Azerbaijan - Demographic and Health Survey - 2008

Publication date: 2008

Azerbaijan Demographic and Health Survey 2006 Azerbaijan Demographic and Health Survey 2006 State Statistical Committee of the Republic of Azerbaijan Baku, Republic of Azerbaijan Macro International Inc. Calverton, Maryland, USA May 2008 State Statistical Committee of Azerbaijan Republic This report summarizes the findings of the 2006 Azerbaijan Demographic and Health Survey (AzDHS) carried out by the State Statistical Committee of the Republic of Azerbaijan. Macro International Inc. provided technical assistance through the MEASURE DHS project and the United States Agency for International Development (USAID) provided funding under the terms of contract number GPO-C-00- 03-00002-00. Additional support for the AzDHS was provided by the United Nations Children’s Fund (UNICEF). The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID or the Republic of Azerbaijan. The 2006 AzDHS is part of the worldwide Demographic and Health Surveys program, which is designed to assist developing countries to collect data on fertility, reproductive health, maternal and child health, nutrition, and HIV/AIDS. Additional information about the survey may be obtained from: State Statistical Committee of the Republic of Azerbaijan, AZ 1136 Baku, Inshaatchilar Ave, Azerbaijan (Telephone: 994-12-438-5143; Fax: 994-12-438-2139; E-mail: rza@azstat.org). Additional information about the MEASURE DHS project may be obtained from: Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA (Telephone: 1-301-572-0200; Fax: 1-301-572-0999; E-mail: reports@macrointernational.com; Internet: www.measuredhs.com). Recommended citation: State Statistical Committee (SSC) [Azerbaijan] and Macro International Inc. 2008. Azerbaijan Demographic and Health Survey 2006. Calverton, Maryland, USA: State Statistical Committee and Macro International Inc. Contents | iii CONTENTS TABLES AND FIGURES . ix PREFACE . xv ACKNOWLEDGEMENTS . xvii CONTRIBUTORS TO THE REPORT . xix SUMMARY OF FINDINGS . xxi MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxix MAP OF AZERBAIJAN . xxx CHAPTER 1 INTRODUCTION 1.1 Geography and Population . 1 1.2 Health Care System . 2 1.2.1 Facilities, Finance, and Human Resources. 2 1.2.2 Health Care Reforms . 3 1.2.3 Primary, Secondary, and Tertiary Health Care . 3 1.2.4 Maternal and Child Health Care . 3 1.2.5 Family Planning Services . 4 1.2.6 Tuberculosis DOTS Program . 5 1.2.7 HIV/AIDS Program . 6 1.3 Systems for Collecting Demographic and Health Data . 6 1.4 Objectives and Organization of the Survey . 7 1.4.1 Sample Design and Implementation . 7 1.4.2 Questionnaires . 8 1.4.3 Training of Field Staff . 9 1.4.4 Hemoglobin Testing . 9 1.4.5 Fieldwork and Data Processing . 9 1.5 Response Rates . 10 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Population . 11 2.1.1 Age-Sex Structure . 11 2.1.2 Household Composition . 13 2.1.3 Children’s Living Arrangements and Orphanhood . 13 2.1.4 Education . 14 2.2 Housing Characteristics . 19 2.2.1 Drinking Water . 21 2.2.2 Sanitation Facility. 22 2.2.3 Household Possessions . 22 2.3 Wealth Quintiles . 23 2.4 Birth Registration . 24 2.5 Child Discipline and Early Development . 25 2.5.1 Children Left Alone. 25 2.5.2 Family Support in Early Learning . 26 2.5.3 Early Childhood Education . 28 2.5.4 Child Discipline . 29 iv | Contents CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3.1 Background Characteristics of Respondents . 31 3.2 Educational Level of Respondents . 32 3.3 Exposure to Mass Media . 34 3.4 Employment . 36 3.5 Occupation . 39 3.6 Employment Characteristics . 41 CHAPTER 4 FERTILITY 4.1 Current Fertility . 43 4.2 Fertility Differentials by Background Characteristics . 44 4.3 Fertility Trends . 46 4.4 Children Ever Born and Living . 46 4.5 Birth Intervals . 47 4.6 Age at First Birth . 49 4.7 Teenage Pregnancy and Motherhood . 51 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods . 53 5.2 Ever Use of Contraception . 55 5.3 Current Use of Contraceptive Methods . 57 5.4 Differentials in Contraceptive Use . 58 5.5 Number of Children at First Use . 60 5.6 Knowledge of the Fertile Period . 61 5.7 Source of Contraception . 61 5.8 Cost of Contraception . 62 5.9 Informed Choice . 63 5.10 Contraceptive Discontinuation . 63 5.11 Future Use of Contraception . 64 5.12 Reasons for Not Intending to Use. 65 5.13 Preferred Method for Future Use . 66 5.14 Exposure to Family Planning Messages . 66 5.15 Contact of Nonusers with Family Planning Providers . 68 5.16 Husband/Partner’s Knowledge of Women’s Use of Contraception . 68 CHAPTER 6 ABORTION 6.1 Pregnancies Ending in Induced Abortion . 69 6.2 Lifetime Experience with Induced Abortion . 70 6.3 Rates of Induced Abortion . 72 6.3.1 Recent Trends in the Total Abortion Rates . 73 6.4 Use of Contraceptive Methods Before Abortion . 74 6.4.1 Advice on Family Planning Methods Before or After the Last Abortion . 75 6.5 Induced Abortions in the Three Years Preceding the Survey . 76 6.5.1 Number of Abortions . 76 6.5.2 Reason for Abortion . 76 6.5.3 Place of Abortion . 78 6.5.4 Method of Abortions . 79 6.5.5 Use of Anesthesia during Abortion . 80 6.5.6 Post-Abortion Complications and Antibiotic Treatment . 81 Contents | v CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY 7.1 Marital Status . 85 7.2 Age at First Marriage . 86 7.3 Age at First Sexual Intercourse . 88 7.4 Recent Sexual Activity . 91 7.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 93 7.6 Termination of Exposure to Pregnancy . 95 CHAPTER 8 FERTILITY PREFERENCES 8.1 Desire for More Children . 97 8.2 Need for Family Planning Services . 100 8.3 Ideal Number of Children . 101 8.4 Wanted and Unwanted Fertility . 103 8.4.1 Planning Status of Births . 104 CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Definitions and Methodology . 107 9.2 Assessment of Data Quality. 107 9.3 Levels and Trends in Infant and Child Mortality . 109 9.4 Differentials in Childhood Mortality . 111 9.5 Perinatal Mortality . 111 9.6 High-Risk Fertility Behavior . 113 CHAPTER 10 REPRODUCTIVE HEALTH 10.1 Antenatal Care . 117 10.1.1 Antenatal Care Provider . 117 10.1.2 Number and Timing of ANC Visits . 118 10.1.3 Antenatal Care Content . 119 10.2 Assistance and Medical Care at Delivery . 121 10.2.1 Place of Delivery . 121 10.2.2 Attended Deliveries . 122 10.2.3 Caesarean Section Delivery . 124 10.3 Postnatal Care . 124 10.4 Women’s Perception of Access to Health Care . 125 CHAPTER 11 CHILD HEALTH 11.1 Child’s Weight and Size at Birth . 127 11.2 Vaccination Coverage . 128 11.3 Acute Respiratory Infection . 132 11.4 Diarrhea . 132 CHAPTER 12 NUTRITION 12.1 Nutritional Status of Children . 137 12.2 Breastfeeding and Supplementation . 140 12.2.1 Initiation of Breastfeeding . 140 12.2.2 Breastfeeding Patterns by Age . 142 12.2.3 Supplemental Foods . 144 12.2.4 Appropriate Infant and Child Feeding . 145 12.3 Anemia in Children . 147 vi | Contents 12.4 Iodization of Household Salt . 150 12.5 Micronutrient Intake in Children . 151 12.6 Nutritional Status of Women . 153 12.7 Nutritional Status of Men . 154 12.8 Anemia in Women . 155 12.9 Micronutrient Intake in Women . 157 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13.1 Knowledge of HIV/AIDS and of Transmission and Prevention Methods . 159 13.1.1 Awareness of AIDS . 159 13.1.2 Knowledge of Ways to Reduce HIV/AIDS Transmission . 159 13.1.3 Knowledge about Transmission . 162 13.2 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS . 164 13.3 Attitudes Towards Negotiating Safer Sex . 166 13.4 Higher-Risk Sex . 167 13.4.1 Multiple Sexual Partners and Higher-Risk Sex . 168 13.4.2 Paid Sex . 169 13.5 Testing for HIV . 170 13.6 Reports of Recent Sexually Transmitted Infections . 171 13.7 Injections . 172 13.8 HIV/AIDS-Related Knowledge and Behavior among Youth . 174 13.8.1 Knowledge about HIV/AIDS and Source for Condoms . 174 13.8.2 Age at First Sex and Condom Use at First Sexual Intercourse . 176 13.8.3 Recent Sexual Activity . 177 13.8.4 Higher-Risk Sex . 177 CHAPTER 14 ADULT HEALTH 14.1 Health Insurance . 179 14.2 Tuberculosis . 179 14.2.1 Knowledge of Tuberculosis . 180 14.2.2 Knowledge That Tuberculosis Is Curable and Willingness to Keep Secret a Family Member’s Tuberculosis Status . 181 14.2.3 Knowledge and Misconceptions about the Ways Tuberculosis Spreads . 182 14.3 Hypertension . 184 14.3.1 Cardiovascular Risk Factors . 184 14.3.2 Hypertension . 185 14.4 Use of Tobacco . 188 14.5 Alcohol Consumption among Men . 189 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Cash Earnings . 191 15.2 Use of Earnings . 192 15.3 Household Decisionmaking . 195 15.4 Men’s Attitudes about Household Decisionmaking . 197 15.5 Attitudes towards Wife Beating . 199 15.6 Attitudes towards Refusing Sexual Relations . 202 15.7 Indicators of Women’s Empowerment . 206 15.8 Current Use of Contraception by Women’s Status . 207 15.9 Women’s Status and Ideal Family Size and Unmet Need . 208 15.10 Women’s Status and Reproductive Health Care . 208 Contents | vii CHAPTER 16 DOMESTIC VIOLENCE 16.1 Women Experiencing Physical Violence . 212 16.2 Perpetrators of Physical Violence . 213 16.3 Force at Sexual Initiation . 214 16.4 Experience of Sexual Violence . 214 16.5 Experience of Different Forms of Violence . 215 16.6 Violence During Pregnancy . 216 16.7 Marital Control by Husband or Partner . 216 16.8 Forms of Spousal Violence . 218 16.9 Violence by Spousal Characteristics and Women’s Indicators . 221 16.10 Onset of Spousal Violence . 222 16.11 Types of Injuries to Women due to Spousal Violence . 222 16.12 Violence by Women against their Spouse . 223 16.13 Women Who Experienced Violence and Sought Help . 223 REFERENCES . 225 APPENDIX A SAMPLE DESIGN FOR THE 2006 AzDHS . 231 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 239 APPENDIX C DATA QUALITY TABLES . 255 APPENDIX D AZERBAIJAN DHS 2006 FIELD STAFF . 265 APPENDIX E SURVEY INSTRUMENTS Household Questionnaire . 271 Woman’s Questionnaire . 293 Man’s Questionnaire . 353 Tables and Figures | ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 10 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 12 Table 2.2 Household composition . 13 Table 2.3 Children’s living arrangements and orphanhood . 14 Table 2.4.1 Educational attainment of household population: Female . 16 Table 2.4.2 Educational attainment of household population: Male . 17 Table 2.5 School attendance ratios . 18 Table 2.6 Household characteristics . 20 Table 2.7 Household drinking water . 21 Table 2.8 Household sanitation facilities . 22 Table 2.9 Household durable goods . 23 Table 2.10 Wealth quintiles . 24 Table 2.11 Birth registration of children under age five . 25 Table 2.12 Children left alone or with other children . 26 Table 2.13 Family support for learning . 27 Table 2.14 Early childhood education . 28 Table 2.15 Child discipline . 30 Figure 2.1 Population pyramid . 12 Figure 2.2 Age-specific school attendance rates, by sex . 19 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents . 32 Table 3.2.1 Educational attainment: Women . 33 Table 3.2.2 Educational attainment: Men . 34 Table 3.3.1 Exposure to mass media: Women . 35 Table 3.3.2 Exposure to mass media: Men . 36 Table 3.4.1 Employment status: Women . 38 Table 3.4.2 Employment status: Men . 39 Table 3.5.1 Occupation: Women . 40 Table 3.5.2 Occupation: Men . 41 Table 3.6 Type of employment . 42 Figure 3.1 Percent distribution of women and men age 15-49, by employment status . 37 CHAPTER 4 FERTILITY Table 4.1 Current fertility . 43 Table 4.2 Fertility by background characteristics . 45 Table 4.3 Trends in age-specific fertility rates . 46 Table 4.4 Children ever born and living . 47 Table 4.5 Birth intervals . 48 x | Tables and Figures Table 4.6 Age at first birth . 50 Table 4.7 Median age at first birth by background characteristics. 50 Table 4.8 Teenage pregnancy and motherhood . 51 Figure 4.1 Age-specific fertility rates for the three-year period preceding the survey, by residence . 44 Figure 4.2 Total fertility rates for three years preceding the survey, by residence and education . 45 Figure 4.3 Percentage of births occurring less than 24 months after a prior birth, by residence and age group . 49 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . 54 Table 5.2 Knowledge of contraceptive methods by background characteristics . 55 Table 5.3.1 Ever use of contraception: Women . 56 Table 5.3.2 Ever use of contraception: Men . 57 Table 5.4 Current use of contraception by age . 58 Table 5.5 Current use of contraception by background characteristics . 59 Table 5.6 Survey based current use of contraception in selected countries . 60 Table 5.7 Number of children at first use of contraception . 60 Table 5.8 Knowledge of fertile period . 61 Table 5.9 Source of modern contraception methods . 62 Table 5.10 Cost of modern contraceptive methods . 62 Table 5.11 Informed choice . 63 Table 5.12 First-year contraceptive discontinuation rates . 63 Table 5.13 Reasons for discontinuation . 64 Table 5.14 Future use of contraception by background characteristics . 64 Table 5.15 Reason for not intending to use contraception in the future . 65 Table 5.16 Preferred method of contraception for future use . 66 Table 5.17 Exposure to family planning messages . 67 Table 5.18 Contact of nonusers with family planning providers . 68 Figure 5.1 Contraceptive use among married women . 58 CHAPTER 6 ABORTION Table 6.1 Pregnancy outcome by background characteristics . 70 Table 6.2 Lifetime experience with induced abortion . 71 Table 6.3 Induced abortion rates . 72 Table 6.4 Induced abortion rates by background characteristics . 73 Table 6.5 Total abortion rates in selected countries . 74 Table 6.6 Use of contraception before pregnancy . 74 Table 6.7 Experience with induced abortions . 77 Table 6.8 Reason for abortion . 78 Table 6.9 Place of abortion . 79 Table 6.10 Method of abortion . 80 Table 6.11 Anesthesia used for abortion . 81 Table 6.12 Health issues related to abortion . 83 Figure 6.1 Age-specific fertility rates (ASFR) and age-specific abortion rates (ASAR) . 72 Figure 6.2 Use of contraception before abortion, Azerbaijan 2006 . 75 Figure 6.3 Family planning counseling before or after the last abortion in the past 3 years . 76 Figure 6.4 Early post-abortion complications . 82 Figure 6.5 Late abortion complications . 82 Tables and Figures | xi CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 7.1 Current marital status . 85 Table 7.2 Age at first marriage . 86 Table 7.3.1 Median age at first marriage: Women . 87 Table 7.3.2 Median age at first marriage: Men . 88 Table 7.4 Age at first sexual intercourse . 89 Table 7.5.1 Median age at first intercourse: Women . 90 Table 7.5.2 Median age at first intercourse: Men . 90 Table 7.6.1 Recent sexual activity: Women . 91 Table 7.6.2 Recent sexual activity: Men . 92 Table 7.7 Postpartum amenorrhea, abstinence, and insusceptibility . 93 Table 7.8 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility . 94 Table 7.9 Menopause . 95 Figure 7.1 Percentage of births in the three years preceding the survey for which the mother reported postpartum amenorrhea, abstinence, and insusceptibility, by number of months since birth . 94 CHAPTER 8 FERTILITY PREFERENCES Table 8.1 Fertility preferences by number of living children . 97 Table 8.2.1 Desire to limit childbearing: Women . 99 Table 8.2.2 Desire to limit childbearing: Men . 99 Table 8.3 Need and demand for family planning among currently married women . 101 Table 8.4 Ideal number of children . 102 Table 8.5 Mean ideal number of children by background characteristics . 103 Table 8.6 Fertility planning status . 104 Table 8.7 Wanted fertility rates . 105 Figure 8.1 Desire for more children among currently married women and men . 98 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Early childhood mortality rates . 109 Table 9.2 Regional infant mortality rates based on recent Demographic and Health Surveys that correspond closely with the 5-9-year period prior to the 2006 AzDHS . 111 Table 9.3 Early childhood mortality rates by background characteristics . 111 Table 9.4 Perinatal mortality . 112 Table 9.5 High-risk fertility behavior . 114 Figure 9.1 Trends in infant mortality rate based on estimates from State Statistical Committee, 2001 RHSA and 2006 AzDHS . 109 Figure 9.2 Births in the past five years in categories of high-risk fertility behavior . 115 CHAPTER 10 REPRODUCTIVE HEALTH Table 10.1 Antenatal care . 118 Table 10.2 Number of antenatal care visits and timing of first visit . 119 Table 10.3 Components of antenatal care . 120 Table 10.4 Place of delivery . 121 xii | Tables and Figures Table 10.5 Assistance during delivery . 123 Table 10.6 Timing of first postnatal checkup. 125 Table 10.7 Problems in accessing health care . 126 CHAPTER 11 CHILD HEALTH Table 11.1 Child’s weight and size at birth . 128 Table 11.2 Vaccinations by source of information . 129 Table 11.3 Vaccinations by background characteristics . 130 Table 11.4 Prevalence of symptoms of ARI . 132 Table 11.5 Prevalence of diarrhea . 133 Table 11.6 Treatment practices during diarrhea. 134 Table 11.7 Feeding practices during diarrhea . 135 Table 11.8 Knowledge of ORS packets . 136 Figure 11.1 Vaccination coverage among children 18-29 months at any time preceding the survey . 130 CHAPTER 12 NUTRITION Table 12.1 Nutritional status of children . 138 Table 12.2 Initial breastfeeding . 141 Table 12.3 Breastfeeding status by age . 142 Table 12.4 Median duration of breastfeeding . 144 Table 12.5 Foods and liquids consumed by children in the day and night preceding the interview . 145 Table 12.6 Infant and young child feeding (IYCF) practices . 146 Table 12.7 Prevalence of anemia in children . 148 Table 12.8 Anemia in children in various countries . 149 Table 12.9 Presence of iodized salt in household . 151 Table 12.10 Micronutrient intake among children . 152 Table 12.11 Nutritional status of women . 154 Table 12.12 Nutritional status of men . 155 Table 12.13 Prevalence of anemia in women . 156 Table 12.14 Anemia in women in various countries . 157 Table 12.15 Micronutrient intake among mothers . 158 Figure 12.1 Nutritional status of children by age . 139 Figure 12.2 Nutritional status of children under five years, by residence . 140 Figure 12.3 Infant feeding practices by age . 143 Figure 12.4 Infant and young child feeding (IYCF) practices . 147 Figure 12.5 Percentage of children with anemia, by severity of anemia and age . 149 Figure 12.6 Percentage of households with adequately iodized salt . 151 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 13.1 Knowledge of AIDS. 159 Table 13.2 Knowledge of HIV prevention methods . 161 Table 13.3.1 Comprehensive knowledge about AIDS: Women . 162 Table 13.3.2 Comprehensive knowledge about AIDS: Men . 163 Table 13.4.1 Accepting attitudes toward those living with HIV/AIDS: Women . 165 Table 13.4.2 Accepting attitudes toward those living with HIV/AIDS: Men . 166 Table 13.5 Attitudes toward negotiating safer sexual intercourse with husband . 167 Tables and Figures | xiii Table 13.6 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men . 169 Table 13.7 Payment for sexual intercourse: Men . 170 Table 13.8 Knowledge of where to get an HIV test . 171 Table 13.9 Prevalence of medical injections . 173 Table 13.10 Comprehensive knowledge about AIDS and of a source of condoms among youth . 175 Table 13.11 Age at first sexual intercourse among youth . 177 Figure 13.1 Knowledge of specific ways to avoid AIDS among women and men age 15-49 . 160 Figure 13.2 Type of facility where last medical injection was received . 174 Figure 13.3 Abstinence, being faithful, and condom use (ABC) among young men . 178 CHAPTER 14 ADULT HEALTH Table 14.1.1 Knowledge of and attitudes toward tuberculosis: Women . 180 Table 14.1.2 Knowledge and attitudes concerning tuberculosis: Men . 181 Table 14.2 Knowledge and misconceptions about the ways tuberculosis spreads . 183 Table 14.3.1 Levels of hypertension: Women . 186 Table 14.3.2 Levels of hypertension: Men . 187 Table 14.4 Use of tobacco: Men . 189 Table 14.5 Use of alcohol: Men . 190 Figure 14.1 Knowledge and misconceptions about tuberculosis transmission among women and men age 15-49 . 184 Figure 14.2 Awareness of hypertension and treatment status among hypertensive women and men age 15-49 . 188 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women and men . 192 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s earnings: Women . 193 Table 15.2.2 Control over men’s cash earnings . 194 Table 15.3 Women’s control over their own earnings and over those of their husband/partner . 195 Table 15.4 Women’s participation in decisionmaking . 195 Table 15.5 Women’s participation in decisionmaking by background characteristics . 197 Table 15.6 Men’s attitudes about decisionmaking roles . 198 Table 15.7 Men’s attitudes toward wives’ participation in decisionmaking . 198 Table 15.8.1 Attitudes toward wife beating: Women . 200 Table 15.8.2 Attitudes toward wife beating: Men . 201 Table 15.9.1 Attitude toward refusing sexual intercourse with husband: Women . 203 Table 15.9.2 Attitude toward refusing sexual intercourse with husband: Men . 204 Table 15.9.3 Men’s attitudes toward a husband’s rights when his wife refuses to have sexual intercourse . 205 Table 15.10 Indicators of women’s empowerment . 206 Table 15.11 Current use of contraception by women’s status . 207 Table 15.12 Women’s empowerment and ideal number of children and unmet need for family planning . 208 Table 15.13 Reproductive health care by women’s empowerment . 209 Figure 15.1 Number of decisions in which currently married women participate . 196 xiv | Tables and Figures CHAPTER 16 DOMESTIC VIOLENCE Table 16.1 Experience of physical violence . 212 Table 16.2 Persons committing physical violence . 213 Table 16.3 Force at sexual initiation . 214 Table 16.4 Experience of sexual violence . 215 Table 16.5 Experience of different forms of violence . 216 Table 16.6 Violence during pregnancy . 216 Table 16.7 Degree of marital control exercised by husbands . 217 Table 16.8 Forms of spousal violence . 218 Table 16.9 Spousal violence by background characteristics. 220 Table 16.10 Spousal violence by husband’s characteristics and empowerment indicators . 221 Table 16.11 Injuries to women caused by spousal violence . 223 Table 16.12 Help seeking to stop violence . 224 Figure 16.1 Percentage of ever-married women who have ever experienced specific forms of physical or sexual violence committed by their current or most recent husband/partner . 219 APPENDIX A SAMPLE DESIGN FOR THE 2006 AzDHS Table A.1 Population distribution in Azerbaijan based on 2005 population projections . 232 Table A.2 Sample allocation of clusters and households by economic region and type of residence, AzDHS 2006 . 233 Table A.3 Sample allocation of eligible women and completed women’s interviews by economic region and type of residence, AzDHS 2006 . 233 Table A.4 Sample allocation of eligible men and completed men’s interviews by economic region and type of residence, AzDHS 2006 . 234 Table A.5.1 Sample implementation: Women . 236 Table A.5.2 Sample implementation: Men . 237 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Azerbaijan, 2006 . 241 Table B.2 Sampling errors: Total sample, AzDHS 2006 . 242 Table B.3 Sampling errors: Urban sample, AzDHS 2006. 243 Table B.4 Sampling errors: Rural sample, AzDHS 2006 . 244 Table B.5 Sampling errors: Baku sample, AzDHS 2006 . 245 Table B.6 Sampling errors: Absheron sample, AzDHS 2006 . 246 Table B.7 Sampling errors: Ganja Gazakh sample, AzDHS 2006. 247 Table B.8 Sampling errors: Shaki Zaqatala sample, AzDHS 2006 . 248 Table B.9 Sampling errors: Lankaran sample, AzDHS 2006 . 249 Table B.10 Sampling errors: Guba Khachmaz sample, AzDHS 2006 . 250 Table B.11 Sampling errors: Aran sample, AzDHS 2006 . 251 Table B.12 Sampling errors: Yukhari Karabakh sample, AzDHS 2006 . 252 Table B.13 Sampling errors: Dakhlik Shirvan sample, AzDHS 2006 . 253 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 257 Table C.2.1 Age distribution of eligible and interviewed women . 258 Table C.2.2 Age distribution of eligible and interviewed men . 258 Table C.3 Completeness of reporting . 259 Tables and Figures | xv Table C.4 Reporting of age at death in months . 260 Table C.5 Reporting of age at death in days . 261 Table C.6 Births by calendar years . 262 Table C.7 Nutritional status of children based on NCHS/CDC/WHO International Reference Population . 263 Preface | xvii PREFACE Data on infant and child mortality from the 2000 MICS and the 2001 RHSA were used by the UNDP for calculating the “Human Development Index” for Azerbaijan. These indicators, which resulted in a low rating for Azerbaijan in the UN Human Development Report, no longer reflect the actual current situation in the country. Following discussions with USAID and UNICEF regarding support for a new survey to obtain precise data on infant and child mortality, the 2006 Azerbaijan Demographic and Health Survey (AzDHS) was carried out from July to November 2006. The survey was implemented by the State Statistical Committee of the Republic of Azerbaijan with support from the United States Agency for International Development (USAID) and UNICEF, with Macro International Inc. providing technical assistance, and participation by the Ministry of Health. The 2006 Azerbaijan Demographic and Health Survey provides recent estimates of infant and child mortality, and these estimates are about half those of the 2000 MICS and the 2001 RHSA. In addition to mortality data, the objectives of the 2006 AzDHS were to collect national- and regional-level data on fertility and contraceptive use, maternal and child health, adult health, and AIDS and other sexually transmitted diseases. The survey obtained detailed information on these topics from women of reproductive age and, for certain topics, from men as well. Data are presented by region when sample size permits. The survey findings provide estimates for a variety of demographic indicators. The 2006 AzDHS results are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of and health services for the people of Azerbaijan. The 2006 AzDHS also contributes to the growing international database of demographic and health indicators. Rza Allahverdiyev Director of the Project Acknowledgements | xix ACKNOWLEDGEMENTS The State Statistical Committee of the Republic of Azerbaijan wishes to express their appreciation to those involved in the implementation of the 2006 Azerbaijan DHS survey and the preparation of this report. Particular thanks go to: • Mr. Elchin Efendiyev, Deputy Prime Minister in leading the whole process and establishing The AzDHS Task Force and division of responsibilities; • The Ministry of Labor and Social Protection for its chairmanship of the Task Force; • The Ministry of Health of Azerbaijan for providing health technicians with medical background for fieldwork, and for participating in questionnaire adaptation, in data analysis and final report writing; • The Ministry of Education and Institute of Economics of the National Academy of Science of Azerbaijan for participating in data analysis and final report writing; • U.S. Agency for International Development (USAID/Azerbaijan), for providing the funding for organizing and conducting the 2006 Azerbaijan Demographic and Health Survey (AzDHS); • Macro International Inc., for providing technical support during the design, training for fieldwork staff, data processing and analyses of the data collected; • UNICEF/Azerbaijan for providing political mobilization, financial and administrative support; • UNFPA/Azerbaijan for improvement of the survey questionnaires and providing other services; • The technical staff of the AzDHS, for the input of field staff and data quality teams, and for the valuable contribution of all experts and organizations, whose joint efforts ensured the effective implementation of the survey. Also to the households whose participation made it possible to obtain the reliable information collected in the survey. State Statistical Committee of the Republic of Azerbaijan Contributors to the Report | xxi CONTRIBUTORS TO THE REPORT Specialists Who Contributed to the AzDHS Final Report Azerbaijan Staff: Mehdi Amrahov – Deputy Chief, Department of Informatics and Statistics, Ministry of Health Sevinj Abdullayeva – Department Head, Scientific-Research Institute on Pediatrics Elminaz Khaliyeva – Scientist, Scientific-Research Institute on Obstetric-Gynecology Rafiq Bakhshi – Department Head, Republic Center for Response to AIDS Zokhra Ismayilova – Department Assistant, Medical University Djalil Guliyev – Department Head, Institute on Economics, National Academy of Sciences of the Republic of Azerbaijan Rasmiya Ashrafova – Researcher, Institute on Economics, National Academy of Sciences of the Republic of Azerbaijan Allahyar Muradov – Researcher, Institute on Economics, National Academy of Sciences of the Republic of Azerbaijan Zohrab Kalbaliyev – Leading Adviser, Department of Strategic Analysis, Planning, and Management of Personnel, Ministry of Education Macro International Inc. Staff and Consultants: Ann Way – Director Gulnara Semenov – Health Specialist Zhuzhi Moore – Demographer Gul Ergor – Consultant Turgay Unalan – Consultant Saida Ismayilova – Consultant Alexander Izmukhambetov – Data Processing Specialist Sidney Moore – Editor Chris Gramer – Graphics/Document Production Specialist Summary of Findings │ xxiii SUMMARY OF FINDINGS The Azerbaijan Demographic and Health Survey (AzDHS) is a nationally representative survey of 8,444 women age 15-49 and 2,558 men age 15-59. Survey fieldwork was conducted during the period of July to November 2006. The AzDHS was conducted by the State Statistical Committee and the Ministry of Health of the Re- public of Azerbaijan. The MEASURE DHS Project provided technical support for the survey. The U.S. Agency for International Development (USAID)/Azerbaijan provided funding, and the United Nations Children’s Fund (UNICEF)/Azerbaijan supported the survey through in-kind contributions. CHARACTERISTICS OF RESPONDENTS Azerbaijan is an ethnically homogeneous country; virtually all respondents are Azerbaijani. The ma- jority, approximately 57 percent, live in urban areas. Baku accounts for more than one-third of all respondents. All households in Azerbaijan have electricity and a majority of households have water piped into the residence, a finished floor, and a color television; two-thirds have a flush toilet. All but a handful of women and men in the sample have attended school. Over half have reached complete secondary school, 14 percent of women and 9 percent of men have reached secondary specialized, and 13 percent of women and 19 per- cent of men have attended university. Twenty per- cent of women and 65 percent of men were em- ployed in the 12 months prior to the survey. FERTILITY Fertility rates. A useful index of the level of fer- tility is the total fertility rate (TFR), which indi- cates the number of children a woman would have if she passed through the childbearing ages at the current age-specific fertility rates. For the three years preceding the survey, the survey estimate of the TFR was 2.0 children per woman. This is be- low replacement level. The survey found that the TFR is lower in urban areas (1.8 children per woman) than in rural areas (2.3 children per woman). This urban-rural differ- ence in childbearing rates can be attributed almost exclusively to younger age groups. Although peak fertility occurs at age 20-24 in both urban and ru- ral areas, the greatest absolute urban-rural differ- ence in ASFR (54 births per woman) is in the 20- 24 age group. Time trends. The total fertility rate of 2.0 children per woman measured the three years preceding the survey, suggesting a small decrease from the level (2.1) observed in the 2001 Reproductive Health Survey of Azerbaijan, but indicating no recent change in overall fertility levels. Age at first birth. Research has shown that child- bearing in the teenage years is associated with in- creased social and health problems for both the mother and her child. The survey found that only 4 percent of women age 15-19 had given birth. Moreover, almost all births to teenage women oc- curred at ages 18 and 19. Thus, the median age at initiation of childbearing in Azerbaijan is about 23 years (23.4 years among women age 25-29 and 23.5 years among women age 25-49). Birth intervals. Research has shown that children born soon after a previous birth, especially those born within two years of the previous birth, have an increased risk of morbidity and mortality. In Azerbaijan, 36 percent of second and higher order births occur after a birth interval of less than two years. The proportion of closely spaced births de- clines as wealth quintile of the mother increases. Fertility preferences. Among currently married women, 72 percent reported that they either wanted no more children or were sterilized. Another 19 percent wanted another child, and 9 percent were infecund (unable to conceive) or un- decided about having another child. CONTRACEPTION Knowledge and ever use. Knowledge of contra- ception is widespread in Azerbaijan. Among mar- ried women, knowledge of at least one method is universal (97 percent). On average, married wom- en reported knowing of four methods of contra- ception. Seventy percent of married women have used a method of contraception at some time. xxiv | Summary of Findings Current use. Over half (51 percent) of married women reported that they were currently using a contraceptive method: 14 percent using modern methods and 37 percent using traditional methods. By far, the most commonly used method is with- drawal; more than half of all users (33 out of 51 percent) are using withdrawal. The second most common method—the IUD—is used by only 9 percent of married women. Overall levels of contraceptive use are similar for women in urban and rural areas and across educa- tional categories and wealth quintile (between 41 and 57 percent). Nevertheless, urban women and women with more education show distinctive be- havior patterns by relying more on modern me- thods (the IUD and condom) and less on tradition- al methods (in particular, withdrawal). Trends in current use. Overall, use of contracep- tion has not changed in the past five years, with 55 percent of married women age 15-44 reporting use of a method in both the 2001 Reproductive Health Survey of Azerbaijan (RHSA) and the 2006 AzDHS1. Compared with the RHSA findings, the AzDHS results, however, indicate a decrease in the use of traditional methods, particularly for withdrawal. On the other hand, the proportion of married women who use modern contraceptive methods increased, in particular the IUD. Method failure. A woman may discontinue use of contraception for many reasons, including the de- sire to have more children, health concerns, or lack of exposure to the risk of pregnancy. In Azerbai- jan, the single most prevalent reason for discontin- uation is method failure, i.e., becoming pregnant while using a method. The method most common- ly used in Azerbaijan, withdrawal, has the second highest failure rate after periodic abstinence (rhythm). Nineteen percent of women practicing withdrawal experience a contraceptive failure with- in 12 months of starting use (data not shown sepa- rately). Future use. Among married women who were not using contraception, 17 percent reported that they intended to use in the future. When asked which method they would prefer to use, almost half (45 percent) of non-users said the IUD, followed by withdrawal (21 percent) and the pill (12 percent). 1 The base female population in the AzDHS is women age 15-49, and in the 2001RHSA is women age 15-44. To make statistics in use of contraceptives comparable between the two surveys, the use of contraceptives among married women in the AzDHS was computed for women age 15-44. Just 4 percent of women report male condoms as their preferred method. Source of supply. Most modern method users re- ported that they obtained their methods through the public sector (72 percent), primarily hospitals and polyclinics/woman’s consultations. Two per- cent obtained their contraceptives from the private sector, and 25 percent from other sources, primari- ly shops. INDUCED ABORTION In Azerbaijan, as in all of the former Soviet Union, induced abortion has been a primary means of fer- tility control for many years. Abortion rates. The use of abortion can be meas- ured by the total abortion rate (TAR), which indi- cates the number of abortions a woman would have in her lifetime if she passed through her childbearing years at the current age-specific abor- tion rates. The survey estimate of the TAR indi- cates that a woman in Azerbaijan will have an av- erage of 2.3 abortions during her lifetime. This rate is considerably lower than the comparable rate in the 2001 Reproductive Health Survey of Azer- baijan (RHSA) of 3.2. Despite this decline, almost half (49 percent) of pregnancies end in an induced abortion. Abortion differentials. The TAR in rural and in urban areas is similar (2.3 abortions per woman). There are significant differentials by region. The total abortion rates vary from a low of 1.0 in Gu- ba-Khachmaz to a high of 3.5 in Ganja-Gazakh. Baku has a TAR of 2.1, a figure close to the na- tional total. The women with the highest education have the lowest TAR. Contraceptive failure and abortion. When for- mulating policies designed to improve the repro- ductive health of women, it is useful to know the contraceptive behavior of women who resort to abortion as a means of fertility control. Over half (42 percent) of all abortions were to women who were using contraception and experienced method failure, a large proportion of whom were using withdrawal (32 percent). Greater access to and use of more reliable methods would reduce the inci- dence of abortion. CHILDHOOD MORTALITY Trends in childhood mortality. Data from the 2006 AzDHS indicate that there has been a decline in childhood mortality over the five years preced- Summary of Findings │ xxv ing the survey. For example, infant mortality has declined from 55 deaths per 1,000 live births for the approximate period 1997-2001 to 43 for the period 2002-2006. There has been a similar de- cline in under-five mortality from 66 to 50 deaths per 1,000 births. Differentials in infant mortality. The survey found levels of infant mortality to be slightly high- er in rural areas than in urban areas. Infant mor- tality levels are also much higher among children of poorer women than among children of women in the higher wealth quintiles. MATERNAL AND CHILD HEALTH AND NUTRITION Antenatal care. Azerbaijan has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. Overall, the levels of antenatal care and delivery assistance are high. Seventy-seven percent of mothers receive antenatal care from professional health providers (doctors, nurses, and midwives). In urban areas, 90 percent of care is provided by a trained provider, as opposed to 63 percent in rural areas. Less than half (45 percent) of pregnant women make four or more antenatal care visits. The percentage of women who made four or more antenatal care visits is much lower in rural areas than in urban areas (30 percent compared with 60 percent). In terms of content of care, two-thirds of women said they were weighed, and almost all women had their blood pressure tested and gave blood and urine specimens (87-80 percent); however, less than half say that they were informed about preg- nancy complications (43 percent). Delivery care. Overall, a majority of births are delivered under the supervision of a trained medi- cal professional (89 percent) and occur at health facilities (78 percent). Twenty-two percent of births occur at home. Home deliveries are more common in Lankaran (41 percent), Aran (35 per- cent), Daghligh Shirvan (28 percent), Yukhari Ga- rabakh (26 percent), and Ganja-Gazakh (23 per- cent) regions. Ten percent of all deliveries are as- sisted by mamachi, a traditional birth attendant. As expected, the role of traditional birth attendants in assisting deliveries is more prominent in Daghligh Shirvan and Lankaran (20 percent each) and Aran (18 percent), regions with the highest home deli- very rates. Childhood vaccinations. The health cards main- tained at the health facilities are the primary source of vaccination data. Almost all children age 18-29 months have received vaccinations for BCG, DPT1 and polio 1. Coverage is also high for the second and third doses of both DPT and polio. Sixty-seven percent of children age 18-29 months had received the MMR (measles, mumps, rubella) vaccination before the survey and 63 received measles vaccine. Only 60 percent of children age 18-29 months had received all the basic vaccina- tions (BCG, MMR or measles, and three doses each of DPT and polio) at any time before the sur- vey. Treatment of diarrhea. The AzDHS asked about the treatment of children who suffered from diarr- hea during the two weeks preceding the survey. Overall, 11 percent of children under five reported an episode of diarrhea in the two weeks before the survey, and among them, over half (54 percent) were given either oral rehydration salts or in- creased fluids (oral rehydration therapy). For 18 percent of children with diarrhea, mothers reported that they engaged in the hazardous practice of cur- tailing fluid intake. Less than one-third (27 per- cent) of mothers who had a birth in the five years preceding the survey know about oral rehydration salts (ORS). About one-third of children with di- arrhea (33 percent) were taken to a health provid- er. Breastfeeding. Eighty-five percent of children born in the five years preceding the survey were breastfed at some time. Although the median dura- tion of breastfeeding is 8 months, the durations of exclusive and predominant breastfeeding (breast- feeding plus plain water) are short: less than one month and two months, respectively. Bottle-feeding. Bottle-feeding is fairly widespread in Azerbaijan. Among children under 2 months of age living with their mother, more than half (53 percent) of infants are fed with a bottle with a nip- ple. This proportion increases to 81 percent for children age 4-5 months before beginning to de- cline. Infant and Young Child Feeding (IYCF). Ap- propriate infant and young child feeding (IYCF) practices include timely initiation of feeding sol- id/semi-solid foods from age six months and in- creasing the amount of foods and frequency of feeding as the child gets older while maintaining frequent breastfeeding. xxvi | Summary of Findings Breastfed children are considered appropriately fed if they consume foods from at least three food groups and are given food or liquids other than breast milk at least twice a day in the case of infants age 6-8 months, and at least three times a day in the case of children age 9-23 months. Nonbreastfed children age 6-23 months are considered to be ap- propriately fed if they consumed foods from four food groups, including milk products, and are fed at least four times a day. The majority of young children in Azerbaijan are not being fed appropriately. Overall, feeding prac- tices meet the minimum standards for only 33 per- cent of children age 6-23 months. Eighty-six per- cent of children age 6-23 months received breast milk or milk products and 81 percent received foods from the recommended number of food groups for their age; however, only 40 percent were fed the minimum number of times. Appropri- ate feeding practices are somewhat more common for breastfeeding children than nonbreastfeeding children (37 percent and 30 percent, respectively). Children born to mothers with a secondary specia- lized or higher education are somewhat more like- ly to be fed appropriately than children born to less educated mothers. Nutritional status. In the AzDHS, the height and weight of children under five years of age were measured. These data are used to determine the nutritional status of children, i.e., the percentage of children who are stunted (measured in terms of height-for-age), wasted (weight-for-height), or underweight (weight-for-age). Stunting is a sign of chronic, long-term undernutrition; wasting is a sign of acute, short-term undernutrition; and un- derweight is a composite measure that takes into account both chronic and acute undernutrition. In a well-nourished population of children, it is expected that slightly more than 2 percent of child- ren will be stunted or wasted. Stunting based on the new WHO Child Growth Standards is expected to be greater throughout childhood. In general, underweight will increase in the first half of infancy, especially in breastfed infants. Wasting will be higher in infancy, then decrease. In Azer- baijan, 25 percent of children under age five are stunted and 7 percent are wasted. Thirteen percent are overweight. Overall, 8 percent of children are underweight. Anthropometric data were also collected from all women age 15-49. According to the findings of the AzDHS, nearly half of Azerbaijani women weigh more than they should: 30 percent are overweight and 18 percent are obese. The preva- lence of obesity increases from 2 percent among women age 15-19 to over one-third of women age 40-49. Nearly two-thirds of women age 30 and older are either overweight or obese, a serious public health challenge for Azerbaijan. The 2006 AzDHS also collected anthropometric data on men age 15- 49. The mean BMI for men age 15-49 in Azerbai- jan is 24. More than half of men (58 percent) are in the normal range of BMI. Only 2 percent of men are considered thin, while 40 percent are overweight or obese. Most of the men in the latter category are overweight rather than obese; only 5 percent of men are considered to be obese com- pared to 18 percent of women. Anemia. Determining anemia levels among wom- en and their children under five was one compo- nent of the AzDHS. Overall, 39 percent of child- ren age 6-59 months have anemia: 21 percent have mild anemia, but 17 percent have moderate ane- mia, and less than 1 percent have severe anemia. Prevalence of anemia in children decreases with increasing level of the mother’s education and wealth index. Urban children were somewhat less likely to be anemic than rural children. Children in Aran region (50 percent) were the most likely to be anemic. Thirty-seven percent of women in Azerbaijan have some level of anemia. The great majority of wom- en are mildly anemic (29 percent), while 7 percent are moderately anemic, and less than one percent were found to be severely anemic. Prevalence of any anemia in women varies among the regions, with the lowest level found in Lankaran and Guba- Khachmaz (27 percent each) and the highest in Daghligh Shirvan (52 percent). MICRONUTRIENT INTAKE In the 2006 AzDHS, information was obtained about the foods children consumed during the 24 hours preceding the survey, whether or not child- ren under age 6-59 months had received vitamin A or iron supplements, and whether or not they had been given deworming medication during the six- month period prior the survey. Seventy-seven per- cent of children age 6-35 months consumed fruits and vegetables rich in vitamin A in the 24 hours preceding the interview, and 73 percent consumed iron-rich foods. Children from wealthier house- holds were generally more likely to consume foods rich in iron and vitamin A than children from the poorest households. Only 4 percent of children age 6-59 months had been given a vitamin A supple- ment during the six-month period prior to the sur- Summary of Findings │ xxvii vey, 3 percent had received iron supplements in the seven days before the interview, and 5 percent of children had been given deworming medication in the six months preceding the survey. About half of children age 6-59 months live in households using adequately iodized salt. In the AzDHS, data were collected on the number of days that pregnant women in Azerbaijan took iron supplementation in the form of tablets or sy- rup during the pregnancy leading to the most re- cent birth in the five years preceding the survey. Nineteen percent of women took some form of iron supplements during their most recent preg- nancy ending in birth and, among them, 17 percent reported taking supplements for less than 60 days. Only 2 percent of pregnant women take iron sup- plements for more than 90 days. Urban women, women living in Baku and Absheron, and women in the two highest wealth quintiles were most like- ly to use iron supplements. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS The currently low level of HIV infection in Azer- baijan provides a unique window of opportunity for early targeted interventions to prevent further spread of the disease. However, the increases in the cumulative incidence of HIV infection suggest that this window of opportunity is rapidly closing. Knowledge and attitudes. Sixty-five percent of women and 77 percent of men reported that they have heard of HIV/AIDS and roughly 30-50 per- cent of women and men know about the three main ways to reduce its transmission, namely, ab- stinence, being faithful to one uninfected partner, and using condoms. Seventeen percent of women and 13 percent of men in Azerbaijan have com- prehensive knowledge of HIV/AIDS prevention and transmission, i.e., they know that using con- doms consistently and having one faithful partner can reduce the chance of getting HIV, that a healthy-looking person can have the AIDS virus, and rejecting the two most common local miscon- ceptions—that a person can become infected with the AIDS virus by kissing someone who is in- fected, and by mosquito bites. Stigma surrounding AIDS is widespread in Azer- baijan. Although sixty-one percent of women and 60 percent of men say that they would not want to keep secret that a family member was infected with the AIDS virus, and 52 percent of women and 24 percent of men say they would be willing to care for a family member with the AIDS virus in their home, only 18 percent of women and 9 per- cent of men say that an HIV-positive teacher should be allowed to continue teaching and only 20 percent of women and 8 percent of men would buy fresh food from a shopkeeper with AIDS. The percentage expressing accepting attitudes on all four measures is low: 4 percent among women and less than 1 percent among men. Sexual behavior. Among respondents who had sexual intercourse in the past 12 months, only 8 percent of men and a negligible fraction of women reported having had more than one sexual partner in the 12 months before the survey and one-quarter of men reported having sex outside of a marital or cohabiting relationship (higher-risk sex). Condom use. Less than one-third of men (30 per- cent) reported using a condom at the most recent higher-risk sexual encounter. Only about two- thirds of male youth (60 percent) and one-third (33 percent) of female youth age 15-24 said they knew a place where they could obtain a condom. ADULT HEALTH The major causes of death in Azerbaijan are simi- lar to those in industrialized countries (cardiovas- cular diseases, cancer, and accidents), but there is also a rising incidence of certain infectious diseas- es, such as tuberculosis. Tuberculosis. Awareness about tuberculosis is virtually universal; almost all men and women have heard of tuberculosis. Seventy-eight percent of female respondents and 70 percent of male res- pondents correctly identified the mode of tubercu- losis transmission (through the air when cough- ing). Hypertension. The 2006 AzDHS included blood pressure measurement for consenting adults age 15-49. Results indicate that about 16-17 percent of adults in Azerbaijan are classified as hypertensive. Nearly one-third of men and women age 40 and older are suffering from some degree of hyperten- sion, confirming that hypertension is a serious health problem in Azerbaijan. Fifty-six percent of women and 86 percent of men with high blood pressure are unaware that they are hypertensive. Smoking. Survey data show that smoking is common among men age 15-49, with about half reporting that they are smokers. Among current smokers, over 90 percent reported that they smoked 10 or more cigarettes during the past 24 xxviii | Summary of Findings hours. The likelihood that a man smokes increases with age. Alcohol intake. Thirty-nine percent of men age 15-49 consumed at least one alcoholic beverage in the month prior to the interview. Ten percent of men consume alcohol 1-2 times per week, and less than 2 percent of men drink alcohol daily or al- most daily. The highest consumption of at least one alcoholic beverage in the month prior to the interview is in Baku (54 percent), followed by Ganja-Gazakh (50 percent). WOMEN’S STATUS Twenty percent of married women make decisions on their own about their own health care, more than half (52 percent) decide jointly with their husband/partner, while 28 percent say that their husband or someone else is the primary decision- maker about the woman’s own health care. The 2006 AzDHS gathered information on wom- en’s and men’s attitudes toward wife beating, a proxy for women’s perception of their status. Women and men were asked whether a husband is justified in beating his wife under a series of cir- cumstances: if the wife burns the food, argues with him, goes out without telling him, neglects the children, or refuses sexual relations. Men are more likely than women to agree with at least one of the reasons justifying a husband’s beating of his wife (58 percent of men compared with 49 percent of women). The 2006 AzDHS survey included questions on whether respondents think that a wife is justified in refusing to have sexual intercourse with her husband under three circumstances: she knows her husband has a sexually transmitted disease (STD); she knows her husband has sexual intercourse with other women; or she is tired or not in the mood. Overall, 64 percent of women agree that a woman is justified in refusing to have sex with her hus- band for all three of the selected reasons, and only 15 percent of women do not agree that a wife is justified in refusing sex for any of the given rea- sons. Men are less likely than women to agree with all three of the selected reasons for a wife to withhold sex from her husband (55 percent com- pared with 64 percent). DOMESTIC VIOLENCE Overall, 13 percent of all women age 15-49 expe- rienced physical violence since age 15. Somewhat more than half of these women—8 percent of all women—had experienced at least one episode of violence in the 12 months preceding the survey. Two percent of the women said they had been sub- jected to violent physical acts often during the year before the survey. Overall, the data show that hus- bands are the main perpetrators of violence. Wom- en whose husbands do not drink are the least likely to report emotional, physical, and/or sexual vi- olence (9 percent), while women whose husbands frequently get drunk are the most likely to report violence (48 percent). Millennium Development Goal Indicators | xxix MILLENNIUM DEVELOPMENT GOAL INDICATORS Value Goal Indicator Male Female Total 1. Eradicate extreme poverty and hunger • Prevalence of underweight in children under five years of age1 8.1 7.2 7.7 • Net attendance ratio in primary school2 73.7 71.9 72.8 • Percent of pupils starting grade 1 who reach grade 43 100.0 100.0 100.0 2. Achieve universal primary education • Primary completion rate4 98.3 97.8 98.1 • Ratio of girls to boys in primary school5 na na 81.7 • Ratio of girls to boys in secondary school5 na na 95.4 • Ratio of girls to boys in tertiary education5 na na 110.2 3. Promote gender equality and empower women • Share of women in wage employment in the nonagricultural sector6 na na 48.3 • Under-five mortality rate7 56 42 50 • Infant mortality rate7 48 38 43 4. Reduce child mortality • Percent of children age 18-29 months immunized against measles8 79.0 69.1 74.4 5. Improve maternal health • Percent of births attended by skilled health personnel9 88.8 88.4 88.6 • Percentage of current users of contraception who are using condoms (all women) 3.9 4.3 na • Condom use at last higher-risk sex10 31.1 na na • Percentage of population age 15-24 years with comprehensive correct knowledge about HIV/AIDS11 5.3 4.8 na • Contraceptive prevalence rate (all women) na 32.0 na • Contraceptive prevalence rate (married women and women in union) na 51.1 na 6. Combat HIV/AIDS, malaria, and other diseases • Ratio of school attendance of orphans to school attendance of nonorphans age 10-14 years12 0.2 0.1 0.1 Urban Rural Total • Percent of population using solid fuels for cooking, urban and rural13 1.0 22.5 10.7 • Percent of population with sustainable access to an improved water source, urban and rural14 86.4 68.7 78.4 7. Ensure environmental sustainability • Percent of population with access to improved sanitation, urban and rural15 83.0 70.4 77.3 na = Not applicable 1 Based on children born in the 5 years preceding the survey. For children without a reported birth weight, the proportion with low birth weight is assumed to be the same as the proportion with low birth weight in each birth size category among children who have a reported birth weight. 2 Based on de jure members. Numerator is children age 6-9 currently attending school; denominator is children 6-9 years old. 3 Based on de jure members. This indicator is calculated using rates of promotion, dropout, and repetition for a given school year. These rates are used to project an estimate for the percentage of students attending grade 1 who are expected to reach grade 5, with or without repetition. 4 Based on de jure members. Numerator is children completed grade 4 or higher; denominator is children 12-14 years old. 5 The ratio of girls to boys for primary/secondary/tertiary education is the ratio of the primary/secondary/tertiary education GAR for females to the GAR for males. (The GAR is the total number of primary/secondary/ tertiary education students, expressed as a percentage of the official level of education-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.) 6 Numerator is all women working in the non-agricultural sector who received payment in cash or kind; denominator is all women. 7 Mortality rates refer to a 5-year period before the survey. 8 In Azerbaijan, the measles and MMR vaccinations are given at the age of 12 months (unlike the standard 9 months in many countries). The values presented in the table are for children 18-29 months who have been vaccinated at any time against measles or MMR. 9 Skilled health personnel includes: doctor, nurse, midwife, and feldsher. 10 Higher-risk sex is sexual intercourse with a nonmarital, noncohabiting partner. 11 Respondents with “comprehensive correct knowledge” of AIDS are those who say that using a condom for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, and furthermore say that a healthy-looking person can have the AIDS virus, and who reject the common misconception that HIV can be spread by mosquito bites and by kissing someone with AIDS. 12 Note that these indicators do not take into account children who live outside of households, e.g., in institutions or on the street, because the AzDHS includes only households in its sample. 13 Solid fuel includes: wood, straw, crops and other. 14 Improved drinking water sources includes: water from pipe/tap and from protected well. 15 Improved sanitary means of excreta disposal includes: flush toilet, improved pit latrine, and latrine with a slab. xxx | Map of Azerbaijan C a s p i a n S e a ARMENIA Kalbajar- Lachin IRAN RUSSIA GEORGIA Aran Ganja- Gazakh Lankaran Shaki- Zaqatala Absheron Guba- Khachmaz Yukhari Garabakh Daghligh Shirvan Baku ± AZERBAIJAN 0 100 20050 Kilometers 2 1 1 The survey covered only parts of Yukhari Garabakh—the Agdam and Terter regions, and part of the Fizuli region. 2 Lachin and Kalbajar are not included in the survey, as they are under occupation. 3 Nakhichevan is not included in the survey. Nakhichevan3 Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY AND POPULATION Azerbaijan is located in the Asian part of the Eurasian continent and has a favorable geo- graphic position between the Black Sea and the Caspian Sea. Historically, Azerbaijan extended 210,000 square kilometers from the Caucasus Mountains in Asia to the mountainous area south and southeast of Lake Urmiya. The land area occupied by Azerbaijan has long been subject to invasion. The 19th and 20th centuries were particularly difficult for Azerbaijan and its people. The Gulistan Agreement of 1813 and the Turkmenchay Agreement of 1828 ended Azerbaijan’s independence. Azerbaijan was divided into two parts: southern Azerbaijan, which became part of Iran, and northern Azerbaijan, which became part of Russia. The first democratic republic in the east was founded in Azerbaijan on May 28, 1918. Its terri- tory extended 114,000 square kilometers and the borders were 3,504 kilometers in length. On April 28, 1920, this territory was occupied by Soviet Russia. In 1924, the regions of Goyca and Zangazur became part of Armenia, and the Autonomous region was established in mountainous Garabagh. The Republic of Azerbaijan regained its independence on October 18, 1991. At present, the area of the Republic of Azerbaijan is 86.6 thousand square kilometers (in the framework of the borders adopted by the United Nations). It is situated between 38°25' and 41°55' north latitude and 44°50' and 50°51' east longitude. The Republic of Azerbaijan has land borders with five countries. It is bordered on the north by Russia (390 kilometers), on the northwest by Georgia (470 kilometers), on the west by Armenia (1,007 kilometers), and on the south by Iran (765 kilometers) and Turkey (15 kilometers). Azerbaijan has sea borders with four countries: Russia, Kazakhstan, Turkmenistan, and Iran. The capital of Azerbaijan is the ancient city of Baku, which is located on a harbor leading to the Caspian Sea, at the 40th parallel. Baku lies 5,550 kilometers below the North Pole and 4,440 kilo- meters above the equator. Twelve percent of the country is covered by forest and about 2 percent is water. Fifty-five percent of Azerbaijan is used for agriculture. Nine of the world’s 11 climate zones are represented in Azerbaijan; these include dry and semi-arid steppes in the east, subtropical climate in the southeast, cold climate in the mountains of the north, and temperate climate along the shores of the Caspian Sea. The country is rich in oil and gas, iron ore, bauxite, molybdenum, mineral water, and other natural resources. The country consists of 66 administrative regions (rayons), 13 urban districts, and the Auto- nomous Republic of Nakhichevan. There are 70 towns, 239 settlements, and 4,272 rural settlements (State Statistical Committee, 2007b). Since the early 1990s, as a result of the conflict with Armenia over Dagligh Garabakh, about 20 percent of the land area of the country has been occupied and con- trolled by Armenia. Azerbaijan has a population in excess of 8.6 million, with approximately 48 percent residing in rural areas. The country is characterized by a moderate rate of population growth, mainly a result of the declining birth rate—from 27 per 1,000 in 1991 to 14 per 1,000 in 2002 and 18 per thousand in 2006—and the relatively low death rate. Due to the conflict with Armenia, the death rate reached 7.3 per 1,000 in the early 1990s; it stabilized after the cease-fire and then decreased to 6.2 per 1,000 in 2006. Twenty-five percent of the population is under 15 years of age, while 7 percent are over 65 (State Statistical Committee, 2007a). 2 | Introduction According to official data, there were nearly one million people refugees and internally dis- placed persons (IDPs) as a result of Armenia’s occupation of Dagligh Garabakh. This represents 12 percent of the country’s population. Of these refugees and IDPs, about 687 thousand are internally displaced persons from Dagligh Garabakh and nearby territories, 250 thousand are Azerbaijanis from Armenia, 50 thousand are Meskhetian Turks from Central Asia, and 3 thousand are persons seeking asylum and refugee status (State Committee on Problems of Refugees and Internal Displaced Persons, 2007). Azerbaijanis constitute more than 91 percent of the country’s population. In 2005, life expec- tancy for men was 70 years and, for women, 75 years. 1.2 HEALTH CARE SYSTEM 1.2.1 Facilities, Finance, and Human Resources The health care system in Azerbaijan was developed as part of the Soviet system with the ob- jective of providing adequate access to health services to all citizens. After the collapse of the Soviet Union, the health system deteriorated because of economic problems, lack of management capacity (previously all decisions were made in Moscow), failure to prioritize the expenditure of limited re- sources, disruption of the existing health network including the distribution of medical supplies, dis- appearance of health programs, weakness of the primary health care system, and low population cov- erage (WHO, 1996). Government policy on protection of the population’s health is reflected in the Constitution of the Republic of Azerbaijan on “Protection of the Health of the Population” and other appropriate leg- islation. Relations between citizens and state bodies, as well as state and private medical institutions and organizations, are regulated by the Law of the Republic of Azerbaijan on “Protection of the Health of the Population” adopted on June 26, 1997, and provision of the population with medical aid and their health protection was guaranteed by article 41 of the Constitution accepted in 1995. In 2005, a nationwide network of more than 3,000 primary, secondary, and tertiary health care facilities was operated under the control of the Ministry of Health (MOH). The health care system is still centralized and almost all facilities are state-owned. Throughout the country, health services are provided free of charge. These services include antenatal care, delivery assistance, neonatal and pedi- atric services, immunizations, family planning, and specialized health care. In addition, the health departments under the Ministries of Oil, Railways, Defense, Internal Affairs, and Justice, and the Caspian Steamship line provide health care for their employees. From an operational and a financial perspective, these health facilities are governed by their own set of rules and regulations, have separate budgets, and exercise more autonomy in daily operations. However, the MOH has a controlling share of the decision-making in parastatal organizations, at least in regards to health care protocols and standards of care used in these facilities. There is a small but growing private sector in Azerbaijan, and almost all pharmacies and den- tal clinics are privately owned. The state budget, derived from taxes and other government revenues, is the main official fi- nancial source for health care. Funds from the budget are allocated directly to local authorities and the Ministry of Health. According to official data, 162 million AZN were allocated for the health sector in the 2006 state budget (MOF, 2006). Additional state funding for health care is channeled through the State Oil Company; Ministries of Railways, Defense, Internal Affairs, and Justice; and the Caspian Steamship line, for their respective health facilities. Introduction | 3 In Azerbaijan, almost all health professionals—32,000 physicians and 62,300 mid-level pro- fessionals at the beginning of 2006—are government employees. There are 38 doctors and 74 mid- level professionals per 10,000 population. The distribution is uneven, with a higher proportion in ur- ban areas than in rural areas (MOF, 2006). 1.2.2 Health Care Reforms In 2006, the Azerbaijani Ministry of Health commenced Azerbaijan’s Health Sector Reform Project (HSRP) with a considerable amount of its own resources (US$28.25 million), supported by a World Bank loan (US$50 million) and grant funding from USAID (US$8 million), UNICEF (US$470,000) and the WHO (US$40,000). The project aims to improve overall health system stew- ardship and financing, and enhance equitable access to, and technical and perceived quality of, essen- tial health care services in the selected districts in a fiscally responsible and sustainable manner, with a view to improving health outcomes. 1.2.3 Primary, Secondary, and Tertiary Health Care Primary health care in Azerbaijan is delivered on a geographical basis through a network of health faculties established in close proximity to residential areas. Primary health care is provided by outpatient polyclinics, feldsher accoucher posts (FAPs), rural ambulatory clinics, primary health fa- cilities at large enterprises, women’s consulting centers (a primary source of family planning services in urban areas), and delivery hospitals. The main focus of these institutions is disease prevention, an- tenatal care services, delivery assistance, and family planning services. The Sanitary Epidemiological Stations (SESs) are directly subordinate to the MOH and are responsible for organization, logistical support, and monitoring of immunization services. However, SESs do not actually vaccinate the public; vaccinations are administered through the network of pri- mary health care institutions. SESs are also responsible for control and regulation of water and food safety, and control of infectious and parasitic diseases. Secondary health services are provided by specialized dispensaries, departments of polyclin- ics, and hospitals in which screening programs are carried out to identify individuals with early mani- festations of disease and to prevent disease progression. Tertiary health services in Azerbaijan are provided within the departments of regional, mu- nicipal, and district general hospitals, specialized referral hospitals, dispensaries, and clinical research institutes. The clinical treatment offered at these facilities is aimed at minimizing the effect of disease and disability. 1.2.4 Maternal and Child Health Care Maternal and child health services in Azerbaijan are mostly provided through primary and secondary health care institutions. Almost all deliveries occur at delivery hospitals and, in rare cases, at regular hospitals or at peripheral hospitals, village ambulatories or feldsher accoucher posts (FAPs) in rural areas. Antenatal care is provided mainly by doctors at women’s consulting centers, rural hos- pitals and ambulatories, and FAPs. Antenatal care starts early in pregnancy (usually during the first trimester) and continues on a monthly basis throughout the pregnancy. Child health care is initially provided during the first week following delivery, while a woman and her newborn stay in the delivery hospital. After discharge from the delivery hospital, a child is visited at home by a pediatrician who conducts a physical examination of the child and provides counseling on child care to the mother. Each child receives at least one visit from a pediatri- cian/physician that can be followed by a nurse’s visit. Additional pediatric services are mainly pro- vided by primary health care facilities. A mother is required to take her child for regular checkups and 4 | Introduction vaccination at the polyclinic or outpatient clinic several times during the child’s first two years. Doc- tors at the polyclinic can refer children to a specialized pediatrician and for hospitalization, as neces- sary. The child vaccination schedule in Azerbaijan requires that BCG and oral polio vaccines be given at birth. Revaccination with oral polio vaccine is usually done at 2, 3, 4, and 18 months and 6-7 years of age. The vaccination schedule for diphtheria, pertussis, and tetanus toxoid (DPT) is similar to the schedule for the polio vaccination, except that the first DPT vaccine is given at 2 months of age. Measles vaccinations are given at 12 months of age as part of the measles, mumps, and rubella (MMR) vaccination. In 2001, the hepatitis B vaccination was introduced throughout the country. The first dose is given at birth; the second and third doses are given at 2 and 4 months. UNICEF has played a crucial role in the re-establishment of proper vaccination practices ac- cording to the World Health Organization (WHO) standards through procurement and distribution of vaccines and supplies for children, a cold chain equipment to health care facilities offering vaccina- tion for children, development of training manuals and national trainers with following training for health care providers on proper vaccination practices and cold chain maintenance. National policy on vitamin A supplementation was adopted and introduced within the EPI national program. Currently the Government of Azerbaijan has taken over procurement of all the vaccines with a gradually reduc- ing share from GAVI for Hepatitis B vaccines. UNICEF is involved in the MOH capacity building on proper vaccination monitoring. USAID and UNICEF provided financial and technical assistance in adoption of the Integrated Management of Childhood Illnesses (IMCI) package for Azerbaijan, and financed the training of trainers (TOT) for national master trainers, and the IMCI training for health care staff in the pilot re- gions. Yet the IMCI is not prioritized by MOH as a major approach to care for children under five in primary health care facilities. UNICEF is protecting, promoting, and supporting breastfeeding by advocating principles of the International code of marketing of breast milk substitutes, promoting exclusive breastfeeding of infants from birth until 6 months of age, and through implementation of The Baby Friendly Hospital Initiative. Baby-friendly health initiatives started in Azerbaijan with a joint MOH/WHO/UNICEF in- troduction in 1995. The national BF/BFHI program was adopted in 1998. A national assessor group was nominated by the MOH and went through training provided by international experts in 2000. By 2002, 19 out of 77 maternity hospitals in the country were certified as baby-friendly. By 2003, the number had risen to 38 out of 77 maternity hospitals, and, by 2004, 67 out of 77 maternity hospitals had been certified. Along with supporting each component of the program, UNICEF continued to support training for health professionals until 2005. “The Law of Azerbaijan Republic on Infant and Young Child Feeding” adopted on August 4, 2003 has a special chapter covering provisions suggested by the International Code of Marketing of Breastmilk substitutes. 1.2.5 Family Planning Services The Ministry of Health is responsible for providing family planning services throughout the country. The main goal of the family planning policy is to ensure low-risk pregnancy and safe moth- erhood, and to reduce complications due to closely spaced pregnancies and pathological conditions among women of reproductive age. The Ministry of Health manages a broad spectrum of activities throughout the country, in- cluding educating the population on family planning and providing contraceptive supplies. The pri- vate sector is also involved in marketing contraceptives, mainly through the network of privately owned pharmacies. The Ministry of Health considers family planning part of maternal health care and requires counseling on the selection and use of contraceptive methods be done by health professionals Introduction | 5 with skills in obstetrics and gynecology. For the past decade, women in Azerbaijan have relied pri- marily on traditional methods of contraception, particularly withdrawal, almost to the exclusion of other methods. Induced abortion is legal in Azerbaijan if carried out during the first 12 weeks of pregnancy.1 These procedures are typically performed at the outpatient departments of general hospitals or deliv- ery hospitals. Family planning services became available in Azerbaijan in 1996 with the support of UNFPA and the international NGO Pathfinder. On June 13, 2000, the Ministry of Health’s Decree No. 54 cre- ated the National Reproductive Health Office (NRHO), which strengthens family planning policy in the country. The National Reproductive Health Office, with financial and technical support provided by UNFPA and Pathfinder, played a leading role in the organization of the 27 Family Planning Cen- ters (FPCs) in the districts of the country. Between 2000 and 2004, modern contraceptive methods, such as condoms, pills, IUDs, sper- micides, and injectables (Depo-Provera), were distributed free of charge through FPCs. UNFPA coor- dinated the distribution of the contraceptives. Distribution was stopped in 2004. FPCs are supplied with computers, other office equipment, training, and health education materials developed by the National Reproductive Health Office, UNFPA, Pathfinder, and other organizations approved by MOH. Consultations and services are free of charge. With technical and financial support from USAID (partners—International Medical Corps and Johns Hopkins University), and in collaboration with the National Reproductive Health and Fam- ily Planning Office (NRHO), 27 Family Planning and Reproductive Health Master Trainers were pre- pared and four training modules were developed. The trainers continue to conduct training for gyne- cologists, midwives, pharmacists, and other health professionals using the aforementioned training materials. In 2004, USAID (partners—EngenderHealth, Meridian, and ADRA), with support from the Azerbaijani Ministry of Health, launched another Reproductive Health and Family Planning Project, aiming to create a more favorable policy environment for RH/FP at the local and regional level. 1.2.6 Tuberculosis DOTS Program Tuberculosis is high on the political agenda of the Government of Azerbaijan. The law on the “Fight against tuberculosis in the Republic of Azerbaijan” that was adopted on May 2, 2000, is a legal base for protection from tuberculosis, as well as for rights and duties of persons with tuberculosis. The World Health Organization recommends a tuberculosis control strategy known as DOTS (directly observed treatment, short-course) that combines: 1) case detection by sputum smear micros- copy among symptomatic patients who self-report to health services; 2) standardized short-course chemotherapy with directly observed treatment; and 3) a standardized recording and reporting system that tracks the treatment of each patient and in turn provides data to the tuberculosis control program (WHO, 1999b). In Azerbaijan, the DOTS strategy was introduced in 2002. Tuberculosis remains one of the main health problems in the country. In 2006, the Ministry of Health received about US$4,000,000 (of a total of about US$10,000,000) in grants from the Global Fund for AIDS, Tuberculosis, and Malaria, as funding for implementation of a five-year program on Strengthening and Expanding DOTS Framework by Improving Management and Coordination of the National TB Control Program, In- 1 In some cases induced abortion can be performed after 12 weeks if certain medical or social conditions exist. These cases require strict supervision of qualified medical personnel in a hospital setting. 6 | Introduction volving Primary Health Care in TB Control, Managing Drug Resistance and Reducing the Burden of TB in Vulnerable Population Groups. 1.2.7 HIV/AIDS Program Azerbaijan is considered a low HIV/AIDS prevalence country. To sustain this low prevalence while recognizing the devastating health and socioeconomic consequences of HIV/AIDS epidemics, the government of Azerbaijan undertook steps to control and prevent the spread of HIV/AIDS in Azerbaijan. A law aimed at preventing the spread of HIV/AIDS by strengthening the logistical basis of AIDS prevention services, accepting the National Program, and providing social support for HIV- infected citizens, was adopted in 1996. In 1997, the Cabinet of Ministries of Azerbaijan approved the National Program on HIV/AIDS Prevention. In 1990, the Republican HIV/AIDS Prevention Center opened in Baku, with other branches throughout the country. The center has an immunodiagnostic laboratory and treatment facilities. The center’s primary aim is prevention, monitoring, and treatment, and it offers anonymous voluntary test- ing and counseling. A mandatory HIV testing policy no longer exists in Azerbaijan and, as of 2003, about 2.3 percent of the population had been tested. During the past decade, the number of new cases of HIV increased from 3 cases in 1996 to 210 cases in 2005. By the end of 2005, Azerbaijan reported 870 HIV cases. Among those with a known mode of transmission, over half were injecting drug users. The acceleration of the epidemic has been especially noticeable during the past two years, as the number of new HIV cases has doubled (122 cases in 2004 versus 210 cases in 2005), according to the World Health Organization’s centralized information system for infectious diseases (CISID) (WHO/ROE, 2006). The Ministry of Health recently received about US$10,000,000 in grants for the next five years from the Global Fund for AIDS, Tuberculosis, and Malaria to implement the program called “Scaling-up the Response to HIV/AIDS in Azerbaijan.” The program started in 2005, when 210 HIV/AIDS patients received medical care for their condition. In November 2006, the first 5 HIV patients initiated highly active anti-retroviral therapy (HAART). 1.3 SYSTEMS FOR COLLECTING DEMOGRAPHIC AND HEALTH DATA The State Statistical Committee (SSC) of the Republic of Azerbaijan is responsible for main- taining the national registration system and conducting censuses. Births, deaths, marriages, and di- vorces are registered at the local administrative level, and aggregated statistics are forwarded through the regional and urban level statistical offices to the Main Accounting Center of the SSC. The last census in Azerbaijan was conducted in 1999. The next census has been approved by order of the President and is scheduled for 2009. The collection of health data is primarily the responsibility of the Statistical Department of the Ministry of Health. Health information is generated by staff at the facilities delivering services and then sent to the Statistical Department through the region level health departments. The Statistical Department of the MOH compiles and analyzes these data, and issues annual reports on the “Health of the Population of the Republic of Azerbaijan and Health Services.” The health data published annually by the Statistical Department of the MOH consist of the following major categories: 1) morbidity specified by type of disease; 2) mortality specified by causes of death; 3) infant deaths, including perinatal and early neonatal deaths; 4) maternal mortality speci- fied by cause of death; 5) data on maternal and child health services; and 6) the number of health fa- cilities, medical personnel, hospital beds, and length of the average hospital stay. These data are tabu- lated at the national and region levels. The national level data are also available at the WHO web site, in the Health for All DataBase. Introduction | 7 1.4 OBJECTIVES AND ORGANIZATION OF THE SURVEY The 2006 Azerbaijan Demographic and Health Survey (2006 AzDHS) is a nationally repre- sentative sample survey designed to provide information on population and health issues in Azerbai- jan. The primary goal of the survey was to develop a single integrated set of demographic and health data pertaining to the population of the Republic of Azerbaijan. The 2006 AzDHS was conducted from August to November by the State Statistical Commit- tee (SSC) of the Republic of Azerbaijan. Macro International Inc. provided technical support for the survey through the MEASURE DHS project. USAID Caucasus, Azerbaijan provided funding for the survey through the MEASURE DHS project. MEASURE DHS is sponsored by the United States Agency for International Development (USAID) to assist countries worldwide in obtaining informa- tion on key population and health indicators. The UNICEF/Azerbaijan country office was instrumen- tal for political mobilization during the early stages of the 2006 AzDHS negotiation with the Govern- ment of Azerbaijan and also supported the survey through in-kind contributions. The 2006 AzDHS collected national- and regional-level data on fertility and contraceptive use, maternal and child health, adult health, tuberculosis, and HIV/AIDS and other sexually transmit- ted diseases. The survey obtained detailed information on these issues from women of reproductive age and, on certain topics, from men as well. The 2006 AzDHS results are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of Azerbaijanis and health ser- vices for the people of Azerbaijan. The 2006 AzDHS also contributes to the growing international database on demographic and health-related variables. 1.4.1 Sample Design and Implementation The sample was designed to permit detailed analysis, including the estimation of rates of fer- tility, infant/child mortality, and abortion, for the national level, for Baku, and for urban and rural ar- eas separately. Many indicators are available separately for each of the economic regions in Azerbai- jan except the Autonomous Republic of Nakhichevan (conducting the survey in Nakhichevan was complicated, since this region is in the blockade). A representative probability sample of households was selected for the 2006 AzDHS sample. The sample was selected in two stages. In the first stage, 318 clusters in Baku and 8 other economic regions were selected from a list of enumeration areas from the master sample frame that was de- signed for the 1999 Population Census.2 In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected from each cluster for participation in the survey. This design resulted in a final sample of 7,619 households. Because of the non-proportional allocation of the sample to the different economic regions, sampling weights will be required in all analysis using the DHS data to ensure the actual representa- tivity of the sample at both the national and regional levels. The sampling weight for each household is the inverse of its overall selection probability with correction for household non-response; the indi- vidual weight is the household weight with correction of individual non-response. Sampling weights 2 A representative probability sample of the 2006 AzDHS yielding 8,400 households was originally selected from 10 economic regions of Azerbaijan, including the Autonomous Republic of Nakhichevan. In the first stage, 350 clusters, with probability proportional to the cluster size, were selected from the sampling frame based on the 1999 population census. Since the Autonomous Republic of Nakhichevan is in the blockade, a total of 318 clusters in Baku and 8 economic regions were selected for the AzDHS implementation. The total population of the Autonomous Republic of Nakhichevan is approximately 4.5 percent of the total population of Azerbaijan. See Appendix A for details of the original sample design. 8 | Introduction are further normalized in order to give the total number of unweighted cases equal to the total number of weighted cases at the national level, for both household weights and individual weights. All women age 15-49 who were either permanent residents of the households in the 2006 AzDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, all men age 15-59 in one-third of the households selected for the survey 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 8,444 women and 2,558 men. 1.4.2 Questionnaires Three questionnaires were used in the AzDHS: Household Questionnaire, Women’s Ques- tionnaire, and Men’s Questionnaire. The household and individual questionnaires were based on model survey instruments developed in the MEASURE DHS program. The model questionnaires were adapted for use by experts from the SSC and Ministry of Health (MOH). Input was also sought from a number of nongovernmental organizations. Additionally, at the request of UNICEF, the Multi- ple Indicator Cluster Survey (MICS) modules on early child education and development, birth regis- tration, and child discipline were adapted for the 2006 AzDHS instrument. The questionnaires were prepared in English and translated into Azerbaijani and Russian. The household and individual ques- tionnaires were pretested in May 2006. The Household Questionnaire was used to list all usual members of and visitors to the se- lected households and to collect information on the socioeconomic status of the household. The first part of the Household Questionnaire collected information on the age, sex, educational attainment, and relationship of each household member or visitor to the household. This information provides basic demographic data for Azerbaijan households. It also was used to identify the women and men who were eligible for the individual interview (i.e., women age 15-49 and men age 15-59). In the sec- ond part of the Household Questionnaire, there were questions on housing characteristics (e.g., the flooring material, the source of water, and the type of toilet facilities), on ownership of a variety of consumer goods, and other questions relating to the socioeconomic status of the household. In addi- tion, the Household Questionnaire was used to obtain information on child discipline, education, and development; to record height and weight measurements of women, men, and children under age five; and to record hemoglobin measurements of women and children under age five. The Women’s Questionnaire obtained information from women age 15-49 on the following topics: • Background characteristics • Pregnancy history • Abortion history • Antenatal, delivery, and postnatal care • Knowledge, attitudes, and use of contraception • Reproductive and adult health • Vaccinations, birth registration, and childhood illness and treatment • Breastfeeding and weaning practices • Marriage and recent sexual activity • Fertility preferences • Knowledge of and attitudes toward AIDS and other sexually transmitted diseases • Knowledge of and attitudes toward tuberculosis • Hypertension and other adult health issues • Domestic violence Introduction | 9 The Men’s Questionnaire, administered to men age 15-59, covered the following topics: • Background characteristics • Reproductive health • Marriage and recent sexual activity • Attitudes toward and use of condoms • Fertility preferences • Employment and gender roles • Attitudes toward women’s status • Knowledge of and attitudes toward AIDS and other sexually transmitted diseases • Knowledge of and attitudes toward tuberculosis • Hypertension and other adult health issues • Smoking and alcohol consumption Blood pressure measurements of women and men were recorded in their individual question- naires. 1.4.3 Training of Field Staff All supervisors, field editors, interviewers, and quality control personnel attended the main survey training, which was conducted by the State Statistical Committee and Macro during a three- week period from late June through July 2006. The training included lectures, demonstrations, prac- tice interviewing in small groups, examinations, and practice in blood pressure measurement. Four- teen health technicians, people with medical backgrounds who were recruited by the Ministry of Health, were trained separately during the same period in the procedures for anthropometric meas- urement and anemia testing. All field staff participated in three days of field practice. 1.4.4 Hemoglobin Testing Hemoglobin testing is the primary method of anemia diagnosis. Reliable measures are ob- tained using the HemoCue system. In all households selected for the 2006 AzDHS survey, women age 15-49 and children age 6 to 59 months were tested for anemia. A consent statement was read to the eligible respondent or to the parent or responsible adult for children and young women age 15-17. This statement explained the purpose of the test, informed them that the results would be made avail- able as soon as the test was completed, and requested permission for the test to be carried out. Before taking any blood, the finger was wiped with an alcohol swab and allowed to air dry. Then, the palm side of the end of a finger was punctured with a sterile, nonreusable, self-retractable lancet and a drop of blood was collected in a HemoCue microcuvette, which serves as a measuring device, and placed in a HemoCue photometer which displays the result. An informative brochure was given to each household explaining what anemia is, its symptoms, and measures to prevent anemia. Each person whose hemoglobin level was lower than the recommended cut-off point was given a written referral recommending immediate follow-up with a health professional. 1.4.5 Fieldwork and Data Processing Eleven teams collected the survey data; each team consisted of four female interviewers, a male interviewer, a field editor, and a team supervisor. A health technician was also assigned to each team. Fieldwork began in late July 2006 and was completed by early November 2006. Senior DHS technical staff visited teams regularly to review the work and monitor data quality. The processing of the AzDHS results began shortly after the fieldwork commenced. Com- pleted questionnaires were returned regularly from the field to SSC headquarters in Baku, where they 10 | Introduction were entered and edited by data processing personnel who were specially trained for this task. The data processing personnel included a supervisor, a questionnaire administrator, several office editors, 10 data entry operators, and a secondary editor. The concurrent processing of the data was an advan- tage since the survey technical staff was able to advise field teams of problems detected during the data entry using tables generated to check various data quality parameters. As a result, specific feed- back was given to the teams to improve their performance. The data entry and editing phase of the survey was completed in late January 2007. 1.5 RESPONSE RATES Table 1.1 presents household and individual response rates for the survey. A total of 7,619 households were selected for the sample, of which 7,341 were found at the time of fieldwork. The main reason for the difference is that some of the dwelling units that were occupied during the house- hold listing operation were either vacant or the household was away for an extended period at the time of interview. Of the households that were found, 98 percent were successfully interviewed. In these households, 8,652 women were identified as eligible for the individual interview. Interviews were completed with 98 percent of the women. Of the 2,717 eligi- ble men identified, 94 percent were success- fully interviewed. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Azerbaijan 2006 Residence Result Urban Rural Total Household interviews Households selected 4,279 3,340 7,619 Households occupied 4,110 3,231 7,341 Households interviewed 3,993 3,187 7,180 Household response rate1 97.2 98.6 97.8 Interviews with women age 15-49 Number of eligible women 4,576 4,076 8,652 Number of eligible women interviewed 4,478 3,966 8,444 Eligible women response rate2 97.9 97.3 97.6 Interviews with men age 15-59 Number of eligible men 1,430 1,287 2,717 Number of eligible men interviewed2 1,357 1,201 2,558 Eligible men response rate 94.9 93.3 94.1 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Household Population and Housing Characteristics | 11 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter provides a summary of the demographic and socioeconomic characteristics of the household population in the 2006 AzDHS, including age, sex, place of residence, educational status, and household characteristics. Information collected on the characteristics of the households and respondents is important in understanding and interpreting the findings of the survey and also provides some indication of the representativeness of the survey. A household is defined as a person or group of related and unrelated persons who live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for cooking and eating their food. The questionnaire for the 2006 AzDHS distinguishes between the de jure population (persons who usually live in a selected household) and the de facto population (persons who stayed the night before the interview in the household). According to the 2006 AzDHS data, the differences between these populations are small. Tabulations for the household data presented in this chapter are primarily based on the de facto population. Due to the way the sample was designed, the number of cases in some regions may appear small since they are weighted to make the regional distribution nationally representative. Throughout this report, numbers in the tables reflect weighted numbers. To ensure statistical reliability, percentages based on 25 to 49 unweighted cases are shown within parentheses, and percentages based on fewer than 25 unweighted cases are suppressed. 2.1 CHARACTERISTICS OF THE POPULATION 2.1.1 Age-Sex Structure Age and sex are important demographic variables and form the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. Table 2.1 presents the percent distribution of the de facto population by five-year age groups, according to urban-rural residence and sex. The information is used to construct the population pyramid shown in Figure 2.1. The total de facto population was 29,506. The data show that 52 percent of the population is female. Among the youngest age groups, however, there are more males than females. It is not until the 15-19 age cohort that women outnumber men (Figure 2.1). About two-thirds of the population is in the 15-64 age group. The proportion of the population falling within this age group is higher in urban areas (69 percent) than in rural areas (63 percent). This difference may be attributed in part to high levels of rural-urban migration, especially among the young in search of jobs and higher education. 12 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Azerbaijan 2006 Age Urban Rural Total Male Female Total Male Female Total Male Female Total <5 7.9 5.9 6.9 9.6 7.4 8.4 8.6 6.6 7.6 5-9 7.4 6.2 6.8 9.1 6.9 7.9 8.2 6.5 7.3 10-14 10.9 9.0 9.9 12.7 10.3 11.5 11.7 9.6 10.6 15-19 9.5 10.5 10.0 9.7 9.9 9.8 9.6 10.2 9.9 15-17 6.7 6.4 6.6 7.5 5.5 6.4 7.0 6.0 6.5 18-19 2.9 4.0 3.5 2.2 4.4 3.4 2.6 4.2 3.4 20-24 8.5 8.9 8.7 8.2 9.0 8.6 8.4 8.9 8.7 25-29 8.0 7.6 7.8 6.9 6.6 6.8 7.5 7.2 7.3 30-34 6.7 6.8 6.7 6.3 6.6 6.5 6.5 6.7 6.6 35-39 6.9 7.7 7.3 6.6 7.6 7.1 6.7 7.6 7.2 40-44 7.8 8.8 8.3 7.0 8.3 7.7 7.4 8.6 8.0 45-49 7.8 7.1 7.4 6.2 5.8 6.0 7.1 6.5 6.8 50-54 5.7 7.1 6.5 4.5 6.4 5.5 5.2 6.8 6.0 55-59 3.3 3.9 3.7 3.0 3.5 3.3 3.2 3.8 3.5 60-64 2.6 1.9 2.2 2.0 1.7 1.9 2.3 1.8 2.0 65-69 2.5 3.5 3.0 2.9 3.7 3.3 2.7 3.6 3.1 70-74 2.5 2.3 2.4 2.7 3.2 3.0 2.6 2.7 2.7 75-79 1.2 1.6 1.4 2.0 1.5 1.7 1.6 1.6 1.6 80 + 0.8 1.1 0.9 0.6 1.5 1.1 0.7 1.3 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 7,751 8,489 16,240 6,300 6,966 13,266 14,051 15,455 29,506 Figure 2.1 Population pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 <5 Age 0123456 0 1 2 3 4 5 6 AzDHS 2006Percent Males Females The data further indicate that 26 percent of the population is less than 15 years of age. The proportion under 15 years of age is larger in the rural areas than in the urban areas (28 percent and 24 percent, respectively). This is evidence of higher fertility in the rural areas (see Chapter 4). The percentages in the 0-4 and 5-9 age cohorts are smaller than those observed in the 10-14 and 15-19 age cohorts, reflecting the effect of recent declines in fertility. Elderly people age 65 and older make up 8 percent of the population. Household Population and Housing Characteristics | 13 2.1.2 Household Composition Table 2.2 presents the percent distribution of households in the 2006 AzDHS sample by sex of the head of the household and by household size for urban and rural areas and mean size of household. These characteristics are important because they are often associated with differences in household socioeconomic levels. For example, female-headed households are frequently poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. In general, heads of household in Azerbaijan are male (75 percent). Women head 25 percent of Azerbaijani households, with no difference between rural and urban areas. The average household size in Azerbaijan is 4.1 persons. The average household size in rural areas is larger than in urban areas (4.5 compared with 3.9 members). Table 2.2 Household composition Percent distribution of households by sex of head of household, household size, and mean size of household, according to residence, Azerbaijan 2006 Characteristic Residence Total Urban Rural Household headship Male 75.1 75.6 75.3 Female 24.9 24.4 24.7 Total 100.0 100.0 100.0 Number of usual members 0 0.5 0.2 0.4 1 8.2 4.0 6.5 2 13.8 10.7 12.6 3 17.7 12.4 15.5 4 28.9 24.6 27.1 5 16.7 21.4 18.6 6 8.2 13.7 10.4 7 3.2 7.0 4.8 8 1.0 2.9 1.8 9+ 1.8 3.1 2.3 Total 100.0 100.0 100.0 Mean size of households 3.9 4.5 4.1 Note: Table is based on the de jure members, i.e., usual residents. 2.1.3 Children’s Living Arrangements and Orphanhood Detailed information on living arrangements and orphanhood for children under 18 years of age is presented in Table 2.3. Of the 9,420 children under age 18 recorded in the 2006 AzDHS, four in five live with both parents, 13 percent live with their mother only, 1 percent live with their father only, and 2 percent live with neither of their natural parents. 14 | Household Population and Housing Characteristics The table also provides data on the extent of orphanhood, that is, the proportion of children who have lost one or both parents. Three percent of children under 18 years of age have lost their fathers. Very few children have lost their mothers or both parents. Table 2.3 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, 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, Azerbaijan, 2006 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 No informa- tion on father or mother Total Percentage not living with a biological parent Percentage with one or both parents dead Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Age 0-4 86.8 10.5 0.7 0.2 0.1 0.7 0.0 0.0 0.1 1.0 100.0 0.8 0.9 2,210 <2 89.0 9.0 0.3 0.2 0.1 0.3 0.0 0.0 0.0 1.2 100.0 0.3 0.4 966 2-4 85.1 11.7 1.0 0.1 0.0 1.0 0.0 0.0 0.2 0.9 100.0 1.2 1.2 1,244 5-9 86.5 9.4 1.4 0.8 0.0 0.8 0.1 0.1 0.3 0.5 100.0 1.3 1.9 2,157 10-14 82.8 11.3 2.8 0.4 0.9 0.8 0.3 0.1 0.1 0.4 100.0 1.3 4.2 3,131 15-17 78.8 9.2 5.2 0.3 0.7 2.6 0.1 0.4 1.0 1.7 100.0 4.2 7.4 1,923 Sex Male 83.6 10.2 3.0 0.4 0.5 0.8 0.2 0.1 0.3 0.8 100.0 1.4 4.1 4,999 Female 83.9 10.3 1.9 0.4 0.4 1.5 0.1 0.2 0.4 0.8 100.0 2.2 3.0 4,421 Residence Urban 85.0 8.6 2.8 0.5 0.6 1.0 0.2 0.2 0.4 0.7 100.0 1.8 4.2 4,906 Rural 82.4 12.1 2.1 0.3 0.4 1.4 0.1 0.1 0.2 1.0 100.0 1.8 2.9 4,514 Region Baku 87.0 8.0 2.4 0.4 0.4 0.6 0.2 0.2 0.3 0.5 100.0 1.2 3.5 2,487 Absheron 88.4 5.6 2.6 0.3 1.0 0.8 0.1 0.0 0.4 0.7 100.0 1.4 4.1 577 Ganja-Gazakh 80.2 11.6 2.4 1.0 0.3 2.0 0.1 0.3 0.3 1.7 100.0 2.8 3.5 1,316 Shaki-Zaqatala 83.3 11.1 2.7 0.2 0.4 1.1 0.1 0.0 0.1 1.1 100.0 1.3 3.3 677 Lankaran 78.9 15.5 2.4 0.5 0.5 1.2 0.1 0.2 0.2 0.4 100.0 1.8 3.4 905 Guba-Khachmaz 89.1 4.0 3.1 0.5 1.2 1.0 0.0 0.0 0.6 0.6 100.0 1.6 5.0 488 Aran 81.7 12.5 2.4 0.3 0.3 1.3 0.2 0.0 0.5 0.8 100.0 1.9 3.4 2,413 Yukhari Garabakh 85.5 8.2 1.8 0.2 0.6 2.0 0.4 0.2 0.5 0.5 100.0 3.1 3.6 233 Daghligh Shirvan 85.0 8.9 2.7 0.0 0.6 1.7 0.0 0.3 0.0 0.8 100.0 1.9 3.6 323 Wealth quintile Lowest 83.7 10.8 2.3 0.3 0.4 1.2 0.1 0.0 0.4 0.9 100.0 1.6 3.2 2,182 Second 82.5 10.6 2.7 0.7 0.2 1.9 0.1 0.1 0.3 0.9 100.0 2.5 3.4 1,916 Middle 80.8 11.7 3.0 0.4 0.7 1.1 0.3 0.2 0.4 1.4 100.0 1.9 4.6 1,917 Fourth 85.8 9.6 1.7 0.3 0.5 1.0 0.2 0.4 0.1 0.4 100.0 1.6 2.9 1,738 Highest 86.5 8.4 2.7 0.5 0.4 0.6 0.1 0.0 0.5 0.3 100.0 1.2 3.7 1,667 Total <15 85.0 10.5 1.8 0.5 0.4 0.8 0.2 0.1 0.2 0.6 100.0 1.2 2.6 7,498 Total <18 83.7 10.3 2.5 0.4 0.5 1.2 0.1 0.1 0.3 0.8 100.0 1.8 3.6 9,420 Note: Table is based on de jure household members, i.e., usual residents. Differentials in the proportion of children not living with a biological parent and the proportion orphaned by background characteristics are not large. As expected, older children are less likely than younger children to live with both parents, and more likely than younger children to have lost one or both parents. Small differences in living arrangements are found between rural and urban children. However, Guba-Khachmaz and Absheron have the highest proportion of children living with both parents (89 percent and 88 percent, respectively), while Lankaran has the lowest (79 percent). Table 2.3 shows that children’s living arrangements have no specific pattern according to the household wealth index1. Table 2.3 also presents the extent of orphanhood among children under age 15 to allow comparison with children under age 18. Negligible differences in living arrangements are found between children under age 15 and under age 18. 2.1.4 Education The educational attainment of household members is an important determinant of their opportunities and behaviors. Many phenomena such as use of health facilities, reproductive behavior, 1 For the definition of the wealth index, see section 2.3. Household Population and Housing Characteristics | 15 health of children, and proper hygienic habits are associated with the educational level of household members, especially women. The education system in Azerbaijan, until independence in 1991, mostly followed the same structure as the Soviet educational system2. In the past 17 years, however, the system has undergone several reforms, making the analysis of education data across a wide range of ages challenging. The current school system in Azerbaijan, which has three levels, has been in place since 1989. The first level, primary school, consists of grades one through four for students age 6-93. The second level, or middle school, consists of grades five through nine for students age 10-14. The first two levels together constitute what is referred to as basic secondary education. The third level, or upper school, comprises grades ten and eleven. The three levels together (primary school plus middle school plus upper school) constitute what is referred to as a complete secondary education. The constitution of the Azerbaijan Republic declared complete secondary education mandatory. Students who have completed a minimum of nine grades may enroll in specialized secondary education. There are two tracks within specialized secondary education. The first track consists of professional-technical institutions, also known as “PTU,” that train students in a variety of manual or basic skills occupations. Upon graduation students receive a degree of primary professional (vocational) education equivalent to a complete secondary education. The second track is called “tekhnicum” or secondary specialized education, and it prepares specialists with mid-level qualifications, such as nurses, midwives, musicians, technicians, and others. This track can be completed in two years by students who have completed the eleventh grade or can be completed in four years by students who completed the ninth grade. Upon graduation students receive a secondary-special education degree, a level that is somewhat higher than complete secondary education, but lower than high education. University and postgraduate education prepares higher level specialists. Students who have complete secondary education or equivalent or secondary specialized education may enroll in university. Tables 2.4.1 and 2.4.2 present information on the educational attainment of the Azerbaijan population age six and over. Virtually all Azerbaijanis have gone to school. The median number of years of schooling is 9.6 years for men and 9.4 years for women. The proportion of the population with no education is low (5 percent or less), with the highest levels being among those age 6-9 (reflecting some who have not yet started school) and those 65 years and older. Individuals residing in urban areas have significantly higher levels of university education than those in rural areas. Nearly one in three men and one in five women living in the capital city of Baku have attended university. Wealth status has a strong positive relationship with education; 38 percent of men in the highest wealth quintile have at least some university education, compared with 3 percent of men in the lowest quintile. The corresponding proportions for women are 29 percent and 1 percent, respectively. 2 An education system that was common for the USSR existed in Azerbaijan until 1989 and consisted of primary school (grades 1-4, age 7-10), middle school (grades 5-8, age 11-14) and upper school (grades 9-10, age 15-16). Students who had completed at least 7 or 8 grades were eligible for PTU. Students who had completed at least 8 grades were eligible for secondary specialized. There were few previous educational reforms in the USSR. Initially, primary school consisted of grades 1-7, which had changed to grades 1-4, and later on to grades 1-3. Compulsory education of at least 8 grades was changed to 10 grades. 3 Since 1995, according to law, age 6 is the mandatory age of enrollment of children to enter school. Before 1995, children were allowed to enter school at age 6 or 7; the majority of children would start school at age 7. 16 | Household Population and Housing Characteristics Table 2.4.1 Educational attainment of household population: Female Percent distribution of the de facto female household populations age six and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Azerbaijan 2006 Background characteristic Highest level of schooling Total educa- tion Basic secondary1 education or higher Complete secondary2 education or higher Number Median number of years No educa- tion Primary school (1-4) Middle school (5-9) Upper school (10-11) PTU Secondary specialized Higher Age 6-9 25.1 74.2 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 842 1.0 10-14 2.0 20.0 77.8 0.2 0.0 0.0 0.0 100.0 3.2 0.3 1,487 5.5 15-19 2.2 2.7 31.4 50.7 0.6 5.1 7.2 100.0 86.3 63.7 1,577 9.9 15-16 3.4 1.5 58.0 33.8 0.0 2.4 0.9 100.0 80.7 37.1 583 8.7 17-19 1.5 3.4 15.7 60.7 1.0 6.7 10.9 100.0 89.6 79.3 994 10.4 20-24 1.6 2.9 20.0 38.2 1.2 16.4 19.7 100.0 86.7 75.5 1,382 10.6 25-29 0.6 0.4 23.2 43.4 2.4 14.1 15.9 100.0 86.4 75.7 1,110 10.4 30-34 1.0 1.2 15.3 52.1 4.4 14.5 10.9 100.0 85.4 82.0 1,035 9.8 35-39 1.2 0.9 11.8 53.6 5.0 15.7 11.8 100.0 87.4 86.2 1,182 9.7 40-44 1.3 0.5 10.4 53.1 6.0 15.9 12.4 100.0 88.2 87.5 1,326 9.7 45-49 2.0 1.2 14.3 47.9 4.9 14.7 15.0 100.0 83.9 82.5 1,006 9.7 50-54 1.0 3.8 22.9 37.8 3.5 16.7 14.3 100.0 74.4 72.3 1,049 9.6 55-59 2.5 7.6 25.4 27.4 2.9 18.5 15.7 100.0 68.0 64.5 582 9.6 60-64 8.0 13.0 28.5 23.7 1.2 13.4 11.9 100.0 54.7 50.2 281 9.0 65+ 18.9 23.5 34.0 13.0 0.8 4.7 4.9 100.0 25.7 23.4 1,413 5.8 Residence Urban 3.5 8.6 23.1 32.7 2.7 13.6 15.7 100.0 69.9 64.7 7,903 9.6 Rural 6.4 12.9 29.7 37.6 2.2 7.5 3.6 100.0 57.5 50.9 6,373 9.0 Region Baku 2.8 7.6 20.2 32.2 2.9 13.4 20.8 100.0 74.3 69.3 4,137 9.9 Absheron 3.3 8.8 23.1 34.0 2.1 16.8 11.8 100.0 70.5 64.7 898 9.6 Ganja-Gazakh 4.5 9.4 26.8 36.7 1.5 11.4 9.5 100.0 64.3 59.1 1,986 9.4 Shaki-Zaqatala 3.6 10.9 25.5 32.9 4.5 16.2 6.4 100.0 68.8 60.0 1,029 9.5 Lankaran 5.0 12.9 34.6 38.3 2.0 5.0 2.2 100.0 54.0 47.4 1,226 8.6 Guba-Khachmaz 2.9 11.0 41.9 34.3 1.0 5.3 3.6 100.0 56.6 44.3 717 8.5 Aran 7.5 13.7 27.2 36.5 2.4 7.8 4.8 100.0 56.6 51.6 3,474 9.1 Yukhari Garabakh 10.3 10.5 22.5 36.6 4.3 10.6 5.1 100.0 60.7 56.5 366 9.3 Daghligh Shirvan 7.8 13.8 28.4 35.1 1.9 9.2 3.7 100.0 55.2 50.0 443 9.0 Wealth quintile Lowest 8.6 15.1 34.5 33.6 2.5 4.3 1.3 100.0 49.2 41.7 2,840 8.0 Second 6.1 11.9 30.5 38.1 2.8 7.4 3.1 100.0 59.1 51.5 2,830 9.1 Middle 4.5 11.0 26.9 38.2 2.1 11.3 5.9 100.0 62.9 57.6 2,875 9.3 Fourth 2.9 8.3 21.6 35.4 2.3 16.9 12.6 100.0 72.1 67.2 2,868 9.7 Highest 1.9 6.5 16.7 29.1 2.8 14.1 28.6 100.0 78.4 74.5 2,864 10.4 Total 4.8 10.5 26.0 34.9 2.5 10.8 10.3 100.0 64.4 58.5 14,276 9.4 Note: Total includes women with missing data that are not shown separately. 1 Attending or completed grade 9 or higher 2 Attending or completed grade 10 or higher Household Population and Housing Characteristics | 17 Table 2.4.2 Educational attainment of household population: Male Percent distribution of the de facto male household populations age six and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Azerbaijan 2006 Background characteristic Highest level of schooling Total educa- tion Basic secondary1 education or higher Complete secondary2 education or higher Number Median number of years No educa- tion Primary school (1-4) Middle school (5-9) Upper school (10-11) PTU Secondary specialized Higher Age 6-9 24.4 75.4 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 980 1.0 10-14 0.8 21.6 77.1 0.4 0.0 0.0 0.0 100.0 2.8 0.4 1,646 5.4 15-19 1.1 1.2 38.0 47.9 1.9 2.4 7.6 100.0 85.5 59.8 1,346 9.4 15-16 1.3 1.0 63.3 32.5 0.7 1.1 0.2 100.0 76.0 34.4 678 8.6 17-19 0.8 1.4 12.3 63.6 3.0 3.8 15.2 100.0 95.1 85.5 668 10.3 20-24 0.5 1.5 15.1 51.9 3.9 4.4 22.7 100.0 91.3 82.9 1,174 10.5 25-29 0.6 0.4 18.1 47.4 4.2 5.6 23.6 100.0 90.7 80.9 1,053 10.5 30-34 0.6 0.4 10.8 50.2 9.4 9.7 18.9 100.0 89.9 88.2 911 10.2 35-39 1.0 0.3 7.7 47.0 14.4 12.4 17.2 100.0 91.3 91.0 948 9.9 40-44 0.5 0.5 9.3 43.5 14.1 15.6 16.6 100.0 91.5 89.8 1,046 9.9 45-49 0.6 1.1 8.2 37.0 13.3 17.5 22.5 100.0 91.3 90.2 1,000 10.2 50-54 0.8 1.4 9.2 32.4 9.7 20.5 26.1 100.0 90.4 88.6 725 11.1 55-59 1.0 1.3 8.4 23.0 7.3 24.0 35.0 100.0 90.4 89.2 447 13.0 60-64 1.1 2.9 15.7 29.4 6.5 12.7 31.7 100.0 82.6 80.3 323 10.4 65+ 7.2 12.4 26.4 21.3 5.2 13.8 13.7 100.0 55.9 53.9 1,062 9.2 Residence Urban 2.6 8.9 21.4 30.2 5.7 9.6 21.6 100.0 72.3 67.1 7,058 9.8 Rural 3.8 12.2 25.4 35.9 7.1 8.0 7.6 100.0 64.1 58.5 5,609 9.4 Region Baku 2.2 7.5 19.8 29.2 4.7 9.6 27.1 100.0 75.4 70.6 3,807 10.1 Absheron 2.7 8.6 22.4 29.4 5.3 12.1 19.5 100.0 72.0 66.3 807 9.8 Ganja-Gazakh 2.6 11.3 26.2 34.7 6.0 6.0 13.0 100.0 65.4 59.8 1,746 9.4 Shaki-Zaqatala 2.6 12.0 24.0 31.7 8.9 12.1 8.7 100.0 69.7 61.4 940 9.5 Lankaran 3.8 12.3 23.9 37.0 7.1 6.6 9.1 100.0 64.1 59.8 1,067 9.4 Guba-Khachmaz 2.4 10.1 34.2 37.8 3.8 5.3 6.4 100.0 64.2 53.3 691 9.1 Aran 4.4 12.5 23.2 34.0 8.1 9.5 8.3 100.0 63.9 59.9 2,911 9.4 Yukhari Garabakh 5.5 10.2 18.8 35.8 9.5 10.0 10.0 100.0 68.8 65.4 314 9.6 Daghligh Shirvan 5.5 13.6 23.5 34.7 4.8 8.9 8.9 100.0 64.0 57.4 383 9.3 Wealth quintile Lowest 4.9 14.8 30.4 33.9 7.5 5.1 3.3 100.0 55.9 49.8 2,452 9.0 Second 3.8 10.9 25.7 36.1 7.9 8.5 7.1 100.0 66.1 59.6 2,492 9.4 Middle 2.7 10.8 24.2 35.2 7.2 10.0 9.8 100.0 67.3 62.2 2,511 9.5 Fourth 2.7 7.7 20.0 36.3 5.8 10.0 17.5 100.0 74.4 69.5 2,566 9.8 Highest 1.7 7.9 16.1 22.5 3.3 10.9 37.5 100.0 78.6 74.2 2,646 10.9 Total 3.1 10.4 23.2 32.7 6.3 8.9 15.4 100.0 68.7 63.3 12,667 9.6 Note: Total includes 5 men with missing data that are not shown separately. 1 Attending or completed grade 9 or higher 2 Attending or completed grade 10 or higher Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex, residence, region, and wealth quintile are shown in Table 2.5. The NAR indicates participation in primary school for the population age 6-9 and complete secondary school (middle and upper-school and PTU) for the population age 10-16. The GAR measures participation at each level of schooling among those of any age from 6 to 24. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level4. 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 Azerbaijan, school attendance among school-age household members is high. The overall NAR for primary school education is 73 and the GAR is 108. A comparison of the NAR and GAR indicates that approximately 35 percent of students are either under age or over age. The NAR and GAR in Lankaran are substantially lower than in the other regions. The highest net primary school attendance in Azerbaijan is among children living in the wealthiest households. There is little difference according to other background characteristics. 4 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. 18 | Household Population and Housing Characteristics Table 2.5 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the gender parity index (GPI), according to background characteristics, Azerbaijan 2006 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 74.5 72.6 73.6 0.98 108.7 104.9 106.9 0.97 Rural 72.9 71.0 72.0 0.97 110.4 106.8 108.8 0.97 Region Baku 75.3 72.1 73.7 0.96 112.5 96.0 104.0 0.85 Absheron 71.4 77.9 74.4 1.09 104.2 101.7 103.0 0.98 Ganja-Gazakh 82.2 75.3 79.2 0.92 122.8 108.9 116.8 0.89 Shaki-Zaqatala 77.0 76.6 76.8 1.00 130.9 108.4 119.9 0.83 Lankaran 70.5 60.9 66.8 0.86 99.6 98.7 99.2 0.99 Guba-Khachmaz 69.5 71.5 70.5 1.03 116.8 102.1 109.5 0.87 Aran 71.1 70.6 70.9 0.99 101.8 118.2 108.9 1.16 Yukhari Garabakh 68.5 71.4 69.9 1.04 103.6 102.1 102.9 0.99 Daghligh Shirvan 68.6 71.8 70.0 1.05 96.7 110.5 102.7 1.14 Wealth quintile Lowest 73.1 70.6 71.9 0.97 110.7 107.4 109.2 0.97 Second 71.0 70.1 70.6 0.99 106.1 102.0 104.2 0.96 Middle 78.1 71.1 74.8 0.91 115.1 110.3 112.9 0.96 Fourth 66.3 74.1 70.0 1.12 100.5 104.5 102.4 1.04 Highest 80.2 74.2 77.5 0.92 114.7 104.0 109.9 0.91 Total 73.7 71.9 72.8 0.98 109.5 105.8 107.8 0.97 COMPLETE SECONDARY SCHOOL AND PTU Residence Urban 83.5 81.6 82.6 0.98 101.8 104.5 103.1 1.03 Rural 80.2 78.2 79.3 0.97 93.1 94.2 93.6 1.01 Region Baku 84.9 85.5 85.2 1.01 106.2 112.0 108.9 1.05 Absheron 82.9 85.5 84.1 1.03 102.3 120.8 111.0 1.18 Ganja-Gazakh 80.4 77.9 79.3 0.97 95.0 100.1 97.3 1.05 Shaki-Zaqatala 78.1 80.8 79.2 1.03 88.1 102.1 93.9 1.16 Lankaran 82.4 80.3 81.4 0.97 96.3 89.1 92.8 0.93 Guba-Khachmaz 82.5 87.2 84.8 1.06 91.4 97.6 94.4 1.07 Aran 79.8 73.4 76.7 0.92 93.9 89.0 91.5 0.95 Yukhari Garabakh 82.7 80.8 81.8 0.98 92.3 97.6 94.8 1.06 Daghligh Shirvan 82.6 68.9 76.1 0.83 97.8 81.7 90.1 0.83 Wealth quintile Lowest 76.4 73.9 75.2 0.97 88.4 83.9 86.3 0.95 Second 82.0 81.0 81.5 0.99 97.8 100.0 98.8 1.02 Middle 83.4 78.7 81.2 0.94 96.0 99.3 97.6 1.03 Fourth 84.8 81.0 83.0 0.96 104.5 105.6 105.1 1.01 Highest 84.1 86.9 85.4 1.03 103.5 113.1 108.2 1.09 Total 81.9 80.0 81.0 0.98 97.5 99.7 98.6 1.02 1 The NAR for primary school is the percentage of the primary-school age (6-9 years) population that is attending primary school. The NAR for complete secondary school is the percentage of the middle and upper-school/PTU age (10-16 years) population that is attending middle and upper secondary school and PTU. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official complete secondary-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 primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for complete secondary school is the ratio of the complete secondary school NAR(GAR) for females to the NAR(GAR) for males. The NAR of 81 for the complete secondary school level is higher than that for the primary school. The GAR of 99 is, however, lower than that for the primary school. This suggests that there has been a decrease in over age or under age participation in complete secondary school level. Indeed, a comparison of the NAR and GAR indicates that approximately 18 percent of students are either under age or over age. The NAR and GAR in Daghligh Shirvan and Aran are lower than in the other regions. As with the primary school level, the highest complete secondary school attendance in Azerbaijan is among children living in the wealthiest households. The gender parity index (GPI), or the ratio of the female to the male NAR/GAR at the primary and complete secondary school levels, indicates the magnitude of the gender gap in attendance ratios. If there is no gender difference, the GPI will be equal to one. GPI will be closer to zero if the disparity is in favor of males. If the gender gap favors females, the GPI will exceed one. Table 2.5 shows the GPI for NAR is 0.98 in the primary school and the same in the complete Household Population and Housing Characteristics | 19 secondary school levels. The GPIs for primary schools is lowest in Lankaran and the highest in Daghligh Shirvan. The GPI of 1.12 among children living in the fourth wealth quintile is highest and indicates that there is a substantial gender gap in favor of females at the primary school level in this group. Figure 2.2 presents the age-specific attendance ratios (ASAR) for the population age 6-24 years by sex. The ASAR indicates participation in schooling at any level, from primary through higher education. The closer the ASAR is to 100 percent, the higher the proportion of a given age attending school. In Azerbaijan, almost all youths of basic secondary age (6-14) attend school and there are no significant differences by gender. Among the high-school age population (15-16), attendance ratios begin to decline, particularly among females. It should be noted that among 18 to 19 year olds, a significantly higher proportion of males than females is attending school. At age 21, the ratio is reversed and the proportion of females attending school exceeds the proportion of males. In Azerbaijan, virtually all primary school students in grades 2 through 4 are promoted every year and nearly all stay in school (estimates not shown). Figure 2.2 Age-specific school attendance rates, by sex 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Male Female AzDHS 2006 2.2 HOUSING CHARACTERISTICS To assess the socioeconomic conditions under which the population lives, respondents were asked to give specific information about their household environment. A number of the characteristics for which information was collected (e.g., type of water source, sanitation facilities, and flooring material) also affect the health status of household members and particularly of children. Tables 2.6 to 2.9 present major housing characteristics by urban-rural residence both for the households interviewed in the survey and for the de jure population living in the households. 20 | Household Population and Housing Characteristics All households in Azerbaijan have electricity (Table 2.6). The majority of households have wooden plank floors in both urban (74 percent) and rural areas (85 percent). Parquet or polished wood floors are most common in urban areas (16 percent). Five percent of households in rural areas have an earth or sand floor. The majority of households have at least two rooms for sleeping. However, urban households (39 percent) are more likely to have only one room for sleeping than rural households (27 percent). Most households also have a specific place within the dwelling for cooking, with only about one-third of rural households and one-tenth of urban households cooking in a separate building or outdoors. Table 2.6 Household characteristics Percent distribution of households and de jure population by housing characteristics, according to residence, Azerbaijan 2006 Housing characteristic Households Population Urban Rural Total Urban Rural Total Electricity Yes 99.8 99.0 99.5 99.7 99.1 99.4 No 0.2 0.9 0.5 0.2 0.8 0.5 Missing 0.1 0.1 0.1 0.1 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 1.0 4.6 2.5 1.1 4.3 2.6 Wood planks 73.8 84.6 78.2 75.6 85.2 79.9 Parquet, polished wood 16.4 3.4 11.1 14.4 3.4 9.4 Vinyl, asphalt strips 0.0 0.0 0.0 0.1 0.0 0.0 Cement 1.0 1.5 1.2 1.2 1.8 1.4 Linoleum 5.2 1.7 3.8 5.0 1.4 3.3 Carpet, laminate, stone, other, missing 2.6 4.1 3.2 2.7 4.0 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 38.8 26.9 33.9 29.9 20.3 25.6 Two 49.4 55.1 51.7 53.3 56.3 54.7 Three or more 11.2 17.3 13.7 16.3 22.7 19.2 Missing 0.5 0.8 0.6 0.5 0.7 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 88.5 65.7 79.2 86.9 64.7 76.9 In a separate building 6.5 16.4 10.5 7.5 16.5 11.5 Outdoors 4.9 17.7 10.1 5.5 18.7 11.4 Other 0.0 0.0 0.0 0.0 0.0 0.0 Missing 0.1 0.2 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 14.9 28.2 20.4 16.2 29.0 22.0 Natural gas/ compressed gas 84.0 48.5 69.5 82.7 47.7 67.0 Wood/straw 0.8 20.1 8.7 0.9 19.9 9.4 No food cooked in HH 0.0 0.1 0.0 0.0 0.0 0.0 Other/ missing 0.2 3.2 1.5 0.2 3.4 1.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 0.9 22.6 9.8 1.0 22.5 10.7 Number of households/population 4,240 2,940 7,180 16,333 13,340 29,674 Type of fire/stove among households using solid fuels1 Closed stove with chimney 64.5 61.5 61.6 59.9 58.1 58.2 Open fire/stove with chimney 13.0 5.6 6.0 15.3 6.1 6.5 Open fire/stove with hood 2.4 9.2 8.8 2.0 10.1 9.7 Open fire/stove without chimney or hood 20.0 23.2 23.0 22.7 25.3 25.1 Other/missing 0.0 0.6 0.5 0.0 0.4 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population using solid fuel 36 666 702 159 3,003 3,162 1 Includes coal/lignite, charcoal, wood/straw and animal dung. Gas is the main cooking fuel followed by electricity. Only 10 percent of households in Azerbaijan use biomass fuel for cooking, with rural households being much more likely to use solid fuel (23 percent) than urban households (1 percent). Table 2.6 shows that, among households cooking with biomass fuels, around two-thirds (62 percent) have a closed stove with chimney, 15 percent cook Household Population and Housing Characteristics | 21 on an open fire or stove with either a chimney or hood, and 23 percent cook on an open fire or stove without a chimney or hood. 2.2.1 Drinking Water Table 2.7 provides information on the source of drinking water, time to obtain the water, the age and sex of the person who usually collects the drinking water and the method used (if any) for treating drinking water. The table presents the percentage of households as well as the percentage of the de jure population living in those households. Table 2.7 Household drinking water Percent distribution of households and de jure population by source, time to collect, and person who usually collects drinking water; and percentage of households by treatment of drinking water, according to residence, Azerbaijan 2006 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 87.6 69.5 80.2 86.2 68.7 78.3 Piped water into dwelling/yard/plot 77.7 19.1 53.7 75.6 19.0 50.2 Public tap/standpipe 1.9 5.8 3.5 2.0 5.9 3.8 Tubewell/borehole 2.5 19.1 9.3 2.6 19.2 10.1 Protected dug well 3.3 10.4 6.2 3.5 10.1 6.5 Protected spring 2.2 15.0 7.5 2.4 14.4 7.8 Non-improved source 11.8 28.2 18.5 13.2 29.3 20.4 Unprotected dug well/unprotected spring 0.4 2.6 1.3 0.5 2.4 1.3 Tanker truck/cart with small tank 10.1 10.4 10.3 11.0 10.8 10.9 Surface water 1.3 15.2 7.0 1.8 16.1 8.2 Bottled water, improved source for cooking/washing1 0.2 0.0 0.1 0.2 0.0 0.1 Bottled water, non-improved source for cooking/washing1 0.0 0.0 0.0 0.0 0.0 0.0 Other sources/missing 0.4 2.3 1.1 0.3 2.1 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 87.8 69.5 80.3 86.4 68.7 78.4 Time to obtain drinking water (round trip) Water on premises 90.5 54.9 75.9 90.1 55.6 74.6 Less than 30 minutes 6.5 26.5 14.7 6.4 26.3 15.3 30 minutes or longer 2.4 17.2 8.4 2.9 16.8 9.2 Don’t know/missing 0.6 1.4 0.9 0.7 1.3 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 5.8 35.0 17.7 5.9 34.1 18.6 Adult male 15+ 2.9 7.2 4.6 3.1 7.3 5.0 Female child under age 15 0.3 1.2 0.6 0.3 1.2 0.7 Male child under age 15 0.3 1.1 0.6 0.4 1.0 0.6 Other/missing 0.2 0.7 0.4 0.3 0.7 0.5 Water on premises 90.5 54.9 75.9 90.1 55.6 74.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 78.4 56.3 69.3 78.3 57.7 69.0 Other (bleaching, strained through cloth, ceramic, or sand filters, solar disinfection) 23.7 14.3 19.8 24.1 14.3 19.7 No treatment 18.7 40.3 27.5 18.8 38.9 27.8 Percentage using an appropriate treatment method3 79.4 56.7 70.1 79.3 58.2 69.8 Number 4,240 2,940 7,180 16,333 13,340 29,674 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. The source of drinking water is an indicator of whether or not it is suitable for drinking. Half of households in Azerbaijan have their drinking water piped directly into the house, yard, or plot. Urban households (78 percent) are much more likely than rural households (19 percent) to have piped water in their house, yard, or plot. In rural areas, about 30 percent of households have a tubewell or protected well and 15 percent obtain water from a protected spring. 22 | Household Population and Housing Characteristics Almost all of urban households (91 percent) and half of rural households (55 percent) have drinking water available on premises. Seventeen percent of rural households spent 30 minutes or longer to fetch water in households with no water in the house, yard, or plot. Water is collected most frequently by an adult woman (age 15 or older). This is particularly true in rural areas (35 percent). Seventeen percent of rural households spent 30 minutes or longer to fetch the water. Twenty-eight percent of households do nothing to treat the water. The most frequently used treatment for water is boiling (69 percent). 2.2.2 Sanitation Facility Table 2.8 shows the proportion of households and of the de jure population with access to hygienic sanitation facilities. A household’s toilet/latrine facility is classified as hygienic if it is used only by household members (i.e., not shared) and the type of facility effectively separates human waste from human contact. The types of facilities that are most likely to accomplish this are flush or pour flush into a piped sewer system/septic tank/somewhere else, or a ventilated and improved pit latrine with a slab. Table 2.8 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Azerbaijan,2006 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 64.7 1.6 38.9 62.4 1.7 35.1 Flush/pour flush to septic tank 1.0 0.8 0.9 1.0 0.8 0.9 Flush/pour to somewhere else 1.1 0.3 0.8 1.1 0.3 0.7 Pit latrine with slab 16.5 67.9 37.5 18.5 67.6 40.6 Non-improved facility Any facility shared with other households 10.8 2.6 7.4 10.2 2.4 6.7 Flush/pour flush not to sewer/septic tank/pit latrine 0.1 0.0 0.1 0.1 0.0 0.1 Open pit/hole in the ground 5.1 25.9 13.6 6.0 26.4 15.2 No facility/bush/field 0.1 0.5 0.3 0.1 0.5 0.3 Other/missing 0.6 0.3 0.5 0.5 0.3 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,240 2,940 7,180 16,333 13,340 29,674 Seventy-eight percent of households in Azerbaijan use improved sanitation facilities which are not shared with another household (Table 2.8). Two in five households in Azerbaijan use a flush toilet connected to piped sewer system and a similar proportion uses improved pit latrine with slab. Flush toilets are widespread in urban areas (67 percent), while improved latrines are the most common type of facility in rural areas (68 percent). One in five households use a non-improved toilet and 7 percent of households share the facility with another household. 2.2.3 Household Possessions The availability of durable goods is a proximate measure of household socioeconomic status. Moreover, particular goods have specific benefits. Having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transport allows greater access to many services away from the local area. Table 2.9 provides information on household ownership of durable goods and modes of transportation. Household Population and Housing Characteristics | 23 Table 2.9 Household durable goods Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Azerbaijan 2006 Possession Households Population Urban Rural Total Urban Rural Total Household effects Clock 99.2 97.0 98.3 99.3 97.5 98.5 Radio 56.9 32.1 46.7 56.9 32.4 45.9 Photo-camera 25.5 9.2 18.8 26.0 9.5 18.6 Video camera 9.1 2.8 6.5 8.5 2.7 5.9 Audio tape player 54.2 36.4 46.9 55.3 37.1 47.1 Sofa 85.1 75.6 81.2 85.8 77.0 81.8 Stenka (multiple set storage unit) 52.8 40.5 47.8 55.1 43.0 49.7 Gorka (living room hutch) 13.6 10.6 12.3 12.9 10.2 11.7 Computer 8.7 1.5 5.8 8.2 1.5 5.2 Black and white TV 12.7 32.7 20.9 12.6 32.9 21.7 Color TV 86.2 62.0 76.3 86.7 63.6 76.3 Satellite dish 14.6 16.2 15.3 14.9 16.5 15.6 DVD player 14.9 4.9 10.8 14.6 5.2 10.4 Mobile telephone 64.2 42.0 55.1 67.2 44.6 57.1 Non-mobile telephone 75.9 37.0 60.0 75.7 36.7 58.2 Refrigerator 88.5 59.2 76.5 88.4 59.8 75.6 Freezer 2.6 1.5 2.2 2.6 1.5 2.1 Washing machine 30.0 9.4 21.6 30.4 9.6 21.0 Electric generator 1.5 5.6 3.2 1.8 5.5 3.5 Fan or air conditioner 46.6 14.0 33.3 46.6 14.9 32.4 Water heater 49.3 12.2 34.1 48.6 12.5 32.4 Means of transport Bicycle 8.8 4.3 6.9 11.0 4.8 8.2 Animal-drawn cart 0.7 6.9 3.3 0.8 7.4 3.8 Motorcycle/scooter 0.7 1.7 1.1 0.8 1.8 1.3 Car/truck 21.8 18.3 20.4 23.6 20.3 22.1 Boat with a motor 0.1 0.1 0.1 0.2 0.0 0.1 Tractor 0.2 2.8 1.2 0.2 3.1 1.5 Ownership of agricultural land 8.5 80.1 37.8 10.2 81.8 42.3 Ownership of farm animals1 12.5 81.0 40.6 15.1 83.2 45.7 Number 4,240 2,940 7,180 16,333 13,340 29,674 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, pigs, rabbits, or chickens Overall, the majority of Azerbaijani households have a clock (98 percent), sofa (81 percent), refrigerator (77 percent), color television (76 percent), and landline telephone (60 percent) or mobile telephone (55 percent). Urban households are more likely than rural households to possess most of the durable goods shown in Table 2.9. For example, both mobile and non-mobile telephones are much more common in urban areas than in rural areas and urban households are much more likely than rural households to have a refrigerator (89 percent and 59 percent, respectively). One in five households in Azerbaijan has a car or truck. Bicycles are more common in urban areas than in rural areas (9 percent and 4 percent, respectively). Rural households are more likely than urban households to own an animal-drawn cart or a tractor. Thirty-eight percent of Azerbaijan households own agricultural land; the proportion is understandably higher in rural than urban areas (80 percent and 9 percent, respectively). Forty-one percent of Azerbaijan households own farm animals. 2.3 WEALTH QUINTILES The wealth index is a recently developed measure that has been tested in a number of countries in relation to inequities in household income, use of health services, and health outcomes (Rutstein, 2004; Rutstein et al., 2000). The wealth index is constructed by assigning a weight or factor score to each household asset through principal components analysis. These scores are summed by household, and individuals are ranked according to the total score of the household in which they 24 | Household Population and Housing Characteristics Table 2.10 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, according to residence and region, Azerbaijan 2006 Residence/region Wealth quintile Total Number in de jure population Lowest Second Middle Fourth Highest Residence Urban 3.8 9.0 19.6 31.8 35.8 100.0 16,333 Rural 39.8 33.4 20.6 5.5 0.6 100.0 13,340 Region Baku 0.3 2.9 13.4 30.7 52.7 100.0 8,598 Absheron 1.9 5.2 17.4 41.1 34.4 100.0 1,901 Ganja-Gazakh 27.2 22.0 23.6 20.6 6.6 100.0 4,181 Shaki-Zaqatala 38.5 25.4 24.5 10.0 1.7 100.0 2,153 Lankaran 27.7 36.8 25.5 8.6 1.4 100.0 2,509 Guba-Khachmaz 31.7 29.6 22.4 13.0 3.2 100.0 1,522 Aran 29.3 30.8 23.3 12.2 4.5 100.0 7,151 Yukhari Garabakh 36.5 39.1 17.7 6.3 0.4 100.0 742 Daghligh Shirvan 40.2 27.0 19.7 10.3 2.7 100.0 917 Total 20.0 20.0 20.0 20.0 20.0 100.0 29,674 resided. The sample is then divided into population quintiles—five groups with the same number of individuals in each. At the national level, approximately 20 percent of the population is in each wealth quintile. Table 2.10 shows the distribution of the population across the five wealth quintiles, by urban and rural areas and region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. For example, over three-fourths of the rural population (73 percent) is in the lowest and second-lowest wealth quintiles. This compares to approximately seven in ten urban residents who are in the two highest wealth quintiles (68 percent). Looking at the regional variation, Baku has the largest proportions of population in the two highest wealth quintiles, while Daghligh Shirvan has the largest proportions of population in the lowest two wealth quintiles. 2.4 BIRTH REGISTRATION According to Article 7 of the Convention on the Rights of the Child, to which Azerbaijan is a party, the child shall be registered immediately after birth. Registration is the State’s first official acknowledgement of the child’s existence; it represents recognition of each child’s individual importance to the State and of the child’s status under the law. The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of the registration of the birth. In the 2006 AzDHS, for all children born since January 2001, mothers were asked if their child had been registered. Table 2.11 gives the percentage of children under five years of age whose births were officially registered and the percentage who had a birth certificate at the time of the survey. Not all children who are reported as registered may have a birth certificate since some certificates may have been lost or were never issued. However, all children with a certificate have been registered. Birth registration is almost universal in Azerbaijan, with 94 percent of births in the 5 years preceding the survey registered and 88 percent having a birth certificate. Small variations are found across subgroups of children. The proportion of births that are registered ranges from 98 percent in Yukhari Garabakh to 90 percent in Aran and Daghligh Shirvan. Children from urban and more well off households are more likely to have their birth registered than children with other backgrounds. Household Population and Housing Characteristics | 25 Table 2.11 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background characteristics, Azerbaijan 2006 Background characteristic Percentage of children whose births are registered Number of children Had a birth certificate1 Did not have a birth certificate2 Total registered Age in months 0-23 82.2 7.9 90.1 966 0-11 75.2 12.7 87.9 490 12-23 89.4 3.0 92.5 476 24-59 93.0 3.3 96.3 1,244 24-35 94.6 3.4 98.0 414 36-47 91.5 3.9 95.4 431 48-59 93.0 2.6 95.6 399 Sex Male 88.9 4.5 93.4 1,202 Female 87.6 6.3 93.9 1,008 Residence Urban 92.0 3.6 95.5 1,103 Rural 84.7 7.0 91.7 1,106 Region Baku 92.9 4.4 97.3 514 Absheron 93.4 2.4 95.8 155 Ganja-Gazakh 87.6 4.6 92.2 351 Shaki-Zaqatala 90.3 4.6 94.8 145 Lankaran 90.8 2.0 92.9 210 Guba-Khachmaz 94.2 2.4 96.5 95 Aran 81.2 9.1 90.3 612 Yukhari Garabakh 95.6 2.8 98.4 59 Daghligh Shirvan 83.9 6.3 90.2 70 Wealth quintile Lowest 84.4 7.2 91.6 500 Second 83.7 8.1 91.8 505 Middle 88.1 6.9 95.0 454 Fourth 92.3 1.6 93.9 398 Highest 96.2 0.8 97.0 352 Total 88.3 5.3 93.6 2,210 1 Includes children, 0-59 months of age, whose birth certificate was seen by the interviewer or whose mother or caretaker says the child has the birth certificate. 2 Includes children, 0-59 months of age, who have no birth certificate, but whose mother or caretaker says the birth has been registered with the civil authority. If the child’s birth was not registered the child’s caregiver was asked to give a reason. Among the small group of children aged 0-59 months whose birth is not registered, the main reason given for non-registration is a high cost of registration (data now shown separately). 2.5 CHILD DISCIPLINE AND EARLY DEVELOPMENT 2.5.1 Children Left Alone Cognitive, physical, and emotional stimulation of the child beginning right after the birth, combined with positive encouragement and affection, are paramount for ensuring development of a child’s brain to its full intellectual potential and fostering effective interaction of the child with the outside world. Children who are often left alone and deprived of adult stimulation are often delayed in their emotional and intellectual development. To obtain information on this issue, for each child born since January 2001, the mother (or the most knowledgeable adult) was asked how many times during the week preceding the survey the child had been left alone or in the care of another child under 10 years of age for one hour or longer. As Table 2.12 shows, at the national level, children under age 5 are rarely left alone (3 percent). The proportions left alone or in the care of a young child are highest in Guba-Khachmaz (9 percent) and Lankaran (7 percent). 26 | Household Population and Housing Characteristics Table 2.12 Children left alone or with other children Percentage of children age 0-59 months left in the care of other children under the age of 10 years or left alone in the past week, Azerbaijan 2006 Background characteristic Left in the care of children under the age of 10 years in the past week Left alone in the past week Left with inadequate care in past week1 Number of children age 0-59 months Age in months 0-23 1.1 0.8 1.5 987 24-59 3.7 1.9 4.0 1,270 Sex Male 3.3 1.8 3.6 1,228 Female 1.6 0.9 2.1 1,028 Residence Urban 2.1 1.0 2.3 1,131 Rural 3.0 1.9 3.5 1,125 Region Baku 1.3 0.8 1.3 525 Absheron 3.6 1.8 4.1 162 Ganja-Gazakh 0.7 0.7 1.0 361 Shaki-Zaqatala 1.1 0.5 1.1 146 Lankaran 5.3 2.6 6.7 212 Guba-Khachmaz 8.5 0.6 8.5 95 Aran 3.0 2.2 3.3 619 Yukhari Garabakh 1.5 0.5 1.5 62 Daghligh Shirvan 2.6 2.3 3.9 75 Mother’s education Basic secondary or less 2.2 1.9 3.2 595 Complete secondary 3.0 1.2 3.0 1,093 Secondary specialized 1.3 0.6 1.7 263 Higher 2.9 2.1 3.0 279 Mother not in household (2.9) (0.0) (2.9) 26 Wealth quintile Lowest 3.6 1.9 4.2 511 Second 1.8 0.8 2.1 512 Middle 2.5 1.7 2.9 463 Fourth 1.6 1.1 1.9 405 Highest 3.2 1.6 3.2 364 Total 2.6 1.4 2.9 2,257 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 MICS indicator 51. Inadequate care is defined as children left in the care of other children under the age of 10 years or left alone in the past week for one hour or longer. 2.5.2 Family Support in Early Learning Family support and a positive learning environment at home in early childhood years provide a good foundation for further development and schooling. In the 2006 AzDHS, for each child born since January 2001, mothers or the most knowledgeable adult was asked if, in the 3 days prior the survey, any household member over 15 years of age had engaged the child in any of the following activities: read books or look at picture books with the child; told stories, sang a song with the child; took the child outside the home; played with the child; or spent time with the child naming, counting, and drawing things. For each activity for which the answer was “yes,” the mother (caretaker) was asked who had engaged in the activity with the child: the mother, the father, or another adult member of the household including caretaker/respondent. Table 2.13 presents the percentage of children under five years of age with whom household members in general and specifically fathers had engaged in activities that promote learning and school readiness in the three days preceding the survey. The results indicate that the majority of children under age five (87 percent) had recently been engaged by an adult in their household in at least one activity that promotes early learning and school readiness. Around two-thirds of children had been engaged in four and more activities. The mean number of activities in which adult members of the household had engaged with the child is four. Household Population and Housing Characteristics | 27 Table 2.13 Family support for learning Percentage of children age 0-59 months for whom household members are engaged in activities that promote learning and school readiness, Azerbaijan 2006 Background characteristic For whom household members engaged in one or more activities that promote learning and school readiness For whom household members engaged in four or more activities that promote learning and school readiness1 Mean number of activities household members engage in with the child For whom the father engaged in one or more activities that promote learning and school readiness2 Mean number of activities the father engaged in with the child Living in a household without their natural father Number of children age 0-59 months Age in months 0-23 86.5 54.1 3.3 18.5 0.3 12.1 987 24-59 87.5 73.4 3.8 27.5 0.5 16.1 1,270 Sex Male 86.9 66.5 3.6 23.3 0.4 13.8 1,228 Female 87.2 63.1 3.5 24.0 0.4 15.0 1,028 Residence Urban 92.2 77.1 4.1 27.2 0.5 10.5 1,131 Rural 81.9 52.7 3.1 20.0 0.3 18.3 1,125 Region Baku 98.0 88.8 4.6 30.8 0.6 6.4 525 Absheron 90.3 79.0 4.1 14.5 0.4 13.3 162 Ganja-Gazakh 77.0 53.9 3.0 23.8 0.4 17.5 361 Shaki-Zaqatala 93.4 53.7 3.3 32.1 0.5 17.4 146 Lankaran 79.4 39.8 2.6 25.0 0.3 20.0 212 Guba-Khachmaz 97.4 88.5 4.5 42.9 0.6 4.2 95 Aran 83.8 59.7 3.4 15.5 0.3 18.4 619 Yukhari Garabakh 82.1 63.1 3.5 21.2 0.4 13.6 62 Daghligh Shirvan 79.1 28.3 2.3 15.5 0.3 14.8 75 Mother’s education Basic secondary or less 80.0 56.8 3.2 16.7 0.3 15.5 595 Complete secondary 87.7 64.0 3.6 26.4 0.5 13.5 1,093 Secondary specialized 95.1 72.1 4.0 24.1 0.4 11.6 263 Higher 92.1 79.3 4.1 28.5 0.6 11.9 279 Mother not in household (87.0) (64.3) (3.6) (8.9) (0.2) (79.4) 26 Father’s education Basic secondary or less 80.2 58.3 3.2 23.5 0.4 na 269 Complete secondary 87.0 61.5 3.5 24.0 0.4 na 1,100 Secondary specialized 92.9 79.1 4.2 29.9 0.5 na 191 Higher 94.4 78.9 4.2 34.9 0.7 na 372 Father not in household 81.1 57.8 3.3 na na na 324 Wealth quintile Lowest 77.8 46.4 2.8 17.0 0.3 14.4 511 Second 86.3 58.6 3.3 22.4 0.3 16.5 512 Middle 86.7 69.4 3.7 25.0 0.5 13.6 463 Fourth 91.8 73.5 4.0 21.9 0.4 16.9 405 Highest 96.3 84.7 4.4 34.7 0.7 9.4 364 Total 87.1 64.9 3.6 23.6 0.4 14.4 2,257 Note: Figures in parentheses are based on 25-49 unweighted cases. na: Not applicable. 1 MICS indicator 46. Any adult has engaged in 4 or more activities to promote learning and school readiness in the past 3 days. 2 MICS Indicator 47. Father has provided one or more activities to promote learning and school readiness. Overall, with exception of child’s sex, the likelihood that at least one household member engaged a young child in at least four activities promoting early learning and school readiness varies significantly according to the child’s age and residence. Adults were more likely to engage in such activities with older children (73 percent) than with infants and toddlers younger than 2 years old (54 percent). Similarly, 77 percent of urban children compared with 53 percent of rural children participated in at least four learning activities with an adult in the household. Looking at the variation with other background characteristics, the proportion of children who were engaged in four or more activities promoting early learning and school readiness ranges from nearly 90 percent in Baku and Guba-Khachmaz to less than 30 percent among children from Daghligh Shirvan (28 percent). As expected, the likelihood that the child is engaged in four or more learning activities rises with parental educational level and caregiver’s wealth quintile. Six in ten children whose parents had the lowest level of education were engaged in at least four activities compared with 8 in 10 children 28 | Household Population and Housing Characteristics whose parents had university education. Twice as many children (85 percent) from the highest wealth quintile engaged in at least four activities with the adult compared with 46 percent of children in the lowest wealth quintile. Fathers clearly were less likely than mothers or other household members to be involved in early learning activities; about one quarter of children engaged in one or more activities that promote early learning with their fathers compared with 87 percent with any adult members of household. As expected, fathers were more likely to engage in such activities with older children (28 percent) than with infants and toddlers younger than 2 years old (19 percent). In Guba-Khachmaz, 43 percent of children benefited from engaging in at least one learning activity with their fathers, compared with 16 percent or less in Absheron, Aran, and Daghligh Shirvan. 2.5.3 Early Childhood Education Children attending specially designed pre-school education classes learn how to interact with peers in a structured learning environment. In the 2006 AzDHS, for all children age 36-59 months, mothers or the most knowledgeable adult was asked if the child attend any organized learning or early childhood education program, including kindergarten or community child care, conducted in a private or government facility. Table 2.14 Early childhood education Percentage of children age 36-59 months who are attending some form of organized early childhood program, Azerbaijan 2006 Background characteristic Percentage of children age 36-59 months currently attending early childhood education1 Number of children age 36-59 months Age in months 36-47 8.1 436 48-59 11.7 408 Sex Male 8.0 434 Female 11.8 410 Residence Urban 17.3 435 Rural 2.0 409 Region Baku 12.7 188 Absheron 28.5 64 Ganja-Gazakh 10.4 144 Shaki-Zaqatala 13.4 58 Lankaran 2.6 80 Guba-Khachmaz 2.7 40 Aran 4.9 215 Yukhari Garabakh 2.8 23 Daghligh Shirvan * 32 Mother’s education Basic secondary or less 4.0 231 Complete secondary 9.7 419 Secondary specialized 17.2 93 Higher 16.7 88 Mother not in household * 12 Wealth quintile Lowest 3.8 219 Second 3.6 172 Middle 8.9 157 Fourth 14.6 156 Highest 22.9 140 Total 9.9 844 Note: An asterisk indicates that a figure based on fewer than 25 unweighted cases and has been suppressed. 1 MICS indicator 52 Household Population and Housing Characteristics | 29 Table 2.14 indicates that only 10 percent of children age 3-4 years are currently attending early childhood education programs. Urban children are significantly more likely to be enrolled in such programs, compared with rural children (17 percent and 2 percent, respectively). Absheron region has the highest proportion of children in the country attending pre-school classes (29 percent). Children living in Lankaran, Guba-Khachmaz, and Yukhari Garabakh are the least likely to benefit from such programs (3 percent in each region). Maternal education and household wealth tend to be positively associated with a child’s participation in organized pre-school learning activities. For example, 23 percent of children from households in the highest wealth quintile are involved in some form of organized early childhood learning program outside the home compared with 4 percent of children from the poorest households. 2.5.4 Child Discipline Some parents believe that it is acceptable to punish children both verbally or physically in order to make them understand their parent’s expectations and what behavior is acceptable and what is not. Although often unrecognized by parents or other community members, child disciplinary practices that involve physical or verbal violence and abuse are detrimental for children’s health and physical and cognitive development. These actions also represent a violation of children’s rights. In the 2006 AzDHS, questions on child discipline were administered to mothers/caretakers or the most knowledgeable adult about one child age 2-14 years who was randomly selected during the household interview5. The questions asked referred to practices that may have been used to discipline the child during the month prior to the interview. Specifically, questions were asked about whether anyone in the household had: taken away privileges, forbade something this child liked, or did not allow this child to leave the house; explained why some behavior was wrong; shook this child; shouted, yelled, or screamed at the child; given the child something else to do; spanked, hit, or slapped on the bottom with bare hand; hit on the bottom or elsewhere on the body with something like a belt, hairbrush, stick, or other; called the child dumb, lazy, or similar name; hit or slapped on the face, head, or ears; hit or slapped on the hand, arm, or leg; beaten the child up with an implement. And finally, caretakers were directly asked if they believe that in order to bring up this child properly, they need to physically punish him/her. Table 2.15 shows that three in four children age 2-14 experienced some form of psychological or physical punishment during the past 30 days preceding the survey. Seventeen percent experienced only non-violent discipline while only 4 percent of children were not disciplined during the period. Boys tend to experience violence more often than girls. Rural children are slightly more likely than urban children to be punished physically. Twenty-two percent of mothers or the most knowledgeable adult believe that in order to bring up the child properly, the child needs to be physically punished. This percentage is similar among all the population, with a striking exception of caretakers from Yukhari Garabakh and Guba-Khachmaz where only 7 percent and 9 percent, respectively, of mothers believe in physical punishment, and 14 percent of mothers in Shaki-Zaqatala. Interestingly, children from Yukhari Garabakh and Shaki-Zaqatala are also among the least likely to have experienced severe physical punishment (7 percent each), but not the children from Guba- Khachmaz (19 percent). At the national level 17 percent of children have experienced severe physical punishment. Poverty and lack of education are positively associated with severe physical punishment; thus about a quarter of the children whose parents have the least education (24 percent) and from the poorest households (25 percent) were severely punished. The highest proportion of children that experienced severe physical punishment is from Daghligh Shirvan (27 percent). 5 If several children in the age 2-14 range were listed in the household schedule, only one child per household was randomly selected about whom the questions on child discipline were administered. If one child age 2-14 was listed in the household schedule, the questions on child discipline were administered about this child. If none of the children listed in the household schedule were age 2-14, the questions on child discipline were not administered. 30 | Household Population and Housing Characteristics Table 2.15 Child discipline Percentage of children age 2-14 years according to method of disciplining the child, Azerbaijan 2006 Background characteristic Percentage of children 2-14 years of age who experience: Mother/caretaker believes that the child needs to be physically punished Number of children3 Only non- violent discipline Psychological punishment Minor physical punish- ment Severe physical punish- ment1 Any psycho- logical or physical punishment2 No discipline or punish- ment Age 2-4 16.2 71.7 48.8 20.0 74.1 5.9 23.6 706 5-9 14.6 77.5 53.0 19.3 78.8 3.8 22.9 1,264 10-14 19.8 70.2 41.2 14.3 73.1 3.5 20.4 1,783 Sex Male 15.1 76.2 49.8 18.6 78.8 3.3 20.8 1,938 Female 19.9 69.4 43.1 15.3 71.4 4.9 22.9 1,815 Residence Urban 17.8 72.4 42.4 14.6 74.0 4.6 22.7 1,931 Rural 17.0 73.4 51.0 19.7 76.5 3.5 20.8 1,822 Region Baku 21.3 65.9 32.1 12.2 66.8 6.1 27.7 946 Absheron 6.7 87.6 59.5 20.7 88.3 4.2 23.7 225 Ganja-Gazakh 21.6 71.7 51.6 23.3 74.9 2.0 17.9 516 Shaki-Zaqatala 20.1 68.2 46.2 7.0 71.6 3.5 14.3 275 Lankaran 8.9 82.0 52.5 18.2 83.3 1.8 25.1 366 Guba-Khachmaz 8.3 84.8 51.3 19.3 86.5 4.8 9.2 215 Aran 19.0 71.4 49.6 19.1 75.2 3.8 22.7 983 Yukhari Garabakh 14.5 68.0 46.8 7.4 70.5 11.1 6.9 93 Daghligh Shirvan 13.9 82.3 62.1 26.6 84.6 1.4 22.8 133 Mother’s education Basic secondary or less 15.5 75.6 53.0 23.8 78.5 3.1 23.7 730 Complete secondary 17.2 73.4 47.7 17.6 75.7 3.8 22.7 2,036 Secondary specialized 15.7 76.0 43.6 13.0 78.1 5.1 16.7 503 Higher 22.6 65.1 35.8 8.2 66.8 4.6 22.2 384 Mother not in household 23.2 58.1 33.2 9.6 58.7 9.4 14.5 99 Wealth quintile Lowest 15.8 76.4 55.1 25.2 79.5 2.0 22.9 921 Second 16.9 74.4 48.3 15.8 75.7 4.3 19.2 725 Middle 17.3 70.7 46.1 15.3 74.2 4.5 23.5 776 Fourth 19.5 72.0 45.6 15.5 73.5 3.9 20.5 689 Highest 17.9 69.9 34.1 10.4 71.6 6.4 22.6 642 Total 17.4 72.9 46.6 17.0 75.2 4.1 21.8 3,753 1 Hit or slapped on the face, head, or ears or beaten with an implement during the past 30 days 2 MICS indicator 74 3 Table is based on children aged 2-14 years randomly selected during fieldwork (one child selected per household, if any children in the age range) about whom the questions on child discipline were administered. Background Characteristics of Respondents | 31 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 The purpose of this chapter is to provide a demographic and socioeconomic profile of the 2006 AzDHS sample. Information on the basic characteristics of women and men interviewed in the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. For tables in this report that relate to the general adult population, the base population includes women and men age 15-49. For the male tables, an ad- ditional row has been added to provide information for all men age 15-59. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 presents the percent distribution of interviewed women and men age 15-49 by background characteristics including age, marital status, educational level, place of residence, and region. As noted in Chapter 1, all women age 15-49 who were usual residents or present in the house- hold on the night before the interviewer’s visit were eligible to be interviewed in the 2006 AzDHS. Men age 15-49 meeting the same criteria were interviewed in every third household. In order not to double count respondents, the tables in this report are based on the de facto population, that is, those who stayed in the household the previous night. For the most part, the male and female populations represented in the sample are fairly evenly distributed by age. However, there is a somewhat greater differential between women and men in their teens and early twenties than in older age groups. Two-thirds of respondents are married or living together (62 percent of women and 61 percent of men). Four percent of women are divorced or separated and 3 percent are widowed, as opposed to one percent or less of men. Thirty-one percent of women and 38 percent of men have never been mar- ried. Slightly over half of women and men are from urban areas, with the majority living in Baku. Looking at the distribution by region, two-thirds of the 2006 AzDHS respondents are from Baku, Aran, and Ganja-Gazakh, the country’s three most populous regions. Woman and men in Azerbaijan are universally well educated. About 70 percent of women and men have at least basic secondary education or complete secondary.1 Fourteen percent of women have attended a secondary specialized,2 as have 9 percent of men. More men (19 percent) than women (13 percent) have higher education. At least 94 percent of respondents are Azerbaijani. Almost all Azerbaijanis (99 percent) report Islam as their religion. 1 Education categories refer to the highest level of education attended, whether or not that level was completed. Basic sec- ondary or less is defined as having completed middle school (grades 5-9) and primary school (grades 1-4) or less. Complete secondary level is defined as having completed high school at grade 10 (old system) or grade 11 (new system) or having attained primary professional (vocational) education (PTU). See chapter 2 for more details on definitions of the educational categories. 2 “Secondary specialized” education is specialized technical training in a specific field such as nursing, agriculture, construction, etc. 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, Azerbaijan,2006 Background characteristic Women Men Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 18.1 1,531 1,509 17.0 382 388 20-24 15.9 1,344 1,329 15.8 356 363 25-29 13.0 1,100 1,108 13.0 293 296 30-34 11.9 1,008 1,003 12.4 279 272 35-39 13.7 1,160 1,168 13.8 309 308 40-44 15.6 1,319 1,309 13.9 312 317 45-49 11.6 982 1,018 14.0 315 309 Marital status Never married 30.9 2,608 2,645 37.8 848 852 Married 62.2 5,251 5,236 60.5 1,358 1,357 Living together 0.2 18 24 0.6 13 17 Divorced/separated 4.0 339 308 1.0 23 23 Widowed 2.7 228 231 0.1 3 4 Residence Urban 56.5 4,772 4,478 56.8 1,274 1,181 Rural 43.5 3,672 3,966 43.2 971 1,072 Region Baku 30.3 2,560 1,312 31.1 699 368 Absheron 6.9 582 875 7.4 167 250 Ganja-Gazakh 13.6 1,148 831 12.5 281 206 Shaki-Zaqatala 7.0 589 828 6.8 153 219 Lankaran 8.4 706 989 8.4 188 251 Guba-Khachmaz 4.5 380 735 5.3 119 223 Aran 23.9 2,019 1,332 22.6 508 339 Yukhari Garabakh 2.4 204 701 2.5 56 180 Daghligh Shirvan 3.0 255 841 3.3 73 217 Education Basic secondary or less 21.5 1,815 1,933 15.4 345 406 Complete secondary 51.9 4,382 4,412 56.7 1,272 1,284 Secondary specialized 13.5 1,138 1,141 8.9 200 203 Higher 13.1 1,110 958 19.1 428 360 Wealth quintile Lowest 18.4 1,550 1,757 18.3 410 473 Second 19.5 1,649 1,825 19.3 433 464 Middle 20.2 1,707 1,873 20.1 452 510 Fourth 20.4 1,719 1,635 20.1 451 446 Highest 21.5 1,819 1,354 22.2 499 360 Religion1 Muslim 99.2 8,379 8,381 99.4 2,232 2,241 Christian/no religion/other 0.7 61 59 0.6 13 11 Ethnic group 2 Azerbaijani 94.0 7,939 7,761 95.5 2,145 2,117 Talish/Russian/Lesgin/other 5.9 501 678 4.4 99 135 Total 15-49 100.0 8,444 8,444 100.0 2,245 2,253 50-59 na na na 0.0 313 305 Total 15-59 na na na 0.0 2,558 2,558 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Basic secondary or less defined as having completed middle school (grades 5-9) and primary school (grades 1-4) or less. Complete secondary level defined as having completed high school at grade 10 (old system) or grade 11 (new system) or having attained primary professional (vocational) education (PTU). na = Not applicable 1 Total includes 3 women and 1 man with information on religion missing. 2 Total includes 4 women and 1 man with information on ethnicity missing. 3.2 EDUCATIONAL LEVEL OF RESPONDENTS Tables 3.2.1 and 3.2.2 show the educational level of female and male respondents by selected background characteristics. The results reflect the fact that education has been almost universal in Azerbaijan for some time. Overall, only 1 percent of respondents have never attended school, and the majority have attained at least a basic secondary or higher education. The median years of schooling for women is 9.9 years and for men is 10.2 years. Background Characteristics of Respondents | 33 Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Azerbaijan 2006 Background characteristic Highest level of schooling Total Basic sec- ondary3 Complete secondary4 Number of women Median number of years of schooling No education Primary school (1-4) Middle school (5-9) Upper school (10-11) PTU1 Secondary specialized2 Higher Age 15-24 1.4 2.8 25.8 46.4 0.9 10.0 12.7 100.0 87.0 69.9 2,875 10.2 15-19 1.6 2.8 30.9 52.0 0.7 5.0 6.9 100.0 86.9 64.3 1,531 9.9 20-24 1.0 2.8 19.9 40.1 1.2 15.8 19.3 100.0 87.2 76.1 1,344 10.6 25-29 1.1 1.0 23.2 41.6 2.2 14.9 15.9 100.0 85.4 74.4 1,100 10.4 30-34 0.7 0.7 15.3 53.0 3.8 14.8 11.7 100.0 86.9 83.4 1,008 9.9 35-39 0.5 1.0 11.9 53.9 5.0 15.7 12.0 100.0 88.0 86.6 1,160 9.7 40-44 1.3 0.8 10.6 53.1 5.9 15.9 12.4 100.0 88.2 87.3 1,319 9.7 45-49 1.4 1.5 15.5 47.6 4.3 14.6 15.1 100.0 83.2 81.6 982 9.7 Residence Urban 0.6 1.2 15.6 43.2 3.1 16.8 19.5 100.0 89.3 82.5 4,772 10.3 Rural 1.8 2.2 22.8 56.0 3.2 9.1 4.9 100.0 83.2 73.2 3,672 9.7 Region Baku 0.4 0.9 12.5 41.9 3.1 16.1 25.1 100.0 91.8 86.0 2,560 10.5 Absheron 0.9 0.5 17.3 42.4 2.9 21.0 15.1 100.0 89.6 81.3 582 10.3 Ganja-Gazakh 0.4 0.9 18.6 52.5 2.3 13.3 12.1 100.0 87.9 80.0 1,148 9.9 Shaki-Zaqatala 1.0 1.4 16.9 44.9 6.8 19.5 9.4 100.0 92.7 80.6 589 10.2 Lankaran 1.5 3.1 26.4 57.9 2.6 5.7 2.7 100.0 78.4 68.9 706 9.5 Guba-Khachmaz 0.2 1.0 32.5 53.0 1.5 7.5 4.3 100.0 83.9 66.3 380 9.5 Aran 2.1 2.7 22.5 53.4 3.1 10.3 6.0 100.0 81.1 72.7 2,019 9.7 Yukhari Garabakh 2.5 1.3 15.9 53.8 5.9 13.0 7.6 100.0 86.4 80.3 204 9.9 Daghligh Shirvan 4.4 2.9 19.7 52.4 2.8 13.6 4.3 100.0 80.5 73.1 255 9.7 Wealth quintile Lowest 3.0 3.2 29.5 53.4 4.0 5.6 1.4 100.0 76.0 64.2 1,550 9.4 Second 1.4 2.3 25.2 54.9 3.8 8.4 3.9 100.0 82.3 71.0 1,649 9.6 Middle 0.7 1.4 19.2 53.6 2.7 14.2 8.2 100.0 86.2 78.7 1,707 9.8 Fourth 0.2 0.7 13.3 45.7 2.5 22.0 15.6 100.0 91.7 85.4 1,719 10.4 Highest 0.5 0.6 8.3 37.7 3.0 16.1 33.8 100.0 95.3 90.5 1,819 11.0 Total 1.1 1.6 18.7 48.8 3.2 13.5 13.1 100.0 86.7 78.5 8,444 9.9 1 PTU is a primary professional (vocational) education institution that trains students in a variety of manual or basic skills occupations. 2 Secondary specialized provides secondary-special education and prepares specialists with mid-level qualifications, such as nurses, midwives, musicians, technicians, and others. This level is somewhat higher than complete secondary education, but lower than high education. 3 Completed grade 9 or higher 4 Completed grade 10 or higher Although virtually all female respondents had attended secondary school, there are marked differences across subgroups of the population in the proportions who have gone beyond that level. For example, Table 3.2.1 shows that 20 percent of urban women have university education compared with only 5 percent of rural women. There also is considerable variation by region, with the largest proportion of university-educated women living in Baku (25 percent) and the smallest proportions in Lankaran (3 percent) and in Guba-Khachmaz and Daghligh Shirvan (4 percent). Attainment of a high- er education is closely related to wealth status; 34 percent of women in the highest wealth quintile have at least some university education, compared with 1 percent of women in the lowest quintile. Overall, the median number of years of schooling varies from 9.4 years among women in the lowest wealth quintile to 11.0 years among those in the highest quintile. 34 | Background Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Azerbaijan 2006 Background characteristic Highest level of schooling Total Basic secondary3 Complete secondary4 Number of men Median number of years of schooling No education Primary school (1-4) Middle school (5-9) Upper school (10-11) PTU1 Secondary specia- lized2 Higher Age 15-24 0.6 0.8 24.5 52.3 2.8 2.6 16.3 100.0 91.0 74.1 738 10.2 15-19 0.5 0.1 35.3 52.3 2.5 1.7 7.6 100.0 88.4 64.1 382 9.6 20-24 0.8 1.5 12.9 52.4 3.2 3.6 25.7 100.0 93.8 84.8 356 10.6 25-29 0.0 0.0 15.1 53.1 6.5 7.8 17.5 100.0 92.1 84.9 293 10.5 30-34 0.6 0.3 9.2 48.5 7.8 8.5 25.1 100.0 91.3 89.9 279 10.3 35-39 0.0 0.3 8.5 52.7 12.7 10.8 15.0 100.0 91.9 90.9 309 9.8 40-44 0.2 0.0 9.1 40.2 11.3 16.6 22.5 100.0 91.2 90.5 312 10.2 45-49 0.1 1.0 7.2 41.1 12.9 15.5 22.2 100.0 92.1 91.7 315 9.9 Residence Urban 0.2 0.1 12.3 42.5 7.7 10.7 26.6 100.0 93.1 87.4 1,274 10.6 Rural 0.5 1.0 17.7 57.0 8.1 6.6 9.1 100.0 89.3 80.7 971 9.9 Region Baku 0.0 0.0 7.4 41.3 5.7 9.3 36.4 100.0 96.5 92.5 699 10.9 Absheron 1.0 0.1 15.1 44.1 9.6 10.5 19.5 100.0 91.8 83.7 167 10.4 Ganja-Gazakh 0.0 0.4 18.3 48.1 10.2 8.7 14.2 100.0 86.6 81.2 281 10.1 Shaki-Zaqatala 0.0 0.5 23.2 40.6 11.6 12.5 11.5 100.0 92.3 76.3 153 9.9 Lankaran 0.4 1.3 15.2 65.9 5.5 4.1 7.5 100.0 86.2 82.7 188 10.0 Guba-Khachmaz 0.3 0.0 27.1 55.2 6.3 7.8 3.2 100.0 88.8 72.5 119 9.7 Aran 0.7 1.0 15.5 55.4 8.2 8.7 10.5 100.0 90.9 82.8 508 10.0 Yukhari Garabakh 1.9 1.0 13.6 48.3 15.9 10.2 9.1 100.0 86.5 83.6 56 10.3 Daghligh Shirvan 0.0 0.6 23.4 49.5 8.2 8.7 9.7 100.0 85.8 76.0 73 10.0 Wealth quintile Lowest 0.6 0.7 27.0 54.4 9.0 5.6 2.7 100.0 83.4 71.7 410 9.6 Second 0.7 1.4 17.8 53.3 11.9 7.2 7.6 100.0 87.7 80.0 433 9.9 Middle 0.1 0.4 17.7 51.5 7.8 11.2 11.4 100.0 89.7 81.7 452 10.1 Fourth 0.1 0.0 7.3 58.5 8.3 7.7 18.1 100.0 97.2 92.3 451 10.3 Highest 0.2 0.0 5.5 28.9 3.1 12.1 50.3 100.0 97.8 94.4 499 13.1 Total 15-49 0.3 0.5 14.6 48.7 7.9 8.9 19.1 100.0 91.5 84.5 2,245 10.2 50-59 0.4 0.2 8.5 30.3 8.9 21.1 30.5 100.0 91.3 90.8 313 12.2 Total 15-59 0.3 0.4 13.9 46.5 8.0 10.4 20.5 100.0 91.5 85.3 2,558 10.3 1 PTU is a primary professional (vocational) education institution that trains students in a variety of manual or basic skills occupations. 2 Secondary specialized provides secondary-special education and prepares specialists with mid-level qualifications, such as nurses, midwives, musicians, techni- cians and others. This level is somewhat higher than complete secondary education, but lower than high education. 3 Completed grade 9 or higher 4 Completed grade 10 or higher As Table 3.2.2 shows, the pattern of educational attainment among men is similar to that of women. Twenty-seven percent of urban men have some university-level education, compared with 9 percent of rural men. Baku residents have a clear educational advantage over the rest of the country: 36 percent of men in Baku are university-educated compared with only 3 percent in Guba-Khachmaz. Wealth status is positively associated with education; while 3 percent of men in the lowest wealth quintile have higher education, the corresponding proportion for men in the highest wealth quintile is 50 percent. Men from the wealthiest households have, on average, an additional 3.5 years of schooling compared to men in the poorest households. This is an even larger difference than that observed among women. 3.3 EXPOSURE TO MASS MEDIA The 2006 AzDHS collected information on the exposure of women and men to both broadcast and print media. This information is important because it can help program managers plan the disse- mination of information on health, family planning, nutrition, and other programs. The results are pre- sented in Tables 3.3.1 and 3.3.2. At least once a week, 92 percent of Azerbaijani women watch television, 25 percent read a newspaper, and 28 percent listen to the radio (Table 3.3.1). Only 7 percent do not regularly have ex- posure to any of the three media, while 15 percent are exposed to all three media on a weekly basis. Women under age 25 were more likely than older women to report exposure to all three types of media. Exposure to all forms of media also is strongly associated with residence, education, and Background Characteristics of Respondents | 35 wealth. Urban women were more than three times as likely to be exposed to television, radio, and newspapers as their rural counterparts. Similarly, women from Baku and Absheron were markedly more likely have been exposed to all of the media than women from other regions. Forty-four percent of women with a higher education were exposed to all three media compared with 6 percent of wom- en with basic secondary or less education. Thirty-four percent of women in the highest wealth quintile were exposed to all three media, while the corresponding proportion for women in the lowest wealth quintile was only 3 percent. 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 characte- ristics, Azerbaijan 2006 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 33.8 94.1 36.7 20.2 5.3 1,531 20-24 26.0 92.1 35.4 18.3 7.0 1,344 25-29 22.1 93.0 29.2 14.0 6.1 1,100 30-34 19.6 92.8 25.4 10.4 6.0 1,008 35-39 22.6 90.9 23.1 12.6 8.5 1,160 40-44 23.7 90.0 22.4 12.8 9.3 1,319 45-49 22.3 89.5 20.8 11.2 10.0 982 Residence Urban 33.7 95.5 39.4 21.6 3.7 4,772 Rural 13.4 87.1 13.7 5.7 12.2 3,672 Region Baku 39.3 97.2 51.3 28.2 2.0 2,560 Absheron 39.3 93.5 39.3 25.1 6.2 582 Ganja-Gazakh 16.9 87.9 13.8 6.2 10.9 1,148 Shaki-Zaqatala 22.1 91.9 14.0 8.0 6.6 589 Lankaran 12.7 87.6 18.4 8.8 11.5 706 Guba-Khachmaz 11.6 93.1 12.2 3.8 6.6 380 Aran 15.9 87.9 16.7 6.9 11.8 2,019 Yukhari Garabakh 19.3 94.4 10.3 4.4 4.3 204 Daghligh Shirvan 18.6 91.4 25.7 10.6 7.6 255 Education Basic secondary or less 10.9 84.7 20.5 5.8 14.5 1,815 Complete secondary 18.1 92.0 22.5 9.7 7.4 4,382 Secondary specialized 33.9 96.1 34.7 19.4 2.7 1,138 Higher 65.1 98.6 56.6 44.2 0.5 1,110 Wealth quintile Lowest 8.8 79.0 7.3 3.1 20.1 1,550 Second 12.3 89.8 14.5 4.2 9.6 1,649 Middle 20.6 93.6 21.4 9.4 6.0 1,707 Fourth 32.4 96.9 37.4 20.0 1.9 1,719 Highest 46.9 98.3 56.2 34.0 1.1 1,819 Total 24.9 91.9 28.2 14.7 7.4 8,444 In general, men report a higher level of exposure to all types of media than women (Table 3.3.2). Almost all men watch television, half of men (48 percent) listen to the radio, and 33 percent read a newspaper at least once a week. Only 4 percent are not regularly exposed to mass media. Around a quarter are exposed to all three types of media on a weekly basis. Table 3.3.2 shows that, for men, the relationships between exposure to mass media and back- ground characteristics are generally similar to those observed among women. However, interestingly, men have a somewhat different pattern of media exposure by age than women. While younger women are more likely than older women to report exposure to all three types of media on a weekly basis, younger men are generally less likely than older men to be exposed to all three media, partly because they are less likely to read a newspaper on a weekly basis. 36 | Background Characteristics of Respondents Table 3.3.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteris- tics, Azerbaijan 2006 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 30.5 94.8 53.1 22.3 3.1 382 20-24 28.0 94.4 52.2 22.3 4.4 356 25-29 35.9 97.9 52.8 28.3 2.1 293 30-34 34.0 95.7 43.6 22.7 2.8 279 35-39 28.7 92.5 42.3 20.1 5.2 309 40-44 35.8 93.4 47.1 24.7 4.4 312 45-49 39.8 94.0 41.6 24.7 4.6 315 Residence Urban 42.7 97.5 55.5 32.0 1.5 1,274 Rural 20.4 90.9 37.7 12.3 6.9 971 Region Baku 57.4 99.5 64.6 44.4 0.5 699 Absheron 31.8 95.6 68.6 27.1 1.6 167 Ganja-Gazakh 9.4 83.5 13.9 5.8 15.1 281 Shaki-Zaqatala 22.9 97.6 55.3 15.8 1.5 153 Lankaran 20.5 93.4 46.8 13.4 4.9 188 Guba-Khachmaz 7.5 97.9 20.1 4.4 2.1 119 Aran 29.4 92.1 41.2 15.8 4.0 508 Yukhari Garabakh 17.8 98.5 34.7 7.0 0.0 56 Daghligh Shirvan 26.4 96.0 58.8 22.2 3.5 73 Education Basic secondary or less 13.9 89.5 37.1 9.6 7.9 345 Complete secondary 22.8 94.2 42.8 15.8 4.3 1,272 Secondary specialized 46.3 97.8 47.0 27.9 1.2 200 Higher 72.8 98.6 71.8 55.5 0.5 428 Wealth quintile Lowest 13.6 86.6 31.0 7.7 10.3 410 Second 21.9 92.2 35.1 13.3 5.2 433 Middle 23.2 97.4 39.5 12.2 1.8 452 Fourth 39.0 97.4 58.1 30.3 1.7 451 Highest 62.2 98.4 70.9 49.4 1.0 499 Total 15-49 33.0 94.6 47.8 23.5 3.8 2,245 50-59 50.6 97.2 46.0 29.6 1.5 313 Total 15-59 35.2 95.0 47.6 24.2 3.5 2,558 3.4 EMPLOYMENT In the 2006 AzDHS, respondents were asked about their employment status at the time of the survey and, if they were not currently employed, about any work they may have done in the 12 months prior to the survey.3 All employed respondents were asked additional questions about their occupation; whether they were paid in cash, in kind, or not at all; and for whom they worked. Tables 3.4.1 and 3.4.2 show the percent distribution of female and male respondents by employment status according to background characteristics. Twenty percent of women reported being currently employed, 1 percent was employed in the 12 months preceding the survey but not working at the time of the survey, and 79 percent were not employed in the 12 months preceding the survey (Figure 3.1). 3 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 women’s employment, therefore, the questions relating to employment in the woman’s questionnaire encouraged women to report such activities. First, women were asked, “Aside from your own housework, have you done any work in the last seven days?” Women who answered “No” to this question were then asked, “As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business, or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?” Background Characteristics of Respondents | 37 Figure 3.1 Percent distribution of women and men age 15-49, by employment status Currently employed 20% Not currently employed 1% No work past 12 months 79% Currently employed 65% Not currently employed 6% No work past 12 months 29% AzDHS 2006 Women Men Three times as many men as women reported being currently employed (65 percent versus 20 percent). Nonetheless, nearly one-third of men reported that they were not employed during the 12 months preceding the survey (29 percent). Looking at the differentials in employment status, women who are formerly married are more likely than other women to be employed at the time of the survey (Table 3.4.1). For men, those who are currently married are most likely to be employed. Employment among women and men generally increases with age. Women and men living in urban areas are slightly more likely to report they are currently employed than their rural counterparts. Employment among women is highest in Yukhari Garabakh (28 percent), followed by Baku and Shaki-Zaqatala (24 percent each), while in Lankaran the proportion of currently employed is only 7 percent. For men, the current employment rate ranges from 54 percent in Ganja-Gazakh and Daghligh Shirvan to 73 percent in Baku. The likelihood that a woman is currently employed rises with both her education level and wealth quintile. Among men, the employment rate also tends to increase with education and wealth, although the relationships are not as uniform as among women. 38 | Background Characteristics of Respondents Table 3.4.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Azerbaijan 2006 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 2.5 0.2 97.1 100.0 1,531 20-24 10.1 1.8 88.0 100.0 1,344 25-29 19.2 1.6 79.2 100.0 1,100 30-34 20.6 1.6 77.8 100.0 1,008 35-39 26.2 2.2 71.6 100.0 1,160 40-44 31.6 1.5 66.9 100.0 1,319 45-49 34.2 1.2 64.6 100.0 982 Marital status Never married 14.4 1.1 84.4 100.0 2,608 Married or living together 19.3 1.6 79.1 100.0 5,269 Divorced/separated/widowed 45.5 1.3 53.2 100.0 567 Number of living children 0 14.3 1.3 84.3 100.0 3,208 1-2 23.0 1.6 75.4 100.0 3,254 3-4 22.8 1.2 76.0 100.0 1,827 5+ 17.1 1.6 81.3 100.0 154 Residence Urban 21.6 1.3 77.0 100.0 4,772 Rural 16.8 1.5 81.7 100.0 3,672 Region Baku 23.6 0.6 75.8 100.0 2,560 Absheron 17.7 4.1 78.1 100.0 582 Ganja-Gazakh 19.6 1.9 78.5 100.0 1,148 Shaki-Zaqatala 23.6 1.7 74.7 100.0 589 Lankaran 6.5 0.0 93.5 100.0 706 Guba-Khachmaz 15.9 0.9 83.1 100.0 380 Aran 19.0 1.5 79.4 100.0 2,019 Yukhari Garabakh 27.7 1.8 70.5 100.0 204 Daghligh Shirvan 12.8 3.3 83.9 100.0 255 Education Basic secondary or less 10.2 0.6 89.1 100.0 1,815 Complete secondary 14.3 0.9 84.8 100.0 4,382 Secondary specialized 34.8 2.3 62.9 100.0 1,138 Higher 39.9 4.0 56.2 100.0 1,110 Wealth quintile Lowest 16.9 1.3 81.7 100.0 1,550 Second 15.9 1.0 83.1 100.0 1,649 Middle 19.4 1.6 79.0 100.0 1,707 Fourth 20.2 1.4 78.4 100.0 1,719 Highest 24.6 1.7 73.7 100.0 1,819 Total 19.5 1.4 79.0 100.0 8,444 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Background Characteristics of Respondents | 39 Table 3.4.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Azerbaijan 2006 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 13.1 2.5 84.2 100.0 382 20-24 49.8 4.7 45.3 100.0 356 25-29 80.5 4.3 15.0 100.0 293 30-34 79.3 9.3 10.0 100.0 279 35-39 84.2 6.9 9.0 100.0 309 40-44 79.6 10.2 10.2 100.0 312 45-49 83.9 7.9 8.1 100.0 315 Marital status Never married 35.7 3.7 60.5 100.0 848 Married or living together 82.9 7.9 8.9 100.0 1,371 Divorced/separated/widowed (69.3) (13.8) (16.9) 100.0 26 Number of living children 0 41.5 4.5 53.9 100.0 996 1-2 84.3 7.8 7.4 100.0 748 3-4 82.2 8.4 9.4 100.0 470 5+ (86.2) (0.7) (13.0) 100.0 31 Residence Urban 67.7 4.4 27.8 100.0 1,274 Rural 61.1 8.9 29.5 100.0 971 Region Baku 73.3 2.6 24.1 100.0 699 Absheron 55.5 2.0 42.2 100.0 167 Ganja-Gazakh 53.9 17.4 27.3 100.0 281 Shaki-Zaqatala 57.6 8.3 34.1 100.0 153 Lankaran 65.0 5.1 29.2 100.0 188 Guba-Khachmaz 69.6 2.2 28.2 100.0 119 Aran 66.3 6.5 27.2 100.0 508 Yukhari Garabakh 54.8 6.4 38.8 100.0 56 Daghligh Shirvan 53.9 14.5 31.7 100.0 73 Education Basic Secondary or less 47.9 6.2 45.6 100.0 345 Complete secondary 64.5 7.3 27.9 100.0 1,272 Secondary specialized 76.9 8.0 15.1 100.0 200 Higher 74.0 3.1 22.9 100.0 428 Wealth quintile Lowest 63.8 11.7 24.3 100.0 410 Second 55.3 8.4 36.0 100.0 433 Middle 64.7 6.5 28.3 100.0 452 Fourth 69.6 3.4 26.8 100.0 451 Highest 69.9 2.8 27.3 100.0 499 Total 15-49 64.9 6.4 28.5 100.0 2,245 50-59 77.5 3.7 18.5 100.0 313 Total 15-59 66.4 6.0 27.3 100.0 2,558 Note: Figures in parentheses are based on 25 to 49 unweighted cases. 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 3.5 OCCUPATION Information on a woman’s occupation not only allows an evaluation of the woman’s source of income but also has implications for her empowerment. In the survey, respondents who indicated that they were currently working or had been employed in the 12-month period prior to the survey were asked about the kind of work that they did. Their responses were recorded verbatim and served as the basis for the coding of occupation that occurred in the central office. Table 3.5.1 shows the percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics. 40 | Background Characteristics of Respondents Table 3.5.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation1, according to background characteris- tics, Azerbaijan 2006 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 (14.1) (3.9) (26.8) (5.3) (1.6) (47.1) (1.2) 100.0 42 20-24 52.8 4.2 12.8 8.3 1.6 15.6 3.1 100.0 161 25-29 60.9 3.1 12.1 5.0 3.1 15.8 0.0 100.0 229 30-34 53.0 4.5 8.7 4.7 10.4 17.6 1.1 100.0 224 35-39 46.0 6.4 11.9 6.8 9.0 19.3 0.7 100.0 329 40-44 49.9 3.4 13.6 5.6 11.4 14.9 1.1 100.0 436 45-49 47.5 3.9 14.9 7.1 14.1 12.1 0.4 100.0 348 Marital status Never married 48.0 6.4 17.2 6.9 2.9 17.2 1.2 100.0 404 Married or living together 53.6 3.3 8.1 4.3 10.5 18.9 1.1 100.0 1,100 Divorced/separated/widowed 37.8 4.9 26.6 12.6 13.0 5.1 0.0 100.0 265 Number of living children 0 50.3 5.3 17.7 6.3 3.0 16.1 1.4 100.0 502 1-2 55.7 3.6 12.8 5.4 10.5 10.8 0.8 100.0 799 3-4 41.8 4.1 7.1 7.8 12.4 26.5 0.4 100.0 439 5+ (6.2) (5.1) (26.7) (0.0) (29.1) (28.3) (4.6) 100.0 29 Residence Urban 57.7 5.4 17.1 8.4 9.6 1.1 0.7 100.0 1,097 Rural 37.3 2.4 6.2 2.6 8.5 41.5 1.3 100.0 672 Region Baku 59.6 6.0 17.3 6.4 10.3 0.0 0.4 100.0 619 Absheron 48.3 5.3 25.7 13.6 6.5 0.1 0.5 100.0 127 Ganja-Gazakh 47.1 1.8 11.7 8.6 6.3 24.5 0.0 100.0 247 Shaki-Zaqatala 55.9 2.1 7.6 3.9 9.9 17.7 2.8 100.0 149 Lankaran 53.1 0.0 18.0 10.3 9.3 9.3 0.0 100.0 46 Guba-Khachmaz 26.6 0.5 13.0 4.5 11.9 42.5 0.9 100.0 64 Aran 41.0 4.5 6.8 3.1 6.7 35.8 1.4 100.0 415 Yukhari Garabakh 39.0 4.2 4.3 0.3 15.5 33.7 3.1 100.0 60 Daghligh Shirvan 43.1 5.5 4.5 9.0 26.1 9.8 2.1 100.0 41 Education Basic secondary or less 10.6 1.7 21.5 4.7 17.9 41.3 0.9 100.0 196 Complete secondary 16.5 4.8 18.7 12.3 17.5 29.3 0.8 100.0 665 Secondary specialized 71.4 6.5 11.1 3.9 2.4 3.6 1.0 100.0 422 Higher 92.7 2.6 3.3 0.3 0.0 0.0 1.1 100.0 486 Wealth quintile Lowest 19.8 2.5 9.0 3.7 12.3 51.1 1.2 100.0 282 Second 39.8 1.2 9.3 6.1 10.0 32.6 1.1 100.0 278 Middle 49.4 4.6 10.8 7.4 12.6 13.7 1.1 100.0 359 Fourth 54.8 6.7 18.5 9.8 7.9 2.0 0.2 100.0 371 Highest 70.2 4.9 14.8 3.8 5.2 0.0 1.1 100.0 478 Total 49.9 4.2 13.0 6.2 9.2 16.5 0.9 100.0 1,769 Note: Figures in parentheses are based on 25 to 49 unweighted cases. 1 The occupational categories are according to the National Occupational Classification, which is based on and similar to ISCO-88 (International Standard Classification of Occupations). For the definitions of the occupational categories and for more detailed information and examples, please visit http://www.ilo.org/public/english/bureau/stat/isco/isco88/index.htm. Half of employed women are in professional, technical, or managerial positions, and 13 per- cent are employed in sales and services. Approximately two in ten women work in agriculture. More than half of urban women, eight in ten women with secondary specialized or higher education, and seven in ten women living in households in the highest wealth quintile hold profes- sional, technical, or managerial jobs. Six in ten employed women in Baku work in professional posi- tions while only around one in four women in Guba-Khachmaz works in these occupations. On the other hand, over 40 percent of women in Guba-Khachmaz were engaged in agricultural jobs. Table 3.5.2 shows that among employed men, 19 percent hold professional, technical, or managerial jobs, 16 percent are in sales and services, 42 percent work as skilled manual laborers, and 15 percent work in agriculture. The variations across subgroups in the occupational profile among employed men are generally similar to those observed among women. Background Characteristics of Respondents | 41 Table 3.5.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation1, according to background characteris- tics, Azerbaijan 2006 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 0.0 0.0 14.3 34.2 17.6 25.4 8.6 100.0 60 20-24 11.8 0.6 25.0 43.7 4.8 12.5 1.6 100.0 194 25-29 16.7 0.9 19.0 42.3 4.6 15.6 1.0 100.0 248 30-34 20.4 2.4 17.5 38.9 4.9 13.1 2.7 100.0 247 35-39 16.5 0.0 13.2 42.7 8.5 17.5 1.6 100.0 281 40-44 21.8 0.9 13.5 42.9 5.1 14.2 1.5 100.0 280 45-49 25.7 0.9 10.4 45.0 3.2 14.1 0.7 100.0 289 Marital status Never married 12.8 0.3 23.2 40.1 7.8 13.0 2.9 100.0 334 Married or living together 20.2 1.1 13.5 43.1 4.9 15.7 1.5 100.0 1,244 Divorced/separated/widowed * * * * * * * 100.0 21 Number of living children 0 14.5 0.2 21.1 41.3 7.1 13.5 2.4 100.0 457 1-2 22.1 1.3 13.9 41.2 5.8 13.8 2.0 100.0 689 3-4 17.8 1.1 13.8 44.6 4.1 17.5 0.9 100.0 425 5+ (9.9) (0.0) (4.7) (51.8) (0.0) (33.6) (0.0) 100.0 27 Residence Urban 23.0 0.9 18.3 48.4 6.0 2.2 1.1 100.0 920 Rural 12.5 0.9 12.3 34.0 5.2 32.4 2.6 100.0 680 Region Baku 28.0 0.5 18.1 45.3 6.7 0.7 0.7 100.0 530 Absheron 19.5 0.9 19.5 52.8 5.5 0.1 1.7 100.0 96 Ganja-Gazakh 15.6 1.6 8.6 44.2 3.9 24.1 2.0 100.0 201 Shaki-Zaqatala 17.0 0.0 17.6 34.1 5.8 22.4 3.1 100.0 101 Lankaran 12.4 2.3 19.9 49.8 5.1 6.1 4.4 100.0 132 Guba-Khachmaz 6.2 0.5 17.4 34.5 3.1 36.2 2.1 100.0 86 Aran 13.3 0.8 13.6 36.6 5.7 28.0 2.0 100.0 370 Yukhari Garabakh 15.8 4.4 7.8 29.4 9.2 33.4 0.0 100.0 34 Daghligh Shirvan 9.7 0.5 16.9 44.1 4.2 22.8 1.8 100.0 50 Education Basic secondary or less 0.5 0.4 13.9 50.1 6.8 26.3 2.0 100.0 187 Complete secondary 4.9 1.0 16.2 50.8 6.7 18.6 1.8 100.0 913 Secondary specialized 26.6 0.5 16.3 41.1 4.3 9.5 1.7 100.0 169 Higher 62.5 1.1 15.3 14.9 2.9 1.6 1.7 100.0 330 Wealth quintile Lowest 6.2 0.6 11.2 30.9 8.3 41.4 1.4 100.0 310 Second 10.5 1.5 10.8 45.1 3.9 25.3 2.9 100.0 275 Middle 16.2 1.2 17.9 45.2 5.2 11.4 3.0 100.0 322 Fourth 15.0 0.4 18.8 57.2 6.2 1.8 0.5 100.0 329 Highest 40.5 0.9 18.9 33.8 4.7 0.0 1.3 100.0 363 Total 15-49 18.5 0.9 15.8 42.3 5.7 15.0 1.8 100.0 1,599 50-59 28.2 2.5 7.8 37.6 5.2 14.8 3.9 100.0 254 Total 15-59 19.9 1.1 14.7 41.7 5.6 15.0 2.1 100.0 1,853 Note: Figures in parentheses are based on 25 to 49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases. 1 The occupational categories are according to the National Occupational Classification, which is based on and similar to ISCO-88 (Interna- tional Standard Classification of Occupations). For the definitions of the occupational categories and for more detailed information and exam- ples, please visit http://www.ilo.org/public/english/bureau/stat/isco/isco88/index.htm. 3.6 EMPLOYMENT CHARACTERISTICS Women who were employed in the 12 months preceding the survey were asked about the type of earnings they received, i.e., whether they were paid in cash, in kind, or not at all. They were also asked about whether they were employed by a relative, a nonrelative, or were self-employed. Addi- tionally, women were asked whether they worked continuously throughout the year or seasonally. Table 3.6 presents the results of these questions. 42 | Background Characteristics of Respondents Table 3.6 Type of employment Percent distribution of women age 15-49 employed in the 12 months preced- ing the survey by type of earnings, type of employer, and continuity of em- ployment, according to type of employment (agricultural or nonagricultural), Azerbaijan 2006 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 26.9 97.2 85.5 Cash and in-kind 21.0 1.8 5.0 In-kind only 15.4 0.5 3.0 Not paid 36.7 0.5 6.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 71.5 14.2 23.7 Employed by nonfamily member 13.3 79.9 68.9 Self-employed 15.2 5.9 7.4 Total 100.0 100.0 100.0 Continuity of employment All year 11.4 92.4 79.0 Seasonal 87.7 5.1 18.8 Occasional 0.8 2.0 1.8 Missing 0.0 0.5 0.4 Total 100.0 100.0 100.0 Number of women employed during the past 12 months 291 1,461 1,769 Note: Total includes 17 women with information missing on type of employ- ment, who are not shown separately. Overall, 86 percent of employed women earn cash only, 5 percent are paid in cash and in kind, 3 percent get in-kind payments only, and 7 percent receive no payment. Four in ten women who work in agriculture did not receive payment while only 27 percent are paid in cash only. Ninety-seven percent who work in nonagricultural jobs were paid in cash only. Table 3.6 shows that 69 percent of women who work are employed by a nonrelative, 24 per- cent are employed by a family member, and 7 percent are self-employed. As expected, most women who work in agriculture are employed by a family member (72 percent), while most of those who hold a position in nonagricultural jobs were employed by nonfamily members (80 percent). With regard to continuity of employment, the data show that eight in ten employed women work all year (79 percent). As expected, most women who work in agriculture work seasonally (88 percent), while most of those who work in nonagricultural jobs typically work all year (92 percent). Fertility | 43 FERTILITY 4 Fertility is one of the three principal components of population dynamics, the others being mortality and migration. This chapter looks at a number of fertility indicators including levels, pat- terns, and trends in current and cumulative fertility; the length of birth intervals; the age at which women initiate childbearing; and teenage fertility. All women who were interviewed in the 2006 AzDHS were asked to give a complete repro- ductive history. In collecting these histories, each woman was first asked about the total numbers of pregnancies that had ended in live births, stillbirths, miscarriages, and induced abortions. After obtain- ing these aggregate data, an event-by-event pregnancy history was collected. For each pregnancy, the duration, the month and year of termination, and the result of the pregnancy were recorded. Informa- tion was collected about the most recent completed pregnancy, then the next-to-last, etc. For each live birth, information was collected on the sex of the child, survival status, and age (for surviving child- ren) or age at death (for deceased children). 4.1 CURRENT FERTILITY The data collected in the reproductive his- tory were used to calculate two of the most widely used measures of current fertility: the total fertili- ty rate (TFR) and its component age-specific fer- tility rates (ASFR). The TFR is interpreted as the average number of children a woman would bear in her lifetime if she experienced the currently observed age-specific rates throughout her repr

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