic Handbook of Armenia,” “Men and Women in Armenia,” “Statistical Yearbook,” and others, all are available at the official website of the NSS of RA. Data on health are collected by the Ministry of Health through administrative statistical reporting forms filled in and provided by the health facilities. The collected information is then passed to the NSS. The NSS compiles and analyzes the data for the country level and publishes monthly, quarterly and annual reports and various publications. Based on compiled health data, the Ministry of Health publishes annual and quarterly thematic repots, such as “Health Indicators of the Population and Efficiency of Healthcare Resources in Armenia.” The country statistics are available at the World Health Organization (WHO) website through the Global Health Observatory, the WHO’s gateway to health-related statistics for its member states. 1.3 HEALTH CARE SYSTEM UPDATES IN ARMENIA Principles of health care policy Soon after regaining its independence Armenia began to reform the health care system. The country has recognized health and health care as a fundamental human right over the past 2 decades, and a number of major reforms have been carried out. These include decentralizing management and organizational structure, privatizing a number of health facilities, centralizing public financing activities, strengthening primary health care (PHC), and reforming the public health care system. The need for continuous reform to the health care system is conditioned by the new health challenges emerging both in the world and in Armenia. In particular, the balance between communicable and non- communicable diseases (NCDs) has changed, and NCDs are now the primary cause of mortality. The main directions of development in the health care system in Armenia arise from the provisions of the Actions Plan of RA Government and the comprehensive policy of “Health 2020,” adopted by the World Health Organization (WHO-EURO 2013). They are directed towards:  Ensuring universal health care coverage, that is, maximum access to health care and services for all the population groups  Maintaining and improving public health  Increasing the efficiency of management in the health care system  Maintaining the principle of social justice and equality, and formation of a stable and “people- centered” health care system The improvement of the quality of medical services is one of the key issues among current health care system priorities. According to the requirements of RA Government Protocol Decision № 40 “On the Concept of Health Care Service Quality Assessment and Approval of the List of Activities for Realization of the Concept” (14 October 2010), and in order to improve the quality of health care and services in the primary health care circle, a complex package of quality ensuring practical measures (methods, procedures, Introduction and Survey Methodology • 3 registration-reporting forms) has been put into use in 139 large health facilities throughout all the regions and the capital city of Yerevan. In Armenia health care services are provided in the outpatient (ambulatory) and inpatient (specialized) levels. Inpatient health care is provided at multiprofile, monoprofile, or specialized hospitals (including maternity homes and children’s hospitals). Outpatient health care is provided by urban polyclinics, health centers, rural ambulatory facilities, and feldsher-accoucher posts. At present there are 85 urban polyclinics, 255 rural ambulatory facilities and health centers, and 617 feldsher-accoucher posts in Armenia. Maternal and Child Health Armenia, as a member of the United Nations, has made the well-being and health of the mother and child a priority at the national level. This emphasis is reflected in the strategic documents of the RA government, particularly those of the Ministry of Health. They are the following:  The strategic program of prospective development for 2014-2025 of RA (GoA 2014a)  The national policy on the improvement of reproductive health and the implementation of an action plan for 2016-2020 (GoA 2016a)  The national policy on the improvement of child and adolescent health and the implementation of an action plan for 2015-2020 (GoA 2016b)  The concept of improvement of child nutrition and the implementation of an action plan for 2015-2020 (GoA 2014b)  The national breastfeeding promotion program and the implementation of an action plan for 2016-2020  The national program on immunization for 2016-2020 These documents reflect the current status of reproductive, maternal, and child health care issues in the country. They define the policies and goals aimed at improving women's and children's health and nutrition, and at reducing maternal and child mortality. Within the framework of the above mentioned policies and programs, the activities aimed at the protection of maternal and child health are considered as priorities of the Ministry of Health. Free delivery care vouchers and state certificates for free child health care have been in use since their respective introductions in 2008 and 2011. Additional financial contributions within these programs resulted in a three-to-four-fold rise in the wages of health workers, which significantly contributed to truly free and affordable delivery services for the population. Financing of the Health Care System Historically, the state budget was the primary financing source of the health care system. Currently, the health care system is financed by both local and international sources. The main local sources are the state budget and out-of-pocket payment. The international financing sources are generally in the form of humanitarian aid and special grants for the implementation of international projects. Grants received from abroad and from international organizations are mainly directed to the implementation of projects aimed at HIV/AIDS prevention, improvement of immunization coverage, and improvements in reproductive, maternal, and child health. The state budget is still the main source of financing. The funding for health care is determined as the final state budget is prepared. Budget allocations to health facilities are administered by the Ministry of Health on a contract basis, according to the principles of a limited budget. The primary health care (PHC) budget is financed according to per capita financing, whereas hospital-level facilities are financed according to the cost of each hospital case presented for reimbursement. The financing for medicine, medical equipment, and other health programs is also organized on a contract basis. State expenditures on the health 4 • Introduction and Survey Methodology care system are not sufficient to support the system and therefore do not meet the health needs of the population. Furthermore, the use of the given financial resources is not efficient. Taking into account the low level of state expenditures on the health care system, the RA government increases financing each year. Serious steps have been taken to reform the structure of the financing system. These have aimed at reducing non-official payment and introducing objective criteria for reimbursement. One valuable future program will be the introduction of compulsory health (medical) insurance, which is considered a way to add financial resources to the health care system, make health care more affordable for the population, promote principles of social justice, and increase the purposeful use of resources and the efficiency of medical services. Family planning policies Good reproductive health forms the basis of every family, the entire society, and the well-being and prosperity of a country. The status of reproductive health guarantees stable economic and social development. Investments in this sector are viewed as investments in the future. Family planning is the key component of reproductive health. The state and society must create proper conditions and take appropriate measures to ensure the birth of healthy children, to provide the prerequisites for education of the growing generation, and to support the reproduction of the population. Family planning has a broad impact on sexual and reproductive health, because it enables women to exercise their right of choice and to control their fertility. It reduces maternal and fetal morbidity and mortality, and lowers the transmission of sexually transmitted infections, including HIV. Family planning increases gender equality and gives opportunities for women to get an education, find a job, and fully engage in society. At present, according to Armenian law, induced abortions are permitted only in the first trimester of the pregnancy, a 12-week period (GoA 2004). In the case of medical or social indications, induced abortions may be done up to 22 weeks of gestation. Contraceptives once were provided free, and the services necessary for their prescription were charged to patients. In 2006, gynecological services were included among those services provided at no cost, in accord with the government’s principle of guaranteed, free primary health care. Because of the high concentration of estrogens in the early contraceptive pills and the frequency of serious complications, the Ministry of Health of the Soviet Union forbade their use and dissemination in 1974 under the “Side Effects and Complications of Oral Contraceptives” order. Today, the concentration of estrogens in the contraceptive pills of the new generation has been reduced, providing safety of use and medical efficiency. The use of modern contraceptive methods, including pills, has been permitted by the RA, as a part of the legislation on reproductive health and reproductive rights” (National Assembly of RA 2002). For the first time in 2015 some funds were allocated from within the state budget (National Assembly of RA 2014) for the purchase of modern contraceptive methods and for the dissemination of these methods among couples in socially insecure families. 1.4 OBJECTIVES AND ORGANIZATION OF THE SURVEY The 2015-16 Armenia Demographic and Health Survey (2015-16 ADHS) is the fourth 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 objective of the 2015-16 ADHS is to provide current and reliable information on fertility and abortion 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, domestic Introduction and Survey Methodology • 5 violence against women, child discipline, awareness and behavior regarding AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking, tuberculosis, and anemia. The survey obtained detailed information on these issues from women of reproductive age and, for certain topics, from men as well. The 2015-16 ADHS results are intended to provide information needed to evaluate existing social programs and to design new strategies to improve the 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 2015-16 ADHS will provide updated estimates of basic demographic and health indicators covered in the 2000, 2005, and 2010 surveys. The long-term objective of the survey includes strengthening the technical capacity of major government institutions, including the NSS. The 2015-16 ADHS also provides comparable data for long- term trend analysis because the 2000, 2005, 2010, and 2015-16 surveys were implemented by the same organization and used similar data collection procedures. It also adds to the international database of demographic and health–related information for research purposes. 1.5 SAMPLE DESIGN AND IMPLEMENTATION The sample was designed to produce representative estimates of key indicators 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. The sampling frame used for the 2015-16 ADHS is the Armenia Population and Housing Census, which was conducted in Armenia in 2011 (APHC 2011). The sampling frame is a complete list of enumeration areas (EAs) covering the whole country, a total number of 11,571 EAs, provided by the National Statistical Service (NSS) of Armenia, the implementing agency for the 2015-16 ADHS. This EA frame was created from the census data base by summarizing the households down to EA level. A representative probability sample of 8,749 households was selected for the 2015-16 ADHS sample. The sample was selected in two stages. In the first stage, 313 clusters (192 in urban areas and 121 in rural areas) were selected from a list of EAs in the sampling 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. Appendix A provides additional information on the sample design of the 2015-16 Armenia DHS. Because of the approximately equal sample size in each marz, the sample is not self-weighting at the national level, and weighting factors have been calculated, added to the data file, and applied so that results are representative at the national level. All women age 15-49 who were either permanent residents of the households in the 2015-16 ADHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. Interviews were completed with 6,116 women. In addition, in a subsample of one-half of all 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 2,755 men. Anemia testing was performed in each household among eligible women age 15-49 who consented. With the parent’s or guardian’s consent, children age 6-59 months were also tested for anemia in each household. Height and weight information was collected from eligible women age 15-49 and children age 0-59 months in all households. In addition, a subsample of one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. 1.6 QUESTIONNAIRES Five questionnaires were used for the 2015-16 ADHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, and the Fieldworker Questionnaire. 6 • Introduction and Survey Methodology These questionnaires, based on The DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Armenia. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. After all questionnaires were finalized in English, they were translated into Armenian. They were pretested in September-October 2015. 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 questionnaire collected, for each household member or visitor, information on 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 (that is, women and men age 15-49). In the second part of the Household Questionnaire, there were questions on housing characteristics (for example, 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, collect information about child discipline from one randomly selected child age 1-14 per household, and identify women age 15-49 and children under age 5 who were eligible for height and weight measurements and hemoglobin testing. The Woman’s Questionnaire obtained information from women age 15-49 on the following topics:  Background characteristics  Pregnancy history, reasons for any abortions, and child mortality  Knowledge, attitudes, and use of contraception  Antenatal, delivery, and postnatal care  Vaccinations of children under age 3  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  Domestic violence  Knowledge, attitudes, and behavior related to other health issues (for example, tuberculosis, anemia, and smoking) The Man’s Questionnaire was administered to all men age 15-49 in the subsample of households selected for the male survey (every second household). The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions about child health or domestic violence. In addition, the Biomarker Questionnaire was used to record the results of the informed consent procedures, as well as the anthropometry measurements and hemoglobin testing results, for consenting respondents. For the first time, the Fieldworker Questionnaire was used in the ADHS. This questionnaire was created to serve as a tool in conducting analyses of data quality. The questionnaire was distributed and collected by the NSS after final selection of fieldworkers was done and before fieldworkers entered the field. Fieldworkers filled out a 2-page self-administered questionnaire on their general background characteristics. 1.7 ANTHROPOMETRY AND ANEMIA TESTING The 2015-16 ADHS incorporated two biomarkers: anthropometry and anemia testing. Data related to the coverage of the biomarker component, the anthropometric measures, and the result of the anemia Introduction and Survey Methodology • 7 testing was directly recorded in the Biomarker Questionnaire. The protocol for anemia testing was reviewed and approved by the National Center for AIDS Prevention of the Ministry of Health and the Institutional Review Board of ICF. Anthropometry In all households, height and weight measurements were recorded for children age 0-59 months and women age 15-49 years. Weight measurements were obtained using lightweight, electronic Seca scales with a digital screen and the mother/child function. Height measurements were carried out with measuring boards provided by UNICEF1. Children younger than age 24 months were measured lying down (recumbent) on the board, while standing height was measured for older children. Anemia Testing Blood specimens were collected for anemia testing from all children age 6-59 months and all women age 15-49 years who voluntarily consented to the testing. Blood samples consisted of a drop of blood taken from a finger prick (or a heel prick, for young children with small fingers) and collected in a microcuvette. Hemoglobin analysis was carried out on site using a battery-operated portable HemoCue® analyzer, which produces a result in less than one minute. Results were given verbally and in writing. Parents of children with a hemoglobin level below 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their hemoglobin level was below 7 g/dl and 9 g/dl, respectively. All households in which anthropometry and/or anemia testing was conducted were given a brochure explaining the causes and prevention of anemia. 1.8 PRETEST Eleven women and four men participated in a training to pretest the ADHS survey questionnaires over a three-week period from September 16 through October 7, 2015. Twelve days of classroom training was provided. The training was led in Armenian by the in-country ADHS core team and was supported by The DHS Program staff. Senior subject specialists from the MOH attended the sessions to provide technical background on different topics included in the questionnaires. In addition, seven women were recruited as health investigators for the pretest. Classroom training for these women was conducted at the National Institute of Health (NIH) from 22-30 September 2015. Biomarker training was led by staff from the DHS Program and the NIH. Before going for the field practice, to make sure that the health investigators had enough practical experience to measure women and children, a standardization exercise was organized in the classroom. 1 Portable baby/child/adult length-height measuring board, UNICEF supply catalogue number S0114540. 8 • Introduction and Survey Methodology The pretest fieldwork was conducted on 1-7 October 2015. A total of 87 interviews with households were completed, as well as 81 interviews of women and 24 interviews of men. All interviews were conducted in Armenian. Approximately 77 women and 55 children were measured and tested for anemia after obtaining informed consent. Following the pretest fieldwork, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.9 TRAINING OF FIELD STAFF The main survey training, which was conducted by NSS, MOH, and the DHS Program staff, was held during a 3-week period in November and was attended by all supervisors, field editors, interviewers, and quality control personnel, a total of 104 people (85 women and 19 men). The training included lectures, demonstrations, practice interviews in small groups, and examinations. All field staff received training in anthropometric measurement and participated in 2 days of field practice. Health investigators were trained separately. Fifteen health investigators (13 women, 2 men) attended the training; all of them were skilled health professionals. The classroom training of the health investigators was conducted at the National Institute of Health (NIH). The biomarker portion of the training was conducted by the NIH/MOH and the DHS Program staff and included classroom instruction focusing on anthropometry measurements, anemia testing, and recording of biomarker information in the Biomarker Questionnaire. The training was divided into three sessions following the DHS biomarker curriculum: class- room training on anthropometry and anemia, in-class standardization of tests and practice sessions, and field practice with interviewers. 1.10 Fieldwork and Data Processing Thirteen teams collected the survey data; each team consisted of four female interviewers, a male interviewer, a field editor, a health investigator, and a team supervisor. Fieldwork started on 8 December 2015 in most regions and stopped from 31 December 2015 until 7 January 2016 for the New Year and Orthodox Christmas holidays. Fieldwork resumed on 8 January 2016, and was completed by 5 April 2016. Fieldwork monitoring was an integral part of the ADHS. Senior ADHS technical staff from NSS and NIH visited teams regularly to review the work and monitor data quality. Representatives from The DHS Program and USAID/Armenia also visited teams to monitor data collection and to observe the anemia testing and height and weight measurements of women and children under age 5. The processing of the 2015-16 ADHS data began shortly after fieldwork commenced. All completed questionnaires were edited immediately by field editors while still in the field and checked by the supervisors before being dispatched to the data processing center at the NSS central office in Yerevan. These completed questionnaires were edited and entered by 15 data processing personnel specially trained for this task. All data were entered twice for 100 percent verification. Data were entered using the CSPro computer package. The concurrent processing of the data was an advantage because the senior ADHS technical staff were able to advise field teams of problems detected during the data entry. In particular, tables were generated to check various data quality parameters. Moreover, the double entry of data enabled easy comparison and identification of errors and inconsistencies. 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 June 2016. Introduction and Survey Methodology • 9 1.11 RESPONSE RATES Table 1.1 shows response rates for the 2015-16 ADHS. A total of 8,749 households were selected in the sample, of which 8,205 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 7,893, yielding a household response rate of 96 percent. The household response rate in urban areas (96 percent) was nearly the same as in rural areas (97 percent). In these households, a total of 6,251 eligible women were identified; interviews were completed with 6,116 of these women, yielding a response rate of 98 percent. In one-half of the households, a total of 2,856 eligible men were identified, and interviews were completed with 2,755 of these men, yielding a response rate of 97 percent. Among men, response rates are slightly lower in urban areas (96 percent) than in rural areas (97 percent), whereas rates for women are the same in urban and in rural areas (98 percent). The 2015-16 ADHS achieved a slightly higher response rate for households than the 2010 ADHS (NSS 2012). The increase is only notable for urban households (96 percent in 2015-16 compared with 94 percent in 2010). Response rates in all other categories are very close to what they were in 2010. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Armenia 2015-16 Result Residence Total Urban Rural Household interviews Households selected 5,369 3,380 8,749 Households occupied 5,017 3,188 8,205 Households interviewed 4,806 3,087 7,893 Household response rate1 95.8 96.8 96.2 Interviews with women age 15-49 Number of eligible women 3,631 2,620 6,251 Number of eligible women interviewed 3,545 2,571 6,116 Eligible women response rate2 97.6 98.1 97.8 Interviews with men age 15-49 Number of eligible men 1,587 1,269 2,856 Number of eligible men interviewed 1,522 1,233 2,755 Eligible men response rate2 95.9 97.2 96.5 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter presents a demographic and socioeconomic profile of the households in the 2015-16 ADHS, including information on the age, sex, place of residence, and educational status of household members; housing characteristics; and the ownership of durable goods. Information on child birth registration and child discipline is also presented. Knowledge about the characteristics of respondents and their households helps in understanding and interpreting the findings of the survey and also in assessing the representativeness of the survey. T Key Findings  The average household has 3.5 members.  All households have electricity.  A majority of households (77 percent) use improved, not shared sanitation facilities.  Nearly all households (98 percent) obtain drinking water from an improved source.  Almost all households (97 percent) have soap and water available at the place that household members use for handwashing.  Most dwellings have some type of flooring, mostly parquet or polished wood, or wood/planks.  More than 9 in 10 households use gas for cooking and have a specific place for cooking inside the house. Natural gas is the most common fuel used for cooking in both urban and rural households (92 percent and 70 percent, respectively).  Eight percent of rural households use solid fuels for cooking versus less than 1 percent of urban households.  Virtually all Armenian households have a television, 97 percent have a refrigerator, and 93 percent have a washing machine. Most households also have a mobile telephone (96 percent).  Possession of a computer has increased from 29 percent of households in 2010 to 69 percent in 2015-16. Ownership among rural households has been especially rapid, increasing from 12 percent in 2010 to 62 percent in 2015-16.  The median number of completed years of schooling is 9.9 years among females and 9.7 years among males.  School attendance among youth is widespread but not universal; 96 percent of the basic school-age population and 56 percent of the high-school-age population attend school.  There is almost no gender gap in basic and high school attendance, but girls are slightly more likely to attend school than boys.  Seven in ten children age 1-14 experienced some form of psychological or physical punishment during the 30 days preceding the survey: 19 percent experienced only non-violent discipline; 65 percent experienced psychological aggression, and 38 percent of children experienced some form of physical punishment. Four percent experienced severe physical punishment. 12 • Housing Characteristics and Household Population 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 2015-16 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 2015-16 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. Throughout the report, because of the way the sample was designed, the number of cases in some regions may appear small in the tables; this is because they are weighted to make the regional distribution nationally representative. To identify results that may be based on numbers too small 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. They answered 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. 2.1.1 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 shows the results separately for households and for the de jure population living in those households. Overall, the 2015-16 ADHS shows that most households (98 percent) in Armenia have access to an improved source of drinking water, with the large majority (96 percent) reporting that their drinking water is piped directly into the dwelling, yard, or plot (Table 2.1). Only 3 percent of rural households and 1 percent of urban households rely on an unimproved source for drinking water, mainly water obtained from a tanker truck/cart. The small number of households that do not obtain their drinking water on the premises spend less than 30 minutes going to get water. Because households may use more than one method to treat water to make it safe to drink, water treatment is shown in Table 2.1 as the percentages of households and of the de jure population using specific treatment methods rather than a percent distribution. Because almost all households rely on piped water, which presumably comes from a public source where it is treated, it is not surprising that water is not treated further in most households (94 percent). At the household level, the most frequently used method for treating water is boiling (4 percent). Overall, 5 percent of households use an appropriate treatment method— boiling, bleaching, straining, filtering, or solar disinfecting. Interruptions to the supply of water may lead households to use unimproved sources for drinking water. Most households in Armenia do not have problems with lack of access to water. Only 8 percent of households using piped water or water from a borehole or dug well reported that water was not available from their usual source for at least 1 day in the 2 weeks prior to the survey (Table 2.2). Housing Characteristics and Household Population • 13 Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water and by time to obtain drinking water; percentage of households and de jure population using various methods to treat drinking water, and percentage using an appropriate treatment method, according to residence, Armenia 2015-16 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 99.0 97.3 98.3 98.9 97.0 98.1 Piped into dwelling/ yard/ plot 98.7 92.5 96.4 98.6 92.2 96.0 Public tap/standpipe 0.1 1.1 0.5 0.1 1.1 0.5 Tube well/borehole 0.0 0.6 0.2 0.0 0.8 0.3 Protected dug well 0.0 0.6 0.2 0.0 0.5 0.2 Protected spring 0.1 2.5 1.0 0.1 2.3 1.0 Unimproved source 1.0 2.7 1.7 1.1 3.0 1.9 Unprotected spring 0.0 0.2 0.1 0.0 0.2 0.1 Tanker truck/cart with small tank 1.0 2.4 1.6 1.1 2.8 1.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 98.8 95.6 97.6 98.7 95.5 97.4 Less than 30 minutes 0.9 2.6 1.5 0.9 2.5 1.6 30 minutes or longer 0.0 0.6 0.2 0.0 0.7 0.3 Don't know/missing 0.3 1.2 0.7 0.3 1.4 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 5.4 2.8 4.4 6.2 3.2 5.0 Bleach/chlorine added 0.0 0.1 0.0 0.0 0.1 0.0 Strain through cloth 0.1 0.1 0.1 0.1 0.1 0.1 Ceramic, sand, or other filter 0.9 1.0 1.0 1.1 1.4 1.2 Solar disinfection 0.1 0.0 0.0 0.0 0.0 0.0 Let it stand and settle 0.8 0.3 0.6 0.7 0.3 0.5 Other 0.8 0.0 0.5 0.9 0.0 0.5 No treatment 92.2 95.6 93.5 91.3 94.7 92.7 Percentage using an appropriate treatment method2 6.4 3.8 5.4 7.3 4.6 6.2 Number 4,924 2,969 7,893 16,482 11,475 27,958 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Table 2.2 Availability of water Among households and de jure population using piped water or water from a tube well or borehole, percentage with lack of availability of water in the last 2 weeks, according to residence, Armenia 2015-16 Availability of water in last 2 weeks Households Population Urban Rural Total Urban Rural Total Not available for at least 1day 8.1 8.1 8.1 8.6 8.2 8.4 Available with no interruption of at least 1 day 91.0 90.7 90.9 90.8 91.0 90.9 Don't know 0.9 1.2 1.0 0.6 0.8 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number using piped water or water from a tube well/borehole 4,868 2,798 7,666 16,281 10,800 27,081 14 • Housing Characteristics and Household Population 2.1.2 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 toilets that flush or pour flush into a piped sewer system/septic tank/pit latrine, and pit latrines 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 2.3 shows the proportion of households and of the de jure population with access to hygienic sanitation facilities (that is, those with access to improved, unshared facilities), shared facilities, and non-improved facilities. The 2015-16 ADHS found that 77 percent of households in Armenia use improved sanitation facilities that are not shared with another household (Table 2.3), which is lower than the percentage using improved, unshared facilities at the time of the 2010 ADHS (80 percent) 1 . Flush toilets are widespread in urban areas (95 percent), while pit latrines without a slab or open pits are the most prevalent type of toilet facility in rural areas (47 percent). Table 2.3 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities and percent distribution of households and de jure population with a toilet/latrine facility by location of the facility, according to residence, Armenia 2015-16 Type and location of toilet/ latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 94.8 27.1 69.3 94.8 28.2 67.5 Flush/pour flush to septic tank 0.3 4.8 2.0 0.3 5.7 2.5 Pit latrine with slab 0.9 14.8 6.2 1.0 14.7 6.6 Total 96.0 46.7 77.4 96.1 48.6 76.6 Shared facility1 Flush/pour flush to piped sewer system 0.6 0.1 0.4 0.5 0.1 0.3 Total 0.6 0.1 0.4 0.5 0.2 0.4 Unimproved facility Flush/pour flush not to sewer/septic tank/pit latrine 0.8 5.6 2.6 0.9 5.5 2.8 Pit latrine without slab/open pit 2.5 47.4 19.4 2.4 45.8 20.2 Missing 0.1 0.0 0.0 0.1 0.0 0.0 Total 3.4 53.1 22.1 3.4 51.3 23.0 Location of toilet facility In own dwelling 94.4 34.6 71.9 94.1 36.7 70.6 In own yard/plot 5.4 65.1 27.9 5.7 63.0 29.2 Elsewhere 0.2 0.3 0.2 0.2 0.2 0.2 Missing 0.0 0.0 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,924 2,969 7,893 16,482 11,475 27,958 1 Facilities that would be considered improved if they were not shared by two or more households 1 It should be noted, that unlike in the 2010 ADHS, the 2015-16 ADHS Household Questionnaire did not include the coding category for toilets that flush to a pit latrine. Housing Characteristics and Household Population • 15 2.1.3 Household Characteristics Table 2.4 presents the distribution of households by housing characteristics, according to residence. All households in Armenia have electricity (Table 2.4). More than 9 in 10 households use gas for cooking and have a specific place for cooking inside the house. Natural gas is the most common fuel used for cooking among both urban and rural households (92 and 70 percent, respectively). Eight percent of rural households rely on biomass fuels, primarily wood, for cooking. The use of biomass fuels may contribute to indoor air pollution, which has been shown to have adverse health effects (Fullerton et al. 2008). Slightly more than one-quarter of households (28 percent) have three or more rooms used for sleeping, and 42 percent have two rooms. Urban households are more likely than rural households to have only one room for sleeping (34 percent versus 22 percent). Virtually all households have a finished floor. Parquet or polished wood is the most common flooring material in both urban areas (77 percent) and rural areas (52 percent). Most rural households (87 percent) have stone walls with lime or cement. The majority of urban households have either stone (51 percent) or cement blocks for walls (39 percent). Shingles, or schiefer, are the most common roofing material in both urban and rural areas (45 and 74 percent, respectively), while taule roofing is used almost exclusively in urban areas (31 percent). Urban and rural households show a similar preference for metal roofing (21 and 24 percent, respectively). 2.2 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 2015-16 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. In over half of the households in Armenia, someone smokes inside the house on a daily basis, compared with just over one-third of households where no one smokes inside the house. Rural households (60 percent) are slightly more likely to report 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 2015-16 Housing characteristic Residence Total Urban Rural Electricity Yes 100.0 100.0 100.0 No 0.0 0.0 0.0 Total 100.0 100.0 100.0 Flooring material Earth/sand 0.4 0.2 0.3 Wood planks 11.7 36.0 20.8 Parquet/polished wood/laminate 76.5 51.9 67.2 Vinyl/linoleum 3.0 2.3 2.7 Ceramic/marble tiles 3.4 3.3 3.4 Cement 1.3 4.1 2.3 Carpet 3.5 2.3 3.1 Missing 0.2 0.0 0.1 Total 100.0 100.0 100.0 Main wall material No walls 0.0 0.0 0.0 Dirt 0.0 0.0 0.0 Stone with mud 6.0 8.2 6.8 Uncovered adobe 0.1 0.0 0.0 Plywood 0.0 0.0 0.0 Reused wood 0.0 0.0 0.0 Cement/monolith 3.2 0.8 2.3 Stone with lime/cement 50.6 86.6 64.1 Bricks 0.7 2.5 1.4 Cement blocks or panels 38.9 1.4 24.8 Covered adobe 0.0 0.1 0.0 Wood planks/ shingles 0.4 0.2 0.3 Other 0.1 0.1 0.1 Total 100.0 100.0 100.0 Main roof material No roof 0.1 0.0 0.1 Wood planks 0.0 0.1 0.1 Metal 20.7 23.5 21.7 Wood 0.1 0.3 0.2 Calamine/cement fiber 3.0 1.4 2.4 Ceramic tiles 0.1 0.5 0.3 Cement 0.1 0.5 0.2 Roofing shingles/schiefer 44.8 73.6 55.6 Taule (tarred roofing paper) 31.0 0.1 19.4 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Rooms used for sleeping One 34.1 22.2 29.6 Two 44.3 37.5 41.8 Three or more 21.5 40.0 28.4 Missing 0.2 0.3 0.2 Total 100.0 100.0 100.0 Place for cooking In the house 99.5 95.2 97.9 In a separate building 0.4 4.7 2.0 Outdoors 0.1 0.0 0.1 Missing 0.0 0.0 0.0 Total 100.0 100.0 100.0 Cooking fuel Electricity 2.8 2.2 2.6 LPG 4.5 19.4 10.1 Natural gas 92.1 70.2 83.9 Biogas 0.3 0.2 0.3 Wood 0.3 7.1 2.9 Animal dung 0.0 0.8 0.3 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 0.3 8.0 3.2 Frequency of smoking in the home Daily 49.5 59.7 53.4 Weekly 4.5 4.7 4.6 Monthly 1.8 1.8 1.8 Less than monthly 3.9 2.3 3.3 Never 40.3 31.5 37.0 Total 400.8 412.8 405.3 Number 4,924 2,969 7,893 LPG = Liquefied petroleum gas 1 Includes wood and animal dung 16 • Housing Characteristics and Household Population someone smokes on a daily basis and less likely to say no one ever smokes inside the house (32 percent) than urban households (50 and 40 percent, respectively). A comparison of the 2010 and 2015-16 ADHS results indicates that there has been virtually no change either in the proportion of households in which members are exposed to smoking on a daily basis (55 percent and 53 percent, respectively) or in the proportion of households in which no one smokes (38 percent and 37 percent, respectively). 2.3 HOUSEHOLD POSSESSIONS The availability of durable goods is an approximate measure of household socioeconomic status. Moreover, particular goods have specific benefits: having access to a radio or a television exposes 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, phones, computers, or refrigerators) and means of transportation (e.g., bicycles, motorcycles, or automobiles). Virtually all Armenian households have a television, 97 percent have a refrigerator, and 93 percent have a washing machine. Most households also have a mobile telephone (96 percent), and 69 percent have a computer. Virtually all households own common household furnishings like a table, sofa, and bed. Thirty-nine percent of households own a car or truck. Urban households are more likely than rural households to own most of the household effects shown in Table 2.5, although the differences in ownership rates are not large for many goods. Rural households are notably more likely to own a car or truck than urban households (48 percent and 34 percent, respectively). As expected, they are also much more likely to own agricultural land and farm animals than urban households. Household ownership of most durable goods has increased since the 2010 ADHS. Particularly noteworthy is the rapid growth in computer ownership. Around 7 in 10 households owned a computer in 2015-16 compared with 29 percent at the time of the 2010 ADHS. The increase in computer ownership among rural households has been especially rapid, from 12 percent in 2010 to 62 percent in 2015-16. The proportion of households owning a mobile phone also increased, from 87 percent in 2010 to 96 percent in 2015-16. On the other hand, there was a sharp drop in the percentage of households owning a non-mobile telephone, from 78 percent in 2010 to 58 percent in 2015-16. The drop in ownership of non-mobile phones was especially large among rural households, from 56 percent in 2010 to 25 percent in 2015-16. 2.4 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). Its construction takes into account urban-rural differences in household and dwelling characteristics Table 2.5 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Armenia 2015-16 Possession Residence Total Urban Rural Household effects Radio 7.8 2.4 5.8 Television 99.6 99.5 99.5 Mobile phone 96.5 96.0 96.3 Non-mobile phone 77.7 25.2 57.9 Computer 72.7 62.2 68.7 Refrigerator 97.9 95.2 96.9 Washing machine 94.2 90.5 92.8 Vacuum cleaner 80.3 62.1 73.4 Video camera camcorder 21.7 12.4 18.2 Table 99.9 99.8 99.9 Chair 100.0 99.8 99.9 Sofa 99.3 98.4 99.0 Bed 99.9 99.9 99.9 Wall unit/buffet 95.4 95.6 95.5 Air conditioner 13.9 6.5 11.1 DVD player 35.4 35.2 35.3 Satellite antenna 26.4 40.6 31.8 Freezer 10.0 6.7 8.8 Sewing machine 42.6 40.0 41.6 Carpet 93.9 92.2 93.3 Internet connection 72.7 62.2 68.8 Means of transport Bicycle 7.2 11.0 8.6 Animal drawn cart 0.2 0.8 0.4 Motorcycle/scooter 0.2 0.3 0.2 Car/truck 34.1 47.7 39.2 Boat with a motor 0.2 0.3 0.3 Ownership of agricultural land 13.0 84.2 39.7 Ownership of farm animals1 4.1 56.1 23.7 Number of households 4,924 2,969 7,893 1 Milk cows or bulls; cattle; horses, donkeys, or mules; goats; sheep; pigs; rabbits; other animals with fur; chickens or other poultry; or beehives Housing Characteristics and Household Population • 17 (Rutstein 2008). Each household is assigned a score based on the assets the household owns, and individuals are ranked according to the total score of the household in which they reside. The sample is then divided into population quintiles—five groups, each with the same number of individuals. At the national level, approximately 20 percent of the population is in each wealth quintile. Table 2.6 shows the distribution of the de jure household population across the five wealth quintiles, for urban and rural areas and by region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed among geographic areas. For example, 82 percent of the rural population is in the lowest and second-lowest wealth quintiles. In contrast, 64 percent of the urban population is in the two highest wealth quintiles. Considering the regional distributions, around 7 in 10 residents in Aragatsotn, Ararat, and Armavir are in the lowest two wealth quintiles compared with only 4 percent of residents in Yerevan. 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 0.05, suggesting a relatively equal distribution of wealth at the national level. The lowest Gini coefficient is seen in Yerevan (0.02), where nearly half of the population (47 percent) is in the highest wealth quintile. The highest Gini coefficients—that is, the least equitable distributions of wealth—are observed in Armavir (0.19) and Vayots Dzor (0.12). 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 2015-16 Residence/region Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 3.9 6.9 25.4 32.1 31.7 100.0 16,482 0.04 Rural 43.1 38.8 12.3 2.6 3.2 100.0 11,475 0.03 Region Yerevan 1.5 2.4 17.0 32.3 46.8 100.0 8,558 0.02 Aragatsotn 30.7 40.4 17.4 9.1 2.4 100.0 1,451 0.06 Ararat 40.1 33.3 13.2 8.3 5.1 100.0 2,623 0.08 Armavir 42.9 27.5 15.1 10.4 3.9 100.0 2,550 0.19 Gegharkunik 27.4 25.9 29.5 12.6 4.6 100.0 2,208 0.05 Lori 28.5 20.6 25.5 20.0 5.3 100.0 1,942 0.08 Kotayk 16.4 26.0 21.2 19.8 16.7 100.0 3,019 0.10 Shirak 18.0 23.8 25.2 20.0 13.0 100.0 2,377 0.09 Syunik 19.0 28.2 26.7 15.5 10.6 100.0 1,295 0.06 Vayots Dzor 27.6 24.4 19.2 16.6 12.2 100.0 578 0.12 Tavush 28.6 29.5 23.0 12.6 6.3 100.0 1,357 0.07 Total 20.0 20.0 20.0 20.0 20.0 100.0 27,958 0.05 2.5 HAND WASHING Washing hands with soap and water is the most hygienic way to wash. 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 2015-16 ADHS, the household respondents were asked to show the interviewer where household members most often wash their hands, and the interviewer recorded if water, soap, and a non-soap cleaning agent were available at that location. A hand washing station was observed in 96 percent of households interviewed in the ADHS (Table 2.7). Among households where a place for hand washing was observed, 97 percent had soap and water available at the time of interview. Only 2 percent of households in Armenia had soap alone, and less than 1 percent did not have water, soap, or another cleansing agent available. Households in the lowest wealth quintile (90 percent) and households in Armavir (91 percent) were least likely to have water and soap or another cleansing agent available. 18 • Housing Characteristics and Household Population Table 2.7 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 2015-16 Background characteristic Percentage of households in which place for washing hands was observed1 Number of house- holds Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Soap and water2 Water and cleansing agent3 other than soap only Water only Soap but no water4 Cleansing agent other than soap only3 No water, no soap, no other cleansing agent Missing Total Residence Urban 97.2 4,924 98.4 0.0 0.6 0.5 0.0 0.1 0.5 100.0 4,788 Rural 94.5 2,969 93.4 0.0 2.2 3.5 0.2 0.7 0.0 100.0 2,806 Region Yerevan 96.8 2,480 98.7 0.0 0.2 0.3 0.0 0.0 0.8 100.0 2,401 Aragatsotn 89.8 387 92.5 0.0 3.3 3.0 0.0 1.1 0.0 100.0 347 Ararat 96.7 682 95.1 0.1 3.1 0.8 0.2 0.6 0.1 100.0 659 Armavir 93.6 633 90.6 0.0 0.5 8.5 0.0 0.5 0.0 100.0 592 Gegharkunik 96.2 601 91.9 0.0 3.5 3.8 0.0 0.7 0.1 100.0 579 Lori 99.1 645 97.5 0.0 0.5 1.9 0.0 0.0 0.0 100.0 639 Kotayk 98.1 799 95.7 0.0 2.2 0.3 0.5 1.0 0.3 100.0 784 Shirak 93.8 685 98.4 0.0 0.3 1.2 0.0 0.0 0.2 100.0 643 Syunik 100.0 448 99.9 0.0 0.0 0.1 0.0 0.0 0.0 100.0 448 Vayots Dzor 95.5 167 98.5 0.0 1.5 0.0 0.0 0.0 0.0 100.0 160 Tavush 93.5 366 97.7 0.0 1.1 0.8 0.0 0.4 0.0 100.0 342 Wealth quintile Lowest 91.4 1,700 89.8 0.0 3.3 5.4 0.3 1.1 0.1 100.0 1,554 Second 97.0 1,452 96.2 0.0 1.7 1.7 0.0 0.3 0.1 100.0 1,409 Middle 97.4 1,791 98.1 0.0 0.6 0.6 0.1 0.2 0.5 100.0 1,744 Fourth 98.3 1,558 99.2 0.0 0.2 0.1 0.0 0.0 0.5 100.0 1,531 Highest 97.4 1,392 99.5 0.0 0.0 0.0 0.0 0.0 0.5 100.0 1,355 Total 96.2 7,893 96.5 0.0 1.2 1.6 0.1 0.3 0.3 100.0 7,594 1 Includes fixed and mobile place 2 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. 3 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 4 Includes households with soap only as well as those with soap and another cleansing agent 2.6 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 2.8 shows how the de facto household population is distributed by 5-year age groups, according to urban-rural residence and sex. The 2015-16 ADHS results indicate that, as expected, women outnumber men in Armenia. Overall, there were only 89 men for every 100 women in the de facto population in the households interviewed in the survey. The gender disparity is much more pronounced in urban areas than in rural areas (83 and 98 men per 100 women, respectively). Among the population under age 15, there are more males than females. The opposite pattern is consistently observed among the population age 50 and over, a result of higher mortality among men than women. The age structure shown in Figure 2.1 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 dependency ratio, which is the ratio of the non-productive population (persons under age 15 and age 65 and over) to the economically active population, is 48, which represents a slight increase over the dependency ratio of 45 at the time of the 2010 ADHS. The increase reflects the aging of the population, which characterizes countries in which fertility has fallen below the replacement level. Housing Characteristics and Household Population • 19 Table 2.8 Household population by age, sex, and residence Percent distribution of the de facto household population by 5-year age groups, according to sex and residence, Armenia 2015-16 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 7.0 5.4 6.1 7.3 5.6 6.4 7.1 5.5 6.3 5-9 7.8 5.4 6.5 6.8 6.3 6.5 7.4 5.8 6.5 10-14 7.4 5.4 6.3 7.3 5.7 6.5 7.4 5.5 6.4 15-19 5.5 4.6 5.0 5.3 6.2 5.7 5.4 5.2 5.3 20-24 6.1 6.3 6.2 8.8 7.1 7.9 7.2 6.6 6.9 25-29 7.5 8.1 7.8 8.8 7.6 8.2 8.0 7.9 8.0 30-34 7.8 7.3 7.5 7.5 6.9 7.2 7.7 7.1 7.4 35-39 7.1 6.3 6.7 5.1 6.2 5.6 6.2 6.2 6.2 40-44 5.6 5.5 5.5 4.8 5.8 5.3 5.2 5.6 5.4 45-49 4.5 5.0 4.8 6.0 5.2 5.6 5.2 5.1 5.1 50-54 7.0 8.6 7.9 9.1 10.1 9.6 7.9 9.2 8.6 55-59 7.6 9.3 8.5 8.2 7.8 8.0 7.8 8.7 8.3 60-64 6.6 7.2 6.9 4.9 5.3 5.1 5.9 6.5 6.2 65-69 4.9 5.5 5.2 2.9 3.6 3.3 4.0 4.8 4.4 70-74 2.4 3.0 2.7 1.6 2.2 1.9 2.0 2.7 2.4 75-79 2.8 4.0 3.5 3.0 4.2 3.6 2.9 4.1 3.5 80 + 2.5 3.1 2.8 2.8 4.2 3.5 2.6 3.5 3.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of persons 7,466 8,955 16,421 5,624 5,758 11,382 13,089 14,713 27,803 Figure 2.1 Population pyramid 8 6 4 2 0 2 4 6 8 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Percent Age Male Female ADHS 2015-16 20 • Housing Characteristics and Household Population 2.7 HOUSEHOLD SIZE AND COMPOSITION Table 2.9 presents the percent distribution of households in the 2015-16 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. The average household size at the time of the 2015-16 ADHS had fallen to 3.5 persons, compared with 4.3 persons in at the time of the 2000 ADHS. The majority of households are headed by males, with one-third (33 percent) headed by females. The rate of households run by women is slightly lower than that reported in the 2010 ADHS; this reverses an upward trend in which the proportion of female- headed households increased from 29 percent at the time of the 2000 ADHS to 37 percent in 2010. The average household size in rural areas is larger than in urban areas (3.9 compared with 3.3 members). On the other hand, households in urban areas are more likely than those in rural areas to be headed by a woman (37 percent compared with 28 percent). Information on households with foster children and orphans also was collected in the 2015-16 ADHS. Foster children are defined here as children under age 18 living in households with neither their mother nor their father present, while orphans are children with one or both parents dead. Table 2.9 shows that only a small proportion of households (2 percent) include orphans or foster children under age 18. 2.8 CHILDREN’S LIVING ARRANGEMENTS AND ORPHANHOOD Table 2.10 presents information on living arrangements and orphanhood for children under age 18. The majority of children under age 18 (86 percent) live with both parents, 11 percent live with their mother only, 1 percent live with their father only, and 1 percent live with neither of their biological parents. The table also provides data on the extent of orphanhood, that is, the proportion of children who have lost one or both parents. Three percent of children under age 18 have lost one or both parents. Two percent of children under age 18 have lost their fathers, while less than 1 percent have lost their mothers. Very few children under age 18 are reported to have lost both parents. Table 2.9 Household composition Percent distribution of households by sex of head of household and by household size; mean size of households; and percentage of households with orphans and foster children under age 18, according to residence, Armenia 2015-16 Characteristic Residence Total Urban Rural Household headship Male 63.5 72.4 66.8 Female 36.5 27.6 33.2 Total 100.0 100.0 100.0 Number of usual members 1 16.6 12.8 15.2 2 21.9 16.9 20.0 3 16.8 15.1 16.1 4 19.1 17.6 18.6 5 12.6 15.7 13.7 6 8.8 13.4 10.5 7 2.6 5.3 3.6 8 0.8 1.8 1.1 9+ 0.8 1.5 1.0 Total 100.0 100.0 100.0 Mean size of households 3.3 3.9 3.5 Percentage of households with orphans and foster children under 18 Double orphans 0.1 0.0 0.1 Single orphans1 1.3 1.0 1.2 Foster children2 0.7 0.7 0.7 Orphans and/or foster children 2.0 1.6 1.9 Number of households 4,924 2,969 7,893 Note: Table is based on de jure household members, that is, usual residents 1 Includes children with one dead parent and an unknown survival status of the other parent 2 Foster children are those under age 18 living in households with neither their mother nor their father present, and the mother and/or father are alive. Housing Characteristics and Household Population • 21 Differentials in fosterhood and orphanhood by background characteristics are generally not large. Older children are less likely than younger children to live with both parents. This results from increases with age in both proportions of children who are fostered and children who are orphaned. Shirak and Yerevan have the lowest proportions of children living with both parents (77 percent and 82 percent, respectively). These regions also report the highest proportions of children who live only with their mothers but whose fathers are alive (18 percent for Shirak and 12 percent for Yerevan). Greater employment-driven outmigration from these regions may be a factor in both patterns. Table 2.10 Children's living arrangements and orphanhood Percent distribution of de jure children under age 18 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 2015-16 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 Percent- age not living with a biolo- gical parent Percent- age with one or both parents dead1 Number of children Both alive Only father alive Only mother alive Both dead Missing infor- mation on father/ mother Father alive Father dead Mother alive Mother dead Age 0-4 91.3 8.0 0.4 0.1 0.1 0.1 0.0 0.0 0.0 0.1 100.0 0.1 0.5 1,743 <2 92.4 7.3 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.3 724 2-4 90.4 8.5 0.5 0.2 0.1 0.2 0.0 0.0 0.0 0.1 100.0 0.2 0.6 1,019 5-9 86.9 9.7 1.3 0.7 0.2 0.8 0.2 0.0 0.1 0.1 100.0 1.1 1.8 1,807 10-14 82.9 9.6 3.8 1.3 0.5 1.3 0.3 0.0 0.0 0.3 100.0 1.6 4.6 1,781 15-17 82.9 10.7 2.5 0.8 0.6 2.1 0.0 0.0 0.3 0.2 100.0 2.4 3.4 988 Sex Male 85.9 9.6 2.2 0.6 0.3 0.8 0.2 0.0 0.1 0.2 100.0 1.1 2.8 3,366 Female 86.8 9.0 1.7 0.8 0.3 1.1 0.1 0.0 0.0 0.1 100.0 1.2 2.1 2,953 Residence Urban 83.3 11.8 2.4 0.7 0.3 1.0 0.2 0.0 0.1 0.1 100.0 1.3 3.0 3,662 Rural 90.5 6.0 1.3 0.8 0.3 0.9 0.0 0.0 0.0 0.2 100.0 0.9 1.7 2,657 Region Yerevan 82.3 12.1 2.8 0.9 0.2 1.1 0.3 0.0 0.2 0.0 100.0 1.6 3.6 1,900 Aragatsotn 93.2 4.3 1.6 0.3 0.2 0.1 0.0 0.0 0.0 0.3 100.0 0.1 1.8 311 Ararat 90.9 5.6 2.1 0.6 0.0 0.6 0.2 0.0 0.0 0.0 100.0 0.8 2.3 600 Armavir 84.8 9.9 1.9 0.7 0.5 1.6 0.0 0.0 0.0 0.6 100.0 1.6 2.4 640 Gegharkunik 91.4 4.6 2.7 0.0 0.8 0.4 0.0 0.0 0.1 0.0 100.0 0.6 3.6 467 Lori 87.7 9.4 1.0 0.0 0.5 1.4 0.0 0.0 0.0 0.2 100.0 1.4 1.4 309 Kotayk 89.7 7.9 0.8 0.7 0.4 0.1 0.1 0.0 0.0 0.2 100.0 0.3 1.3 772 Shirak 77.0 17.5 2.5 1.2 0.4 1.4 0.0 0.0 0.0 0.0 100.0 1.4 2.9 568 Syunik 88.9 7.0 1.2 0.7 0.0 2.3 0.0 0.0 0.0 0.0 100.0 2.3 1.2 281 Vayots Dzor 94.7 3.5 1.1 0.0 0.0 0.7 0.0 0.0 0.0 0.0 100.0 0.7 1.1 128 Tavush 91.9 4.4 0.1 1.8 0.2 0.7 0.0 0.0 0.0 0.8 100.0 0.7 0.4 344 Wealth quintile Lowest 86.3 8.9 2.7 1.2 0.1 0.4 0.1 0.0 0.0 0.3 100.0 0.5 2.8 1,287 Second 88.8 6.7 1.3 0.6 0.4 1.9 0.0 0.0 0.0 0.3 100.0 1.9 1.8 1,201 Middle 82.8 11.8 2.4 0.7 0.5 0.8 0.7 0.0 0.2 0.1 100.0 1.7 3.8 1,189 Fourth 86.1 10.4 1.5 0.6 0.2 1.0 0.0 0.0 0.0 0.2 100.0 1.0 1.8 1,211 Highest 87.5 9.1 1.7 0.6 0.3 0.7 0.0 0.0 0.1 0.0 100.0 0.8 2.2 1,431 Total <15 87.0 9.1 1.8 0.7 0.2 0.7 0.2 0.0 0.0 0.2 100.0 0.9 2.3 5,331 Total <18 86.3 9.4 1.9 0.7 0.3 0.9 0.1 0.0 0.1 0.2 100.0 1.2 2.5 6,319 Note: Table is based on de jure members, that is, usual residents 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent 2.9 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Education is important because it helps individuals make informed decisions that influence their health and well-being. Armenia’s educational system has undergone several stages of restructuring over the past decade, making the analysis of educational data across a wide range of ages challenging.2 The current school system has been in place since 2007. The system consists of primary school (grades 1 through 4 for students age 6-9), middle school (grades 5 through 9 for students age 10-14), and high school (grades 10 2 The Armenian educational system before 2007 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, when children were allowed to enter school at age 6 or 7, the majority of children would start school at age 7. 22 • Housing Characteristics and Household Population through 12 for students 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, midwives, musicians, technicians, and others. The course of study for specialized secondary education can be completed in 3-5 years depending on the number of grades. Upon graduation students receive a secondary- special education degree, which recognizes 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 specialist. Students who have completed secondary education or secondary-special education may enroll in a university. Tables 2.11.1 and 2.11.2 present information on the educational attainment of the Armenian population age 6 and older. Virtually all Armenians have gone to school. The proportions of the female and male populations with no education are negligible (less than 1 percent each) in most age groups, with the highest levels observed among those age 6 to 9 (reflecting some who have not yet started school) and those age 65 and older. Overall, more than 9 in 10 women and men age 6 and over have attended secondary school, and more than 4 in10 women and around one-third of men have a secondary-special or higher education. The median number of years of schooling is 9.9 years for women and 9.7 years for men. Individuals residing in urban areas have substantially higher rates of secondary-special and higher education than those residing in rural areas. Individuals in Yerevan are around twice as likely to have at least some higher education compared with those in other regions. Wealth status has a strong positive relationship with education; 43 percent of women in the highest wealth quintile have at least some higher education compared with 6 percent of women in the lowest quintile. The corresponding proportions for men are 40 percent and 6 percent, respectively. Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex, residence, region, and wealth quintile are shown in Table 2.12. 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.3 A NAR of 100 percent would indicate that all children in the official age range for the level are attending education at that level. The GAR can exceed 100 percent if there is significant over-age or under-age participation at a given level of schooling. In Armenia, attendance among school-age household members is high. The overall NAR for basic education is 96, indicating that, among children who should be attending basic education, 96 percent are currently doing so. The NAR for basic education in 2015-16 is slightly higher than the NAR at the time of the 2010 ADHS (92 percent). The basic school NARs are virtually the same for females and males. Differences in basic school attendance by residence, region, and wealth quintile are not large, with the NAR lowest in Shirak (91 percent) and highest in the highest wealth quintile (98 percent). The basic school GAR is 101 percent. A comparison of the NAR and GAR indicates that approximately 5 percent of students attending basic school are either under age or over age for their grade level. 3 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 2.11.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Armenia 2015-16 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Don't know/ missing Total Number Median years completed Age 6-9 6.7 93.0 0.3 0.0 0.0 0.0 0.0 0.0 100.0 693 0.6 10-14 0.3 7.3 20.0 72.4 0.0 0.0 0.0 0.0 100.0 813 5.0 15-19 0.1 0.0 0.0 46.1 21.5 16.2 16.1 0.0 100.0 770 10.3 20-24 0.2 0.0 0.0 2.9 31.9 16.4 48.6 0.0 100.0 969 12.5 25-29 0.1 0.2 0.2 3.7 34.3 20.4 41.0 0.0 100.0 1,161 12.3 30-34 0.1 0.0 0.1 4.6 42.1 22.5 30.7 0.0 100.0 1,052 11.4 35-39 0.0 0.2 0.0 6.6 43.7 22.9 26.6 0.0 100.0 919 10.0 40-44 0.3 0.0 0.0 4.3 42.3 28.6 24.4 0.0 100.0 825 11.2 45-49 0.3 0.0 0.0 5.6 40.2 30.9 23.0 0.0 100.0 746 11.2 50-54 0.2 0.1 0.1 5.3 46.8 25.6 21.7 0.1 100.0 1,353 9.9 55-59 0.1 0.1 0.2 6.4 44.6 28.5 20.1 0.0 100.0 1,281 10.0 60-64 0.3 0.4 0.2 9.6 40.3 27.5 21.7 0.0 100.0 949 10.0 65+ 1.1 2.7 3.6 22.7 38.0 15.0 16.8 0.1 100.0 2,219 9.5 Residence Urban 0.5 4.8 1.4 11.3 28.8 22.3 30.9 0.0 100.0 8,376 11.3 Rural 1.0 6.9 2.6 18.7 44.4 16.2 10.3 0.0 100.0 5,374 9.5 Region Yerevan 0.3 4.9 1.3 9.9 23.0 20.3 40.4 0.0 100.0 4,409 12.2 Aragatsotn 0.2 6.2 0.9 13.1 52.5 14.9 12.1 0.0 100.0 697 9.6 Ararat 0.5 7.4 2.7 20.9 40.9 15.3 12.3 0.0 100.0 1,232 9.5 Armavir 1.5 6.5 2.0 19.2 38.8 19.4 12.7 0.0 100.0 1,181 9.6 Gegharkunik 1.8 6.3 3.2 18.2 49.9 11.7 8.9 0.0 100.0 1,105 9.5 Lori 0.5 4.1 1.8 16.5 41.0 21.7 14.4 0.0 100.0 978 9.7 Kotayk 0.7 7.0 2.2 12.9 36.2 22.3 18.5 0.1 100.0 1,452 9.8 Shirak 0.7 4.6 1.2 12.1 36.8 24.8 19.8 0.0 100.0 1,154 9.9 Syunik 0.5 3.8 2.0 16.0 39.9 20.6 17.2 0.0 100.0 627 9.8 Vayots Dzor 0.2 6.0 3.0 12.3 41.0 24.4 13.1 0.0 100.0 278 9.7 Tavush 1.0 7.0 1.6 18.0 29.9 27.5 15.0 0.0 100.0 635 9.8 Wealth quintile Lowest 1.1 7.4 3.1 23.1 45.9 13.2 6.1 0.0 100.0 2,705 9.4 Second 0.8 5.8 2.1 14.3 42.9 19.3 14.8 0.0 100.0 2,667 9.7 Middle 0.6 4.0 1.3 13.9 39.6 22.6 18.0 0.1 100.0 2,810 9.8 Fourth 0.5 5.1 1.2 9.8 27.0 24.2 32.3 0.0 100.0 2,832 11.6 Highest 0.2 6.0 1.6 10.1 19.6 20.0 42.6 0.0 100.0 2,735 12.3 Total 0.7 5.6 1.8 14.2 34.9 19.9 22.9 0.0 100.0 13,750 9.9 1 Completed 4 grade at the primary level 2 Completed grade 12 or completed more than 9 years of schooling and has a secondary school attestat Table 2.11.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Armenia 2015-16 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Don't know/ missing Total Number Median years completed Age 6-9 6.8 93.1 0.1 0.0 0.0 0.0 0.0 0.0 100.0 764 0.8 10-14 0.2 6.3 19.2 74.3 0.0 0.0 0.0 0.0 100.0 967 5.2 15-19 0.5 0.0 0.0 49.8 20.7 16.0 13.0 0.0 100.0 706 10.0 20-24 0.2 0.1 0.2 9.6 44.9 10.7 34.3 0.0 100.0 948 10.9 25-29 0.2 0.4 0.0 10.2 43.7 11.5 33.8 0.1 100.0 1,050 9.9 30-34 0.5 0.1 0.0 11.3 44.5 9.4 34.1 0.1 100.0 1,003 9.8 35-39 0.2 0.3 0.2 11.2 51.4 12.5 24.1 0.1 100.0 814 9.7 40-44 0.2 0.0 0.0 7.3 47.9 19.1 25.4 0.0 100.0 686 9.9 45-49 0.0 0.0 0.0 8.5 46.8 25.3 19.4 0.1 100.0 674 9.9 50-54 0.2 0.5 0.1 6.7 50.6 21.8 20.1 0.0 100.0 1,038 9.8 55-59 0.0 0.1 0.2 8.1 42.3 25.1 24.2 0.1 100.0 1,025 10.0 60-64 0.3 0.4 0.1 6.9 45.6 22.8 23.9 0.0 100.0 773 9.9 65+ 0.4 1.3 2.5 20.7 37.2 15.7 22.1 0.0 100.0 1,512 9.7 Residence Urban 0.6 7.1 1.6 13.7 30.8 16.2 30.0 0.0 100.0 6,830 9.9 Rural 0.8 6.3 2.3 22.8 45.1 12.2 10.5 0.0 100.0 5,130 9.5 Region Yerevan 0.3 7.1 1.6 12.1 24.6 15.0 39.4 0.0 100.0 3,531 11.4 Aragatsotn 0.2 6.5 1.7 17.5 49.0 9.6 15.3 0.2 100.0 662 9.5 Ararat 0.8 6.7 2.7 23.4 40.3 12.4 13.6 0.0 100.0 1,141 9.5 Armavir 0.8 8.5 2.6 28.2 37.0 12.5 10.4 0.0 100.0 1,117 9.3 Gegharkunik 1.0 6.3 2.2 18.3 54.7 6.2 11.2 0.0 100.0 1,025 9.5 Lori 0.9 5.0 1.4 15.8 49.1 16.2 11.2 0.4 100.0 837 9.6 Kotayk 1.1 6.6 1.9 17.1 38.5 16.6 18.2 0.0 100.0 1,242 9.7 Shirak 1.2 5.9 2.1 16.6 37.9 18.5 17.7 0.0 100.0 984 9.7 Syunik 0.2 5.8 1.7 16.6 44.8 14.7 16.3 0.0 100.0 593 9.6 Vayots Dzor 0.3 6.8 1.2 14.8 37.2 25.1 14.6 0.0 100.0 251 9.8 Tavush 0.8 7.9 2.0 24.6 28.9 20.9 14.8 0.0 100.0 578 9.6 Wealth quintile Lowest 1.0 7.4 2.9 27.8 45.1 10.2 5.5 0.2 100.0 2,421 9.3 Second 0.8 5.5 1.7 18.8 44.3 14.0 14.8 0.0 100.0 2,499 9.6 Middle 0.8 6.8 1.5 16.6 40.0 16.1 18.1 0.0 100.0 2,354 9.7 Fourth 0.2 6.6 1.7 12.3 31.3 17.0 31.0 0.0 100.0 2,353 10.0 Highest 0.6 7.6 1.8 11.9 22.9 15.2 40.0 0.0 100.0 2,334 11.6 Total 0.7 6.8 1.9 17.6 36.9 14.5 21.7 0.0 100.0 11,961 9.7 1 Completed 4 grade at the primary level 2 Completed grade 12 or completed more than 9 years of schooling and has a secondary school attestat 24 • Housing Characteristics and Household Population The NAR is much lower at the high school level: only 56 percent of students age 15-17 who should be attending high school are in school. While it is low, a comparison with the NAR in 2010 (45 percent) indicates that high school attendance improved substantially in the period between the two surveys. High school attendance ratios are higher among females than males (62 percent and 51 percent, respectively). Surprisingly, both the NAR and GAR at the high school level are slightly higher among students living in rural areas than among those living in urban areas. The high school NAR and GAR are also lower in Yerevan than in other regions. The high school GAR is 64 percent. A comparison of the NAR and GAR indicates that approximately 8 percent of students are either under age or over age for their grade level. Syunik has the highest proportion of high school age students who are either under age or over age for their grade level (21 percent). Table 2.12 School attendance ratios Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population, by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Armenia 2015-16 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 BASIC SCHOOL Residence Urban 97.5 95.5 96.6 0.98 102.5 100.1 101.4 0.98 Rural 95.5 96.1 95.8 1.01 100.4 100.3 100.4 1.00 Region Yerevan 99.5 95.5 97.6 0.96 104.3 101.3 102.9 0.97 Aragatsotn 95.9 95.4 95.6 0.99 104.4 97.5 101.2 0.93 Ararat 96.9 98.0 97.5 1.01 102.2 101.7 102.0 1.00 Armavir 96.0 98.3 96.9 1.02 101.0 102.2 101.5 1.01 Gegharkunik 96.2 93.5 95.0 0.97 99.9 96.4 98.2 0.97 Lori 95.1 95.0 95.0 1.00 97.9 99.4 98.6 1.01 Kotayk 95.8 96.1 95.9 1.00 101.0 100.3 100.7 0.99 Shirak 94.8 94.8 94.8 1.00 101.9 101.4 101.7 1.00 Syunik 91.1 91.5 91.3 1.00 96.6 94.6 95.6 0.98 Vayots Dzor 97.8 94.4 96.2 0.97 101.6 100.6 101.1 0.99 Tavush 94.0 97.7 95.6 1.04 96.3 100.4 98.1 1.04 Wealth quintile Lowest 95.7 96.1 95.8 1.00 100.8 100.1 100.5 0.99 Second 95.8 95.5 95.7 1.00 101.7 100.0 100.9 0.98 Middle 96.0 94.9 95.5 0.99 99.7 98.5 99.2 0.99 Fourth 97.7 94.9 96.4 0.97 102.8 99.8 101.4 0.97 Highest 98.1 97.0 97.5 0.99 103.3 102.1 102.7 0.99 Total 96.7 95.7 96.2 0.99 101.7 100.2 101.0 0.99 HIGH SCHOOL Residence Urban 44.0 53.8 48.7 1.22 49.7 62.6 55.9 1.26 Rural 60.6 71.7 66.1 1.18 70.7 78.3 74.4 1.11 Region Yerevan 36.5 49.8 43.0 1.36 37.0 58.3 47.4 1.58 Aragatsotn 64.9 61.2 63.6 0.94 72.6 68.4 71.2 0.94 Ararat 51.8 68.0 59.7 1.31 64.3 74.9 69.5 1.16 Armavir 51.8 47.4 49.9 0.92 57.1 50.9 54.4 0.89 Gegharkunik 69.0 76.4 73.2 1.11 78.1 83.5 81.2 1.07 Lori 59.0 65.7 62.3 1.11 68.1 82.7 75.3 1.21 Kotayk 51.0 71.0 60.3 1.39 62.2 77.2 69.2 1.24 Shirak 52.9 57.4 55.0 1.08 67.5 59.6 63.8 0.88 Syunik 64.7 78.9 72.3 1.22 86.8 99.2 93.4 1.14 Vayots Dzor 67.1 80.8 73.7 1.20 69.8 92.8 80.9 1.33 Tavush 61.3 77.0 69.7 1.26 76.7 79.9 78.4 1.04 Wealth quintile Lowest 61.1 77.7 69.3 1.27 70.1 85.2 77.6 1.21 Second 56.3 64.2 60.0 1.14 64.1 72.4 68.0 1.13 Middle 56.4 53.3 54.8 0.95 69.9 56.4 62.8 0.81 Fourth 43.4 57.6 49.3 1.33 47.8 71.4 57.7 1.49 Highest 41.3 56.8 49.2 1.38 45.7 64.0 55.1 1.40 Total 51.3 61.9 56.4 1.21 58.9 69.7 64.1 1.18 1 The NAR for basic school is the percentage of the basic-school age (6-14 years) population that is attending basic school (grades 1-9). The NAR for high school is the percentage of the high-school age (15-17) 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. Housing Characteristics and Household Population • 25 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 2.12 shows the GAR GPI is 0.99 for the basic level, which indicates that there is no gender gap at the basic level. At the high school level, the GPI is 1.18, indicating a gender gap favoring females at the high school level. Figure 2.2 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 virtually no differences by gender. Among the high-school-age population (15-17), attendance ratios begin to decline, with a particularly sharp decline at age 17 among males. One possible explanation is that the requirement to serve in the military at age 18 keeps some young men out of school once they have completed the secondary level. Figure 2.2 Age-specific attendance rates in the de facto population age 5-24 2.10 CHILD PROTECTION 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. Information obtained in the 2015-16 ADHS allows for an assessment of two topics that bear on the protection of Armenia’s children: birth registration and child discipline. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age (years) Male Female ADHS 2015-16 26 • Housing Characteristics and Household Population 2.10.1 Birth Registration In Armenia, birth registration is recognized as a child’s right. The registration of a birth involves the inscription of the facts of the birth into an official log in the registrar’s office. A birth certificate is issued at the time of registration or later as proof that the birth was registered. The certificate establishes a child’s legal identity, which is important not only during childhood, e.g., to gain access to school, but later in life when the child seeks to marry, vote, or inherit property. In the 2015-16 ADHS, birth registration information was collected in the Household Questionnaire for children under age 5. Table 2.13 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. Birth registration is virtually universal in Armenia, with 99 percent of births in the 5 years preceding the survey registered. Practically all births have a certificate. Only small variations are found across subgroups of children, with children in Armavir and Ararat regions the least likely to have a birth certificate (96 percent and 97 percent, respectively). 2.10.2 Child Discipline The manner in which parents and caretakers discipline children can have long-term consequences for their physical and psychological development and well-being. To identify the types of child disciplinary methods used in Armenia, questions on child discipline were asked about one randomly selected child age 1-14 in each household.4 The questions were addressed to the household respondent. Questions referred to practices that may have been used to discipline the child during the 30 days prior to the interview. Specifically, questions asked 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 the child 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 hard object; 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 over and over as hard as possible. 4 If several children age 1-14 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 1-14 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 1-14, the questions on child discipline were not administered. Table 2.13 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 2015-16 Background characteristic Children whose births are registered Percentage registered Number of children Percentage who had birth certificate Percentage who did not have birth certificate Age <2 98.6 0.1 98.7 724 2-4 98.7 0.0 98.7 1,019 Sex Male 98.7 0.1 98.9 930 Female 98.5 0.0 98.5 813 Residence Urban 99.0 0.1 99.1 1,009 Rural 98.1 0.0 98.1 734 Region Yerevan 99.0 0.0 99.0 499 Aragatsotn 97.8 0.0 97.8 64 Ararat 96.5 0.0 96.5 174 Armavir 96.0 0.0 96.0 195 Gegharkunik 100.0 0.0 100.0 80 Lori 98.8 0.0 98.8 98 Kotayk 99.6 0.4 100.0 249 Shirak 99.5 0.0 99.5 182 Syunik 100.0 0.0 100.0 64 Vayots Dzor 100.0 0.0 100.0 37 Tavush 100.0 0.0 100.0 98 Wealth quintile Lowest 98.1 0.0 98.1 340 Second 97.4 0.0 97.4 341 Middle 99.7 0.0 99.7 325 Fourth 99.3 0.3 99.7 311 Highest 98.8 0.0 98.8 427 Total 98.6 0.1 98.7 1,743 Housing Characteristics and Household Population • 27 Table 2.14 shows that 7 in 10 children age 1-14 experienced some form of psychological or physical punishment during the 30 days preceding the survey. Approximately one-fifth of children (19 percent) experienced only non-violent discipline. Psychological aggression was more common than physical punishment; about two-thirds of children (65 percent) experienced psychological aggression while 38 percent of children experienced some form of physical punishment. Four percent experienced severe physical punishment. Violent methods were used almost as often to discipline girls (67 percent) as boys (71 percent). Very young children experienced violence less often than children age 3-14; nevertheless, some type of violent method was used to discipline half of 1- and 2-year-old children. Violent disciplinary methods were almost as common among urban (68 percent) as rural children (71 percent). Children from Syunik and Vayots Dzor were least likely to have experienced any violent disciplinary method (56 percent and 59 percent, respectively). In contrast, some type of violent method was used to discipline around 8 in 10 children in Aragatsotn and Lori. Lack of education tends to be positively associated with the use of violent disciplinary methods, especially psychological aggression. Seventy-two percent of children whose head of household had only basic education experienced some form of psychological aggression during the month before the survey compared with 58 percent of children whose head of household had a higher education. The use of violent methods to discipline children tends to decline with the wealth quintile. The relationship between the use of severe physical punishment and both education and wealth is marked. Severe methods were used to discipline 8 percent of children whose head of household had only basic education compared with only 2 percent of children whose head of household had secondary special or higher education. Similarly, the percentage experiencing severe physical punishment decreased from 8 percent among children in the lowest wealth quintile to 2 percent among children in the fourth and fifth quintiles. 28 • Housing Characteristics and Household Population Table 2.14 Child discipline Percentage of children age 1-14 by child disciplinary methods experienced during the month before the survey, according to background characteristics, Armenia 2015-16 Background characteristic Percentage of children age 1-14 years who experienced: Number of children age 1-14 years Only non- violent discipline1 Psychological aggression2 Physical punishment Any violent discipline method5 Any3 Severe4 Age 1-2 12.0 41.5 33.0 0.9 50.1 394 3-4 15.1 67.9 53.4 1.2 74.7 375 5-9 17.3 72.0 41.1 4.0 74.9 1,081 10-14 23.8 65.8 30.6 6.6 67.7 1,030 Sex Male 16.7 67.2 39.0 4.5 70.8 1,515 Female 20.7 62.7 36.6 3.7 66.8 1,365 Residence Urban 21.0 63.7 37.2 2.7 67.6 1,677 Rural 15.3 67.0 38.8 6.2 70.7 1,203 Region Yerevan 22.0 63.7 41.8 1.9 68.9 870 Aragatsotn 17.9 70.4 49.4 9.6 78.6 138 Ararat 7.2 69.0 34.4 9.6 70.4 295 Armavir 14.2 62.9 33.2 2.9 65.0 287 Gegharkunik 13.9 68.4 57.1 20.0 74.7 203 Lori 14.2 76.7 44.8 2.1 79.3 142 Kotayk 17.8 70.1 24.3 0.7 71.2 353 Shirak 18.9 59.4 35.6 1.5 62.7 261 Syunik 34.4 51.9 15.1 0.8 56.2 121 Vayots Dzor 26.3 52.6 36.8 1.7 59.4 58 Tavush 26.6 62.5 41.4 0.8 66.3 153 Education of head of household No education * * * * * 5 Basic 12.4 72.1 40.9 7.7 73.6 359 Secondary 17.6 66.8 37.6 4.8 71.0 1,370 Secondary special 19.2 64.2 37.2 1.9 66.8 552 Higher 24.4 57.7 37.0 2.3 63.1 593 Wealth quintile Lowest 12.2 69.6 43.1 8.0 73.1 595 Second 17.9 65.2 35.4 4.2 69.3 538 Middle 18.3 66.0 36.8 4.2 69.0 547 Fourth 23.9 61.0 33.2 2.4 64.9 543 Highest 20.9 63.4 39.8 2.0 68.0 657 Total 18.6 65.1 37.8 4.1 68.9 2,880 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases. Total includes one child with missing information on education of head of household. 1Only non-violent discipline: (1) providing an affirmative response to one or both of the following: took away child’s privileges, forbade something the child liked, or 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) a negative response to all of the following: shook the child; shouted, yelled, or screamed at the child; spanked, hit, or slapped the child on the bottom with a bare hand; hit the child on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other hard object; 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; or beat the child over and over as hard as possible. 2 Psychological aggression: providing an affirmative answer to one or both of the following: shouted, yelled, or screamed at the child or called the child dumb, lazy, or similar name. 3 Any physical punishment: providing an affirmative response to any of the following: shook the child; spanked, hit, or slapped the child on the bottom with a bare hand; hit the child on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other hard object; hit or slapped the child on the face, head, or ears; hit or slapped the child on the hand, arm, or leg; or beat the child over and over as hard as possible. 4 Severe physical punishment: providing an affirmative response to one or both of the following: hit or slapped the child on the face, head, or ears; or beat the child over and over as hard as possible. 5 Any violent discipline method (MICS indicator 8.3 - Violent discipline): providing an affirmative response to any of the following: shook the child; shouted, yelled, or screamed at the child; spanked, hit, or slapped the child on the bottom with a bare hand; hit the child on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other hard object; 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; or beat the child over and over as hard as possible. Housing Characteristics and Household Population • 29 2.11 POVERTY BENEFITS The government of Armenia provides a number of benefits to assist poor families. According to the Law on State Benefits, there are 10 types of benefits financed from the state budget: a family benefit, a social benefit, an emergency benefit, a lump-sum benefit at childbirth, a child-care leave benefit (under age 2), a temporary disability benefit, an old-age benefit, a disability benefit, a survivor benefit, and a funeral benefit. In ADHS 2015-16 respondents were asked about two types of benefits: a family benefit and an emergency benefit. To provide information on the coverage of these benefits, the 2015-16 ADHS included questions on whether or not households received any of the following benefits in the 6 months before the survey: (1) a monthly cash benefit, that is, the poverty family benefit; (2) an emergency benefit, a cash benefit available to families four times per year. The respondents were also asked to report if any member of their household received a government “order” to cover the costs of health services for which fees are charged. The ADHS questionnaire also included a question to determine if households that had not received any of the benefits during the 6 months prior to the survey had registered or updated their registration in the family benefit program in the 6-month period before the survey. Table 2.15 shows that 14 percent of households interviewed in the ADHS had received at least one of the family benefits during the 6 months prior to the survey. Eleven percent of households received a monthly cash benefit, 3 percent received a government order to cover health care costs, and 1 percent received an emergency cash benefit. Virtually no households received all three benefits. Among the households not receiving benefits, 3 percent had registered or updated their registration in the family benefit program database. Overall, one in six households either received benefits or were registered in the family benefit database in the 6 months before the survey. Table 2.15 Poverty benefits Percentages of households receiving a poverty family benefit, an emergency benefit in the past 6 months or a government order for any health services that are otherwise not free; percentages receiving all three types of poverty family benefits and none of the poverty family benefits in the 6 months prior to the survey; and, among households receiving no poverty family benefits, percentage that registered or updated their registration in the family benefit program database in the s6months prior to the survey, according to selected background characteristics, Armenia 2015-16 Background characteristic Percent- age of households receiving a poverty family benefit1 Percent- age of households receiving an emergency benefit2 Percent- age of house-holds receiving a government order to any health services that are otherwise not free3 Percent- age of households receiving at least one of the family benefits Percent- age of households receiving all three of the family benefits Percent- age of households received none of the family benefits Number of house- holds Among households receiving none of the family benefits: Percentage registering or updating registration in the family benefit program database Number of households not receiving benefits Residence Urban 8.5 0.9 2.0 10.8 0.1 89.2 4,924 2.3 4,390 Rural 15.4 1.1 3.3 18.9 0.0 81.1 2,969 2.7 2,408 Region Yerevan 3.8 0.2 1.9 5.6 0.1 94.4 2,480 2.3 2,340 Aragatsotn 10.1 0.6 0.1 10.9 0.0 89.1 387 1.7 345 Ararat 8.9 0.6 0.2 9.3 0.0 90.7 682 0.9 618 Armavir 8.8 0.7 3.8 12.4 0.0 87.6 633 5.7 554 Gegharkunik 23.1 2.8 8.5 31.1 0.3 68.9 601 5.2 414 Lori 17.0 0.5 0.5 17.3 0.2 82.7 645 0.2 533 Kotayk 13.6 0.6 1.2 15.1 0.0 84.9 799 1.7 678 Shirak 21.2 0.6 1.3 22.5 0.0 77.5 685 2.4 531 Syunik 7.4 6.5 7.7 20.8 0.0 79.2 448 0.1 355 Vayots Dzor 12.5 0.0 4.4 16.1 0.0 83.9 167 3.4 140 Tavush 18.5 0.6 2.5 21.0 0.0 79.0 366 5.9 289 Wealth quintile Lowest 20.6 1.9 3.2 24.5 0.1 75.5 1,700 3.3 1,284 Second 12.8 1.1 2.2 15.7 0.0 84.3 1,452 2.4 1,224 Middle 10.8 1.2 3.1 14.1 0.3 85.9 1,791 3.0 1,539 Fourth 6.9 0.4 1.8 8.6 0.0 91.4 1,558 1.7 1,423 Highest 2.8 0.1 1.8 4.5 0.0 95.5 1,392 1.9 1,329 Total 11.1 1.0 2.5 13.9 0.1 86.1 7,893 2.5 6,798 1 A poverty family benefit’ that is, a monthly cash benefit 2 An emergency benefit; that is, a cash benefit up to four times per year 3 A government order to cover the cost of any health services that are not free (for example, an operation board) 30 • Housing Characteristics and Household Population Rural households were almost twice as likely as urban households to have received at least one of the family benefits. Gegharkunik (31 percent) had the highest proportion of households receiving one family benefits and Yerevan the lowest (6 percent). Households receiving family benefits were largely concentrated in the bottom three wealth quintiles, with one in four households in the lowest quintile receiving benefits. Background Characteristics of Respondents • 31 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 his chapter gives a demographic and socioeconomic profile of respondents in the 2015-16 ADHS sample. Information on the basic characteristics of women and men interviewed in the survey is essential to interpret the findings on reproduction, health, and women’s status that are presented in final chapters of the report. The distribution of the respondents by their various demographic and socioeconomic characteristics can be compared to the likelihood of occurrence in the general population and, thus, offer a means of assessing the representativeness of the ADHS sample. 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 and employment. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS 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 2015-16 ADHS. Men age 15-49 were interviewed in every second household. To avoid double counting the respondents, the tables in this report are, in most cases, based on the de facto population, that is, those who stayed in the household the night before the interview. Table 3.1 presents the distribution of interviewed women and men age 15-49 by selected background characteristics. The age distribution shows that 45 percent of the women and a similar percentage of the men (46 percent) are under age 30. About one-quarter of both women and men are age 40-49. Nearly two-thirds of the women (64 percent) and more than half of the men (55 percent) are married or living together. Because men tend to marry later in life than women do, more men (43 percent) than women (30 percent) have never been married. Six percent of women and two percent of men are divorced, separated, or widowed. T Key Findings:  Virtually all women and men age 15-49 have at least a secondary education, and 31 percent of women and 27 percent of men have some higher education.  More than 9 in 10 women and men in Armenia are exposed to some form of mass media, primarily television, at least once per week.  Internet usage is almost as widespread; 91 percent of women and 89 percent of men access the Internet at least once per week.  More than 7 in 10 men and 4 in 10 women report they were employed in the 12 months prior to 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 2015-16 Background characteristic Women Men Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 11.9 725 743 12.5 345 346 20-24 15.2 928 922 17.0 467 450 25-29 18.0 1,099 1,076 16.9 464 477 30-34 16.5 1,007 1,005 15.5 427 434 35-39 14.2 867 874 13.6 376 373 40-44 12.8 784 782 12.6 346 341 45-49 11.5 706 714 12.0 330 334 Marital status Never married 29.9 1,830 1,747 43.2 1,190 1,179 Married 63.3 3,870 3,973 49.4 1,361 1,368 Living together 0.4 25 25 5.3 145 159 Divorced/separated 4.3 262 244 2.0 56 46 Widowed 2.1 128 127 0.1 3 3 Residence Urban 59.8 3,657 3,545 56.5 1,558 1,522 Rural 40.2 2,459 2,571 43.5 1,197 1,233 Region Yerevan 32.7 2,001 1,055 30.2 833 440 Aragatsotn 5.2 315 453 5.8 159 228 Ararat 9.0 552 597 10.5 290 313 Armavir 9.6 586 642 9.7 268 284 Gegharkunik 7.8 478 551 8.5 235 268 Lori 5.8 355 337 6.7 184 164 Kotayk 11.1 678 659 10.8 299 288 Shirak 8.3 510 536 7.3 201 191 Syunik 3.9 238 383 3.8 104 174 Vayots Dzor 1.9 119 405 2.0 56 186 Tavush 4.6 283 498 4.6 126 219 Education No education 0.1 5 5 0.2 5 6 Basic 6.5 396 406 13.1 360 379 Secondary 40.0 2,444 2,580 45.4 1,250 1,293 Secondary special 22.2 1,360 1,444 14.6 403 422 Higher 31.2 1,910 1,681 26.7 736 655 Wealth quintile Lowest 17.7 1,081 1,137 19.0 523 536 Second 20.3 1,242 1,358 21.2 583 626 Middle 18.7 1,142 1,324 18.9 521 608 Fourth 21.0 1,287 1,293 20.5 566 565 Highest 22.3 1,365 1,004 20.4 562 420 Total 100.0 6,116 6,116 100.0 2,755 2,755 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Three-fifths of the respondents live in urban areas. The majority live in Yerevan. Outside of Yerevan, the largest proportions of respondents are found in Kotayk, Ararat, and Armavir, each with around 10 percent of the total sample. The regions with the smallest proportions of respondents are Vayots Dzor and Syunik. Male and female respondents are universally well educated, with 93 percent of the women and 87 percent of the men having at least some secondary education. Thirty-one percent of the women and just over a quarter of the men have some higher education. 3.2 EDUCATIONAL ATTAINMENT OF RESPONDENTS Education provides people with the knowledge and skills to lead a better quality of life. Educational attainment has been found to be closely associated with the health of women and children as well as with the reproductive behavior of women and men. Background Characteristics of Respondents • 33 Tables 3.2.1 and 3.2.2 show the distribution of women and men age 15-49 by highest level of schooling1 attended or completed and the median number of years of schooling completed, according to background characteristics. Education has been almost universal in Armenia for some time, and almost all women and men have completed at least some secondary education. More than a fifth of women and 15 percent of men have secondary special education. Three in 10 women and more than one-quarter of the men have had at least some university education. 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 2015-16 Background characteristic Highest level of schooling Total Median years completed Number of women No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Age 15-24 0.0 0.2 0.1 23.0 25.9 16.4 34.3 100.0 11.0 1,653 15-19 0.0 0.3 0.0 48.6 18.2 16.9 16.0 100.0 10.1 725 20-24 0.0 0.2 0.1 3.0 32.0 16.1 48.6 100.0 11.9 928 25-29 0.1 0.6 0.1 3.7 33.9 20.7 40.9 100.0 12.3 1,099 30-34 0.1 0.2 0.1 5.2 41.6 22.6 30.2 100.0 11.5 1,007 35-39 0.0 0.3 0.0 6.6 43.7 22.6 26.9 100.0 10.0 867 40-44 0.3 0.0 0.0 4.4 42.5 28.3 24.6 100.0 11.2 784 45-49 0.0 0.2 0.0 5.8 40.2 30.6 23.1 100.0 11.3 706 Residence Urban 0.0 0.3 0.0 6.5 26.6 24.9 41.7 100.0 12.2 3,657 Rural 0.2 0.2 0.1 15.0 50.6 18.3 15.6 100.0 9.8 2,459 Region Yerevan 0.0 0.2 0.0 5.7 20.3 22.0 51.8 100.0 12.7 2,001 Aragatsotn 0.0 0.0 0.0 7.7 57.4 15.4 19.5 100.0 9.9 315 Ararat 0.0 0.3 0.2 12.9 51.8 16.2 18.6 100.0 9.9 552 Armavir 0.5 1.1 0.2 19.6 41.2 19.7 17.7 100.0 9.8 586 Gegharkunik 0.0 0.0 0.0 12.7 56.7 17.3 13.3 100.0 9.8 478 Lori 0.0 0.0 0.0 7.4 43.3 23.1 26.2 100.0 11.1 355 Kotayk 0.0 0.4 0.0 9.9 36.5 26.5 26.8 100.0 11.0 678 Shirak 0.2 0.2 0.0 8.6 39.6 25.3 26.0 100.0 11.0 510 Syunik 0.2 0.0 0.0 13.1 36.6 28.7 21.3 100.0 10.9 238 Vayots Dzor 0.0 0.0 0.0 10.6 40.2 29.6 19.6 100.0 10.3 119 Tavush 0.3 0.0 0.0 13.9 32.3 32.0 21.5 100.0 11.1 283 Wealth quintile Lowest 0.1 0.4 0.1 21.0 53.2 16.1 9.0 100.0 9.7 1,081 Second 0.1 0.1 0.1 9.6 47.6 20.8 21.6 100.0 10.0 1,242 Middle 0.0 0.4 0.0 9.2 41.4 25.4 23.6 100.0 10.7 1,142 Fourth 0.2 0.4 0.0 5.6 25.5 26.7 41.6 100.0 12.2 1,287 Highest 0.0 0.0 0.0 6.0 18.2 21.6 54.2 100.0 12.8 1,365 Total 0.1 0.3 0.0 9.9 36.2 22.2 31.2 100.0 11.3 6,116 1 Completed 4 grade at the primary level 2 Completed 12 grade at the secondary level or completed more than 9 years of schooling and has a secondary school attestat Although virtually all female respondents have attended secondary school, differences in attendance at higher levels of education are evident by background characteristics. For example, 42 percent of urban women have some higher education compared with only 16 percent of rural women. There also is considerable variation by region: the largest proportion of highly educated women is found in Yerevan (52 percent), and the smallest proportion in Gegharkunik (13 percent). Attainment of higher education is closely related to wealth status; more than half of the women in the highest wealth quintile (54 percent) have some university education compared with less than 1 in 10 women in the lowest quintile. Differences in the proportion of men attaining higher education are similar to those among women (Table 3.2.2). Thirty-seven percent of urban men have some higher education compared with 14 percent of rural men. As with women, there is considerable variation by region. Yerevan residents have a clear 1 As reported in Chapter 2, Armenia’s educational system has undergone several stages of restructuring. Since 2007, basic education has consisted 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). 34 • Background Characteristics of Respondents educational advantage over the rest of the country: nearly half of the men in Yerevan (47 percent) have some university education compared with 10 percent of men in Armavir and 12 percent in Gegharkunik. Wealth status is positively associated with education; half of men in the highest wealth quintile have some higher education compared with 5 percent of men in the lowest wealth quintile. 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 2015-16 Background characteristic Highest level of schooling Total Median years completed Number of men No education Some primary Completed primary1 Some secondary Completed secondary2 Secondary special Higher Age 15-24 0.2 0.6 0.0 28.8 31.4 13.4 25.7 100.0 10.4 813 15-19 0.4 0.1 0.0 53.1 18.2 14.4 13.9 100.0 10.1 345 20-24 0.0 0.9 0.0 10.9 41.1 12.6 34.5 100.0 10.9 467 25-29 0.0 1.1 0.0 12.2 40.8 11.7 34.2 100.0 9.9 464 30-34 0.4 0.1 0.0 12.9 45.8 10.2 30.6 100.0 9.8 427 35-39 0.7 0.3 0.3 12.9 50.0 13.2 22.7 100.0 9.7 376 40-44 0.0 0.0 0.0 7.1 52.2 17.9 22.8 100.0 9.8 346 45-49 0.0 0.0 0.0 9.3 42.4 26.0 22.3 100.0 10.0 330 Residence Urban 0.2 0.1 0.0 11.1 33.6 18.2 36.8 100.0 11.2 1,558 Rural 0.2 0.8 0.1 23.1 52.2 10.0 13.6 100.0 9.6 1,197 Region Yerevan 0.0 0.0 0.0 7.7 28.1 17.0 47.2 100.0 12.0 833 Aragatsotn 0.0 0.0 0.0 12.7 55.7 9.4 22.2 100.0 9.8 159 Ararat 0.0 0.6 0.0 22.2 51.1 9.4 16.7 100.0 9.6 290 Armavir 0.4 1.5 0.5 33.9 44.5 8.7 10.4 100.0 9.4 268 Gegharkunik 0.0 0.9 0.0 17.0 64.2 6.0 11.9 100.0 9.7 235 Lori 0.0 1.2 0.0 14.0 53.7 12.5 18.6 100.0 9.8 184 Kotayk 0.0 0.0 0.0 20.0 39.2 19.5 21.3 100.0 9.9 299 Shirak 1.7 0.0 0.0 18.4 38.7 18.4 22.8 100.0 9.9 201 Syunik 0.0 0.0 0.0 16.4 40.1 22.4 21.2 100.0 9.9 104 Vayots Dzor 0.0 0.8 0.0 8.2 44.6 21.9 24.4 100.0 10.0 56 Tavush 0.7 0.7 0.0 20.7 36.1 22.6 19.3 100.0 9.9 126 Wealth quintile Lowest 0.5 0.9 0.2 30.2 53.7 8.9 5.4 100.0 9.4 523 Second 0.3 1.1 0.0 17.6 51.5 11.9 17.7 100.0 9.7 583 Middle 0.0 0.0 0.0 15.6 44.0 16.3 24.1 100.0 9.9 521 Fourth 0.0 0.0 0.0 10.7 36.8 17.1 35.4 100.0 11.0 566 Highest 0.2 0.1 0.0 8.4 22.9 18.8 49.7 100.0 12.4 562 Total 15-49 0.2 0.4 0.0 16.3 41.7 14.6 26.7 100.0 9.9 2,755 1 Completed 4 grade at the primary level 2 Completed 12 grade at the secondary level or completed more than 9 years of schooling and has a secondary school attestat A comparison of the median years of schooling among women and men in the 2010 ADHS and 2015-16 ADHS shows educational attainment increased only modestly for women between the surveys, from 11.2 to 11.3 years, and remained stable at 9.9 years among men. The proportion of women with some higher education also increased only slightly in the period between the 2010 and 2015-16 ADHS surveys, from 30 to 31 percent. Among men, the proportion with some higher education actually dropped from 30 percent in 2010 (NSS et al. 2012) to 27 percent in 2015-16. 3.3 EXPOSURE TO MASS MEDIA AND INTERNET Access to information is essential to increase people’s knowledge and awareness of what happens around them. The 2015-16 ADHS collected information relating to the respondent’s access to mass media, including print and broadcast media, as well as usage of the Internet. This information can help program managers plan the dissemination of information on health, family planning, nutrition, and other topics. Background Characteristics of Respondents • 35 3.3.1 Mass Media In the survey, exposure to media was assessed by asking how often respondents read a newspaper or magazine, watched television, or listened to the radio. The results indicate that more than 9 in 10 Armenian women watch television at least once a week, just over a quarter read a newspaper or magazine, and 15 percent listen to the radio (Table 3.3.1). In general, men report a slightly lower level of exposure to television and newspapers or magazines and a higher level of exposure to radio than women (Table 3.3.2). Eighty-nine percent of men watch television, 22 percent read a newspaper or magazine, and 24 percent listen to the radio at least once a week. Overall, around one in eight women and men are exposed to all three types of media on a weekly basis, while 10 percent of men and 6 percent of women are not regularly exposed to any of the three types of media. Among both women and men, media exposure rates are highest among urban residents, those living in Yerevan, those with higher education, and those in the highest wealth quintile. 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 2015-16 Background characteristic Reads a newspaper or magazine at least once a week Watches television at least once a week Listens to the 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 25.4 90.4 14.6 9.8 8.3 725 20-24 27.1 93.3 16.9 12.9 6.0 928 25-29 28.5 93.9 17.9 13.7 5.5 1,099 30-34 26.9 94.2 17.8 13.0 5.7 1,007 35-39 28.1 94.3 13.9 11.4 5.1 867 40-44 26.5 94.3 13.4 10.4 4.7 784 45-49 27.1 93.4 10.1 7.1 5.8 706 Residence Urban 33.7 94.6 20.9 15.8 4.5 3,657 Rural 17.4 91.8 7.0 5.1 7.8 2,459 Region Yerevan 41.3 96.9 30.4 23.8 2.5 2,001 Aragatsotn 15.5 86.9 4.2 3.8 12.7 315 Ararat 15.9 97.2 15.7 10.1 1.8 552 Armavir 18.0 97.8 7.2 5.5 2.0 586 Gegharkunik 3.6 65.7 0.3 0.0 32.7 478 Lori 8.7 87.3 2.5 1.5 12.1 355 Kotayk 26.4 97.8 14.0 10.0 1.5 678 Shirak 18.4 95.8 11.3 7.3 3.9 510 Syunik 29.4 97.7 6.0 4.5 2.0 238 Vayots Dzor 37.0 98.0 2.1 1.6 1.1 119 Tavush 56.1 95.4 2.3 1.6 3.7 283 Education Basic 10.5 91.0 6.3 2.8 8.1 396 Secondary 14.5 91.7 8.8 5.1 8.0 2,444 Secondary special 26.8 94.8 11.4 8.1 4.5 1,360 Higher 47.1 95.4 28.3 24.0 3.5 1,910 Wealth quintile Lowest 11.5 92.0 4.9 2.5 7.8 1,081 Second 22.2 93.1 9.3 7.2 6.3 1,242 Middle 25.3 91.0 14.9 10.9 8.2 1,142 Fourth 29.4 93.8 17.3 11.9 4.9 1,287 Highest 43.6 96.9 27.5 22.7 2.8 1,365 Total 27.2 93.5 15.3 11.5 5.8 6,116 Note: Total includes 5 (weighted) women with no education. Looking at the trends in exposure to specific media between the 2010 and 2015-16 ADHS surveys, the greatest change was in the proportion of women reading a newspaper or magazine at least once a week, which dropped from 45 percent in 2010 to 27 percent in 2015-16. Men also were less likely to have regular exposure to newspapers or magazines in 2015-16 compared with 2010 (30 percent and 22 percent, respectively). The level of exposure to radio and television also changed between 2010 and 2015-16. Among women, the percentage listening to the radio at least once per week declined from 20 percent in 2010 to 15 percent in 2015-16 while, among men, regular exposure to radio broadcasts increased from 18 percent to 24 36 • Background Characteristics of Respondents percent. Considering television exposure, the percentage of men watching television at least once per week dropped from 96 percent in 2010 to 89 percent in 2015-16, while the percentage of women regularly exposed to television broadcasts remained essentially stable (93 percent in 2010 and 94 percent in 2015-16). Overall, the proportion of women who accessed none of the three mass media on a weekly basis remained stable at 6 percent between 2010 and 2015-16 while the proportion of men who did not access any of the three media rose from 3 percent to 10 percent. 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 2015-16 Background characteristic Reads a newspaper or magazine at least once a week Watches television at least once a week Listens to the 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 12.2 87.4 10.0 6.4 12.5 345 20-24 17.2 87.2 16.7 8.1 12.3 467 25-29 22.4 89.8 23.3 11.5 9.1 464 30-34 23.5 88.8 27.0 13.6 10.5 427 35-39 28.6 89.9 34.8 19.0 8.5 376 40-44 24.3 87.2 23.9 13.4 12.0 346 45-49 28.8 91.4 32.1 18.0 8.1 330 Residence Urban 27.5 92.2 30.1 17.5 6.9 1,558 Rural 15.4 84.3 15.6 6.3 15.0 1,197 Region Yerevan 35.5 97.6 40.6 27.1 1.6 833 Aragatsotn 12.1 98.7 4.6 1.0 1.3 159 Ararat 12.6 93.4 9.7 4.9 5.6 290 Armavir 26.3 99.0 53.9 21.3 0.7 268 Gegharkunik 0.7 2.9 0.0 0.0 96.4 235 Lori 3.7 98.9 8.2 2.0 1.1 184 Kotayk 17.6 99.4 22.4 5.7 0.6 299 Shirak 27.6 85.6 14.7 4.5 9.8 201 Syunik 10.5 98.8 3.6 1.2 1.2 104 Vayots Dzor 16.8 93.9 6.2 4.2 5.7 56 Tavush 42.7 99.7 14.8 13.0 0.0 126 Education Basic 8.0 90.4 17.2 4.0 9.4 360 Secondary 13.0 83.6 17.1 6.7 15.8 1,250 Secondary special 19.5 94.7 25.1 9.7 4.5 403 Higher 46.5 93.5 37.9 28.7 5.2 736 Wealth quintile Lowest 12.9 87.5 16.6 6.0 12.1 523 Second 17.0 86.2 16.9 7.3 12.8 583 Middle 17.9 82.9 19.0 8.8 16.8 521 Fourth 26.1 91.9 24.9 14.4 7.3 566 Highest 36.5 95.0 40.8 26.1 3.7 562 Total 22.2 88.8 23.8 12.6 10.4 2,755 Note: Total includes 5 (weighted) men with no education. 3.3.2 Internet Usage Changes in the level of exposure to various mass media may relate at least in part to the rapid growth in computer ownership among Armenian households between the 2010 and 2015-16 ADHS surveys (see Chapter 2). Increased access to the Internet, which accompanied computer ownership, affected usage of traditional mass media. Tables 3.4.1 and 3.4.2 present information from the 2015-16 ADHS on the extent to which respondents accessed the Internet. Background Characteristics of Respondents • 37 Overall, a large majority of women and men reported that they had ever used the Internet (87 percent and 91 percent, respectively), and most women and men had used it at some point in the 12 months prior to the survey (85 percent and 89 percent, respectively). Overall, among respondents who had used the Internet in the 12 months before the survey, around 90 percent reported that they were online at least once a week during the month before the survey; 70 percent of women and 61 percent of men reported use almost every day during the month. Table 3.4.1 Internet usage: Women Percentage of women age 15-49 who have ever used the Internet, and percentage who have used the Internet in the past 12 months; and among women who have used the Internet in the past 12 months, percent distribution by frequency of Internet use in the past month, according to background characteristics, Armenia 2015-16 Background characteristic Ever used the Internet Used the Internet in the past 12 months Number of women Among women who have used the Internet in the past 12 months, percentage who, in the past month, used Internet: Number of women Almost every day Less than every day but at least once a week Less than once a week Not at all Missing Total Age 15-19 93.7 93.1 725 85.1 10.2 4.6 0.2 0.0 100.0 675 20-24 94.8 93.4 928 83.4 10.9 5.7 0.1 0.0 100.0 867 25-29 91.1 89.9 1,099 76.7 17.1 5.8 0.4 0.0 100.0 988 30-34 89.5 87.5 1,007 65.5 24.1 10.2 0.1 0.0 100.0 881 35-39 81.5 80.2 867 63.1 25.6 10.1 1.2 0.0 100.0 695 40-44 81.4 79.8 784 54.6 32.1 13.1 0.1 0.0 100.0 625 45-49 71.3 69.3 706 52.6 29.7 16.8 0.8 0.2 100.0 489 Residence Urban 92.9 91.9 3,657 75.2 18.3 6.2 0.3 0.0 100.0 3,360 Rural 77.8 75.6 2,459 61.3 24.5 13.7 0.5 0.0 100.0 1,860 Region Yerevan 95.1 94.5 2,001 76.9 17.4 5.4 0.3 0.0 100.0 1,891 Aragatsotn 83.1 77.7 315 63.4 26.2 9.8 0.6 0.0 100.0 245 Ararat 79.5 78.4 552 66.3 23.8 9.6 0.3 0.0 100.0 433 Armavir 73.9 71.5 586 70.3 18.8 10.9 0.0 0.0 100.0 419 Gegharkunik 82.4 81.1 478 41.4 37.5 20.5 0.6 0.0 100.0 388 Lori 87.1 84.8 355 63.9 22.8 11.7 1.3 0.3 100.0 301 Kotayk 86.2 84.7 678 67.3 18.4 13.6 0.7 0.0 100.0 574 Shirak 84.2 81.7 510 75.6 18.5 5.6 0.3 0.0 100.0 417 Syunik 92.2 91.4 238 80.8 16.6 2.5 0.0 0.0 100.0 218 Vayots Dzor 88.4 87.9 119 68.4 21.4 10.2 0.0 0.0 100.0 105 Tavush 81.4 81.1 283 76.3 16.5 7.3 0.0 0.0 100.0 229 Education Basic 65.2 62.8 396 59.1 25.4 15.3 0.1 0.0 100.0 249 Secondary 80.0 77.7 2,444 59.9 25.9 13.4 0.7 0.0 100.0 1,899 Secondary special 89.4 88.4 1,360 66.3 23.9 9.6 0.2 0.0 100.0 1,203 Higher 98.4 97.8 1,910 84.9 12.0 2.9 0.2 0.0 100.0 1,867 Wealth quintile Lowest 62.9 59.7 1,081 55.0 24.6 19.0 1.3 0.0 100.0 645 Second 84.8 82.9 1,242 65.2 23.7 10.8 0.3 0.0 100.0 1,029 Middle 88.8 87.1 1,142 65.9 24.1 9.7 0.4 0.0 100.0 994 Fourth 95.6 95.2 1,287 75.2 19.2 5.3 0.3 0.1 100.0 1,225 Highest 97.7 97.2 1,365 80.5 14.4 5.1 0.0 0.0 100.0 1,327 Total 86.8 85.3 6,116 70.3 20.5 8.8 0.4 0.0 100.0 5,220 Note: Total includes five (weighted) women with no education. Among women and men, both the likelihood that an individual had ever used the Internet and had used the Internet in the 12 months before the survey decreased with age. Ever use and use in the 12 months before the survey was lower among rural than urban residents and among women living in Armavir and men living in Vayots Dzor compared with those living in other regions. Such use rose with increasing education and wealth. Among those who had used the Internet in the 12 months before the survey, the likelihood that use was infrequent during the month before the survey, (i.e., less than once a week or not at all), was greatest for women in Gegharkunik (21 percent) and in the lowest wealth quintile (19 percent) and for men in Aragatsotn (28 percent) and Ararat (21 percent) and in the lowest wealth quintile (19 percent). 38 • Background Characteristics of Respondents Table 3.4.2 Internet usage: Men Percentage of men age 15-49 who have ever used the Internet, and percentage who have used the internet in the past 12 months; and among men who have used the Internet in the past 12 months, percent distribution by frequency of Internet use in the past month, according to background characteristics, Armenia 2015-16 Background characteristic Ever used the Internet Used the internet in the past 12 months Number of men Among men who have used the Internet in the past 12 months, percentage who, in the past month, used Internet: Number of men Almost every day Less than every day but at least once a week Less than once a week Not at all Missing Total Age 15-19 95.5 95.2 345 76.0 18.3 5.6 0.0 0.0 100.0 329 20-24 96.3 95.2 467 72.5 21.2 5.4 0.9 0.0 100.0 445 25-29 94.1 93.5 464 66.8 24.3 8.5 0.3 0.0 100.0 434 30-34 91.2 89.9 427 64.6 22.4 12.5 0.5 0.0 100.0 384 35-39 89.6 87.0 376 52.0 33.3 13.6 0.5 0.5 100.0 327 40-44 86.9 83.1 346 43.1 38.5 17.6 0.9 0.0 100.0 287 45-49 75.8 74.1 330 36.3 45.9 16.0 1.8 0.0 100.0 244 Residence Urban 94.4 93.5 1,558 66.7 24.2 8.5 0.4 0.1 100.0 1,456 Rural 85.4 83.0 1,197 52.5 32.7 13.9 1.0 0.0 100.0 994 Region Yerevan 94.0 93.4 833 67.5 24.1 8.2 0.2 0.0 100.0 778 Aragatsotn 78.5 77.9 159 27.7 43.9 28.4 0.0 0.0 100.0 124 Ararat 86.9 77.8 290 49.6 25.7 20.5 4.2 0.0 100.0 225 Armavir 76.4 76.4 268 67.3 28.1 4.6 0.0 0.0 100.0 204 Gegharkunik 94.7 93.2 235 25.0 57.7 17.3 0.0 0.0 100.0 219 Lori 94.4 91.9 184 60.2 22.5 16.8 0.6 0.0 100.0 170 Kotayk 94.1 94.1 299 67.9 24.1 6.3 1.1 0.6 100.0 281 Shirak 97.3 97.3 201 74.1 20.7 5.2 0.0 0.0 100.0 196 Syunik 92.2 89.8 104 70.1 27.0 2.5 0.5 0.0 100.0 94 Vayots Dzor 75.8 75.4 56 46.8 39.3 13.9 0.0 0.0 100.0 42 Tavush 93.1 92.8 126 91.2 4.8 4.0 0.0 0.0 100.0 116 Education Basic 80.4 78.4 360 53.0 30.8 16.0 0.2 0.0 100.0 282 Secondary 89.5 87.2 1,250 50.3 34.5 14.2 0.8 0.2 100.0 1,090 Secondary special 90.2 89.1 403 60.9 28.9 9.5 0.7 0.0 100.0 359 Higher 97.9 97.4 736 80.2 15.4 3.9 0.5 0.0 100.0 717 Wealth quintile Lowest 77.3 74.0 523 49.1 31.4 18.5 1.1 0.0 100.0 387 Second 90.4 87.8 583 57.3 31.1 10.6 1.0 0.0 100.0 512 Middle 92.0 91.0 521 55.9 32.4 11.3 0.4 0.0 100.0 474 Fourth 95.0 94.8 566 66.8 22.7 9.9 0.6 0.0 100.0 537 Highest 97.0 96.2 562 71.5 22.5 5.4 0.2 0.3 100.0 540 Total 90.5 88.9 2,755 60.9 27.7 10.7 0.6 0.1 100.0 2,450 Note: Total includes five (weighted) men with no education. 3.4 EMPLOYMENT In the 2015-16 ADHS, respondents were asked about their employment status at the time of the survey as well as their continuity of employment in the 12 months prior to the survey. The measurement of women’s employment can be especially 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. Tables 3.5.1 and 3.5.2 show the percent distribution of female and male respondents by employment status, according to background characteristics. Respondents are considered “employed” if they were currently working at the time of the survey (that is, if they had worked in the past 7 days). Thirty-four percent of women reported being currently employed and 6 percent were employed in the 12 months preceding the survey but not working at the time of the survey. As expected, employment was more common among men than women (Figure 3.1). Fifty-six percent of men reported they were employed at the time of the survey and 16 percent had worked in the 12 months prior to the survey but were not employed at the time of the survey. Background Characteristics of Respondents • 39 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Armenia 2015-16 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don’t know Total Number of women Currently employed1 Not currently employed Age 15-19 2.5 1.4 96.0 0.1 100.0 725 20-24 19.9 4.2 75.9 0.0 100.0 928 25-29 34.7 6.3 58.9 0.0 100.0 1,099 30-34 34.4 6.7 58.9 0.1 100.0 1,007 35-39 44.7 8.7 46.6 0.0 100.0 867 40-44 50.5 9.2 40.2 0.0 100.0 784 45-49 51.5 7.8 40.7 0.0 100.0 706 Marital status Never married 28.6 3.3 68.0 0.1 100.0 1,830 Married or living together 34.3 7.5 58.2 0.0 100.0 3,895 Divorced/separated/ widowed 56.0 8.7 35.3 0.0 100.0 390 Number of living children 0 29.8 3.6 66.6 0.0 100.0 2,120 1-2 35.4 6.8 57.8 0.0 100.0 2,990 3-4 39.2 10.5 50.3 0.0 100.0 966 5+ (25.7) (15.6) (58.7) (0.0) 100.0 39 Residence Urban 37.9 2.7 59.4 0.0 100.0 3,657 Rural 28.2 11.8 60.0 0.0 100.0 2,459 Region Yerevan 41.5 1.8 56.6 0.0 100.0 2,001 Aragatsotn 27.3 0.9 71.8 0.0 100.0 315 Ararat 37.3 13.6 49.0 0.1 100.0 552 Armavir 36.0 17.0 47.0 0.0 100.0 586 Gegharkunik 32.4 15.4 52.3 0.0 100.0 478 Lori 15.1 1.1 83.6 0.3 100.0 355 Kotayk 33.5 8.2 58.3 0.0 100.0 678 Shirak 17.7 4.4 77.8 0.0 100.0 510 Syunik 39.3 3.8 56.9 0.0 100.0 238 Vayots Dzor 34.9 2.9 62.2 0.0 100.0 119 Tavush 29.1 2.3 68.6 0.0 100.0 283 Education Basic 22.2 8.6 69.3 0.0 100.0 396 Secondary 23.6 9.3 67.1 0.0 100.0 2,444 Secondary special 37.2 5.6 57.1 0.0 100.0 1,360 Higher 47.4 2.6 49.9 0.1 100.0 1,910 Wealth quintile Lowest 22.6 13.7 63.7 0.0 100.0 1,081 Second 31.6 9.4 58.9 0.1 100.0 1,242 Middle 31.6 5.2 63.2 0.1 100.0 1,142 Fourth 39.5 3.2 57.4 0.0 100.0 1,287 Highest 41.9 1.8 56.2 0.0 100.0 1,365 Total 34.0 6.4 59.6 0.0 100.0 6,116 Note: Figures in parentheses are based on 25-49 unweighted cases. Total includes five (weighted) women with no education. 1 Currently employed is defined as having done work in the past 7 days and includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Current employment among both women and men generally increased with age, education, and wealth quintile. Divorced, separated, or widowed women were substantially more likely to be employed at the time of the survey than currently or never-married women. Among men, those who were currently married were more likely to be currently employed than those who were formerly married or especially those who were never-married. Urban residents were more likely to be currently employed than rural residents. Considering regional differences, the proportion of women who were currently employed was highest in Yerevan (42 percent) and Syunik (39 percent) and lowest in Lori (15 percent) and Shirak (18 percent). Among men, the highest proportions currently employed were found in Ararat (76 percent), Syunik (72 percent), and Kotayk (71 percent), and the lowest proportion was in Shirak (31 percent). 40 • Background Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Armenia 2015-16 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Currently employed1 Not currently employed Age 15-19 4.2 5.7 90.1 100.0 345 20-24 34.9 16.0 49.1 100.0 467 25-29 63.7 18.8 17.5 100.0 464 30-34 73.5 17.4 9.2 100.0 427 35-39 72.4 14.8 12.8 100.0 376 40-44 71.2 17.8 11.0 100.0 346 45-49 68.4 18.5 13.1 100.0 330 Marital status Never married 33.7 14.2 52.1 100.0 1,190 Married or living together 72.6 16.4 11.0 100.0 1,506 Divorced/separated/ widowed (59.9) (30.9) (9.1) 100.0 59 Number of living children 0 37.5 14.3 48.1 100.0 1,321 1-2 71.5 17.0 11.5 100.0 1,100 3-4 75.0 16.3 8.8 100.0 322 Residence Urban 58.8 10.4 30.8 100.0 1,558 Rural 51.4 22.7 25.9 100.0 1,197 Region Yerevan 59.7 6.9 33.4 100.0 833 Aragatsotn 43.8 18.0 38.2 100.0 159 Ararat 75.9 7.9 16.2 100.0 290 Armavir 59.5 22.6 17.9 100.0 268 Gegharkunik 32.5 49.0 18.4 100.0 235 Lori 34.6 26.4 39.0 100.0 184 Kotayk 70.7 9.9 19.4 100.0 299 Shirak 30.7 23.3 46.0 100.0 201 Syunik 71.5 0.4 28.1 100.0 104 Vayots Dzor 64.8 9.7 25.5 100.0 56 Tavush 48.0 14.3 37.7 100.0 126 Education Basic 44.8 17.7 37.5 100.0 360 Secondary 51.4 21.7 26.9 100.0 1,250 Secondary special 59.3 15.4 25.3 100.0 403 Higher 66.1 5.0 28.9 100.0 736 Wealth quintile Lowest 49.5 24.0 26.5 100.0 523 Second 51.6 20.4 28.0 100.0 583 Middle 51.8 17.7 30.5 100.0 521 Fourth 58.0 10.9 31.0 100.0 566 Highest 66.4 6.2 27.4 100.0 562 Total 55.6 15.7 28.7 100.0 2,755 Note: Figures in parentheses are based on 25-49 unweighted cases. Total includes 13 (weighted) men with five or more living children and 5 (weighted) men with no education. 1 Currently employed is defined as having done work in the past 7 days and includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. The proportions of women and men who had worked in the 12 months prior to the survey but were not currently employed also varied by background characteristics. As expected, given the seasonality of agricultural employment, it was higher in rural than in urban areas among both women (12 percent and 3 percent, respectively) and men (23 percent and 10 percent, respectively). Looking at the regional patterns, the proportion that had been employed in the 12 months prior to the survey but were not currently working was highest among men in Gegharkunik (49 percent) and among women in Armavir (17 percent). Although the relationship was not uniform, the proportion tended to decrease with increasing education and wealth among both women and men. Background Characteristics of Respondents • 41 Figure 3.1 Employment status 3.5 OCCUPATION Respondents who indicated that they had worked at any time in the 12 months prior to the survey 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. Information on occupation not only allows for an evaluation of the source of income for both women and men but also has implications for women’s empowerment. Tables 3.6.1 and 3.6.2 show the occupational profiles of male and female respondents who were employed in the 12 months preceding the survey, according to background characteristics. The majority of employed women were working in professional, technical, or managerial (42 percent) or in sales and services (23 percent) positions, and about one-fifth worked in agriculture. Among employed men, 21 percent held professional, technical, or managerial jobs, 27 percent worked in sales and services, more than one-third were employed as manual laborers, either skilled (28 percent) or unskilled (6 percent), and 13 percent worked in agriculture. 34 6 60 56 16 29 Currently employed Not currently employed, but worked in last 12 months Did not work in last 12 months Percentage Women Men ADHS 2015-16 42 • Background Characteristics of Respondents Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Armenia 2015-16 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 (14.4) (0.0) (33.4) (10.0) (1.0) (41.2) (0.0) 100.0 28 20-24 48.6 8.3 27.5 4.1 1.6 8.8 1.2 100.0 224 25-29 50.5 4.7 22.8 5.6 1.3 14.9 0.3 100.0 451 30-34 43.3 3.9 21.3 5.1 4.1 21.5 0.8 100.0 413 35-39 42.9 2.1 21.3 6.8 4.3 21.6 1.1 100.0 463 40-44 32.3 2.3 27.3 9.2 4.8 24.1 0.0 100.0 468 45-49 39.2 2.8 18.9 9.1 4.0 25.3 0.7 100.0 419 Marital status Never married 54.9 5.9 27.8 4.0 0.9 6.1 0.4 100.0 585 Married or living together 38.8 3.0 18.7 7.3 4.3 27.4 0.5 100.0 1,629 Divorced/separated/ widowed 31.5 2.0 39.9 11.2 4.2 9.9 1.4 100.0 252 Number of living children 0 52.9 5.6 28.1 5.1 0.9 6.9 0.6 100.0 708 1-2 42.2 3.5 23.1 7.8 3.5 19.2 0.7 100.0 1,262 3-4 26.3 0.9 15.5 7.3 6.9 42.5 0.6 100.0 480 Residence Urban 53.8 4.6 29.0 7.5 1.7 2.4 0.8 100.0 1,484 Rural 23.8 1.9 13.9 6.0 6.1 47.9 0.3 100.0 982 Region Yerevan 59.7 3.8 27.9 6.6 0.9 0.3 0.8 100.0 868 Aragatsotn 40.1 2.6 15.6 8.5 1.5 31.6 0.0 100.0 89 Ararat 34.0 0.6 22.6 10.8 3.7 27.3 1.1 100.0 281 Armavir 19.0 3.9 11.5 3.5 8.8 52.9 0.4 100.0 311 Gegharkunik 18.8 2.9 13.0 1.6 4.1 59.6 0.0 100.0 228 Lori 47.8 3.2 36.4 6.4 0.0 3.6 2.7 100.0 57 Kotayk 34.0 4.7 24.7 11.8 7.1 17.6 0.0 100.0 283 Shirak 55.6 8.0 26.3 4.4 1.0 4.7 0.0 100.0 113 Syunik 41.6 3.0 28.9 10.4 2.2 14.0 0.0 100.0 102 Vayots Dzor 39.0 2.2 23.5 12.1 11.1 10.3 1.8 100.0 45 Tavush 39.8 4.0 24.7 3.7 0.8 25.7 1.3 100.0 89 Education Basic 5.3 0.0 21.4 8.0 15.7 49.6 0.0 100.0 122 Secondary 6.4 1.3 34.6 9.2 6.1 41.8 0.6 100.0 804 Secondary special 40.8 5.0 28.2 7.6 2.6 15.3 0.6 100.0 583 Higher 77.2 5.1 10.3 4.5 0.2 2.0 0.7 100.0 956 Wealth quintile Lowest 10.9 1.7 16.6 6.2 9.7 54.6 0.3 100.0 392 Second 33.5 2.6 15.8 7.0 4.3 36.5 0.3 100.0 509 Middle 34.2 5.2 31.0 8.9 2.8 17.3 0.7 100.0 420 Fourth 53.8 4.4 28.3 8.0 1.2 3.5 0.9 100.0 548 Highest 63.9 3.7 22.9 4.9 1.3 2.5 0.8 100.0 597 Total 41.9 3.6 23.0 6.9 3.5 20.5 0.6 100.0 2,466 Note: Figures in parentheses are based on 25-49 unweighted cases. Total includes 1 (weighted) woman with no education and 16 women with5 or more living children. Background Characteristics of Respondents • 43 Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Armenia 2015-16 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 (7.8) (1.5) (30.8) (10.8) (24.3) (24.8) (0.0) 100.0 34 20-24 13.9 0.8 19.6 35.3 7.9 16.7 5.8 100.0 238 25-29 21.2 1.6 26.3 26.8 5.7 15.0 3.4 100.0 383 30-34 22.6 1.2 30.6 26.4 5.5 8.7 5.1 100.0 388 35-39 22.6 0.4 28.1 31.0 5.8 8.1 4.0 100.0 328 40-44 19.9 1.1 30.0 26.8 7.0 12.7 2.6 100.0 308 45-49 23.6 0.6 26.8 23.8 3.7 18.9 2.6 100.0 287 Marital status Never married 19.1 1.0 23.0 29.7 6.4 17.0 3.7 100.0 570 Married or living together 21.4 0.9 29.0 27.2 5.8 11.7 4.0 100.0 1,341 Divorced/separated/ widowed (21.0) (4.4) (31.2) (21.3) (12.2) (9.9) (0.0) 100.0 53 Number of living children 0 20.1 0.9 23.1 30.0 6.3 15.7 3.9 100.0 685 1-2 21.6 1.3 30.7 26.6 5.5 10.5 3.8 100.0 973 3-4 20.1 0.5 27.4 25.4 7.4 15.2 3.9 100.0 294 Residence Urban 30.2 1.4 32.5 25.1 5.0 1.4 4.4 100.0 1,078 Rural 9.2 0.6 21.1 30.9 7.6 27.5 3.2 100.0 887 Region Yerevan 37.1 2.1 33.2 19.9 4.6 0.3 2.8 100.0 555 Aragatsotn 17.5 1.0 28.4 23.4 1.7 26.3 1.7 100.0 98 Ararat 13.5 0.7 26.9 27.0 6.0 23.0 2.9 100.0 243 Armavir 12.0 0.2 19.0 19.0 8.0 37.8 3.8 100.0 220 Gegharkunik 6.4 0.0 17.8 41.7 5.7 26.3 2.2 100.0 192 Lori 17.2 0.0 28.2 36.1 6.9 6.7 4.9 100.0 113 Kotayk 18.9 1.1 30.6 34.4 8.9 3.3 2.8 100.0 241 Shirak 15.9 1.1 24.6 47.3 2.1 3.2 5.8 100.0 109 Syunik 18.0 0.8 22.9 30.1 10.8 5.9 11.5 100.0 75 Vayots Dzor 13.7 2.0 26.6 15.2 23.5 9.4 9.5 100.0 42 Tavush 15.2 0.0 30.1 25.6 1.8 18.6 8.8 100.0 78 Education Basic 5.1 0.0 19.6 30.1 14.3 28.7 2.3 100.0 225 Secondary 7.2 0.1 28.8 36.3 7.1 17.6 2.9 100.0 913 Secondary special 12.0 2.8 38.9 30.4 6.2 5.5 4.2 100.0 301 Higher 56.2 2.1 21.3 10.3 1.1 3.2 5.8 100.0 524 Wealth quintile Lowest 4.4 0.3 18.7 31.1 8.9 33.8 2.7 100.0 384 Second 10.6 0.7 25.0 33.1 7.3 19.5 3.9 100.0 420 Middle 16.8 0.4 30.7 30.7 6.8 9.0 5.6 100.0 362 Fourth 31.1 1.2 29.1 27.0 5.0 2.0 4.7 100.0 390 Highest 40.1 2.4 33.3 17.1 2.9 1.7 2.4 100.0 408 Total 20.7 1.0 27.3 27.7 6.2 13.2 3.8 100.0 1,965 Note: Figures in parentheses are based on 25-49 unweighted cases. Total includes 13 (weighted) men with 5 or more living children and 1 (weighted) man with no education. 44 • Background Characteristics of Respondents As expected, the proportions of both women and men who worked in professional, technical, and managerial occupations were higher in urban than in rural areas. The proportions in these occupations also rose rapidly with both increasing education and wealth. Men and especially women with basic education and those in the lowest wealth quintile were most likely to be working in agriculture. 3.6 WOMEN’S EMPLOYMENT CHARACTERISTICS As with education, employment can be a source of empowerment for women, particularly employment that involves cash earnings. Table 3.7 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 nonagricultural). Overall, 74 percent of employed women earn cash only, 12 percent were paid in cash and in kind, and 14 percent either received only in-kind payment or were not paid at all. Virtually all women who worked in nonagricultural jobs (95 percent) were paid in cash. On the other hand, women who worked in agricultural positions most often did not receive any cash payments for the work they did; more than half were paid either in kind only (33 percent) or not paid at all (22 percent). Table 3.7 Type of employment Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Armenia 2015-16 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 4.5 94.5 73.9 Cash and in-kind 40.6 3.4 11.9 In-kind only 33.0 0.1 7.6 Not paid 21.9 2.1 6.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 14.2 4.2 6.5 Employed by nonfamily member 4.2 88.4 69.1 Self-employed 81.6 7.4 24.4 Total 100.0 100.0 100.0 Continuity of employment All year 48.4 94.4 83.9 Seasonal 51.6 5.2 15.8 Occasional 0.0 0.3 0.2 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 564 1,887 2,466 Note: Total includes women with missing information on type of employment who are not shown separately. Women who work in agriculture were mainly either self-employed (82 percent) or employed by a family member (14 percent), while the majority of women employed in nonagricultural jobs were employed by nonfamily members (88 percent). More than 8 in 10 working women were employed throughout the year, while 16 percent had seasonal jobs. As expected, the ADHS results confirm that continuity of employment is more assured for women engaged in nonagricultural work; more than half of women employed in agricultural occupations had seasonal jobs compared with 5 percent of women in nonagricultural occupations. Background Characteristics of Respondents • 45 3.7 EMPLOYMENT ABROAD Armenia is a country that regularly experiences an outflow of citizens, particularly men, in search of employment. The 2015-16 ADHS collected information about recent employment abroad as a proxy indicator for labor migration. To obtain this information, all women and men age 15-49 were asked whether they had worked abroad during the 3 years preceding the survey for 3 or more months at a time. In addition, currently married women and men age 15-49 in the 2015-16 ADHS were asked whether their spouses were working abroad during the 3 years preceding the survey for 3 or more months at a time. Table 3.8 shows the percentages of women and men age 15-49 who worked abroad during the 3 years preceding the survey for 3 or more months at a time, by background characteristics. Overall, 1 percent of women and 12 percent of men reported that they had worked abroad at some point in the 3 years preceding the 2105-16 ADHS for 3 or more months at a time. The rates of employment abroad among women and men have not changed much over the past 5 years since the 2010 ADHS when 3 percent of women and 11 percent of men reported they had worked abroad. Marked differences were evident by background characteristics in the likelihood that men had worked abroad (Table 3.8). Eighteen percent of rural men had worked abroad compared with 8 percent of urban men. Considering regional differences, men in Shirak (26 percent), Lori (27 percent) and Gegharkunik (31 percent) were the most likely to have worked abroad, while men in Syunik (1 percent) were the least likely. Men with secondary special or less education were more than twice as likely as men with higher education to have worked abroad. Similarly, men in the lowest wealth quintiles were more than twice as likely to have recently worked abroad as men in the two highest quintiles. Finally, although few currently married women themselves had worked abroad recently, 22 percent reported that their spouse had worked abroad in the 3 years prior to the 2015-16 ADHS. Among currently married men only 1 percent reported that their wife had worked abroad during the referenced period (data not shown). Table 3.8 Respondent’s employment abroad Percentage of women and men 15-49 who worked abroad during the 3 years before the survey for 3 or more months at a time, by background characteristics, Armenia 2015-16 Background characteristic Women Men Worked abroad1 Number of women Worked abroad1 Number of men Age 15-24 1.0 1,653 6.6 813 25-29 0.9 1,099 17.5 464 30-39 1.7 1,874 13.5 802 40-49 1.5 1,490 13.4 676 Marital status Never married 1.2 1,830 8.6 1,190 Married/living together 1.3 3,895 15.0 1,506 Divorced/separated/ widowed 2.2 390 (8.4) 59 Residence Urban 1.7 3,657 7.8 1,558 Rural 0.7 2,459 17.7 1,197 Region Yerevan 2.5 2,001 3.0 833 Aragatsotn 0.0 315 2.0 159 Ararat 0.5 552 3.2 290 Armavir 1.0 586 18.8 268 Gegharkunik 0.4 478 30.9 235 Lori 0.8 355 26.9 184 Kotayk 1.0 678 16.1 299 Shirak 1.9 510 25.5 201 Syunik 0.0 238 1.1 104 Vayots Dzor 0.0 119 6.3 56 Tavush 0.8 283 16.0 126 Education Basic 1.0 396 12.5 360 Secondary 0.8 2,444 16.0 1,250 Secondary special 1.5 1,360 13.0 403 Higher 1.9 1,910 5.0 736 Wealth quintile Lowest 0.8 1,081 16.0 523 Second 0.6 1,242 16.8 583 Middle 1.3 1,142 16.5 521 Fourth 1.1 1,287 6.8 566 Highest 2.6 1,365 5.1 562 Total 1.3 6,116 12.1 2,755 Note: Figures in parentheses are based on 25-49 unweighted cases. Total includes five (weighted) women and five (weighted) men with no education. 1 Employment abroad refers to working abroad during the past 3 years before the survey for 3 or more months at a time. Marriage and Sexual Activity • 47 MARRIAGE AND SEXUAL ACTIVITY 4 his chapter presents 2015-16 ADHS data on marriage and sexual activity. If couples have the biological capacity to reproduce, the social environment in which they live largely determines whether they will have children and, if so, how many and how often. In Armenia, sexual activity usually takes place within marriage; therefore, marriage is a primary indicator of a woman’s sustained exposure to the risk of pregnancy. More direct measures of exposure are age at first sexual intercourse and the frequency of intercourse. Although postpartum amenorrhea, abstinence, and menopause also influence fertility, their impact is reviewed in the next chapter. None of these determining factors are independent; they interact and influence each other to affect fertility levels and trends. Their contribution varies from person to person, from region to region, and from time to time. 4.1 MARITAL STATUS Table 4.1 shows the percent distribution of all women and men age 15-49 by their marital status at the time of the survey, according to age. The term married refers to legal or formal marriage (civil or religious), while living together refers to informal unions. In subsequent tables, these two categories are merged and referred to collectively as currently married. Persons who are divorced, separated, or widowed are considered to be formerly married. T Key Findings  Approximately two-thirds of women age 15-49 (64 percent) and more than half of men age 15-49 (55 percent) are currently married or living together with a partner. Thirty percent of women and 43 percent of men have never been married; 4 percent of women and 2 percent of men are divorced or separated; and 2 percent of women but virtually no men are widowed.  Most Armenian women and men marry at least once during their lifetime; the proportion who have never married decreases rapidly with age, dropping to 6 percent among women age 45-49 and 4 percent among men age 45-49.  Less than 1 percent of women age 25-49 married for the first time before age 15, and only 13 percent married before age 18.  The percentage of women age 25-49 who were married by age 18 decreases from 21 percent among those age 40-44 to 5 percent among those age 20-24.  Men in Armenia marry on average 5 years later than women. The median age at first marriage among women age 30-49 is 20.9 years, compared with 25.9 years among men in the same age group.  Women in Armenia generally initiate sexual intercourse around the time of their first marriage. In contrast, men age 30-49 initiate intercourse 4.7 years before their first marriage.  Fifty-seven percent of women were sexually active within the 4 weeks before the survey, and an additional 6 percent were active within the 12 months before the survey although not in the month before the survey; corresponding figures for men are 64 percent and 9 percent. 48 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Armenia 2015-16 Age Marital status Total Percentage of respondents currently in union Number of respondents Never married Married Living together Divorced Separated Widowed WOMEN 15-19 95.2 4.6 0.0 0.2 0.0 0.0 100.0 4.6 725 20-24 60.1 39.2 0.1 0.2 0.2 0.1 100.0 39.3 928 25-29 27.4 69.1 0.2 2.4 0.5 0.4 100.0 69.2 1,099 30-34 12.5 81.5 0.5 4.1 0.8 0.6 100.0 82.0 1,007 35-39 8.2 81.4 0.4 6.3 1.5 2.2 100.0 81.8 867 40-44 5.2 81.1 0.4 6.3 1.3 5.6 100.0 81.5 784 45-49 6.0 78.1 1.5 6.3 0.6 7.5 100.0 79.6 706 Total 29.9 63.3 0.4 3.6 0.7 2.1 100.0 63.7 6,116 MEN 15-19 100.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 345 20-24 87.9 8.6 2.6 0.4 0.4 0.0 100.0 11.2 467 25-29 55.1 40.1 4.3 0.3 0.2 0.0 100.0 44.4 464 30-34 21.6 67.3 8.1 2.0 0.5 0.5 100.0 75.4 427 35-39 13.5 77.3 8.0 0.7 0.2 0.3 100.0 85.3 376 40-44 6.0 82.2 7.1 3.5 1.1 0.0 100.0 89.3 346 45-49 4.4 82.6 7.3 4.2 1.5 0.0 100.0 90.0 330 Total 43.2 49.4 5.3 1.5 0.5 0.1 100.0 54.7 2,755 According to the 2015-16 ADHS, more than three-fifths of women (64 percent) and more than half of men (55 percent) are married or living together with a partner. Four percent of women and 2 percent of men are either divorced or separated, while 2 percent of women but virtually no men are widowed. The proportion of women currently married increases with age, peaking at 82 percent among women age 30-44, and then declining slightly among the oldest women. Among women age 45-49, only 6 percent have never married, 80 percent are married or cohabiting with a man, 7 percent are divorced or separated, and 8 percent are widowed. Men, in comparison with women, are more likely to have never married (43 percent versus 30 percent). This difference is largely explained by the tendency of men to marry at later ages. For example, 11 percent of men age 20-24 are in union compared with 39 percent of women of the same age. Marriage patterns have remained largely stable over the past decade in Armenia. The proportions reported as ever married varied only slightly between the 2005, 2010, and 2015-16 ADHS surveys among both women (69 percent, 68 percent, and 70 percent, respectively) and men (58 percent, 55 percent, and 57 percent, respectively). 4.2 AGE AT FIRST MARRIAGE AND SEXUAL INTERCOURSE Marriage is an important demographic and social indicator; it generally marks the point in a person’s life when parenthood becomes socially acceptable. Information on age at first marriage was obtained in the 2015-16 ADHS by asking all ever-married respondents the month and year they started living together with their first spouse. Table 4.2 shows the proportions of women and men who first married by specific exact ages and the median age at first marriage among women age 25-49 and women and men age 30-49. The median age at first marriage is not shown for men age 25-49 because less than 50 percent of men married for the first time before reaching age 25. The results in Table 4.2 show that more than one-third of women age 25-49 had married by age 20, and 73 percent had married by age 25. The median age at first marriage among women age 25-49 was 21.4 years. An examination of cohort differences in the median age at first marriage among women age 25-49 indicates that younger women married more than 2 years later than older women; the median age at first marriage among women age 25-29 was 22.9 years compared with 20.6 years among women age 45-49. Marriage and Sexual Activity • 49 Table 4.2 Age at first marriage Percentage of women and men age 15-49 who were first married, by specific exact ages, and median age at first marriage, according to current age, Armenia 2015-16 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 WOMEN 15-19 0.0 na na na na 95.2 725 a 20-24 0.0 5.3 19.1 na na 60.1 928 a 25-29 0.2 7.6 23.9 41.7 63.3 27.4 1,099 22.9 30-34 0.1 11.1 32.4 52.4 69.5 12.5 1,007 21.7 35-39 0.7 16.0 39.5 56.7 73.6 8.2 867 21.0 40-44 0.2 20.6 51.4 67.6 81.1 5.2 784 19.9 45-49 0.0 14.0 43.0 65.6 82.6 6.0 706 20.6 25-49 0.2 13.3 36.7 55.3 72.9 13.0 4,463 21.4 30-49 0.2 15.2 40.9 59.8 76.0 8.3 3,364 20.9 MEN 15-19 0.0 na na na na 100.0 345 a 20-24 0.0 0.4 1.6 na na 87.9 467 a 25-29 0.0 0.3 0.9 7.7 26.9 55.1 464 a 30-34 0.0 0.5 2.4 11.2 35.4 21.6 427 26.3 35-39 0.0 0.9 3.5 13.0 41.7 13.5 376 26.1 40-44 0.0 0.5 4.5 15.1 37.8 6.0 346 26.6 45-49 0.0 0.5 2.8 21.3 52.1 4.4 330 24.7 25-49 0.0 0.5 2.7 13.1 37.9 22.3 1,942 a 30-49 0.0 0.6 3.3 14.8 41.3 12.0 1,478 25.9 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women or men began living with their spouse or partner for the first time before reaching the beginning of the age group Unlike women, very few men age 25-49 had married by age 20 (3 percent), and only 38 percent had married by age 25. The majority of men marry between ages 25 and 30, with nearly 90 percent of men age 30-49 reporting they had married. The tendency of men to delay marriage to much older ages than women is further evidenced by the 5-year difference between the median ages at first marriage among men and women age 30-49 (25.9 years and 20.9 years, respectively). The median ages at first marriage among women age 25-49 and women and men age 30-49 are shown by background characteristics in Table 4.3. The median age at first marriage is lower in rural areas than in urban areas for both women and men age 30-49. Considering regional differentials, Yerevan has by far the highest median age at first marriage among women (22.4), while Yerevan and Aragatsotn have the highest median ages among men (26.8 years and 27.1 years, respectively). The median age at first marriage rises with increasing education among women and men. However, education clearly has a much stronger influence on age at first marriage among women than men. On average, women age 30-49 with higher education married more than 5 years later than women with basic education (23.8 years and 18.5 years, respectively). In contrast, men age 30-49 with higher education married less than 2 years Table 4.3 Median age at first marriage by background characteristics Median age at first marriage among women age 25-49 and age 30-49, and median age at first marriage among men age 30-49, according to background characteristics, Armenia 2015-16 Background characteristic Women age Men age 25-49 30-49 30-49 Residence Urban 22.3 21.9 26.4 Rural 20.1 19.7 25.3 Region Yerevan 22.8 22.4 26.8 Aragatsotn 21.0 20.3 27.1 Ararat 21.3 21.0 25.7 Armavir 20.0 19.6 25.5 Gegharkunik 20.1 19.8 25.4 Lori 21.3 20.8 25.3 Kotayk 20.7 20.4 25.3 Shirak 21.0 20.5 26.3 Syunik 20.8 20.4 26.6 Vayots Dzor 20.2 20.0 26.2 Tavush 20.4 19.9 24.6 Education No education * * * Basic 18.8 18.5 25.5 Secondary 19.9 19.7 25.6 Secondary special 21.2 20.9 25.9 Higher 24.1 23.8 27.2 Wealth quintile Lowest 20.3 19.9 25.8 Second 20.4 20.0 25.5 Middle 20.8 20.2 25.8 Fourth 22.4 21.7 26.6 Highest 22.7 22.4 26.1 Total 21.4 20.9 25.9 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 50 • Marriage and Sexual Activity later than men with basic education (27.2 years and 25.5 years, respectively). Among women, wealth is directly related to the age at first marriage; the median age at first marriage increases steadily among women age 30-49, from 19.9 years in the lowest quintile to 22.4 years in the highest quintile. The relationship between wealth and age at marriage is not as strong among men, but men in the fourth and the highest wealth quintiles report marrying somewhat later on average (26.6 years and 26.1 years, respectively) than men in the lowest three quintiles (between 25.5 years and 25.8 years). With regard to recent trends in the age at first marriage, the median age at first marriage among women age 25-49 increased from 21.1 years in 2010 to 21.4 years in 2015-16, while the median age at first marriage among men age 30-49 increased from 25.8 in 2010 to 25.9 in 2015-16. 4.2 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage is sometimes seen as a proxy for a woman’s first exposure to intercourse, but the two events need not occur at the same time. Because women and men may engage in sexual relations prior to marriage, age at first sexual intercourse is a more reliable indicator of a woman’s exposure to the risk of pregnancy than age at first marriage. In the 2015-16 ADHS, women and men were asked how old they were when they first had sexual intercourse. Table 4.4 shows the proportion of women and men who first had sex by specific exact ages and the median ages at first intercourse. Overall, the 2015-16 ADHS results indicate that, among Armenian women, the reported age at first marriage and age at first intercourse correspond closely. Among all women age 25-49, for example, the median age at first intercourse was 21.2 years, only very slightly lower than the median age at first marriage (21.4 years). The very close correspondence between the age at first intercourse and the age at first marriage may be in part a result of women’s unwillingness to report premarital sexual activity due to the strong cultural norms against such behavior. Table 4.4 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Armenia 2015-16 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number of respondents Median age at first intercourse 15 18 20 22 25 WOMEN 15-19 0.0 na na na na 95.2 725 a 20-24 0.2 5.9 19.6 na na 59.9 928 a 25-29 0.2 8.1 25.0 42.1 64.3 27.0 1,099 22.8 30-34 0.1 11.7 33.3 52.9 70.0 12.1 1,007 21.7 35-39 0.7 16.8 40.4 57.3 74.7 8.2 867 20.9 40-44 0.5 21.2 51.9 68.2 81.4 5.1 784 19.9 45-49 0.0 15.4 44.2 66.9 83.6 5.9 706 20.4 20-49 0.2 11.1 30.6 na na 29.6 5,265 a 25-49 0.3 14.1 37.6 56.0 73.6 12.8 4,463 21.2 30-49 0.3 16.0 41.8 60.6 76.7 8.2 3,364 20.7 15-24 0.1 na na na na 75.4 1,653 a MEN 15-19 1.0 na na na na 87.5 345 a 20-24 1.0 14.9 31.8 na na 39.9 467 a 25-29 0.7 15.5 35.4 65.0 87.6 7.5 464 21.1 30-34 0.8 15.9 33.6 58.9 83.4 3.3 427 21.3 35-39 0.8 19.2 37.0 59.3 84.2 3.4 376 21.1 40-44 0.3 11.1 28.0 57.5 84.3 1.7 346 21.5 45-49 0.9 14.4 37.3 66.4 88.9 0.5 330 20.9 20-49 0.8 15.3 33.8 na na 10.6 2,410 a 25-49 0.7 15.4 34.3 61.5 85.6 3.6 1,942 21.2 30-49 0.7 15.3 34.0 60.3 85.0 2.3 1,478 21.2 15-24 1.0 na na na na 60.1 813 a na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 51 Unlike women, it is common for Armenian men to report having sexual intercourse before marriage. For example, although very few men age 30-49 were married by age 20 (just 3 percent), one-third of men said they had had sexual intercourse for the first time by that age. The median age at first sexual intercourse among men age 30-49 is more than 4 years younger than the median age at first marriage (21.2 years and 25.9 years, respectively). Table 4.5 shows the median age at first sexual intercourse for women and men in the age groups 25-49 and 30-49 by background characteristics. Looking at the results for the women, differentials in the median age at first intercourse within subgroups closely parallel the differentials observed in the median ages at first marriage; the highest median ages at first sex were observed among women in

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