Bangladesh - Demographic and Health Survey - 1997

Publication date: 1997

Bangladesh Demographic and Health Survey 1996-1997 A NIPORT National Institute of Population Research and Training (NIPORT) Ministry of Health and Family Welfare Ira Mitra and Associates -~DHS Demographic and Health Surveys Macro International Inc. Bangladesh Demographic and Health Survey 1996-1997 A NIPORT National Institute of Population Research and Training (NIPORT) Ministry of Health and Family Welfare Ira Mitra and Associates -~DHS Demographic and Health Surveys Macro International Inc. World Summit for Children Indicators: Banaladesh 1996-97 Value BASIC INDICATORS Infant mortality Childhood undernutrition Clean water supply Sanitary excreta disposal Basic education Children in especially difficult situations Infant mortality rate Under-five mortality rate Percent stunted Percent wasted Percent underweight Percent of households with a safe water supply I Percent of households with flush toilets or VIP latrines Percent of women 15-49 with completed primary education Percent of men 15-49 with completed primary education Percent of girls 6-12 attending school Percent of boys 6-12 attending school Percent of women 15-49 who are literate Percent of children who live in single-adult households 82 per 1,000 116 per 1,000 54.6 17.7 56.3 97.4 30.5 35.2 47.8 76.3 74.8 36.4 3.3 SUPPORTING INDICATORS Women's Health Birth spacing Safe motherhood Family planning Nutrition Maternal nutrition Breastfeeding Child Health Vaccinations Percent of births within 24 months of a previous birth Percent of births with medical prenatal care Percent of births with prenatal care in first trimester Percent of births with medical assistance at delivery Percent of births in a medical facility Percent of births at high risk Contraceptive prevalence rate (any method, married women) Percent of currently married women with an unmet demand for family planning Percent of currently married women with an unmet need for family planning to avoid a high-risk birth Percent of mothers with low BM1 Percent of children under 4 months who are exclusively breastfed 17.7 26.4 12.1 8.1 4.1 58.0 49.2 15.8 12.4 52.0 50.9 Percent of children whose mothers received tetanus toxoid vaccination during pregnancy 74.7 Percent of children 12-23 months with measles vaccination 69.9 Percent of children 12-23 months fully vaccinated 54.1 Diarrhea control Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 61.0 Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were seen by medical personnel 32.9 1 Piped, well, and bottled water Bangladesh Demographic and Health Survey 1996-1997 S. N. Mitra Ahmed A1-Sabir Anne R. Cross Kanta Jamil National Institute of Population Research and Training (NIPORT) Dhaka, Bangladesh Mitra and Associates Dhaka, Bangladesh Macro International Inc. Calverton, Maryland USA December 1997 The Bangladesh Demographic and Health Survey (BDHS) is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the BDHS may be obtained from the Mitra and Associates at 2/17 lqbal Road, Block A, Mohammadpur, Dhaka, Bangladesh (Telephone: 818-065; Fax: c/o 832-915) or from NIPORT, Azimpur, Dhaka, Bangladesh (Telephone: 507-866 and Fax: 863-362). Additional information about the DHS project may be obtained by writing to : DHS, Macro International Inc., 11785 Beltsville Drive, Calverton, MD 20705 (Telephone: 301-572-0200 and Fax: 301-572-0999). Reconur~nded citation: Mitra, S.N., Ahmed A1-Sabir, Anne R. Cross, and Kanta Jamil. 1997. Bangladesh Demographic and Health Survey, 1996-1997. Dhaka and Calverton, Maryland: National Institute of Population Research and Training (NIPORT), Mitra and Associates, and Macro International Inc. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Bangladesh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER1 1.1 1.2 1,3 1.4 INTRODUC~ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population, Family Planning and Maternal and Child Health Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Organization of the 1996-97 Bangladesh Demographic and Health Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHAPTER 2 2.1 2.2 2.3 CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . 7 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Background Characteristics of Women and Men Respondents . . . . . . . . . . . . . . . . . . 16 CHAPTER3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Teenage Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 CHAPTER4 4.1 4.2 4.3 4,4 4,5 4.6 4.7 FERT IL ITY REGULAT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Knowledge and Ever Use of Menstrual Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Number of Children at First Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Problems with Current Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Reasons for Selecting Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 iii Page 4.8 Use of Social Marketing Brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.9 Age at Sterilization and Sterilization Regret . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.10 Cost of Contraceptive Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.11 Source of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.12 Contraceptive Discontinuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 4.13 Nonuse of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 4.14 Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 4.15 Family Planning Outreach Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 4.16 Couples' Communication and Attitudes Toward Use of Family Planning . . . . . . . . . . 77 CHAPTER5 5.1 5.2 5.3 OTHER PROXIMATE DETERMINANTS OF FERT IL ITY . . . . . . . . . . . . . . . . 81 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 CHAPTER6 6.1 6.2 6.3 6.4 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 CHAPTER7 7.1 7.2 7.3 7.4 7.5 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Socioeconomic Differentials in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . 102 Demographic Differentials in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . 103 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 CHAPTER8 8.1 8.2 8.3 8.4 MATERNAL AND CHILD HEALTH . 109 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Childhood Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Childhood Illness and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 CHAPTER 9 9.1 9.2 9.3 INFANT FEEDING, CHILDHOOD AND MATERNAL NUTRIT ION . . . . . . 129 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Children' s Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 iv CHAPTER 10 CHAPTER 11 REFERENCES APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E Page KNOWLEDGE OF A IDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 AVAILABIL ITY OF HEALTH AND FAMILY PLANNING SERVICES . . . 145 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149 SURVEY IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 PERSONS INVOLVED IN THE 1996-97 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 V Table 1.1 Tal:le 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11.1 Table 2.11.2 Table 2.12 Table 2.13 Table 2.14 Table 2.15.1 Table 2.15.2 Table 2.16 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 3.11 Table 3.12 Table 3.13 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 TABLES Fage Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Educational level of the female and male household population . . . . . . . . . . . . . . . . 11 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Household possessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Health-care-seeking behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Differentials in age and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Level of education by background characteristics: women . . . . . . . . . . . . . . . . . . . . 19 Level of education by background characteristics: men . . . . . . . . . . . . . . . . . . . . . . . 19 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Occupation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Decisions on use of earuings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Trends in current fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Trends in fertility by division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Percent pregnant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Trends in age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Trends in fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Trends in children ever born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Age ;t first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Adolescent pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Trends in knowledge of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of contraceptive methods among couples . . . . . . . . . . . . . . . . . . . . . . . . 45 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Trends in ever use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Menstrual regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Trends in current use of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . 53 Trends in current use of family planning methods by division . . . . . . . . . . . . . . . . . . 55 Comparison of reported contraceptive use by spouses . . . . . . . . . . . . . . . . . . . . . . . . 57 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 vii Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 4.22 Table 4.23 Table 4.24 Table 4.25 Table 4.26 Table 4.27 Table 4.28 Table 4.29 Table 4.30 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Page Problems with current method of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Reason for using current method of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Use of pill brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Use of condom brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Timing of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Sterilization regret . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Cost of methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . 65 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Reasons for discontinuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Exposure to family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Contact with family planning fieldworkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Satellite clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Perception of spouse's attitude toward family planning . . . . . . . . . . . . . . . . . . . . . . . 79 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Trends in proportion never married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . . . . 85 Median duration of postpartum insusceptibility by background characteristics . . . . 86 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . 96 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Trends in infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . 102 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . 104 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Opinion on medical checkups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . 112 Tetanus toxoid vaccinations and medical testing . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 viii Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 10.1 Table 10.2 Table 10.3 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table A.I.1 Table A. 1.2 Table B. 1 Table B.2 Table B.3 Table B.4 Table B.5 Table B.6 Table B.7 Table B.8 Table B.9 Table B.10 Table B. 11 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Page Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . 122 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Men who report signs and symptoms of disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Treatment with vitamin A capsules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Nutritional status of children by demographic characteristics . . . . . . . . . . . . . . . . . 135 Nutritional status of children by background characteristics . . . . . . . . . . . . . . . . . . 137 Nutritional status of mothers by background characteristics . . . . . . . . . . . . . . . . . . 139 Knowledge of AIDS and sources of AIDS information: women . . . . . . . . . . . . . . . 142 Knowledge of ways to avoid HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Awareness of AIDS-related health issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Distance to public services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Presence of income-generating organizations in cluster . . . . . . . . . . . . . . . . . . . . . . 147 Presence of health and family planning workers and services in the communi ty . . . 147 Presence of government and non-governmental family planning fieldworkers . . . . 148 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 List of selected variables for sampling errors, Bangladesh 1996-97 . . . . . . . . . . . . 162 Sampling errors - National sample, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . 163 Sampling errors - Urban sample, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . 164 Sampling errors - Rural sample, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . 165 Sampling errors - Barisal, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Sampling errors - Chittagong, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . 167 Sampling errors - Dhaka, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Sampling errors - Khulna, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Sampling errors - Rajshahi, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Sampling errors - Sylhet, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Sampling errors of differences between contraceptive prevalence rates from the 1993-94 and 1996-97 BDHSs (for the 301 clusters common to both surveys), Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . 176 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 ix Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 4.5 Figure 4.6 Figure 4.7 Figure 5.1 Figure 6.1 Figure 6.2 Figure 6.3 Figure 6.4 Figure 6.5 Figure 6.6 Figure 7.1 Figure 7.2 Figure 7.3 Figure 7.4 Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 FIGURES Page Population Pyramid, Bangladesh 1996-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Distribution of De Facto Household Population by Single Year of Age and Sex . . . . 9 Percentage of Males and Females with No Education by Age Group . . . . . . . . . . . . 12 Trends in Household Ownership of Durable Goods . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Age-Specific Fertility Rates by Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Total Fertility Rates by Selected Background Characteristics . . . . . . . . . . . . . . . . . . 29 Trends in Total Fertility Rates, 1971-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Trends in Total Fertility Rates by Calendar Year from Selected Sources, 1985-1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Age-Specific Fertility Rates 1989, 1991, 1993-94 and 1996-97 . . . . . . . . . . . . . . . . . 32 Trends in Fertility by Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Trends in Contraceptive Use Among Currently Married Women 10-49 . . . . . . . . . . 51 Trends in Use of Specific Contraceptive Methods Among Currently Married Women Age 10-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Trends in Contraceptive Method Mix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Percentage of Currently Married Women Using a Contraceptive Method by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Trends in Contraceptive Use by Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Trends in Use of Types of Pill Brands, 1991-1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Distribution of Current Users of Contraception by Source of Supply . . . . . . . . . . . . 66 Trends in Proportion Never Married Among Women 15-19 and 20-24 . . . . . . . . . . . 83 Fertility Preferences Among Currently Married Women 10-49 . . . . . . . . . . . . . . . . . 89 Percentage of Currently Married Women and Men Who Want No More Children by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Fertility Preferences Among Married Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Percentage of Married Women with Two Children Who Want No More Children by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Trends in Unmet Need for Family Planning by Division . . . . . . . . . . . . . . . . . . . . . . 94 Percentage of Births by Planning Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Trends in Infant and Child Mortality 1989-93 to 1992-1996 . . . . . . . . . . . . . . . . . . 100 Infant Mortality Rates from Selected Sources, 1985-1995 . . . . . . . . . . . . . . . . . . . . 101 Under-Five Mortality by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . 103 Under-Five Mortality by Selected Demographic Characteristics . . . . . . . . . . . . . . . 105 Percent Distribution of Births by Antenatal and Delivery Care . . . . . . . . . . . . . . . . 111 Percentage of Children 12-23 Months Who Have Received Specific Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Percentage of Children Age 12-23 Months Who Have Received All Vaccinations by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Trends in Vaccination Coverage Among Children Age 12-23 Months . . . . . . . . . . 120 xi Figu~9.1 ~gu~9.2 ~gu~9.3 ~gu~9.4 Figure 10.1 Page Median Duration of Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Percentage of Children under Five Who Are Stunted, According to Demographic Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Percentage of Children under Five Who Are Stunted, According to Socioeconomic Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Percentage of Mothers Shorter than 145 cm or with Low Body Mass Index (BMI), Selected Countries . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Percentage of Women and Men Who Have Ever Heard of AIDS, According to Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 xii Secretary Ministry of Health and Family Welfare Government of the People's Republic of Bangladesh FOREWORD The 1996-97 Bangladesh Demographic and Health Survey (BDHS) is a nationally representative sample survey designed to provide information on basic national indicators of social progress including fertility, childhood mortality, contraceptive knowledge and use, maternal and child health, nutritional status of mothers and children and awareness of AIDS. BDHS data indicate decline in fertility and infant and child mortality and steady increase in contraceptive use. Despite the relatively high and increasing level of contraceptive use, BDHS data indicate that unplanned pregnancies are still common. If unplanned births could be eliminated altogether, the total fertility rate in Bangladesh would reach the replacement level of 2.1 births per woman instead of actual level of 3.3. The findings of this report together with other national surveys are very Important in assessing the achievements of Family Planning and Health Programmes. Information obtained from the 1996-97 BDHS can be used to review the progress of Health and Family Planning Programmes, and to improve future policies and programmes. The need, however, for further detailed analysis of BDHS data remains. It Is hoped that such analysis will be carried out by the academiclans, researchers and programme personnel to provide more in-depth knowledge for future direction and effective implementation of a national Health and Family Planning Programme. In conclusion, I would like to thank NIPORT, Mitra and Associates and Macro International Inc. for their efforts in conducting the 1996-97 BDHS. USAID/Dhaka also deserve thanks for their Nnancial assistance that helped ensure the ultimate success of this important undertaking. ( M u ~ xiii A NIIDiDRT Director General National Institute of Population Research and Training (NIPORT) PREFACE The 1996-97 Bangladesh Demographic and Health Survey (BDHS) is the second of this kind of survey conducted in Bangladesh. The BDHS was implemented through a collaborative effort of NIPORT, Mitra and Associates, and Macro International Inc. The financial support for the survey was made by the United States Agency for International Development (USAID)IDhaka. The main objective of the 1996-97 BDHS is to provide policy-makers and programme managers in population and health with detailed information on fertility and family planning, childhood mortality, and maternal and child health. The content of the 1996-97 BDHS has been significantly expanded from the previous survey to include two new modules on nutritional status of mothers and children and awareness of AIDS. The Technical Review Committee (TRC) consisted of experts from government, non- government and international organization as well as researchers and professionals working in health and population sector put forth their valuable opinion in major phases of the survey. In addition, a Technical Task Force (TTF) was formed with the representatives from NIPORT, Mitra and Associates, USAID/Dhaka, ICDDR, B, Population Council/Dhaka and Macro International Inc. for designing and implementing the survey. I would like to extend my gratitude and appreciation to the members of the TRC and TTF for their contributions at different phases of the survey. The preliminary results of the 1996-97 BDHS, with its major findings, were officially announced through a press conference and a dissemination seminar was held in June 1997. The final report supplements the preliminary report released earlier. I hope that the survey results would be useful for monitoring as well as development of national health and family planning programmes. I express my heartfelt thanks to the professionals of Macro International Inc., professionals and staff of Mitra and Associates and professionals of research unit of NIPORT for their sincere efforts in successful completion of the survey. (Anil ~ h a ) XV SUMMARY OF FINDINGS The 1996-97 Bangladesh Demographic and Health Survey (BDHS) is a nationally-representative survey of 9,127 ever-married women age 10-49 and 3,312 currently married men age 15-59. The BDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health and nutrition. Fieldwork for the BDHS took place from early November 1996 to mid-March 1997. Survey data generally confirm patterns observed in the 1993-94 BDHS, showing increasing contraceptive use and declining childhood mortality; however, many challenges still await. FERTILITY Fertility Decline. The BDHS data indicate that there has been an imperceptibly small decline in fertility since the 1993-94 survey. The total fertility rate has declined from 3.4 births per woman in the period 1991-93 to 3.3 births for the period 1994-96. Although such an apparently abrupt halt in the previously rapid fertility decline is difficult to explain, the results from the 1996-97 survey confirm that fertility is now at a low level. Fertility Differentials. Although the rate of fertility decline has been generally uniform across groups, significant differences in fertility levels still exist. For example, fertility is considerably higher in Sylhet and Chittagong Divisions (with total fertility rates of more than 4 births per woman), than in Rajshahi and Khulna Divisions (with rates of 2.8 and 2.5 births per woman, respectively). Barisal and Dhaka Divisions have intermediate levels of fertility (3.3 and 3.2 births per woman, respectively). Moreover, fertility is about 60 percent higher in rural areas than in urban areas, a pattern that has persisted in various censuses and demographic surveys that have been carried out in the country. Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 3.9 children in their lifetime, compared with 2.1 for women with at least some secondary education, a difference of 86 percent. Women with either incomplete primary or complete primary education have intermediate fertility rates. Small Family Norm. The 1996-97 BDHS data confirm that Bangladeshi couples have accepted the small family norm. Sixty percent of ever-married women prefer a two-child family, and another 21 percent consider a three-child family ideal, while less than 1 percent of respondents say they would choose to have six or more children. Overall, the mean ideal family size among married women is 2.5 children, identical to the mean found in 1993-94. BDHS data also indicate a high degree of agreement between women and men as to fertility preferences. The proportion of women who want to stop childbearing has increased substantially in Bangladesh over the past decade. For example, the percentage of women with two children who want no more children has risen from only 39 percent in 1991 to 50 percent in 1996-97. Almost half of all currently married women age 10-49 in Bangladesh say they want no more children and 9 percent have been sterilized. An additional 22 percent say they would like to wait two or more years before having their next birth. Thus, the vast majority of women want either to space their next birth or to limit childbearing altogether. These women can be considered to be potentially in need of family planning services. Unplanned Fertility. Despite the relatively high and increasing level of contraceptive use, BDHS data indicate that unplanned pregnancies are still common. Overall, about one-third of births in the three years prior to the survey were reported to be unplanned; 20 percent were mistimed (wanted later) and 11 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in Bangladesh would reach the replacement level of 2.1 births per woman instead of the actual level of 3.3. xvii FAMILY PLANNING Increasing Use of Contraception. A major cause of declining fertility in Bangladesh has been the steady increase in contraceptive use over the last two decades. The contraceptive prevalence rate has increased sixfold since 1975, from 8 to 49 percent of married women. Use of modem methods has grown even faster. Between 1993-94 and 1996-97, contraceptive use increased from 45 to 49 percent of married women and use of modem methods rose from 36 to 42 percent. Overall, there has been a steady growth in the contraceptive prevalence rate with an average increase of almost two percentage points a year. Pill-Dominated Method Mix. In terms of"method mix," the dominant change since the late 1980s has been the large increase in the number of couples using oral contraception. The proportion of married women relying on the pill quadrupled in the last 11 years, from 5 percent in 1985 to 21 percent in 1996-97 and the pill now accounts for 42 percent of all contraceptive use. Conversely, use of female and male sterilization has stagnated or declined slightly since 1989 and now accounts for only 18 percent of all contraceptive use. This shift away from permanent methods to modem reversible methods has important implications for the family planning program in terms of costs, supply logistics, and method efficacy and is especially important given the increasing proportion of women who say they want no more children. Aside from the pill and sterilization, use of injectables, condoms, and periodic abstinence (rhythm method) have increased since 1993-94, while use of IUDs and withdrawal have declined slightly. Differentials in Family Planning Use. Differentials in current use of family planning in the six administrative divisions of the country are large and indicate that Sylhet Division is lagging behind the rest of the country. Sixty-two percent of married women in Khulna Division and 59 percent of those in Rajshahi Division are current users. In contrast, only 20 percent of the married women in Sylhet Division and 37 percent of those in Chittagong Division are using a method of contraception. Intermediate are Dhaka and Barisal Divisions with contraceptive prevalence rates of around 50 percent. Urban-rural gaps in contraceptive use are large (62 vs. 48 percent, respectively) and increasing. Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has been almost universal in Bangladesh for some time and the BDHS results indicate that 100 percent of currently married women age 10-49 know at least one method of family planning. More than 9 in 10 married women know the pill, IUD, injectables, condom, and female sterilization, while about 8 in 10 know male sterilization and menstrual regulation. Considering traditional methods, periodic abstinence is more widely known than withdrawal (68 vs. 50 percent of currently married women). Unmet Need for Family Planning. Unmet need for family planning services has declined since 1993-94. Data from the 1993-94 BDHS show that 19 percent of currently married women were in need of services, compared with 16 percent in the 1996-97 BDHS. Half of the unmet need is comprised of women who want to space their next birth, while just under half is for women who do not want any more children (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 49 percent to 67 percent of married women. Currently, 76 percent of this "total demand" for family planning is being met. Discontinuation Rates. One challenge for the family planning program is to reduce the high levels of contraceptive discontinuation. BDHS data indicate that almost half of contraceptive users in Bangladesh stop using within 12 months of starting; one-fifth of those who stop do so as a result of side effects or health concerns with the method. Discontinuation rates vary by method. Not surprisingly, the rates for the condom (65 percent) and withdrawal (60 percent) are considerably higher than for the IUD and periodic abstinence (both 41 percent) and the pill (44 percent). However, discontinuation rates for injectables are relatively high, considering that one dose is usually effective for three months. Fifiy-one percent of injection users discontinue within one year of starting, a rate that is higher than for the pill. xviii Availability of Services. Health and family planning services are widely available in Bangladesh. BDHS data indicate that 97 percent of ever-married women live in areas covered by family planning fleldworkers and the vast majority also have health workers and satellite clinics available. Social Marketing. After a decline between 1989 and 1991 in the proportion of both pill and condom users supplied through the Social Marketing Company, market share has been increasing slightly for pills and substantially for condoms. In 1996-97, 19 percent of pill users were using social marketing brands, up from 1993-94. The proportion of condom users using social marketing brands dropped from 62 percent in 1989 to 41 percent in 1991, rebounded to 52 percent in 1993-94, and increased further to 58 percent in 1996- 97. Family Planning Fieldworkers. Fieldworkers are providing a slightly smaller share of family planning services now than in 1993-94 39 percent of modem method users in 1996-97 vs. 42 percent in 1993-94. This has occurred in spite of the fact that much of the increase in modem method use since 1993- 94 is due to increased use of the pill, which is distributed predominantly by fieldworkers, as well as the fact that fieldworkers have been increasingly used to distribute other methods such as injectables and IUDs. The proportion of supply provided through the private sector--most notably pharmacies--has increased from 10 to 15 percent since 1993-94. Fieldworker Visitation. Despite the impressive coverage in placement of family planning fleldworkers, survey data show a slight decrease in fieldworker visitation rates since 1993-94. In 1996-97, 35 percent of currently married women said they had been visited by a family planning fieldworker in the previous six months, down from 38 percent in 1993-94. Some women are more likely than others to have been visited by a fleldworker. Younger and older women are less likely to have been visited, presumably because they are either more likely to want to get pregnant or to be either infecund or sterilized. Women in Chittagong and Sylhet Divisions are less likely and those in Rajshahi and Khuina Divisions more likely to have been visited by a fieldworker than women in Barisal or Dhaka Divisions. MATERNAL AND CHILD HEALTH Declining Childhood Mortality. Survey results confirm the improvement in child survival since the early 1980s. Under-five mortality declined from 133 deaths per 1,000 births in 1989-93 to 116 for the period 1992-96. The infant mortality rate declined over the same period (from 87 to 82 per 1,000 births). Although encouraging, the BDHS rates show that almost 1 in 9 children born in Bangladesh dies before reaching the fifth birthday, an indication that there is still much improvement to be made. The data also show that early childbearing (under age 18) increases the risk of childhood mortality. Childhood Vaccination Coverage. The 1996-97 BDHS results show that 54 percent of children 12-23 months are fully vaccinated, a decline from 59 percent in 1993-94. However, closer examination of the data by vaccine reveals that this trend is entirely due to a decline in the proportion receiving the third dose of polio vaccine (from 67 to 62 percent). Coverage of all other vaccines has increased slightly since 1993-94. Childhood Health. The BDHS provides some data on childhood illness and treatment. Approxi- mately 1 in 3 children under age five had a fever and 13 percent had respiratory illness in the two weeks before the survey. Of these, one-third were taken to a health facility for treatment. Eight percent of children under five were reported to have had diarrhea in the two weeks preceeding the survey. The fact that three- quarters of children with diarrhea received some type of oral rehydration therapy (fluid made from an ORS packet, recommended homemade fluid, or increased fluids) is encouraging. Also notable is the fact that two- thirds of children under five received a vitamin A capsule in the six months prior to the survey. xix Breasffeeding Practices. The BDHS results document an exceptionally long duration ofbreastfeed- ing, with a median duration of 33 months. Although breastfeeding has beneficial effects on both the child and the mother, BDHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in Bangladesh. For example, among newborns less than two months of age, 30 percent were already receiving supplemental foods or liquids. Maternal Health Care. BDHS data point to several areas regarding maternal health care in which improvements could be made. Results show that most Bangladeshi mothers do not receive antenatal care. Among births that occurred in the five years before the survey, almost three-quarters received no antenatal care during pregnancy. Moreover, 95 percent of births in Bangladesh are delivered at home and 57 percent are assisted by untrained traditional birth attendants. Only 8 percent of births are assisted by medically trained personnel, with another 8 percent assisted by trained traditional birth attendants. Proper medical attention during pregnancy and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for either the mother or the newborn. Somewhat more encouraging is the fact that tetanus toxoid coverage is relatively widespread in Bangladesh. For three- quarters of births, the mothers received a tetanus toxoid injection during pregnancy. Nutritional Status of Children and Mothers, Unlike the 1993-94 BDHS, the 1996-97 survey included an anthropometric component in which all children under five and their mothers were weighed and measured. Results show that malnutrition is a serious problem in Bangladesh. Over half of children under five (55 percent) show evidence of chronic malnutrition or stunting, while 18 percent are acutely malnourished (wasted). The situation is also serious among women--17 percent of mothers of children under five are less than 145 cm in height, an indication of malnutrition. Over half have a body mass index (BMI) below 18.5, indicating that they are acutely malnourished. Awareness of AIDS. The BDHS results indicate that awareness of AIDS is low in Bangladesh. Only 19 percent of ever-married women and 33 percent of currently married men had ever heard of the disease. Of those who had heard of it, only small percentages could name a means of avoiding getting AIDS. XX RAJSHAHI DIVISION BANGLADESH • OA • e • .~ • ~o • "5 ~•o o• INDIA KHULNA DIVISION I • 0 O0 ••0 • O~ ~ " ( • • •A ' ~ O0 - - Q A ~ • • OSylhet•(" :. •" • . . • " ' " . - ' " . c. ,oo,o o• " •"qro0~ t(' %~,/olvIs,oN • ummm I • . . ~ "& • • ~! m• O, " J -e- -• '1 g (~•0• nu 00 • . , , ( ,o • . o _-"l~-~,,,-1o) ~ '%• SYLHET DIVISION INDIA 1 Chittagong BARISAL DIVISION BAY OF BENGAL SAMPLING POINTS • Rural (242) i Statistical Metropolitan Area (29) & Municipality (42) MYANMAR xxii CHAPTER 1 INTRODUCTION 1.1 Geography and Economy Bangladesh, a small country of 147,570 square kilometers and over 120 million people, gained independence on March 26, 1971 following a war of liberation. It is almost entirely surrounded by India, except for a short southeastern frontier with Myanmar and a southern coastline on the Bay of Bengal. The most significant feature of the landscape is the extensive network of large and small rivers that are of primary importance in the socioeconomic life of the nation. Chief among these, and lying like a fan on the face of the land are the Ganges-Padma, Brahmaputra-Jamuna, and the Megna. The climate of Bangladesh is dominated by seasonal monsoons. It experiences a hot summer season with high humidity from March to June, a somewhat cooler but still hot and humid monsoon season from July through early October, and a cool, dry winter from November to the end of February. The fertile delta is frequented by natural calamities such as flood, cyclone, tidal-bore and drought. For administrative purposes, the country is divided into six divisions, t 64 districts, and 490 thanas (subdistricts) (BBS, 1997a:3). Muslims constitute almost 90 percent of the population of Bangladesh, Hindus about 10 percent, and others less than one percent. The national language of Bangladesh is Bangla, which is spoken and understood by all. Agriculture is the most important sector of the nation's economy. It accounts for 30 percent of the gross domestic product (GDP) and provides employment to 64 percent of the workforce (BBS, 1997a:270,159). Jute is the main non-food crop and the main cash crop of Bangladesh. Less than 20 percent of the cropped land area is used for crops other than jute and rice (BBS, 1997a: 187,188). Industry, though small, is increasing in importance as a result of foreign investments. Prospects for mineral resources, gas, coal, and oil, appear to be bright. However, the per capita income is only US$210 and half of Bangladesh's population entered the 1990s with incomes below the poverty line (GOB, 1994:2; World Bank, 1995:xvii). Unemployment/underemployment is a serious problem, and pressure on the land in rural areas has led to influx of people from rural to urban areas. 1.2 Population The population of the area which now constitutes Bangladesh has grown from about 42 million in 1941 to about 120 million in 1995 (BBS, 1997a: 149,140), making it the ninth most populous country in the world and one of the most densely populated. The intercensal population growth rate peaked in the early 1970s at around 2.5 percent per annum, followed by a decline to 2.2 percent during the 1981-91 period (BBS, 1997a:149). The relatively young age structure of the population indicates continued rapid population growth in the future; according to the 1991 census, 45 percent of the population is below 15 years of age, 52 percent are between 15 and 64 years and 3 percent are age 65 or over (BBS, 1997a: 139). This young age structure constitutes a built-in "population momentum," which will continue to generate population increases well into the future, even in the face of rapid fertility decline. For example, in 1992 Bangladesh had around The sixth division, Sylhet, was created in 1994 by subdividing the former Chittagong Division. 22 million married women in the reproductive ages; by the year 2001, this number is projected to rise to 31 million (GOB, 1994:8). Even if replacement level fertility is achieved by the year 2005--as targeted by government policy--the population will continue to grow for 40 to 60 years later. One projection suggests that the population of Bangladesh may stabilize at 211 million by the year 2056. Bangladesh has undergone a remarkable demographic transition over the last two decades. The total fertility rate has declined from about 6.3 in the early 1970s (MOHPC, 1978:73) to 3.4 in the early 1990s (Mitra et al., 1994:27). The crude death rate has also fallen dramatically, from about 19 per 1,000 population in 1975 to 8 in 1995 (GOB, 1994:4; BBS, 1997a:144). Although infant and under-five mortality rates are declining, they are still high. The infant mortality rate was 150 deaths per 1,000 live births in 1975 and fell to 87 in 1989-93 (GOB, 1994:5; Mitra et al., 1994:92). Maternal mortality has come down from 6.2 deaths per 1,000 births in 1982 to 4.4 in 1995. This small but important decline is mainly attributed to increased availability of family planning and immunization services, improved antenatal and delivery care, and a reduction in the number of births to high-risk mothers (GOB, 1994:5; BBS, 1997a: 144). Because of the mortality decline, there is evidence of modest improvement in life expectancy during the past decade. Life expectancy at birth was 46 years for males and 47 years for females in 1974 (UN, 1981:60). It increased to 59 years for men and 58 years for women in 1995 (BBS, 1997a:145). Striking changes have also been observed in the fertility preferences of ma~ied Bangladeshi women. In 1975, when married women were asked how many children they would ideally like to have, the response was an average of 4.1 children (Huq and Cleland, 1990:53,54). By 1993-94, the mean ideal family size had dropped to 2.5 (Mitra et al., 1994:88). 1.3 Population, Family Planning and Maternal and Child Health Policies and Programs Family planning was introduced in the early 1950s through the voluntary efforts of social and medical workers. The government, recognizing the urgency of moderating population growth, adopted family planning as a government sector program in 1965. The policy to reduce fertility rates has been repeatedly reaffirmed since liberation in 1971. The First Five-Year Plan (1973-78) of Bangladesh amplified "the necessity of immediate adoption of drastic steps to slow down the population growth" and reiterated that, "no civilized measure would be too drastic to keep the population of Bangladesh on the smaller side of fifteen crore (i.e., 150 million) for sheer ecological viability of the nation" (GOB, 1994:7). From mid-1972, the family planning program received virtually unanimous, high-level political support. All subsequent governments that have come into power in Bangladesh have identified population control as the top priority for government action. This political commitment is crucial in understanding the fertility decline in Bangladesh. In 1976, the government declared the rapid growth of population as the country's number one problem and adopted a broad-based, multisectoral family planning program along with an official population policy (GOB, 1994:9). Population planning was seen as an integral part of the total development process, and was incorporated into successive five-year plans. Policy guidelines and strategies for the population program are formulated by the National Population Council (NPC), which is chaired by the Prime Minister. Bangladesh population policy and programs have evolved through a series of development phases and have undergone changes in terms of strategies, structure, contents, and goals. In the mid-1970s, the government instituted the deployment of full-time, local Family Welfare Assistants (FWAs)----community- based family planning motivators and distributors who currently number almost 24,000. A social marketing program to promote the sale of pills and condoms was also initiated in the mid-1970s. Another characteristic of the population program is the involvement of more than 200 non-governmental organizations. 2 Since 1980, the program has stressed functionally integrated health and family planning programs. The goal is to provide an essential package of high quality, client-centered, reproductive and child health care, family planning, communicable disease control and limited curative services at a one-stop service point. Currently, the government's most important objectives in the area of health and population are the reduction of infant mortality and morbidity, reduction of maternal mortality and morbidity, improvement of nutrition, and reduction of fertility to replacement level by 2005. The government's policy of providing health care is based on the principles of universal coverage and accessibility, optimum utilization and development of human resources for health, appropriate use of technology, gender equity, improvement of the quality of life, priority service for the most vulnerable groups including women, children and the poor, and promoting health as an integral part of overall socioeconomic development. Although no comprehensive health policy has ever been formulated since independence, development of such a policy is a high priority of the current administration. Private sector involvement in both health and population services is being encouraged. Numerous factors have contributed to the increase in contraceptive use over the past 20 years. The elements identified as having contributed to the success of the program are: (1) strong political commitment to family planning programs by successive governments, (2) successful promotion of a small family norm through information and education activities and other multisectoral programs, (3) establishment of a widespread infrastructure for delivering family planning and health services down to the village level, (4) increased involvement of nongovernmental organizations to supplement and complement government's efforts, (5) flexibility to make policy and programmatic adjustments in response to emerging needs, and (6) strong support of the program by the international aid community (GOB, 1994:36). The success achieved so far in the national family planning program is encouraging and has increased the confidence that it is possible to achieve further progress. But there remain several issues of concern, such as the tremendous growth potential built into the age structure as a consequence of past high fertility. Due to the increasing population entering childbearing age, the program will have to expand efforts substantially just to maintain the current level of contraceptive use. If demand for family planning also increases, that will put even more strain on the program. Other concerns are lack of a steady supply of contraceptives from external sources, which affects program performance; the need for further improvement in access to and quality of facilities and services; and the need for men to participate more actively in family planning acceptance. 1.4 Organization of the 1996-97 Bangladesh Demographic and Health Survey Survey Objectives and Implementing Organizations The BDHS is intended to serve as a source of population and health data for policymakers and the research community. In general, the objectives of the BDHS are to: assess the overall demographic situation in Bangladesh, assist in the evaluation of the population and health programs in Bangladesh, and advance survey methodology. More specifically, the objective of the BDHS is to provide up-to-date information on fertility and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in the country. 3 The 1996-97 BDHS was conducted under the authority of the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. Macro International Inc. of Calverton, Maryland provided technical assistance to the project as part of its international Demographic and Health Surveys program, while financial assistance was provided by the U.S. Agency for International Development (USAID)/Bangladesh. Sample Design Bangladesh is divided into six administrative divisions, 64 districts (zillas), and 490 thanas. In rural areas, thanas are divided into unions and then mauzas, a land administrative unit. Urban areas are divided into wards and then mahallas. The 1996-97 BDHS employed a nationally-representative, two-stage sample that was selected from the Integrated Multi-Purpose Master Sample (IMPS) maintained by the Bangladesh Bureau of Statistics. Each division was stratified into three groups: 1 ) statistical metropolitan areas (SMAs) 2, 2) municipalities (other urban areas), and 3) rural areas. 3 In the rural areas, the primary sampling unit was the mauza, while in urban areas, it was the mahalla. Because the primary sampling units in the IMPS were selected with probability proportional to size from the 1991 Census frame, the units for the BDHS were subselected from the IMPS with equal probability so as to retain the overall probability proportional to size. A total of 316 primary sampling units were utilized for the BDHS (30 in SMAs, 42 in municipalities, and 244 in rural areas). In order to highlight changes in survey indicators over time, the 1996-97 BDHS utilized the same sample points (though not necessarily the same households) that were selected for the 1993-94 BDHS, except for 12 additional sample points in the new division of Sylhet. Fieldwork in three sample points was not possible (one in Dhaka Cantonment and two in the Chittagong Hill Tracts), so a total of 313 points were covered. Since one objective of the BDHS is to provide separate estimates for each division as well as for urban and rural areas separately, it was necessary to increase the sampling rate for Barisal and Sylhet Divisions and for municipalities relative to the other divisions, SMAs and rural areas. Thus, the BDHS sample is not self-weighting and weighting factors have been applied to the data in this report. Mitra and Associates conducted a household listing operation in all the sample points from 15 September to 15 December 1996. A systematic sample of 9,099 households was then selected from these lists. Every second household was selected for the men's survey, meaning that, in addition to interviewing all ever-married women age 10-49, interviewers also interviewed all currently married men age 15-59. It was expected that the sample would yield interviews with approximately 10,000 ever-married women age 10-49 and 3,000 currently married men age 15-59. Questionnaires Four types of questionnaires were used for the BDHS: a Household Questionnaire, a Women's Questionnaire, a Men' s Questionnaire and a Community Questionnaire. The contents of these questionnaires were based on the DHS Model A Questionnaire, which is designed for use in countries with relatively high levels of contraceptive use. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a small Technical Task Force that consisted of representatives from NIPORT, Mitra and Associates, USAID/Bangladesh, the International Centre for Diarrhoeal Disease Research, Bangladesh 2 SMAs are extensions of the four original division headquarters (Dhaka, Chittagong, Khulna, and Rajshahi cities) and include rural areas. 3 In the original IMPS (and therefore in the BDHS subsample), urban areas were confined to the urban parts of SMAs and other municipalities as defined in 1991. Subsequent definitions of urban have included all 490 thana headquarters, new growth centers, and peripheral areas of SMAs and yield estimates of about 20 percent urban (Hossain, 1997). (ICDDR,B), Population Council/Dhaka, and Macro International Inc (see Appendix D for a list of members). Draft questionnaires were then circulated to other interested groups and were reviewed by the BDHS Technical Review Committee (see Appendix D for list of members). The questionnaires were developed in English and then translated into and printed in Bangla (see Appendix E for final version in English). The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In addition, information was collected about the dwelling itself, such as the source of water, type of toilet facilities, materials used to construct the house, and ownership of various consumer goods. The Women's Questionnaire was used to collect information from ever-married women age 10-49. These women were asked questions on the following topics: Background characteristics (age, education, religion, etc.), Reproductive history, Knowledge and use of family planning methods, Antenatal and delivery care, Breastfeeding and weaning practices, Vaccinations and health of children under age five, Marriage, Fertility preferences, Husband's background and respondent's work, Knowledge of AIDS, Height and weight of children under age five and their mothers. The Men's Questionnaire was used to interview currently married men age 15-59. It was similar to that for women except that it omitted the sections on reproductive history, antenatal and delivery care, breastfeeding, vaccinations, and height and weight. The Community Questionnaire was completed for each sample point and included questions about the existence in the community of income-generating activities and other development organizations and the availability of health and family planning services. Training and Fieldwork The BDHS questionnaires were pretested in July 1996. Male and female interviewers were trained at the office of Mitra and Associates. After training, the teams conducted interviews in various locations in the field under the observation of staff from Mitra and Associates and members of the Task Force. Altogether, 300 Women's and 90 Men's Questionnaires were completed. Based on observations in the field and suggestions made by the pretest field teams, the Task Force made revisions in the wording and translations of the questionnaires. In October 1996, candidates for field staff positions for the main survey were recmited. Recruitment criteria included educational attainment, maturity, ability to spend one month in training and at least four months in the field and experience in other surveys. Training for the main survey was conducted at the office of Mitra and Associates for four weeks (5-31 October 1996). Initially, training consisted of lectures on how to complete the questionnaires, with mock interviews between participants to gain practice in asking questions. Towards the end of the training course, the participants spent several days in practice interviewing in various places close to Dhaka. Trainees whose performance was considered superior were selected as supervisors and field editors. Fieldwork for the BDHS was carried out by 12 interviewing teams. Each consisted of 1 male supervisor, 1 female field editor, 5 female interviewers, 2 male interviewers, I porter for the anthropometric equipment, and 1 cook, for a total of 132 field staff. In addition, Mitra and Associates fielded four quality control teams of two persons each to check on the field teams. In order to monitor the quality of the data collection, officials from the Ministry of Health and Family Welfare, NIPORT, USAID/Bangladesh, Population Council/Bangladesh, and Macro visited selected sample points. Fieldwork commenced on 2 November 1996 and was completed on 11 March 1997. The distribution of interviews with individual women was roughly: November (24 percent); December (26 percent); January (26 percent); February (19 percent); and March (6 percent). Data Processing All questionnaires for the BDHS were returned to Dhaka for data processing at Mitra and Associates. The processing operation consisted of office editing, coding of open-ended questions, data entry, and editing inconsistencies found by the computer programs. The data were processed on 5 microcomputers working in double shifts. The DHS data entry and editing programs were written in ISSA (Integrated System for Survey Analysis). Data processing com- menced in mid-November 1996 and was completed by mid-April 1997. Response Rates Table 1.1 shows response rates for the survey and reasons for nonresponse. A total of 9,099 households was selected for the sample, of which 8,682 were successfully interviewed. The shortfall is primarily due to dwellings that were vacant or in which the inhabitants had left for an extended period at the time they were visited by the interviewing teams. Of the 8,762 households occupied, 99 percent were success- fully interviewed. In these households, 9,335 women were identified as eligible for the individual interview (i.e., ever-married and age 10-49) and interviews were completed for 9,127 or 98 percent of them. In the half of the households that were selected for inclusion in the men's survey, 3,611 eligible ever-married men age 15-59 were identified, of whom 3,346 or 93 percent were interviewed. 4 The principal reason for nonresponse among eligible women and men was the failure to find them at home despite repeated visits to the household. The refusal rate was low. T~ble 1.1 Results of the household an 0 individual interviews Number of households, number of interviews, and response rates, Bangladesh 1996-97 Residence Result Urban Rural Total Household interviews Households sampled 1,462 7,637 9.099 Households occupied 1,369 7,393 8,762 Households interviewed 1,355 7.327 8,682 Household response rate 99.0 99.1 99. l Individual interviews Number of eligible women 1,494 7,841 9,335 Number of eligible women interviewed 1,449 7.678 9,127 Eligible woman response rate 97.0 97.9 97.8 Household interviews Households sampled 737 3,837 4,574 Households occupied 688 3,714 4,402 Households interviewed 679 3,681 4,360 Household response rate 98.7 99.1 99.0 Individual interviews Number of eligible men 589 3,022 3,611 Number of eligible men interviewed 535 2,811 3,346 Eligible man response rate 90.8 93,0 92.7 4 The intent of the survey was to collect data on currently married men. However, the Household Questionnaire followed the same format as for women and required all ever-married men be identified for interview. One of the first questions in the Men's Questionnaire concerned current marital status, at which point, interviewers stopped interviewing all formerly married men. Thus, although 3,346 ever-married men were interviewed, completed questionnaires are available only for the 3,312 currently married men. CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS The purpose of this chapter is to provide a short descriptive summary of some socioeconomic characteristics of the household population and the individual survey respondents, such as: age, sex, residence and educational level. Also examined are environmental conditions such as housing facilities and household characteristics. This information on the characteristics of the households and the individual women and men interviewed is essential for the interpretation of survey findings and can provide an approximate indication of the representativeness of the survey. 2.1 Characteristics of the Household Population In the BDHS, information was collected about all usual residents and visitors who had spent the previous night in the selected household. This approach makes it possible to distinguish between the de jure population (those usually resident in the household) and the de facto population (those who spent the night before the interview in the household). A household is defined as a person or group of people who live together and share food. Age and Sex The distribution of the household population in the BDHS is shown in Table 2.1 by five-year age groups, according to sex and urban-rural residence. Because of relatively high levels of fertility in the past, Table 2.1 Household nooulation by abe. residence and sex Percent distribution of the de facto household population by five*year age groups, according to urban-rural residence and sex, Bangladesh 1996-97 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 10.2 10.2 10.2 13.3 13.2 13.2 12.9 12.8 12.9 5-9 11.7 11.8 11.8 15.0 14.6 14.8 14.6 14.3 14.5 10-14 13.1 13.9 13.5 13.9 13.5 13.7 13.8 13.5 13.7 15-19 10.9 12.6 11.8 10.2 11.5 10.9 10.3 11.6 11.0 20-24 8.4 11.9 10.2 7.1 9.4 8.3 7.3 9.7 8.5 25-29 9.7 11.0 10.4 7.0 8.6 7.8 7.3 8.9 8.1 30-34 8.0 7.6 7.8 6.3 6.3 6.3 6.5 6.5 6.5 35-39 8.4 5.1 6.8 6.3 5.2 5.7 6.5 5.2 5.8 40-44 5.9 4.5 5.2 4.6 3.9 4.2 4.8 4.0 4.4 45-49 4.0 2,2 3.1 4.0 3. I 3.6 4.0 3.0 3.5 50-54 3.1 2,5 2.8 2.8 2.7 2.8 2.8 2.7 2.8 55-59 1.7 2,2 2.0 2.3 2.8 2.6 2.3 2.8 2.5 60-64 1.6 1.9 1.7 2.0 2.1 2.1 2.0 2.1 2.0 65-69 1.4 0,8 1.1 2.0 1.2 1.6 1.9 1.2 1.5 70-74 1.0 0,6 0.8 1.5 0.8 1.2 1.4 0.8 1.1 75-79 0.5 0,4 0.5 0.8 0.3 0.5 0.7 0.3 0.5 80+ 0.2 0,6 0.4 0.9 0.6 0.7 0.8 0.6 0.7 Missing/ Don't know 0.0 0.1 0.1 0,0 0.0 0.0 0.0 0.0 0.0 Total 100,0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0 Number 2,554 2,614 5,168 19,519 19,912 39,431 22,073 22,526 44,599 7 Bangladesh has a larger proportion of its population in the younger age groups than in the older age groups. Evidence of recent declines in fertility is reflected in the fact that there is a smaller proportion of children under age five than age 5 to 9, which confirms recent declines in fertility (see Figure 2.1). Figure 2.1 Population Pyramid, Bangladesh 1996-97 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 0-4 Age 10 5 O 5 10 Percent BDHS 1996-97 Urban areas have relatively fewer people under age 15 than rural areas (36 vs. 42 percent). Another indication of the 'older' age of the urban population is the fact that the largest age group is 10-14, as opposed to 5-9 in rural areas. Overall, the number of women slightly exceeds the number of men. This pattern is especially pronounced at ages 15-29, which may be due in part to international migration of young men for work. However, some combination of overreporting of ages of men and/or underreporting of ages of women may account for the excess of men over women at ages 65 and above. Figure 2.2 presents the distribution of the male and female household population by single year of age (see also Appendix Table C. 1). The data show evidence of a preference for reporting ages that end in zero or five (age "heaping" or digit preference) that is common in countries where ages are not well known. Digit preference is considerably more pronounced for men than for women. This is probably due to the fact that many of the women were individually interviewed and their ages probed in detail, while many of the men's ages were provided by proxy. Women also provided a detailed history of all their births, which is likely to have resulted in more accurate reporting of their own ages due to probing the dates of birth of their children. Figure 2.2 Distribution of De Facto Household Population by Single Year of Age and Sex Percent 0 1 O 20 30 40 60 60 70 Single Year of Age [--Female --Male] BDHS 1996-97 Table 2.2 compares the broad age structure of the population from the 1989 Bangladesh Fertility Survey (BFS), the 1989 and 1991 Contraceptive Prevalence Surveys (CPS), and the 1993-94 and 1996-97 Bangladesh Demographic and Health Surveys (BDHS). There has been a decline in the proportion of population less than 15 years of age and an increase in the proportion ages 15-59. Although this pattern is consistent with a decline in fertility, the slight decline since 1993-94 in the proportion age 60 and above is less explicable. Table 2.2 Povulation by aze from selected source~ Percent distribution of the de facto population by age group, selected sources, Bangladesh, 1989-97 1989 1989 1991 1993-94 1996-97 Age group BFS CPS CPS BDHS BDHS <15 43.2 43.2 42.7 42.6 41.0 15-59 50.9 50.9 51.2 51.2 53.1 60+ 5.9 5.9 6.0 6.2 5.9 Total 100.0 100.0 100.0 100.0 100,0 Median age U U U 18.4 18.8 U = Unknown (not available) Source: Huq and Cleland, 1990:28; Mitra et al., 1993:14; Mitra et al., 1994:11 Household Composition Table 2.3 shows that a small minority of households in Bangladesh are headed by females (9 percent), with more than 90 percent headed by males. Female-headed households are equally uncommon in rural and urban areas. The average household size in Bangladesh is 5.3 persons, with no variation be- tween rural and urban areas. Single-person house- holds are rare in both rural and urban areas. Education Education is a key determinant of the life style and status an individual enjoys in a society. It affects almost all aspects of human life, including demographic and health behavior. Studies have consistently shown that educational attainment has strong effects on reproductive behavior, contracep- tive use, fertility, infant and child mortality, morbid- ity and issues related to family health and hygiene. Table 2.4 provides data on educational attainment of the household population listed in the 1996-97 BDHS. Table 2.3 Household comoosition Percent distribution of households by sex of head of household and household size, according to urban-rural residence, Bangladesh 1996-97 Characteristic Residence Urban Rural Total Household headship Male 90.6 90.8 90.7 Female 9.4 9.2 9.3 Number of usual members 1 0.9 1.5 1.5 2 6.2 6.3 6.3 3 13.0 14.8 14.6 4 20.6 19.5 19.6 5 20.2 18.8 19.0 6 15.2 14.7 I4.7 7 9.5 9.6 9.6 8 6.2 6.1 6.1 9+ 8.2 8.7 8.6 Total 100.0 100.0 100.0 Mean size 5.3 5.3 5.3 Note: Table is based on de jure members, i.e., usual residents. Education has become more widespread over time in Bangladesh. This is apparent from the differences in levels of educational attainment by age groups. A steadily decreasing percentage of both males and females have never attended school in each younger age group. For men, the proportion who have never attended school decreases from 52 percent in the oldest age group (65 years or more) to 17 percent among those age 10-14; for women the decline is more striking: from 87 percent to 17 percent (see Figure 2.3). Despite this improvement in the spread of education, levels of educational attainment still remain low in Bangladesh, with a strong differential persisting between males and females. One-third of men (33 percent) and 44 percent of women age six years and above, have not received any formal education. The median number of years of schooling is 1.7 for men and less than one full year for women) In almost every age group there are smaller proportions of men than women with no education and more men than women with secondary education. However, over time, the sex differential is narrowing. For example, at age group 10-14. differences in educational attainment between boys and girls are insignificant (see Figure 2.3). Substantial urban-rural gaps in educational attainment persist. Over one-third of rural men (35 percent) have never attended school, compared with less than one-fifth of urban men (17 percent). The differences are also striking for women 46 percent of rural women have never attended school, compared with only 30 percent of urban women. Conversely, the proportions of men and women with some secondary education are twice as high in urban as in rural areas t Comparison with data from the 1993-94 BDHS is made difficult due to an error in the earlier survey in which the levels of schooling were mislabeled and the median years of schooling were overestimated. This accounts for the apparent decline in median years of schooling between the two surveys. 10 Table 2.4 Ed¢cational lev¢l 9f the female and male household oooulation Percent distribution of the de facto female and male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Bangladesh 1996-97 Don't Median Background No Primary Primary know/ years of characteristic education incomplete complete Secondary+ Missing Total Number schooling FEMALE Age ~ 6-9 22.6 77.1 0.1 0.2 0.0 100.0 2,670 0.0 10-14 17.1 54.4 8.0 20.5 0.0 100.0 3,045 2.4 15-19 29.6 18.8 11.9 39.7 0.0 100.0 2,623 4.1 20-24 43.7 15.4 10.8 30.1 0.0 100.0 2,185 2.1 25-29 52.5 16.9 9.2 21.4 0.0 100.0 1,996 0.0 30-34 56.2 17.5 9.0 17.3 0.0 100.0 1,458 0.0 35-39 56.7 18.6 8.3 16.3 0.1 100.0 1,163 0.0 40-44 66.9 13.8 8.9 10.3 0,0 100.0 894 0.0 45-49 70.2 15.5 7.1 7.2 0.0 100.0 683 0.0 50-54 77.9 12.1 4.4 5.5 0.1 100.0 610 0.0 55-59 79.5 11.8 5.0 3,6 0.1 100.0 622 0.0 60-64 82.7 9.8 4.5 2.7 0.3 100.0 464 0.0 65+ 86.5 7.9 3.0 2.2 0.3 100.0 657 0.0 Residence Urban 30.3 24,2 6.9 38.6 0.0 100.0 2,289 3.2 Rural 45.8 31.4 7.6 15.1 0.0 100.0 16,790 0.0 Division Barisal 26.8 38.8 12.8 21.6 0.1 100.0 1,271 2.2 Chittagong 41.8 28.5 8.5 21.3 0.0 100.0 4,251 0.5 Dhaka 45.9 29.1 6.2 18.8 0.0 100.0 5,897 0.0 Khulna 39.6 34.5 6.8 19.1 0, l 100.0 2,236 0.7 Rajshahi 48.5 30.7 7.1 13.6 0. l 100.0 4,284 0.0 Sylhet 52.7 28.1 7.9 11.4 0.0 100.0 1,141 0.0 Total 44.0 30.6 7.5 17.9 0.0 100.0 19,080 0,0 MALE Age L 6-9 23.5 75.7 0.6 0.2 0.1 100.0 2,683 0.0 10-14 17.0 55.9 7.7 19.2 0.1 100.0 3,052 2.4 15-19 21.8 20.9 8.5 48.6 0.1 100.0 2,269 4.7 20-24 30.3 14.7 9.7 45.1 0.1 100.0 1,602 4.5 25-29 37.1 14.8 8.2 39.7 0.2 100.0 1,622 3.5 30-34 42.9 15.6 7.1 34.3 0.1 100.0 1,442 2.1 35-39 41.8 17.4 8.5 32.0 0.2 100.0 1,442 1.9 40-44 43.3 15.4 8.1 32.7 0.5 100.0 1,050 1.5 45-49 42.8 16.7 9.2 30.6 0.8 100.0 877 1.8 50-54 44.5 14.5 11.2 29.6 0.2 100.0 624 1.8 55-59 48.2 17.7 11.3 22.5 0.2 100.0 500 0.0 60-64 52.2 16.6 8.9 21.5 0.8 100.0 436 0.0 65+ 52.2 17.0 9.5 20.0 1.2 100.0 1,078 0.0 Residence Urban 16.8 22.9 5.8 54.1 0.3 100.0 2,243 5.6 Rural 34.8 32.8 7.7 24.5 0.3 100.0 16,440 1.3 Division Barisal 20.6 37.9 9.0 32.4 0.1 100.0 1,152 2.8 Chittagong 27.7 32.9 8.4 30.9 0.2 100.0 3,967 2.3 Dhaka 34.7 29.4 6.7 28.9 0.3 100.0 5,821 1.4 Khulna 30.0 33.3 6.5 29.7 0.4 100.0 2,308 2.1 Rajshahi 37.0 30.6 6.8 25.2 0.3 100.0 4,304 1.1 Sylhet 40.2 32.3 10.5 16.7 0.2 100.0 1,132 0.5 Total 32.6 31.6 7.4 28.0 0.3 100.0 18,684 1.7 i Excludes 10 women and 8 men for whom an age was not reported 11 100 80 60 40 20 Percent Figure 2.3 Percentage of Males and Females With No Education by Age Group 0 6-9 10 14 15 19 20-24 25-29 30 34 35 39 4044 45-49 50 54 55 59 60-64 65+ Age Group [-.-Male +Femai~ I BDHS 1996-97 As for differences by division, both men and women in Barisal Division have higher educational attainment than residents of other divisions. The proportion of the population with no education is lower and the proportion with some secondary education is higher in this division than in the other divisions. Men and women in Sylhet Division are the most educationally disadvantaged. Table 2.5 presents enrollment rates by age, sex and residence of the population age 6-24 years. Of every ten children age 6-15 years, seven (71 percent) are enrolled in school. But enrollment drops substantially after age 15; only about one-third of older teenagers (32 percent) are still in school and only 1 out of 7 in their early 20s (14 percent) are still in school. The substantial decline after age 15 may be partly due to the fact that many families need their grown children (age 16-24) for work or do not have the means to bear their educational expenses. Table 2.5 School enrollment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban-rural residence, Bangladesh 1996-97 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 80.4 74.8 75.3 77.9 76.1 76.3 79.1 75.5 75.8 11-15 65.9 65.8 65.8 62.3 65.8 65.4 64.0 65.8 65.6 6-15 73.1 70.7 71.0 69.9 71.4 71.2 71.4 71.1 71.1 16-20 52.0 37.9 39.7 38.3 22.5 24.5 44.6 29.6 31.5 21-24 36.0 19.0 21.3 26.6 6.9 9.8 30.2 11.8 14.4 12 Table 2.6 Housin~ characteristics Percent distribution of households by housing characteristics, according to urban-rural residence. Bangladesh 1996-97 Characteristic Residence Urban Rural Total Electricity Yes 79.5 15.1 22.4 No 20.0 83.9 76.7 Don't know/Missing 0.5 1.0 0.9 Total 100.0 100.0 100.0 Source of drinking water Piped into residence 32.1 0.4 4.0 Piped outside residence 7.1 0.3 1.1 Tube well 60.0 94.0 90.2 Surface well 0.2 2.2 2.0 Pond/lake 0.4 2.3 2.1 River/stream 0.1 0.5 0.5 Other 0.1 0.2 0.2 Total 100.0 100.0 100.0 Sanitation facility Septic tank, modem 50.8 4.3 9.6 Water sealed/slab latrine 26.6 20.2 20.9 Traditional pit toilet 5.6 13.6 12.7 Open latrine 11.4 26.6 24.9 Hanging latrine 1.4 6.1 5.5 No facility/bush 4.2 29.1 26.3 Other 0.1 0.2 0.2 Total 1(30.0 100.0 100.0 Roof material Katcha (bamboo/thatch) 9.2 31.8 29.2 Tin 53.7 59.3 58.7 Cement/concrete 34,5 2.0 5.7 Other 2.6 6.9 6.4 Total 100.0 100.0 1(30.0 Wall material Jute/bamboo/mud 33.9 75.2 70.6 Wood 0.8 2.6 2.4 Brick/cement 56.3 6.6 12.3 Tin 7.3 12.2 11.7 Other 1.7 3.3 3.1 Total 100.0 100.0 100.0 Floor material Earth/bamboo 39.9 94.9 88.7 Wood 1.5 0.2 0.3 Cement/concrete 58.5 4,7 10.8 Other 0.0 0.2 0.2 Total 100.0 1130.0 100.0 It is encouraging that urban-rural gaps in enrollment of children have become virtually nonex- istent, with 71 percent of both urban and rural chil- dren age 6-15 currently enrolled in school. In fact, a slightly higher proportion of rural than urban children age 11-15 years are enrolled in school. However, rural enrollment rates still lag far behind urban rates among children older than 15. At ages 16-20 years, only 30 percent of rural adolescents are still in school, compared with 45 percent of urban youth; at ages 21-24 years, only 12 percent of rural young adults are in school, compared with 30 percent in urban areas. The sex differential in school enrollment also seems to be disappearing, at least among younger children. At ages 6-15, the proportions of boys and girls enrolled are indistinguishable. However, by ages 16-20 years, men are much more likely than women to be enrolled (40 vs. 25 percent), presumably due to early marriage or social seclusion, which cause young women to drop out of school. 2.2 Housing Characteristics Socioeconomic conditions were assessed by asking respondents questions about their household environment, This information is summarized in Table 2.6. As the table shows, only 22 percent of households in Bangladesh have electricity. Electric- ity is much more common in urban areas; 4 in 5 urban households have electricity, compared with 15 percent of rural households. The proportion of households with electricity has increased from 18 percent in 1993-94 to 22 percent in 1996-97. Tubewells are the major source of drinking water in Bangladesh. Overall, 9 in 10 households obtain their drinking water from tubewells. Only 5 percent depend on surface water such as surface wells, ponds and rivers/streams. Piped water is available mostly in urban areas. Among urban households, 32 percent have water piped into the residence, 7 percent obtain drinking water from taps (public or private) outside the residence, and 60 percent get their drinking water from tubewells. In rural areas, tubewells are the only major source of drinking water; 94 percent of rural households obtain their drinking water from tubewells. There has been little change in sources of drinking water since 1993- 94. 13 The majority (74 percent) of households in Bangladesh have sanitation facilities; however, only 43 percent have hygienic toilets (septic tank/modern toilets, water-sealed/slab latrines and pit toilets), while 26 percent have no facility at all. As expected, sanitation facilities vary between rural and urban areas. In rural areas, only 38 percent of households have hygienic toilets, compared with 83 percent of urban households. Moreover, 29 percent of rural households have no facility at all, compared with only 4 percent of urban households. Tin is the most common roofing material in Bangladesh, accounting for over half of both urban and rural households. However, urban and rural households vary widely in the use of other types of roofs. In urban areas, 34 percent of households live in dwellings with cement or concrete roofs, while in rural areas, bamboo or thatch (32 percent) is the most common roofing material after tin. Seven in ten households in Bangladesh live in structures with walls made of natural materials such as jute, bamboo or mud. Twelve percent live in houses with brick or cement walls and the same proportion live in houses with tin wails. Urban households live in more solid dwellings than rural households. Over half of urban households live in structures with brick or cement walls, compared with only 7 percent of rural households. Overall, 9 out of 10 households in Bangladesh live in residences with floors made of earth (89 per- cent). However, almost 6 in 10 urban households have cement or concrete flooring in their residences. Earth flooring is almost universal in rural areas (95 percent). Household Possessions Respondents were asked about ownership of selected durable goods and agricultural land. The information was collected primarily as socioeco- nomic indicators of the population. Results are shown in Table 2.7. Possession of household durable goods is not very common in Bangladesh, since many fami- lies cannot afford them. Nationally, 78 percent of households own a cot or bed, 55 percent a table, chair, or bench, 46 percent a watch or clock, and only 27 percent an almirah (wardrobe). As for more valuable items, 32 percent of households possess radios, 19 percent own bicycles, and only I 1 percent possess televisions. One in six households owns none of the items asked about. More urban than rural households possess every durable good asked about except bicycles, which reflects, among other things, the relatively better economic conditions in urban areas. There is also evidence that the socio- Table 2.7 Household DOSSeSsions Percentage of households possessing various consumer durable goods, according to urban-rural residence, Bangladesh 1996-97 Durable good Residence Urban Rural Total Almirah 60.0 22,6 26.8 Table/chair/bench 74.5 52.2 54.7 Watch/clock 76.7 41.6 45.6 Cot/bed 93.0 75.9 77.9 Radio 51.5 29,1 31.6 Television 48.6 5,8 10.6 Bicycle 18.4 19,4 19.3 None of the above 4.2 17,4 15.9 Agricultural land 39.2 58.7 56.5 Number of households 984 7,698 8,682 economic status of Bangladeshi households has improved over time, since there has been an increase since 1993-94 in the proportion of households owning all the durable goods asked about (Mitra et al., 1994:18)(Figure 2.4). Just over half of households in Bangladesh own agricultural land. This indicates that a large number of Bangladeshi families live in poverty, given that Bangladesh's economy is largely dependent on agriculture. Two-fifths of households in rural areas are without agricultural land (41 percent); as expected, households without agricultural land are more common in urban areas (61 percent). 14 Figure 2.4 Trends In Household Ownership of Durable Goods 100 80 60 40 20 0 Percent of households 78 AImlrah Table, Watch, Cot, Radio Tele- Bicycle Land chair clock bed vision 1[£]1993-94 m1996-97 I BDHS 1996-97 Health Care The 1996-97 BDHS included a question as to whether anyone in the interviewed household had been to a health facility, a doctor, or a nurse in the two weeks prior to the survey and, if so, where he or she went and the purpose of the visit. Answers to these questions can provide a picture of the health-care-seeking behavior of the population. As shown in Table 2.8, almost one in four households reported that a member of the household had recently sought medical care. Differences in health-care-seeking behavior by urban-rural residence and division are not large, although households in Chittagong appear to have higher levels than those in other divisions. Private doctors and clinics and traditional doctors provide almost half of the health care visits reported by households, with another 19 percent provided by pharmacies. Only 20 percent of health care visits are provided by government facilities, with roughly equal proportions visiting a hospital or medical college, a thana health complex, and a family welfare center. Urban households are more likely to report visits to private doctors and clinics, while rural households are more likely to report visits to traditional doctors. Although urban and rural households in which a member recently sought health care are almost equally likely to report visits to government facilities (20 percent), urban households are more likely than rural households to have visited a hospital or medical college, presumably because they are more common in urban areas, while rural households are more likely than urban households to report visits to thana health complexes or family welfare centers. Differences in sources of health care by division are not great. It is interesting that households in Barisal Division are more likely to report visits to satellite or immunization clinics and less likely than households in other divisions to have visited traditional doctors. Households in Rajshahi Division are most likely to report visits to traditional doctors. By far the most common reason for seeking health care is illness. 15 Table 2.8 Health-care-seeking behavior Percentage of households in which someone visited a health facility or a doctor or nurse in the 2 weeks preceding the survey and, of these households, the percent distribution by type of place visited and reason for visit, Bangladesh 1996-97 Residence Division Place visited/ reason Urban Rural Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Total Percentage of households seeking health care 29.2 23.0 19.0 32.6 23.7 23.1 19.2 19.9 23.7 Place visited Hospital/medical college 15.5 5.8 8.6 6.7 9.5 9.5 2.4 6.5 7.2 Family welfare center 2.3 5.6 4.5 6.3 4.3 4.2 4.9 7.6 5.1 Thana health complex 2.0 6.7 8.9 6.1 5.2 2.8 7.1 12.4 6.0 Satellite/EPl clinic 0.2 1.5 8.3 1.3 0.6 1.3 0.5 1.9 1.3 Privateclinic/doctor 43.5 21.1 26.8 22.2 26.3 34.0 18.1 19.6 24.2 Traditional doctor 4.1 28.5 12.9 27.4 18.9 23.3 35.9 27.0 25.1 Pharmacy 20.6 18.5 17.2 18.5 22.8 12.5 17.7 15.1 18.8 Shop 1.2 3.3 3.8 1.1 3.4 3.9 4.6 0.6 3.0 Friends/relatives 0,4 0.3 0.6 0.5 0.4 0.4 0.0 0.0 0.3 Fieldworker. FWA 0.9 0.8 0.0 1.1 1.3 0.0 0.7 0.0 0.8 Other 7.9 6.6 7.8 7.8 5,2 6.8 7.3 8.8 6.8 Does not know 0.2 0.4 0.0 0.3 0.4 0.4 0,5 0.0 0.4 Missing 1.3 0.9 0.6 0.8 1.6 0.9 0.2 0.6 1.0 Total 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 100.0 100.0 Reason for the visit Immunization 2.2 2.7 11.7 2.4 1.7 1,5 2.0 5.2 2.6 Family planning 0.6 1.3 1.9 0.5 1.3 2.0 1.2 1.9 1.2 Antenatal checkup 2.6 0.8 1.3 1.1 0.9 1.0 0.9 2.5 1.1 Illness 85.5 88.8 78.2 88.8 87.9 88.0 92.7 81.6 88.3 Accident 3.2 1.6 3.2 1.0 2.6 1.3 1.3 1.9 1.8 Other 6.0 4.4 3.1 5.9 4.8 6,2 1.6 6.3 4.6 Missing 0.0 0.5 0.6 0.3 0.7 0.0 0.2 0.6 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households with a visit 287 1,771 107 540 661 243 413 94 2,058 EPI = Expanded Programme on Immunization FWA = Family Welfare Assistant 2.3 Background Characteristics of Women and Men Respondents General Characterist ics Table 2.9 shows the distribution of female and male respondents by selected background characteristics. To assess their age, respondents were asked two questions in the individual interview: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained to probe in situations in which respondents did not know their age or date of birth, and they were instructed as a last resort to record their best estimate of the respondent's age. The age distribution of ever-married women is very similar to that found in the 1993-94 BDHS, with the majority (54 percent) of ever-married women age 15-29 years. The currently married men interviewed are older than the ever-married women, in large part because men marry at older ages than women. 16 Table 2.9 Background characteristics of resoondents Percent distribution of ever-married women and currently married women and men by selected background characteristics, Bangladesh 1996-97 Background characteristic Ever-married women Currently married women Currently married men Number of women Number of women Number of men Weighted Un- Weighted Un- Weighted Un- percent Weighted weighted percent Weighted weighted percent Weighted weighted Age 10-i4 1.6 145 146 1.7 143 144 NA NA NA 15-19 14.3 1,301 1,272 14.8 1,252 1,223 0.7 23 23 20-24 18.9 1,727 1,716 19.6 1,655 1,644 5.9 194 190 25-29 20.9 1,905 1,921 21.4 1,812 1,828 14.7 487 469 30-34 15.4 1,402 1,412 15.3 1,297 1,307 18.7 620 619 35-39 12.4 1,128 1,144 12.2 1,031 1,046 18.8 621 627 40-44 9.4 861 867 8.8 740 745 14.8 492 491 45-49 7.2 658 649 6.2 520 513 11.2 371 383 50-54 NA NA NA NA NA NA 8.2 272 281 55-59 NA NA NA NA NA NA 7.0 231 229 Marital status Currently marred 92.6 8,450 8,450 100.0 8,450 8,450 100.0 3,312 3,312 Widowed 4.3 391 389 NA NA NA NA NA NA Divorced 3.1 286 288 NA NA NA NA NA NA Residence Urban 11.7 1,063 1,449 11.5 968 1,328 12.1 400 532 Rural 88.3 8,064 7,678 88.5 7,482 7,122 87.9 2,912 2,780 Division Barisal 6.5 598 937 6.6 560 879 6.0 199 315 Chittagong 20.1 1,836 1,359 20.1 1,701 1,259 17.6 584 411 Dhaka 31.6 2,882 2,529 31.4 2,656 2,334 31.9 1,056 950 Khulna 12.1 1,107 1,084 12.1 1,024 1,003 12.9 428 406 Rajshahi 24.1 2,198 2,314 24.2 2,049 2,154 26.5 877 934 Sylhet 5.5 506 904 5.4 460 821 5.1 168 296 Education No education 54.6 4,983 4,899 53.3 4,502 4,422 42.0 1,390 1,376 Primary incomplete 17.2 1,572 1,602 17.4 1,470 1,497 22.6 750 734 Primary complete 10.0 913 928 10.2 862 881 6,2 204 210 Secondary+ 18.2 1,659 1,698 19.1 1,615 1,650 29.2 968 992 Religion Islam 89.5 8,168 8,I09 89.3 7,549 7,493 87.5 2,897 2,871 Hinduism 9.9 906 975 10.1 851 916 12.1 401 428 Buddhism 0.4 36 28 0.4 36 27 0.1 4 4 Christianity 0.1 14 13 0.1 13 12 0.2 6 6 Other 0.0 2 2 0.0 2 2 0.l 3 3 Total 100.0 9,127 9,127 100.0 8,450 8,450 100.0 3,312 3,312 NA=Not applicable Twelve percent of respondents live in urban areas, with 88 percent in rural areas. This is a lower proportion urban than the 20-22 percent currently quoted. The major reason for the discrepancy is the definition of urban (see Footnote 3). Almost one-third of female and male respondents live in Dhaka Division, while roughly one-quarter live in Rajshahi Division and one-fifth in Chittagong Division. About 12 percent of respondents live in Khulna Division, 6-7 percent in Barisal Division, and 5-6 percent in Sylhet Division. The distribution of ever-married women by division is very similar to that in the 1993-94 BDHS (Mitra et al., 1994:19). 17 The majority (55 percent) of ever-married women have never attended school. Only 28 percent have completed primary school and only 18 percent have secondary education. Nevertheless, the data show some improvement in female education since 1993-94, with the proportion of ever-married women with no formal education declining from 58 to 55 percent and the proportion with secondary education increasing from 15 to 18 percent (Mitra et al., 1994:19). In general, married men are better educated than women, with the majority having some education and 29 percent having some secondary school, compared with only 18 percent of ever-married women. About 9 in 10 respondents are Muslim, with most of the remainder being Hindu. The composition by religion is similar to that reported in the 1993-94 BDHS (Mitra et al., 1994:19). Because the married men interviewed in the BDHS were selected from a subsample of households in which ever-married women were interviewed, it is possible to match male respondents with their wives to obtain a dataset of matched couples. Table 2.10 shows husband-wife differentials in age and educa- tion for 3,028 couples. For almost all married cou- ples, the husband is older than the wife--generally 5 to 14 years older. The mean age difference is 9 years. Regarding educational differences, in about one-third of married couples, neither the husband nor the wife has any education, while in another third, both have some education. For the remaining one- third of couples, the proportion in which the husband has some education and the wife has none is twice that in which the wife is educated and the husband is not (22 vs. 10 percent). Table 2.10 Differentials in age and education Percent distribution of couples by differences between spouses in age and level of education, Bangladesh 1996- 97 Number of Characteristic Percent couples Age (husband's age minus wife's age) Wife older 1.3 40 0-4 years 12.9 392 5-9 years 42.1 1,273 10-14 years 31.3 947 15 years + 12.4 376 Mean age difference (years) 9.4 3,028 Education Both husband and wife not educated 32.4 98 l Wife educated, husband not 9.9 301 Husband educated, wife not 21.5 651 Both husband and wife educated 36.2 1,095 Total 100.0 3,028 Differential Education Tables 2.11.1 and 2.11.2 present the distribution of women and men by education, according to selected characteristics. Among ever-married women, education is inversely related to age, that is, older women are less educated than younger women. For instance, 41 percent of ever-married women age 15-19 years have never attended school, compared with 71 percent of those age 45-49. Among currently married men, the distribution by education level is more uniform across age groups. Among both women and men, urban residents have more education than rural residents. For example, 57 percent of rural women have had no education at all, compared with 36 percent of urban women. In contrast, while about 4 in 10 urban women (42 percent) have attended secondary school, only 15 percent of rural women have done so. Women and men in Barisal, Chittagong, and Khulna Divisions appear to be more educated than those in the other divisions. For example, less than half the ever-married women in Barisal and Khulna have no education, compared with about 60 percent or more in Rajshahi and Sylhet. Women in Barisal and Chittagong Divisions are also more likely than women in the other divisions to complete primary school and to attend secondary school. 18 Table 2.11.1 Level of education by backfrround characteristics: women Percent distribution of ever-roamed women by highest level of education attended, according to age, residence, and division, Bangladesh 1996-97 Level of education Number Background No Primary Primary Secon- of characteristic educ. incomplete complete dary+ Total women Age 10-14 42.0 27.2 16.1 14.7 100.0 145 15-19 40.8 20.6 13.8 24.8 100.0 1,301 20-24 49.8 16.2 10.7 23.3 100.0 1,727 25-29 54.9 16.9 9.6 18.6 100.0 1,905 30-34 56.7 17.8 8.8 16.6 100.0 1,402 35-39 57.4 18.1 8.4 16.1 100.0 1,128 40-44 66.6 13.7 8.5 11.1 100.0 861 45-49 71.0 14.1 7.7 7.1 100.0 658 Residence Urban 35.5 13.1 9.2 42.2 100.0 1,063 Rural 57.1 17.8 10.1 15.0 100.0 8,064 Division Barisal 30.0 29.2 18.5 22.2 100.0 598 Chittagong 51.0 14.1 11.8 23.2 100.0 1,836 Dhaka 57.6 14.8 8.8 18.8 100.0 2,882 Khulna 47.9 23.7 9.2 19,3 100.0 1,107 Rajshahi 61.0 17.2 8.6 13.1 100.0 2,198 Sylhet 66.5 14.3 8.0 11.2 100.0 506 Total 54.6 17.2 10.0 18.2 100.0 9,127 Table 2.11.2 Level of education bv backaround characteristics: men Percent distribution of currently married men by highest level of education attended, according to age, residence, and division, Bangladesh 1996-97 Level of education Number Background No Primary Primary Secon- of characteristic educ. incomplete complete dary+ Total men Age 15-19 49.1 22.1 6.1 22.7 100.0 23 20-24 46.3 26.3 6.1 21.2 100.0 194 25-29 43.8 18.2 7.9 30.1 100.0 487 30-34 38.9 24.8 4.4 31.8 100.0 620 35-39 42.8 22.5 6.0 28.7 100.0 621 40.44 37.9 22.0 5.1 35.0 100.0 492 45-49 41.6 21.2 8.7 28.5 100.0 371 50-54 43.7 24.2 5.2 26.9 100.0 272 55-59 46.6 25.3 7.0 21.1 100.0 231 Residence Urban 20.8 13.2 4.1 61.9 100.0 400 Rural 44.9 23.9 6.4 24.8 100.0 2,912 Division Barisal 30.5 23.7 6.7 39.2 100.0 199 Chittagong 34.9 27.9 5.7 31.5 100.0 584 Dhaka 43.0 19.4 6.1 31.5 100.0 1,056 Khulna 38.9 25.3 5.3 30.5 100.0 428 Rajshahi 48.0 21.6 6.1 24.3 100,0 877 $ylhet 49.7 22.2 9.9 18.3 100,0 168 Total 42.0 22.6 6.2 29.2 100,0 3,312 19 Access to Media Female and male respondents were asked in the BDHS if they usually read a newspaper, listen to the radio or watch television at least once a week. This information is of use in planning the dissemination of family planning and health messages. The data indicate that of the three media, radio is by far the most widespread and that men are more likely than women to access all three media. For example, Table 2.12 shows that two-fifths (40 percent) of ever-married women listen to the radio weekly, compared with two- thirds of men. Only 27 percent of women watch television at least once a week, compared with more than half of the men. And while less than 1 in 10 women reads a newspaper, one-quarter of men report doing so. Consequently, half of women report having weekly exposure to none of the three media, compared with only one-quarter of men. Tabl¢ 2.12 Access to mass media Percentage of ever-married women who usually read a newspaper once a week, watch television once a week, or listen to radio daily, by selected background characteristics and percentage of men who carry out these activities, Bangladesh 1996-97 Mass media Read Watch Listen Number No news- tele- to All of Background mass paper vision radio three women/ characteristic media weekly weekly daily media men Age 10-14 48.2 6.7 19.9 45.8 1.7 145 15-19 45.2 9.4 28.2 44.9 4.7 1,301 20-24 47.2 9.4 28.9 43.3 6.1 1,727 25-29 48.2 9.7 30.6 41.9 6.8 1,905 30-34 53.1 7.4 27.7 36.4 4.1 1,402 35-39 54.4 9.0 25.5 36.9 6.5 1,128 40-44 57.8 7.5 21.7 33.4 4.4 861 45-49 62.2 5.8 18.7 30.4 4.1 658 Residence Urban 16.9 29.4 76.1 52.5 21.5 1,063 Rural 55.5 5,9 20.5 37.9 3.3 8,064 Division Barisal 54.4 10.5 21.6 41.0 7.0 598 Chittagong 48.5 I0.5 29.7 41.0 6.5 1,836 Dhaka 49.8 10.4 32.1 37.8 6.8 2,882 Khulna 50.1 7.2 28.6 40.3 4.4 1,107 Rajshahi 50.9 5.8 21.5 42.3 3.3 2,198 Sylhet 66.2 5.2 14.3 29.1 2.6 506 Education No education 66.5 0.0 14.8 27.4 0.0 4,983 Primary incomplete 48.5 2.0 25.2 42.9 1.1 1,572 Primary complete 35.6 9.5 34.8 52.4 5,2 913 Secondary+ 15.6 40.2 61.0 66.0 25.7 1,659 All women 51.0 8.6 27.0 39.6 5,4 9,127 All men 26.1 25.1 52.7 63.8 18,3 3,312 20 Differentials in exposure to media are shown only for ever-married women. They indicate that younger women are somewhat more likely than older women to listen to the radio. Exposure to all three media is higher among urban and more educated women. For example, the proportion of women who watch television at least once a week ranges from 15 percent of those with no education to 61 percent of those with some secondary school. Differentials by division are not large, except that women in Sylhet Division have less exposure to all three media than women in other divisions. It is interesting to note that, while women's access to radio and newspapers has hardly changed since 1993-94, television-viewing has increased considerably. For example, the proportion of ever-married women who read newspapers weekly has increased from 7 percent in 1993-94 to 9 percent in 1996-97, while the proportion who listen to the radio has increased from 39 to 40 percent. The proportion who watch television weekly, however, has increased from 18 to 27 percent (Mitra et al., 1994:21). Employment and Occupation In the 1996-97 BDHS, information was collected about current employment. Although data were collected from ever-married female and currently married male respondents, the analysis in this section concentrates on women. Data in Table 2.13 indicate that 63 percent of ever-married women report being unemployed and 37 percent employed at the time of the survey. Most employed women work all year, with a minority working seasonally. The proportion unemployed is higher among younger women, urban women, and better educated women. Women in Rajshahi Division are more likely to be employed than women in the other divisions. Rural women are more likely to be employed seasonally than urban women, presumably as agricultural laborers. Women who reported themselves as employed at the time of the survey were asked if they worked for a member of their family, for someone else, or if they were self-employed. They were also asked if they earned cash for their work (Table 2.14). Roughly one-quarter of working women are self-employed, while 20 percent work for others and 54 percent work in a family business. Sixty-two percent of employed women earn cash for their work. Rural working women are more likely than urban women to work in a family business, while urban women are more likely to work for others. Urban women who work are also much more likely than rural women to receive cash earnings (88 vs. 60 percent). Divisional differences show that women in Barisal Division are more likely to be self-employed, less likely to work for relatives, and more likely to earn cash than women in other divisions, while working women in Sylhet are less likely to be self-employed and less likely to be paid in cash. Differences by education level in type of employment and form of payment are not large. Table 2.15.1 indicates the types of occupations in which working women are engaged. Almost half of employed women are manual laborers, with 41 percent engaged in skilled labor and 8 percent in unskilled labor. Another 46 percent are employed in agricultural jobs, with the vast majority working on other people's land. Only 4 percent of working women are employed in professional, technical, or managerial jobs. As expected, agricultural jobs are more common among rural women, while urban women are more likely to be employed in manual labor. Women in Khulna Division are more likely and those in Dhaka Division less likely to be employed in agriculture; conversely, women in Dhaka Division are more likely to be employed in manual jobs. As expected, women with no education are more likely to be employed in the agriculture sector, while those with some secondary school are more likely to have skilled manual labor. 21 Percent distribution of ever-married women by employment status and continuity of employment, according to background characteristics, Bangladesh 1996-97 Currently employed Work Work Work Number Background Not all season- occasion- of characteristic employed year ally ally Missing Total women Age 10-14 80.8 12.4 6.8 0.0 0.0 100.0 145 15-19 75.8 14.1 9.5 0.4 0.1 100.0 1,301 20-24 66.7 20.3 11.9 0.8 0.3 100.0 1,727 25-29 59.8 27.0 12.5 0.7 0.1 100.0 1,905 30-34 57.0 30.7 12.0 0.3 0.0 100.0 1,402 35-39 56.2 31.2 11.4 1.2 0.0 100.0 1,128 40-44 56.6 27.8 14.4 0.9 0.3 100.0 861 45-49 64.0 20.6 14.3 1.1 0.0 100.0 658 Residence Urban 72.1 23.9 3.4 0.4 0.3 100.0 1,063 Rural 61.6 24.4 13.1 0.7 0.1 100.0 8,064 Division Barisal 72.7 19.6 6.1 1.3 0.3 100.0 598 Chittagong 69.1 18.9 11.5 0.4 0.1 100.0 1,836 Dhaka 64.7 24.7 9.7 0.7 0.1 100.0 2,882 Khulna 61.1 23.8 14.3 0.6 0.2 100.0 1,107 Rajshahi 51.4 32.4 15.3 1.0 0.1 100.0 2,198 Sylhet 71.7 14.0 14.2 0.1 0.0 100.0 506 Education No education 58.9 27.0 13.3 0.7 0.l 100.0 4,983 Primary incomplete 63.1 23.5 13.0 0.3 0.I 100.0 1,572 Primary complete 68.1 20.2 10.2 1.4 0.1 100.0 913 Secondary+ 71.6 19.5 8.0 0.6 0.3 100.0 1,659 Total 62.9 24.4 12.0 0.7 0.1 100.0 9,127 Table 2.15.2 presents similar data for currently married men. It shows that only a fraction of men are not currently working. Almost half of men work in agriculture, mostly on their own land. One-quarter of men have professional, technical or managerial jobs, while another quarter work as manual laborers. Women who said they were paid in cash for their work were asked whether they themselves or someone else usually decides how the money they earn is used. As shown in Table 2.16, more than 2 in 5 employed women decide for themselves how to spend their cash earnings, while almost half say they decide with someone else how to spend their money. Nine percent of working women say that someone else decides how to spend their earnings. Older women, urban women, women in Barisal Division, and those who are not currently married are more likely than other women to decide for themselves how to spend their earnings. In the survey, all employed women who had a child under age six l iving at home were asked who cared for the child while the mother was working. Less than half of working women (45 percent) have a child under age six (data not shown). The vast majority of these women (69 percent) say they look after their own children while at work, while 14 percent leave the child in the care of older children and 12 percent use other relatives as caretakers. Very few employed mothers leave their young children with their husbands, with neighbors or friends, with servants, or with child care institutions. Urban working women are less likely than rural women to have a child under six and when they do, they are also less likely to care for their children themselves while at work. 22 Table 2.14 Emvlover and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to background characteristics, Bangladesh 1996-97 Employed by Employed by Self-employed a noarelative a relative Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women Age 10-14 (21.8) (0.0) (8.3) (0.0) (13.9) (56.0) (0.0) 100.0 28 15-19 18.3 7.7 11.6 4.0 21.3 36.4 0.7 100.0 314 20-24 17.3 5.1 14.3 4.3 27.9 30.2 0.9 100.0 573 25-29 20,4 5.6 17.6 4.7 27.8 23.7 0.2 100.0 766 30-34 23.4 6,6 17.0 3.5 27.7 21.5 0.4 100.0 603 35-39 25.3 3.9 15.2 3,4 29.6 22.4 0.1 100.0 494 40-44 15.4 5.1 17.4 6.9 25.7 28.9 0.6 100.0 374 45-49 15.5 5.4 11.0 8.8 22.6 36.8 0.0 100.0 236 Residence Urban 25.8 1.8 39.6 2.4 22.4 7.1 0.8 100.0 297 Rural 19.5 5.9 13.2 4,9 27.2 29.1 0.4 100.0 3,090 Divtslon Barisal 33.7 3.7 15.1 5,5 23.9 18.0 0.0 100.0 161 Chittagong 17.8 6.5 7.6 6,2 29.8 31.5 0.6 100.0 567 Dhaka 24.2 4.5 16.7 3.5 26.6 24.1 0.4 100.0 1,016 Khulna 15.5 6.3 20.9 6.1 23.3 27.4 0.5 100.0 430 Rajshahi 18.1 5.9 15.3 4.0 28.9 27.3 0.4 100.0 1,069 Sylhet 12.5 5.8 23.3 5.8 12.6 40.0 0.0 100.0 143 Education No education 19.1 5.7 16.4 5.7 27.8 25.0 0.3 100.0 2,046 Primary incomplete 21.7 6.3 10.3 4.7 25.9 30.5 0.5 100.0 580 Primary complete 22.0 4.1 10.2 2.2 27.2 34.0 0.4 100.0 291 Secondary+ 21.3 4.8 20.8 1.6 22.7 27.8 0.9 100.0 471 Total 20.1 5.5 15.5 4.6 26.7 27.1 0.4 100.0 3,387 Note: Figures in parentheses are based on 25 to 49 unweighted cases. 23 Table 2,15.10ccuoation: women Percent distribution of currently employed women by occupation and type of agricultural land worked or type of nonagricultural employment, according to background characteristics, Bangladesh 1996-97 Agricultural Nonagricultural ProL/ Number Background Own Rented Other's tech./ Skilled Unskilled of characteristic land land land manag, manual manual Other Missing Total women Age 10-14 (12.1) (0.0) (27.1) (0.0) (60.2) (0.7) (0.0) (0,0) I00.0 28 15-19 10.8 2.1 33.2 1.0 47,3 4.7 0.1 0.7 100.0 314 20-24 9.7 1.2 34.6 2.6 42,1 7.9 0.7 1.1 100.0 573 25-29 9~2 0.8 36.3 3.2 40,8 8.5 0.7 0.4 100.0 766 30-34 7.4 2.0 35.6 5.5 38.4 9.7 1.1 0.4 100.0 603 35-39 7.0 2.1 37.9 4.6 37.2 8.7 2.3 0.2 100.0 494 40-44 8,1 3.4 32.7 3.3 40.3 9.9 0.9 1.5 100.0 374 45-49 10.5 4.4 28,9 2.6 44.2 7.2 2.1 0.2 100.0 236 Residence Urban 0.7 0,2 11.0 6.3 57.7 19.8 3.0 1.3 100.0 297 Rural 9.6 2.I 37.1 3.2 39.4 7.2 0.9 0.6 100.0 3,090 Division Barisal 2.0 0.0 39.0 4.4 41.4 9,6 0.6 3.0 100,0 161 Chittagong 15.3 3.5 36.1 3.9 33.1 5.2 2.3 0.6 100.0 567 Dhaka 3.9 0.5 31.5 3.0 48.2 11.7 0.7 0.5 100.0 1,016 Khulna 21.8 2.5 40.6 3.6 22.1 7.3 1.2 1.0 100.0 430 Rajshahi 2.6 1.2 37.5 3.8 47.3 6.4 0.7 0.4 100.0 1,069 Sylhet 32.5 l 1.2 I 1.2 1.2 30.9 I 1.3 1.5 0.0 100.0 143 Education No education 6.5 2.3 36.9 4.1 36.6 12.2 0.9 0.4 100.0 2,046 Primary incomplete 12.8 1.6 38.8 2.1 38.7 3.9 1.1 1.1 I00.0 580 Primary complete 11.9 1.3 37.0 3.9 41.9 2.7 0.7 0.6 100.0 291 Seconda~+ 11.9 0.8 19.6 1.9 62.6 0.2 1.8 I.I 100.0 471 Total 8.8 [.9 34.8 3.5 41.0 8.3 1.1 0.6 I00.0 3,387 Note: The "professional, technical, managerial" category includes professional, technical, clerical and managerial occupations, Figures in parentheses are based on 25-49 unweighted cases. 24 Table 2.15.2 Occupation: men Percent distribution of cutter, fly marred men by occupation and type of agricultural land worked or type of nonagi'icuRural employment, accordin to background characteristics, Bangladesh 1996-97 Agricultural Nonagricultural Not Prof./ Number Background currently Own Rented Other teeh./ Skilled Unskilled of characteristic employed land land land manag, manual manual Other Missing Total men Age 15-19 (3.4) (27.9) (0.0) (35.6) (1.8) (8.6) (22.7) (0.0) (0.0) 100.0 23 20-24 3.7 26.0 10.0 15.4 14.2 12.3 14.9 1.4 2.1 100.0 194 25-29 1.0 18.9 8.1 14.7 25.6 12.7 18.2 0.6 0.I I00.0 487 30-34 0.5 22.2 6.9 13.2 27.3 13.7 14.9 0.7 0.6 I00.0 620 35-39 0.2 23.5 8.5 13.8 25.9 13.9 13.6 0.4 0.2 I00.0 621 40-44 0.1 23.6 7.7 13.6 32.9 10.7 10.8 0.2 0.4 100.0 492 45-49 2.9 25.6 8.7 16.1 24.5 10.5 11.7 0.0 0.0 I00.0 371 50-54 1.7 25.8 12.8 14.5 22.6 12.8 7.8 1.0 1.0 100.0 272 55-59 7.3 39.0 9.3 13.7 22.3 4.0 4.2 0.0 0.3 I00.0 231 Residence Urban 1.7 2.3 0.2 0.8 48.4 29.5 15.6 1.5 0.0 I00.0 400 Rural 1.5 27.3 9.6 16.2 22.5 9.5 12.5 0.3 0.5 I00.0 2,912 Division Bafisal 0.1 16.9 7.5 10.6 37.6 11.3 11.9 0.7 3.4 100.0 199 Chittagong 3.4 13.6 11.6 8.6 32.1 13.9 15,7 0.9 0,0 100.0 584 Dhaka 1.4 25.1 7.3 13.3 24.7 14.2 13.1 0.5 0.4 100.0 1,056 Khulna 1.4 31.1 6.7 13.5 25.7 9.7 11.5 0.4 0.0 100.0 428 Rajshahi 0.5 28.6 8.9 19.6 20.5 9.8 11.6 0.2 0.3 100.0 877 Sylhet 2.5 25.0 8.7 19.9 21.1 8.2 13.8 0.4 0.4 100.0 168 Education No education Primary incomplete Primary complete Secondary+ 0.9 20.6 11.5 25.6 13.0 8.2 19.7 0.4 0.2 100.0 1,390 1.0 29.3 10.7 11.7 22.2 10.2 13.8 0.2 0.8 100.0 750 1.1 33.9 8.6 8.4 26.8 12.8 7.3 0.6 0.6 100.0 204 2.9 23.6 2.4 1.6 46.0 18.5 3.7 0.7 0.5 100.0 968 Total 1.5 24.3 8.5 14.4 25.6 11.9 12.9 0.5 0.5 100.0 3,312 Note: The "professional, technical, managerial" category includes professional, technical, clerical and managerial occupations, Figures in parentheses are based on 25-49 unweighted cases 25 Table 2,16 Decisions on use of earnings Percent distribution of women receiving cash earnings by person who decides how earnings will be used, according to background characteristics, Bangladesh 1996-97 Person who decides how earnings will be used Jointly with Number Background Self someone Someone of characteristic only else else Missing Total women Age 10-19 32.2 53.9 13.8 0.0 100.0 174 20-24 35.2 55.7 9.0 0.0 100.0 341 25-29 43.0 50.3 6.7 0.0 100.0 504 30-34 43.9 47.9 8.1 0.0 100.0 412 35-39 42.5 48.3 8.8 0.4 100.0 347 40-44 47.2 41.7 11.1 0.0 100.0 220 45-49 49.8 39.1 11.1 0.0 100.0 116 Residence Urban 60.5 36.3 3.2 0.0 100.0 263 Rural 39.1 51.0 9.8 0.1 100.0 1,851 Division Barisal 56.6 34.7 8.7 0.0 100.0 117 Chittagong 46.1 43.4 10.5 0.0 100.0 313 Dhaka 42.9 50.0 6.9 0.2 100.0 688 Khulna 44.2 43.6 12.1 0.0 100.0 257 Rajshahi 34.3 55.9 9.8 0.0 100,0 669 Sylhet 48.1 47,6 4.3 0.0 100.0 69 Education No education 41.1 50.0 9.0 0.0 100.0 1.298 Primary incomplete 38.5 49.8 11.7 0.0 100.0 337 Primary complete 43.3 49.6 7.1 0.0 100.0 173 Secondary+ 47.3 45.0 7.3 0.4 100.0 306 Marital status Currently married 35.l 55.3 9.5 0.1 100.0 1,819 Not married 82.8 l 1.3 5.8 0.0 100.0 295 Total 41.8 49,2 9.0 0.1 100.0 2,114 26 CHAPTER 3 FERTILITY 3.1 Introduction The measurement of fertility levels, differentials and determinants was a major objective of the 1996- 97 BDHS. Interest in the fertility data was particularly keen, given the fact that the 1993-94 BDHS estimated a very low fertility rate that engendered some skepticism. The fertility indicators presented in this chapter are based on reports provided by ever-married women age 15-49 years regarding their reproductive histories. Each woman was asked to provide information on the number of sons and daughters to whom she had given birth who were living with her, the number living elsewhere, and the number who had died. The women were then asked for a history of all their live births, including such information as: name, month and year of birth, sex and survival status. For children who had died, information on age at death was solicited. The above information is analyzed in the following sections to provide fertility levels and trends; fertility differentials by residence, division, and educa- tion; information on length of interval between births; age at first birth; and the extent of childbearing among adolescents. A brief discussion of the quality of the BDHS fertility data appears in Appendix C.2. 3.2 Fert i l i ty Leve ls Table 3.1 gives the reported age-specific fertility rates for the three-year period preceding the survey per 1,000 women) The sumof the age-specific fertility rates (known as the total fertility rate) is a useful means of summarizing the level of fertility. It can be interpreted as the number of children a woman would Table 3.1 Current fertility rates Age-specific and cumulative fertility rates and the cmde birth rate for the three years preceding the survey, by urhan-mral residence, Bangladesh 1996- 97 Residence Age group Urban Rural Total 15-19 88 155 147 20-24 140 200 192 25-29 99 158 150 30-34 53 102 96 35-39 28 46 44 40-44 12 19 18 45-49 (0) 7 6 TFR 15-49 2.10 3.43 3.27 TFR 15-44 2.10 3.40 3.24 GFR 86 135 129 CBR 22.6 30.2 29.4 Note: Ratesarefor theperiod 1-36monthspreceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Rates in paren- theses are based less than 250 woman-years of exposure. TFR: Total fertility rate, expressed per woman GFR: Ganeral fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate. expressed per 1,000 pop- ulation have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. The general fertility rate represents the annual number of births in a t Numerators of the age-specific fertility rates are calculated by summing the number of live births that occurred in the period 1-36 months preceding the survey (determined by the date of interview and the date of birth of the child), and classifying them by the age (in five-year groups) of the mother at the time of birth (determined by the mother's date of birth). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. Since only women who had ever married were interviewed in the BDHS, the numbers of women in the denominators of the rates were inflated by factors calculated from information in the household questionnaire on proportions ever married in order to produce a count of all women. Never-rnarried women are presumed not to have given birth. 27 population per 1,000 women age 15-44. The crude birth rate is the annual number of births in a population per 1,000 people. Both these measures are calculated using the birth history data for the three-year period before the survey and the age and sex distribution of the household population. The total fertility rate for the three years before the survey (approximately 1994 through 1996) is 3.3 children per woman. This represents a statistically insignificant decline in fertility over the 3-year period since the 1993-94 BDHS (see section 3.4). The age-specific rates indicate a pattern of early childbearing, with a peak at age group 20-24. Three-quarters of childbearing occurs before age 30. The crude birth rate for the whole country is 29 births per 1,000 population. This is unchanged from the level measured in the 1993-94 B DHS, but is somewhat higher than the rate of 27 reported both by the government's sample vital registration system for 1995 (BBS, 1997:144) and by the Health and Demographic Survey for 1995 (BBS, 1995:2). Fertility is higher in rural areas than in urban areas (see Figure 3.1), a pattern that has persisted in various censuses and demographic surveys that have been carried out in Bangladesh (Huq and Cleland, 1990:106; Mitra et al., 1994:24). The difference is especially large at younger ages, which probably reflects longer education and later marriage of women in urban areas. The total fertility rate is estimated at 3.4 in rural areas and has more or less reached replacement level in urban areas (2.1). Figure 3.1 Age-Specific Fertility Rates by Residence Births per 1,000 Women 250 200 150 100 i 5O 0 200 99 102 i i i [ p 15o19 20-24 25-29 30-34 35-39 40-44 45-49 Age I'P, Urban q-Rural] BDHS 1996-97 3.3 Fertility Differentials Table 3.2 and Figure 3.2 show differentials in fertility by administrative division of residence and education. Fertility is highest in Sylhet and Chittagong Divisions, with total fertility rates of 4.2 and 4.1 children per woman, respectively. Fertility is lowest in Khulna (2.5) and Rajshahi (2.8) Divisions. Barisal 28 and Dhaka Divisions have intermediate levels of fertility, with total fertility rates of 3.3 and 3.2 children per woman, respectively. This pattern is similar to that found in the 1993-94 BDHS. Female education is strongly related to fertility levels. At current rates, women with no formal educa- tion would give birth to an average of 3.9 children in their lifetime, compared with 2.1 for women with at least some secondary education, a difference of 46 percent. Women with either incomplete primary or complete primary education have intermediate fertility rates between these two extremes. One way of examining trends in fertility over time is to compare the total fertility rates for the three years preceding the survey with the average number of children ever born to women who are now at the end of their childbearing period, age 40-49. The former is a measure of current fertility, while the latter is a measure of past or completed fertility. The data in Table 3.2 indicate that there has been a decline of about three children over the past 10 to 20 years in Bangladesh, from 6.0 to 3.3 births per woman. The decline has occurred across all divisions and all education levels, although it has been greater for women in Khulna and Rajshahi Divisions where the current total fertility rates Table 3.2 Fertility by back~ound characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40-49, by selected background char- acteristics, Bangladesh 1996-97 Mean number of children Total ever bum Background fertility to women characteristic rat~ age 40-49 Residence Urban 2.10 4.61 Rural 3.43 6.13 Division Barisal 3.31 5.81 Chittagong 4.06 6.58 Dhaka 3.18 5.77 Khulna 2.52 5.68 Rajshahi 2.78 5,73 Sylhet 4.20 6.40 Education No education 3.93 6.14 Primary incomplete 3.27 5.86 Primary complete 3.01 6.27 Secondary+ 2,12 4,56 Total 3.27 5.97 Women age 15-49 years are less than half the average number of children ever born to women now in their 40s. Fertility declines have also been large among women in all education groups. Figure 3.2 Total Fertility Rates by Selected Background Characteristics RESIDENCE L Urban Rural ~ DIVISION Barisal Chittagong Dhaka Khulna Rajshahi Sylhet EDUCATION No education Prim. incomplete Prim. complete Secondary+ 0 ~ 2 . 1 " - - 3,4 3.3 3,2 2.5 2.8 ;, 3.9 3,3 3,0 ~;~ ~ ~:~ ; ~;~ ~# ~s ~:~ ~1 2.1 1 2 3 4 Births per Woman 4.1 4.2 BDHS 1996-97 29 3.4 Fertility Trends Fertility in Bangladesh has declined extremely rapidly over the past 20 years, from 6.3 births per woman in the mid-1970s to 3.3 births for the period 1994-96 (Table 3.3 and Figure 3.3). This is truly an exceptionally steep decline. However, although few would deny that fertility has fallen rapidly, the various data sources show rather different pictures of fertility trends, especially when examined by calendar year (see Figure 3.4). The rates from the 1989 BFS and the 1991 CPS are generally consistent, while the data from the Bangladesh Bureau of Statistics' sample registration system are initially implausibly low and therefore show a more moderate decline over time. The rate of 3.4 from the 1993-94 BDHS (which is placed in 1992, the midpoint of the 3-year reference period) is considerably lower than rates from the other sources, while the rate from the 1996-97 BDHS (plotted at 1995) is more in line. Moreover, the total fertility rate for the period 1991-93 constructed from the retrospective birth histories in the 1996-97 BDHS data (3.8) is higher than the rate of 3.4 derived from the 1993-94 survey itself for the same period. This is a curious finding, given that a 1994 study appeared to validate the 1993-94 estimates of fertility. 2 Investigation of the age pattern of fertility shows no anomalies; the decline since the mid-1980s has been generally uniform over all age groups of women except those 45-49, for whom there has been no change (Figure 3.5). 3 However, data Table 3.3 Trends in current fertility rates Age-specific and total fertility rates, selected sources, Bangladesh, 1975 to 1996-97 Survey and approximate time period 1975 1989 1991 1993-94 1996-97 BFS BFS CPS BDHS BDHS Age group 1971-75 1984-88 1989-91 1991-93 1994-96 15-19 109 182 179 140 147 20-24 289 260 230 196 192 25-29 291 225 188 158 150 30-34 250 169 129 105 96 35-39 185 114 78 56 44 40-44 107 56 36 19 18 45-49 35 18 13 14 6 Total fertility rate 6.3 5.1 4.3 3.4 3.3 Note: For the 1975 and 1989 BFSs, the rates refer to the 5.year period preceding the survey; for the other surveys, the rates refer to the 3-year period preceding the survey. The two BFSs and BDHSs utilized full birth histories, while the 1991 CPS used an 8-year truncated birth history. Source: 1975 BFS (MHPC, 1978:73); 1989 BFS (Huq and Cleland, 1990:103); 1991 CPS (Mitra et al., 1993:34); 1993-94 BDHS (Mitra et al., 1994:24) 2 The study was implemented in Matlab thana by the International Centre for Diarrhoeal Disease Research, Bangladesh (Bairagi, et al., 1995). The study involved conducting a BDHS-type survey in a sample of about 3,000 households. The data were then compared with those from the ICDDR, B continuous surveillance system. The fact that the fertility rates from the two sources were almost identical lent support to the BDHS fertility data. 3 Because the surveys were based on ever-married women only and weights were used to inflate results to reflect fertility rates for all women, data for the youngest age group (15-19) are particularly unstable due to fluctuations of the weighting factors. This may account for the inconsistent trend in fertility rates for this age group. 30 from the 1996 Health and Demographic Survey conducted by the Bangladesh Bureau of Statistics show a very different age pattern of fertility, having much lower rates for younger women and much higher rates for older women (BBS, 1997b:20). Figure 3.3 Trends In Total Fertility Rates, 1971-1996 Births per Woman 1971-75 1984-88 1986-88 1989-91 1991-93 1994-96 BDHS 1996-97 Another source of fertility data comes from ICDDR,B' s surveillance system in Matlab thana. Unlike survey data, the data are collected in a surveillance system in which women are interviewed by field workers every two weeks. Thus, the data are less likely than survey data to suffer from recall error or problems in remembering or reporting dates. The demographic surveillance system covers a population of approximately 100,000 each in a "treatment" area, in which an intensive maternal and child health and family planning program has been in effect and a "comparison" area in which the residents receive the normal government and private health care (ICDDR,B, 1994:2). Although data from Matlab are not nationally representative and therefore not comparable to data from the other sources, they do provide evidence of the unprecedented decline in fertility that has taken place in Bangladesh. Estimates for 1995 put the total fertility rate at 3.0 for the treatment area and 3.6 for the comparison area, down from 3.4 and 5.0 prevailing in 1990 (Mostafa, et al., 1996:40). Results show that the recent declines in fertility have occurred throughout the country. Because of changes in division boundaries, it is necessary to recalculate fertility rates for the former four divisions of the country. Table 3.4 and Figure 3.6 show that all divisions in Bangladesh experienced recent declines in fertility of similar magnitude. Although Chittagong/Sylhet Division had the highest fertility in the mid- 1980s and still does today, the rate of decline in fertility is almost identical with that of the other divisions. 31 Figure 3.4 Trends In Total Fertlllty Rates by Calendar Year from Selected Sources, 1985-1995 Births per Woman -}- 1989 BFS E-1991 CPS ~-BBS ÷BDHSs i I I i I 1985 1987 1989 1991 1993 1995 Note: Ratu are ba~=d on 3-yur moving averages, except BDHS rates whi~ refer to a 3-ysar mfomnce pedod and BBS data for 1994.96 whloh =re from the Health and Demographic Surveys. BDHS 1996-97 Figure 3.5 Age-Specific Fertility Rates 1989, 1991, 1993-94 and 1996-97 Births per 1,000 Women 3O0 250 200 150 100 50 0 I I I / I 15-19 20-24 25-29 30-34 35-39 40-44 Age 1"~-1989 BFS "K-1991 CPS - - 1993-94 BE)HS --1996-97 BDHS J 45-49 Note: 1989 rates refer to the 5-ysar pedod preceding the survey; aN Others are 3-year rates, BDHS 1996-97 32 Table 3.4 Trends in fertility by division Total fertility rates by division and percent change from the period 1984-88 to 1994-96, Bangladesh, 1989 BFS. 1993-94 BDHS, and 1996-97 BDHS 1989 1993-94 1996-97 Percent BFS BDHS BDHS change Division 1984-88 1991-93 1994-96 1984-96 Chittagong 1 5.94 3.95 4.10 -31 Dhaka 5.18 3.45 3.18 -39 Khulna I 4.71 3.20 2.80 -4l Rajshahi 4.60 3.03 2.78 -40 Note: Rates for the 1989 BFS refer to the 5-year period preceding the survey, while those for the BDHSs refer to the 3-year period preceding the surveys. Rates are calculated for women age I5-49. l Refers to the former boundaries prior to the creation of Bafisal and Sylhet Divisions. Source: Huq and Cleland, 1990:106; Mitra et al, 1994:30 Figure 3.6 Trends in Fertility by Division Births per Woman 7.0 6,0 5.0 4.0 3.0 2.0 1.0 0.0 Chittagong/ Sylhet Dhaka Khulna/ Barisal Im1989 BFS m1993-94 BDHS D1996-97 BDHS I Rajshahi BDHS 1996-97 33 Table 3.5 Percent nre~ant Percentage of currently married women who were pregnant at the time of interview, by age group, selected sources, Bangladesh, 1975-1997 1975 1989 1991 1993-94 1996-97 Age group BFS BFS CPS BDHS BDHS 15-19 15.2 a 14.7 a 19,6 17.1 14.7 20-24 15.5 13.3 16.2 13.0 10.3 25-29 14.9 10.4 11.2 9.0 8.9 30-34 11.2 8.3 7.1 7.0 5.1 35-39 10.7 4.8 4.2 2.7 3.4 40-44 U U 1.5 0.8 1.3 45-49 U U 0.2 0.0 0.0 Total 12.5 9.3 10.7 8.7 7.7 2c= Unknown (not available) urrently married women less than 20 years Source: 1975 BFS and 1989 BFS (Cleland et al., 1994:21); 1991 CPS (Mitra et al., 1993:39) Table 3.5 shows trends in the proportion of currently married women who reported that they were pregnant at the time of the survey, according to age group. Reports on current pregnancy are almost surely underestimates, since many women may be pregnant but not yet aware of their status. However, the data are useful because, while fertility rates depend to some extent on accurate reporting of dates of events, the proportion pregnant is a "current status" indicator. Change over time in the percentage pregnant is an independent indicator of fertility change, In Bangladesh, the proportion pregnant has generally declined over time, although not in a steady fashion. In the 1975 BFS, 13 percent of currently married women reported themselves as pregnant at the time of the survey. By 1989, this proportion had declined to 9 percent; it then increased to 11 percent in 1991, again declined to 9 percent in the 1993-94 BDHS and then to 8 percent in 1996-97. Although it is entirely possible that such fluctuations are real, misreporting may also be a factor. Table 3.6 provides further insights into the fertility decline discussed above. The table gives the age- specific fertility rates for f ive-year periods preceding the survey, using data from respondents' birth histories. Table 3.6 Trends in age-sDecific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by women's age at the time of birth, Bangladesh 1996-97 Number of years preceding the survey Woma/l's age at birth 0-4 5-9 10-14 15-19 15-19 157 211 243 246 20-24 198 255 287 291 25-29 153 218 251 272 30-34 101 151 193 [246] 35-39 53 100 [167] 40-44 20 [70] 45-49 [7] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 34 Figures in brackets represent partial fertility rates due to truncation; women 50 years of age and older were not included in the survey and the further back into time rates are calculated, the more severe is the truncation. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years before the survey because those women would have been over age 50 at the time of the survey and thus were not interviewed. The data show generally declining fertility experienced by women in most age groups during the last two decades. The decline from the period 5-9 to 0-4 years before the survey was much larger than the decline from 10-14 to 5-9 years before the survey, implying that the fertility decline has increased substantially in recent years. However, trends in fertility rates calculated from retrospective birth histories must be viewed with caution, since they may suffer from errors due to age and date misreporting. Table 3.7 presents fertility rates for ever-married women by duration (years) since first marriage for five-year periods preceding the survey. It is analogous to Table 3.6, but is confined to ever-married women and replaces age with duration since first marriage. The data show that the decline in fertility is apparent for all marriage durations in the two decades preceding the survey, with the exception of those married 0-4 years. This pattern implies that fertility control tends to be practiced later in marriage and that newly married couples continue to have children at more or less the same rate as before. Table 3.7 Trends in fertility by marital duration Fertility rates for ever-married women by duration (years) since first marriage for five-year periods preceding the survey, Bangladesh 1996-97 Number of years preceding the survey Marriage duration 0-4 5-9 10-14 15-19 0-4 255 262 260 234 5-9 226 278 300 306 10-14 158 220 257 279 15-19 I l l 175 213 [253] 20-24 66 119 [185] 25-29 31 [85] Note: Duration-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 3.5 Chi ldren Ever Born The distribution of all women and currently married women by age and number of children ever born is presented in Table 3.8, The table also shows the mean number of children ever born to women in each five-year age group, an indicator of the momentum of childbearing. The data indicate that almost one-third (31 percent) of all women age 15-19 years have given birth. On average, women have given birth to three children by their late 20s and over six children by the end of their childbearing years. Figures for currently married women do not differ greatly from those for all women at older ages; however, at younger ages the percentage of currently married women who have had children is much higher than the percentage among all women. 35 Table ~-8 Children ~ver born and livin~ Percent distribution of all women and of currently married women age 15-49 by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Bangladesh 1996-97 Number of children ever born (CEB) Number Mean Mean no. Age of no. of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 69.0 24.1 6.3 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,592 0.39 0.35 20-24 27.6 24.1 28.4 14.3 4.6 0.9 0.1 0.0 0.0 0.0 0.0 1(30.0 2,087 1.47 1.29 25-29 8.0 12.2 25.0 24.8 16.8 7.7 3.5 1.5 0.4 0.1 0.0 100.0 1,973 2.78 2.40 30-34 2.4 5.5 15.6 19.4 22.6 14.6 11.2 5.5 2.1 0.8 0.3 100.0 1,409 3.91 3.28 35.39 1.9 3.5 9.7 15.4 15.5 17.5 13.3 10.1 7.9 2.8 2.3 100.0 1,129 4.82 3.95 40-44 1.9 3.1 5.4 10.3 15.1 13.0 14.8 13.9 9.0 7.1 6.5 100.0 861 5.60 4.48 45-49 1.3 1.6 3.7 6.3 8.7 14.3 16.3 14.3 11.7 10.3 11.5 100.0 658 6.44 5.07 Total 24.3 14.2 15.4 12.9 10.4 7.3 5.7 4.1 2.6 1.6 1.5 100.0 10,707 2.76 2.30 CURRENTLY MARRIED WOMEN 15-19 37.5 48.3 12.9 1.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,252 0.78 0.70 20-24 11.9 28.5 34.8 17.8 5.7 1.1 0.1 0.0 0.1 0.0 0.0 100.0 1,655 1.81 1.59 25-29 3.9 11.5 26.0 26.2 18.1 8.4 3.7 1.6 0.4 0.1 0.0 1100.0 1,812 2.94 2.55 30-34 1.3 4.3 14.5 19.6 23.8 15.6 11.6 5.7 2.2 0.9 0.3 100.0 1,297 4.05 3.40 35-39 1.3 2.6 8.8 15.4 15.9 18.5 12.9 10.7 8.5 3.0 2.4 100.0 1,031 4.96 4.07 40-44 1.7 2.3 4.4 8.5 15.6 13.0 14.8 14.6 10.1 7.6 7.4 100.0 740 5.82 4.68 45-49 0.9 1.4 3.1 5.8 7.7 14.5 15.8 15.0 12.6 10.2 12.9 lO0.O 520 6.63 5.22 Total 9.5 16.8 18.5 15.5 12.7 8.8 6.6 4.8 3.2 1.8 1.8 100.0 8,307 3.30 2.76 The percentage of women in their 40s who have never had children provides an indicator of the level of primary infertility--the proportion of women who are unable to bear children at all. Since voluntary childlessness is rare in Bangladesh, it is likely that married women with no births are unable to bear children. The BDHS results suggest that primary infertility is low, less than 2 percent, It should be noted that this estimate of primary infertility does not include women who may have had one or more births but who are unable to have more (secondary infertility). A comparison of the mean number of children ever born reported in the 1996-97 BDHS and various other surveys is presented in Table 3.9. The comparison does not highlight recent changes in fertility, but Table 3.9 Trends in children ever born Mean number of children ever born by age group, selected sources, Bangladesh, 1975-1996 1975 1981 1983 1985 1989 1989 1991 1993-94 1996-97 Age group BFS CPS CPS CPS BFS CPS CPS BDHS BDHS 15-19 0.6 0.5 0.6 0.4 0.4 0.4 0.4 0.3 0.4 20-24 2.3 2.0 2.2 2.0 1.7 1.8 1.7 1.6 1.5 25-29 4,2 3.7 3.8 3.6 3.1 3.3 3.2 2.9 2.8 30-34 5.7 5.4 5.5 5.1 4.7 4.7 4.5 4.1 3.9 35-39 6.7 6.4 6.5 6.5 5.9 5.9 5.7 5.2 4.8 40-~ 7.1 7.3 7.4 7.4 6.6 7.0 6.7 6.4 5.6 45-49 6.7 7.6 7.5 7.2 7.3 7.5 7.4 6.9 6.4 Total U U U U U U 3.5 3.0 2.8 U = Unknown (not available) Source: 1983 and 1985 CPSs (Kanmer and Frankenberg, 1988:21); 1991 CPS (Mitra et al., 1993:31); 1993-94 BDHS (Mitra et al. 1994:33); all others (Cleland et al., 1994:11) 36 rather is an indication of the cumulative changes in fertility over the decades prior to the surveys. Despite the fluctuations between surveys, the data generally show only modest declines until the mid-1980s. Between 1985 and 1989, the decline in mean number of children ever born was substantial in all but the youngest and oldest age groups. Although there was then little change between 1989 and 1991, the rates again decline considerably between 1991 and 1993-94, especially among women age 25 and above and show further decline between 1993-94 and 1996-97 at all ages except 15-19. 3.6 B i r th Intervals Information on birth intervals provides insight into birth-spacing patterns which have far-reaching impact on both fertility and child mortality levels. Research has shown that children born too soon after a previous birth are at increased risk of dying at an early age. Table 3.10 shows the percent distribution of non- first births that occurred in the five years before the BDHS by the number of months since the previous birth. The data show that birth intervals are generally long in Bangladesh. Over half (52 percent) of non- first births occur three or more years after the previous birth, while almost one-third take place 24-35 months after the previous birth. Fewer than 1 in 5 births occurs after an interval of less than 24 months. The median birth interval is 37 months. This is slightly longer than the median birth interval of 35 months reported in the 1993-94 BDHS (Mitra et al., 1994:34). As expected, younger women have shorter birth intervals than older women, presumably because they are more fecund and want to build their families. The median birth interval for women age 15-19 is 25 months, compared with 44 months fur women over age 40. A shorter median interval also prevails for children whose preceding sibling has died, compared with those whose prior sibling is alive. This pattern presumably reflects a shortened breastfeeding period due to the death of the prior sibling, as well as minimal use of contraceptives. 3.7 Age at First Birth The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of mother and child. In many countries, postponement of first births--reflecting an increase in the age at marriage--has contributed greatly to overall fertility decline. Early initiation into childbearing is generally a major determinant of large family size and rapid population growth, particularly in countries where family planning is not widely practiced. Moreover, bearing children at a young age involves substantial risks to the health of both the mother and child. Early childbearing also tends to restrict educational and economic opportunities for women. Table 3.11 presents the percent distribution of women by age at first birth according to current age. 4 For women age 20 and over, the median age at first birth is presented in the last column of the table. Childbearing begins early in Bangladesh, with the large majority of women becoming mothers before they reach the age of 20. The median age at first birth is between 17 and 18. The data show that the median age at first birth has increased slightly from around 17 for older women to around 18 for women in their early 20s. This slight change to later age at first birth is reflected in the smaller proportion of younger women whose first births occurred before age 15; about 20 percent of women in their 40s report having had their first birth before age 15, compared with only 9 percent of women age 15-19. 4 The data are based on all women, including those who have never married (see Footnote 1 for a description of the inflation factors used to estimate the total number of women). 37 Table 3.10 Birth intervals Percent distribution of non-first births in the live years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Bangladesh 1996-97 Number of months since previous birth Characteristic 7-17 18.23 24-35 36-47 48+ Total Median number of Number months since of previous birth births Age of mother 15-19 23.3 19.9 36.7 13.3 6.8 100.0 25.3 194 20-29 6.8 11.3 31.6 24.2 26.0 I00.0 36.1 2,857 30-39 5.9 8.1 26.9 22.8 36.3 1190.0 40.0 1,287 40 + 4.1 6.4 27.5 I8.7 43.3 100.0 44.4 212 Birth order 2-3 6.6 10.4 28.1 23.5 31.4 100.0 37.8 2,456 4-6 7.3 10.3 31.9 22.6 27.9 100.0 36.1 1,541 7 + 9.3 11.6 35.7 22.9 20.4 100.0 33.4 553 Sex of prior birth Male 6.8 10.6 29.2 23.7 29.6 100.0 37.1 2,231 Female 7.5 10.5 31.4 22.5 28.2 100.0 36.2 2,319 Survival of prior birth Living 4.8 9.3 30.2 24.5 31.2 100.0 37.9 3,876 Dead 20.3 17.5 31.2 15.4 15.5 I00.0 26.8 675 Residence Urban 8.6 8.2 20.2 19.4 43.6 I00.0 43.2 356 Rural 7.0 10.8 31.2 23.4 27.6 100.0 36.3 4,194 Division Barisal 5.8 10.2 30.5 22.6 30.9 100.0 36.7 298 Chittagong 7.5 10.6 36.8 22.4 22.6 100.0 34.4 1,174 Dhaka 6.8 9.8 28.3 23.4 31.7 100.0 37.7 1,387 Khulna 6.9 11.7 25.7 20.6 35.1 100.0 38.8 406 Rajshahi 6.7 10.2 27.3 23.4 32.4 100.0 38.1 943 Sylhet 9.8 13.3 29.7 27.1 20.0 100.0 35.1 341 Education No education 7.5 10.3 32.2 23.4 26.6 100.0 36.0 2,874 Primary incomplete 6.7 11.9 28.3 23.5 29.6 100.0 37.1 752 Primary complete 6.4 11.3 28.9 21.9 31.4 I00.0 37.3 402 Secondary+ 6.6 9.6 23.8 21.8 38.2 100.0 41.3 522 Total 7.1 10.6 30.3 23.1 28.9 100.0 36.6 4,550 Note: First births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Comparisons with data from other sources confirm that the age at which women in Bangladesh have their first child has increased steadily over time, in line with increases in age at marriage, with the exception of the past few years. For example, in 1975, the median age at first birth among women age 20-24 was 16.8; in 1989, it had risen to 18.0 and by 1996-97, to 18.4 (Huq and Cleland, 1990:92). However, comparison of data from the 1993-94 and 1996-97 BDHSs shows a slight decline in the overall median age at first birth among women age 20-49, from 17.7 to 17.4. This may signal a plateau in the trend towards later age at first birth. 38 Table 3.11 A~e at first birth Pement distribution of women 15-49 by age at first birth, according to current age, Bangladesh 1996-97 Women with Age at first birth no Current age births <15 15-17 18-19 20-21 22-24 25+ Median Number age at of first Total women birth 15-19 69.0 9.2 18.9 3.0 NA NA NA 100.0 2,592 a 20-24 27.6 14.7 31.8 16.8 6.5 2.6 NA 100.0 2,087 18.4 25-29 8.0 16.0 41.0 17.8 8.9 6.3 2.0 100,0 1,973 17.4 30-34 2.4 15.9 45.7 17.1 8.5 6.5 3.9 100.0 1,409 17.2 35-39 1.9 19.3 39.9 18.3 8.4 7.3 4.8 100.0 1,129 17.3 40-44 1.9 20.9 48.5 14.7 6.0 5.2 2.8 100,0 861 16.6 45-49 1.3 18.7 45.6 18.4 8.6 4.3 3.0 1130,0 658 16.9 [qA = Not applicable Omitted because less than 50 percent of the women in the age group x to x+4 have had a birth by age x Differentials in median age at first birth as reported in the 1996-97 BDHS are shown in Table 3.12. Urban women start childbearing later than rural women; the median age at first birth is 18.9 for urban women and 17.2 for rural women age 20-49. Women in Sylhet Division consistently have higher median ages at first birth than women in the other divisions, while women in Raj shahi Division generally have the lowest median ages at first birth. Women with secondary education start child-bearing later than those with less or no education. Among women age 25-49, the median age at first birth is 16.8 for women with no education and 19.3 for women with at least some secondary education. Table 3.12 Median ate at first birth Median age at first birth among women age 20-49 years, by current age and selected background characteristics, Bangladesh 1996-97 Current age Background Ages Ages characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 23.6 18.6 17,9 18.3 17.5 19.0 18.9 18.2 Rural 18.1 17.3 17.1 17.2 16.5 16.8 17.2 17.0 Division Batisal 18.4 17.3 17.3 17.7 16.7 17.9 17.5 17.3 Chittagoog 19.4 17.9 17.6 17.3 17.3 17.4 17.9 17.6 Dhaka 18.5 17.3 17,2 16.9 16.8 16.9 17.4 17.1 Khulna 18.4 17.4 17.0 17.2 16.1 16.2 17,2 16.9 Rajshahi 17,0 16.8 16.7 17.4 15.8 16.2 16.7 16.7 8ylhet a 19.6 18.3 17.9 17.4 18.2 18.9 18.4 Education No education 17.0 16.8 16.9 16.9 16.6 16.7 16.8 16.8 Primary incomplete 17.0 16.8 16.9 17.0 16,0 17.1 16.9 16.8 Primary complete 18.2 17.7 17.4 17.4 16.2 17.6 17.5 17,3 Secondary+ a 20.3 19.0 19.0 18.2 18.6 a 19.3 Total 18.4 17.4 17,2 17.3 16.6 16.9 17.4 17.2 ~qote: The medians for cohort 15-19 could not be determined because half the women have not yet had a birth. Medians were not calculated for these cohorts because less than 50 percent of women in the ago group x to x+4 had a birth by age x. 39 3.8 Teenage Fert i l i ty Early childbearing, particularly among teenagers (those under 20 years of age) has negative demographic, socioeconomic and sociocultural consequences. Teenage mothers are more likely to suffer from severe complications during delivery, which result in higher morbidity and mortality for both themselves and their children. In addition, the socioeconomic advancement of teenage mothers in the areas of educational attainment and accessibility to job opportunities may be curtailed. Table 3.13 Adolescent ore~nancv and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Bangladesh 1996-97 Percentage who are; Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women Age 15 8.5 5.5 14.1 540 16 23.5 5.2 28.7 635 17 32.6 3.7 36.4 478 18 43.2 4.7 48.0 525 19 54.6 3.1 57.7 414 Residence Urban 20.3 4.5 24.8 329 Rural 32.2 4.5 36.7 2,291 Division Barisat 28.4 5.1 33.5 185 Chittagong 27.4 3.8 31.1 599 Dhaka 31.7 3.6 35.3 769 Khulna 30.9 5.2 36.1 296 Rajshahi 37.9 5.9 43.8 598 Sylhet 18.6 5.5 24.1 140 Education No education 48.2 5.8 54.0 767 Primary incomplete 33.7 5.2 38.8 494 Primary complete 35.8 3.7 39.5 317 Secondary+ 15.1 3.6 18.7 1,024 Total 31.0 4.6 35.6 2,592 Table 3.13 shows the percentage of teenagers age 15-19 who are mothers or pregnant with their first child, according to various background characteristics. Thirty-one percent of teenage women in Bangladesh are mothers and another 5 percent are pregnant with their first child. Thus, 36 percent of teenage women have begun childbearing. There has been a slight increase in this proportion since the 1993-94 BDHS, which indicated that 33 percent of women age 15-19 had begun childbearing (27 percent had delivered a child and 6 percent were pregnant with their first child) (Mitra et al., 1994:37). While this trend may signal an increase in early childbearing, the differences are not large and they are highly dependent on the sensitive inflation factors used to estimate the total number of women (see Footnote 1). 40 AS expected, the proportion of women who have begun childbearing rises rapidly with age, from 14 percent of those age 15 to 58 percent of those age 19 (see Table 3.13). Those residing in rural areas and especially those residing in Rajshahi Division are also more likely than others to have begun childbearing, while girls in Sylhet Division are the least likely to have started childbearing. Education is strongly related to early childbearing. Girls with no education are far more likely to have begun childbearing than those with primary and especially those with some secondary education. 41 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contracept ion In the BDHS, knowledge of contraceptive methods was assessed through a series of questions combining spontaneous recall and prompting procedures. Female and male respondents were first asked to name the ways or methods by which a couple could delay or avoid pregnancy. Interviewers then asked about specific methods not mentioned spontaneously by the respondent. The ability to name or recognize the name of a family planning method is a nominal test of respondents' knowledge and not a measure of how much they might know about the method. However, knowledge of specific methods is a precondition for their use. In the 1996-97 BDHS, information was sought about seven modem methods--the pill, IUD, injection, Norplant, condom, and female and male sterilization--as well as two traditional methods, periodic abstinence (safe period or rhythm method) and withdrawal. Other methods mentioned by the respondent, such as herbs or breastfeeding, were also recorded. It should be noted that information about Norplant was not sought in the 1993-94 BDHS. Table 4.1 shows the percentage of ever-married women, currently married women and currently married men who have heard about specific methods of family planning. Although the data are given separately for ever-married and currently married women, ever-married women are not included in the discussion of knowledge of family planning methods because there is virtually no difference in the proportion knowing a method between ever-married and currently married women. Table 4.1 Knowledge of contracentive methods Percentage of ever-married and currently married women and of currently married men who know any contraceptive methods, by specific methods, Bangladesh 1996-97 Ever- Currently Currently Contraceptive roamed married married method women women men Any method 1(30.0 100.0 99.9 Any modern method 100.0 100.0 99.8 Pill 99.9 99.9 99.7 IUD 91.4 91.8 68.1 Injectables 98.0 98.2 92.7 Condom 9t.0 91.6 97.1 Female sterilization 98.9 98.9 98.5 Male sterilization 83.4 83.8 90.0 Norplant 26.5 27.0 13.7 Any traditional method 76.6 77.4 79.8 Periodic abstinence 68.2 68.9 70.4 Withdrawal 49.8 50.9 49.2 Other 9.9 10.2 9.2 Number of women/men 9,127 8,450 3,312 Mean number of methods 8.0 8.0 7.4 43 Knowledge of at least one family planning method is universal among married Bangladeshi women and men. More importantly, virtually all respondents who know at least one method know a modem method. Traditional methods are considerably less widely known than modem methods, probably because traditional methods are not included in the organized family planning program efforts. In addition, learning of these methods through informal channels is not easy in a society like that in Bangladesh where matters relating to sex are not freely discussed. With regard to knowledge of specific methods, virtually all currently married women have heard about the pill, injectables, and female sterilization and 92 percent know about the IUD and condom. Other methods recognized by at least half of all currently married women are male sterilization (84 percent), periodic abstinence (safe period or calendar rhythm--69 percent), and withdrawal (51 percent). Only about 1 in 4 currently married women has heard of Norplant. Ten percent of women mentioned methods that were not on the list, mostly traditional methods like ayurvedic methods, plants and herbs. As among currently married women, the pill and female sterilization are universally known among currently married men. There is also virtually no difference between currently married women and men in knowledge of periodic abstinence and withdrawal. However, for the remaining methods, men are less likely to know about female methods, such as the IUD, injectables, and Norplant, while they are more likely to have heard about male methods, namely, condoms and male sterilization. For example, only 68 percent of currently married men have heard about the IUD, compared with 92 percent of currently married women and the proportion knowing condoms was higher for men (97 percent) than for women (92 percent). Trends in Knowledge of Family Planning Methods Trends in knowledge of family planning methods are shown in Table 4.2 in terms of the proportion of ever-married women who have heard of specific methods. The proportion of women of reproductive age who know of at least one family planning method has been extremely high in Bangladesh (99 percent) since the early 1980s. However, knowledge of specific methods has become more widespread since then. For example, the proportion of ever-married women who have heard of the IUD has more than doubled since 1983, from 42 to 91 percent in 1996-97. Knowledge of injectables and condoms also increased significantly over the same period. Although the largest increases in knowledge levels occurred between 1975 and 1983 for most modem methods, it is notable that awareness of all modem methods increased between 1993-94 and 1996-97. Knowledge of periodic abstinence and condoms increased the most between these two recent surveys. The 1996-97 BDHS data confirm the findings of the 1993-94 BDHS, indicating that contraceptive knowledge is widespread among subgroups in the country. Knowledge of at least one method, particularly a modem method, is universal among both women and men in all age groups, in both urban and rural areas, in all the divisions and across all categories of educational attainment (data not shown). The high level of knowledge found in every subgroup indicates the success of program efforts to disseminate contraceptive information to all eligible couples. However, there is still scope to increase the amount of information that is known about specific methods of contraception. Table 4.3 shows the correspondence in knowledge of family planning methods between husbands and wives interviewed in the 1996-97 BDHS. Generally, there is a high degree of correspondence between spouses; if one partner knows a method, the other is likely to know it as well, or, if one partner does not know a method, the other is also likely not to know it. However, there is less consistency for female methods such as the IUD, Norplant, and periodic abstinence, and for male methods such as condoms and male sterilization; wives are generally more likely to know the female methods than their husbands, while husbands are more likely to know the male methods than their wives. 44 Table 4.2 Trends in knowledge of family nlannina methods Percentage of ever-married women age 10-49 who know specific family planning methods, selected sources, Bangladesh, 1975-1996 1975 1983 1985 1989 1989 1991 1993-94 1996-97 Method BFS CPS CPS CPS BFS t CPS BDHS BDHS Any method 81.8 98.6 99.6 99.9 100.0 99.9 99.7 100.0 Any modern method 80.0 98.4 99.5 99.9 99.0 99.8 99.7 100.0 Pill 63.9 94. I 98.6 99.0 99.0 99.7 99.5 99.9 IUD 40.1 41.6 65.4 80.4 78.0 88.9 89.4 91.4 lnjectables U 61.8 74.1 87.5 81.0 95.2 96.3 98.0 Vaginal methods 10.0 19.4 26.3 25.8 24.0 U U U Condom 21.1 59.0 75.5 76.9 83.0 85.6 86.6 91.0 Female sterilization 53.1 95.5 97.8 99.2 98.0 99.4 98.8 98.9 Male sterilization 51.4 72.9 84.3 84.0 87.0 87.4 82.9 83.4 Any traditional method 49.0 54.8 62.8 71.7 U 83.3 75.0 76.6 Periodic abstinence 28.0 26.4 41.2 40.1 46.0 68.0 64.0 68.2 Withdrawal 15.1 19.8 20.8 14.4 30.0 48.6 49.0 49.8 Number of women 6,515 8,523 8,541 10,293 11,907 10,573 9,640 9,127 iU --- Unknown (no information) Published data were presented in whole numbers; the decimal was added to balance the table. Source: 1975 BFS (MHPC, 1978:A245 and Vaessan, 1980:16); 1983 CPS (Mitra and Kamal, 1985:85. 89); 1985 CPS (Mitra, 1987:67, 70); 1989 CPS (Mitra et al., 1990:81, 84); 1989 BFS (Huq and Cleland, 1990:60); 1991 CPS (Mitra et al., 1993:42); 1993-94 BDHS (Mitra et al., 1994:40) Table 4.3 Knowledge of contracentive methods amon~ counles Percent distribution of couples by contraceptive knowledge, according to specific methods, Bangladesh 1996-97 Only Only Both husband wife Neither Contraceptive know knows knows knows method method method method method Total Any method 99.9 0.0 0.1 0.0 100.0 Any modern method 99.8 0.0 0.2 0.0 10O.0 Pill 99.6 0.1 0.3 0.0 100.0 IUD 65.4 3.4 27.1 4.2 100.0 Injectables 91.5 1.2 6.9 0.4 100.0 Condom 89.8 7.2 2.2 0.8 100.0 Female sterilization 97.6 0.9 1.5 0.0 100.0 Male sterilization 78.3 12.2 6.9 2.6 100.0 Norplant 6.3 7.5 21.6 64.7 100.0 Any traditional method 65.4 14.6 14.6 5.4 100.0 Periodic abstinence 52.0 18.4 19.7 9.9 100.0 Withdrawal 29.7 19.7 22.3 28.3 100.0 Other 2.4 6.9 8.1 82.6 100.0 Note: Figures are based on 3,028 couples. 45 4.2 Ever Use of Contracept ion Both women and men interviewed in the 1996-97 BDHS who said that they had heard of a method of family planning were asked if they had ever used the method, that is, if they had used it at least once. Ever use of family planning methods thus refers to use of a method at any time without making a distinction between past and current use. Collection and analysis of ever use data has special significance for family planning programs. These data indicate the proportion of the population having exposure to contraceptive use at least once. Therefore, data on ever use indicate the success of programs in promoting use of family planning methods among eligible couples. In addition, data on ever use--together with data on current use--are valuable for studying couples who discontinue use. Table 4.4 shows the percentage of ever-married women, currently married women and currently married men who have ever used specific family planning methods. The data for women are given by age group. Among ever-married women, almost 7 in l0 (69 percent) have ever used a method and nearly 6 in l0 (63 percent) have used a modem method, while only a quarter (23 percent) reported having ever used a traditional method. The pill has, as expected, by far the highest ever use rate, having been used by half (49 percent) of ever-married women. The next most common ever used methods are periodic abstinence (17 percent), injectables (16 percent) and condoms (15 percent), followed by withdrawal (10 percent), female Table 4.4 Ever use of contraceofon Percentage of ever-mamed and currently married women and currently mamod men who have ever used any contraceptive method, by specific method and age, Bangladesh 1996-97 Modem method Traditional method Number Any Any modem Age method method Pill IUD Female Male Menstrual Any Periodic of Inject- sterili- sterili- Nor- regu- trad. abstin- With- Other respon- ables Condom zation zation plant lation method ence drawal method dents EVER-MARRED WOMEN 10-14 24.5 18.7 12.7 0.4 0.7 7.5 0.0 0.0 0.0 0.0 9,6 7.3 6.3 0.8 145 15-19 52.9 46.9 38.7 1.6 6.9 14.0 0.1 0.1 0.2 1.5 14.8 9.7 7.6 0.6 1,301 20-24 68.6 62.3 53.2 4.9 15.3 16.1 1.6 0.4 0.2 2.1 19.9 13.4 9.5 1.0 1,727 25-29 78.0 73.0 60.3 9.0 21.0 18.5 4.5 1.0 0.2 4,9 24,2 17.2 11.4 2.4 1,905 30-34 81.9 76.9 61.7 11.2 22.2 19.2 10.7 0.9 0.5 5.3 28.6 20,8 I L4 3.2 1,402 35-39 76.4 70,0 49.4 9.8 19.1 14.2 15.4 1.9 0.0 4.5 29,8 23.0 9.4 4.8 1,128 40-44 67.3 60.5 37.8 5.7 13.1 9.2 18.0 3.3 0.0 2.9 25.1 19.0 8.7 4.2 861 45-49 50.3 39.4 19.9 4.7 5.8 5.3 14.9 2.6 0.0 1.6 21.3 17.3 5.7 1.9 658 Total 69.2 63.0 48.9 6.9 15.7 15,0 7.6 1.2 0.2 3.4 23.0 16.7 9.5 2.4 9,127 CURRENTLY MARRIED WOMEN 10-14 24.7 18.9 12.8 0.4 0.7 7.5 0.0 0.0 0.0 0.0 9.7 7.4 6.3 0.8 143 15-19 54,4 48.2 39.8 1.7 7.2 14.4 0.0 0.1 0.2 1.6 15.3 10.1 7.8 0.7 1.252 20-24 70,2 63.9 54.5 5.1 15.7 16.8 1.7 0.4 0.2 2.2 20.4 13.7 9.8 1.0 1,655 25-29 79,9 74.7 62.0 9.4 22,0 18.9 4.5 1.0 0.2 5. I 24.8 17.6 11.6 2.5 1.812 30-34 85.5 80.7 65.1 11.9 23,8 20.4 11.1 0.8 0.5 5.7 29.9 21.7 12.1 3.5 1,297 35-39 80.4 74.0 52,4 10.3 20.0 15.2 15.9 2.0 0.0 4.8 31.1 23.9 9.7 5.2 1,031 40-44 73.8 66.8 42.2 6.5 15.1 10.4 19.0 3.6 0.0 3.2 27.7 20.9 9,3 4.6 740 45-49 55.9 44.6 22.7 5.9 6.7 5.9 16.2 3.3 0.0 2.0 23.4 18.8 6,3 2.4 520 Total 72.2 66.0 51.5 7.3 16,7 15.9 7.6 1.2 0.2 3.6 24.0 17.3 9.9 2.6 8,450 CURRENTLY MARRIED MEN Total 81.3 73.5 59.9 7.5 15.8 30.1 8.1 1.6 0,1 4.8 39.5 33.6 11.0 2.8 3.312 46 sterilization (8 percent) and the 1UD (7 percent). A negligible 1 percent report use of male sterilization and very few women report ever use of the newest method, Norplant. As expected, currently married women are more likely than ever-married women to say they have ever used a family planning method. Ever use rates are higher among men than among women for every contraceptive method inquired about. Eighty-one percent of currently married men, compared with 72 percent of currently married women, report having ever used a method. Differences are strikingly large in the case of condom use; 30 percent of currently married men have ever used condoms, compared with only 16 percent for currently married women. Ever use rates vary with age of women, being lowest among the youngest women. However, the fact that more than half (54 percent) of currently married women age 15-19 have used a contraceptive method at some time and nearly half (48 percent) have used a modem method indicates that women in Bangladesh have begun to understand the advantages of practicing family methods early in their reproductive careers. The level of ever use rises to a high of 86 percent for currently married women age 30-34, then declines to 56 percent among those age 45-49. Ever use of modem methods by age of women follows a similar pattern. There has been a steady increase in the level of ever use of family planning over the past two decades in Bangladesh. In 1975, only 14 percent of ever-married women of reproductive age had ever used a family planning method, compared with 69 percent in 1996-97, a fivefold increase (Table 4.5). For modem methods, the increases have been even steeper, with ever use of the pill increasing the most rapidly. Ever use of both female and male sterilization, as well as of periodic abstinence and withdrawal appears to have either reached a plateau or declined in recent years. Table 4.5 Trends in ever use of family plannin~ methods Percentage of ever-married women age 10-49 who have ever used specific family Bangladesh, 1975-1996 planning methods, selected sources, 1975 1983 1985 1989 1989. 1991 1993-94 1996-97 Method BFS CPS CPS CPS BFS " CPS BDHS BDHS Any method 13.6 33.4 32.5 44.2 45.0 59.0 63.1 69.2 Any modern method U 23.8 25.9 37.5 U 49.2 56.4 63.0 Pill 5.0 14.1 14.3 23.3 22.0 34.1 42.0 48.9 IUD 0.9 2.2 2.7 4.6 4.0 6.2 7.3 6.9 Injectables U 1.2 1.3 2.8 2.0 6.6 11.0 15.7 Vaginal methods 0.5 2.2 1.6 2.4 1.0 2.9 U U Condom 4.8 7.1 5.7 9~3 6.0 13.4 13.9 15.0 Female sterilization 0.3 5.8 7.4 8.7 9.0 8.0 7.9 7.6 Male sterilization 0.4 1.4 1.6 1.6 1.0 1.4 1.4 1.2 Any traditional method U 17.3 11.9 15.3 U 29.6 24.0 23.0 Periodic abstinence 4.5 11.0 7.8 9.7 13.0 21.5 16.5 16.7 Withdrawal 2.6 5.3 2.9 3.6 7.0 11.1 10.1 9.5 Number of women 6,515 8,523 8,541 10,293 11,907 10,573 9,640 9,127 = Unknown (no information) Published data were presented in whole numbers; the decimal was added to balance the table. Source: 1975 BFS (MHPC, 1978:A275); 1983 CPS (Mitra and Kamal, 1985:117, 122); 1985 CPS (Mitra, 1987:108, 112); 1989 CPS (Mitra et al., 1990:88, 92); 1989 BFS (Huq and Cleland, 1990:61); 1991 CPS (Mitra et al., 1993:52) 47 4.3 Knowledge and Ever Use of Menstrual Regulation Respondents in the 1996-97 BDHS were also asked if they knew about or had ever used menstrual regulation (MR). Results shown in Table 4.6 indicate that almost 4 in 5 ever-married and currently married women know about MR, in contrast to only half of currently married men. Ever use of the method is negligible, however, with only 3-4 percent of women and about 5 percent of men saying they had ever used MR. Levels of ever use are highest among respondents who are currently in their late 20s and 30s. Table 4.6 Menstrual re~,ulation Percentage of ever-married and currently married women and of currently married men who know of menstrual regulation and the percentage who have ever used menstrual regulation by age group. Bangladesh 1996-97 Ever- Currently Currently married married married Age group women women men 78.2 78.9 52.1 Know of menstrual regulation Ever used menstrual regulation 10-14 0.0 0.0 15-19 1.5 1.6 20-24 2.1 2.2 25-29 4.9 5.1 30-34 5.3 5.7 35-39 4.5 4.8 40-44 2.9 3.2 45-49 1.6 2.0 Total 3.4 3.6 4.8 Note: Data are not shown for men by age group due to small sample size. 4.4 Cur rent Use o f Cont racept ion Current use of contraception is defined as the proportion of women and men who reported they were using a family planning method at the time of interview. Although ever-married women age 10-49 were interviewed in the BDHS, only women who were currently married at the time of the survey were asked the questions on current use of family planning. Table 4.7 shows the percent distribution of currently married women and men by current contraceptive use status according to age group. Overall, 49 percent of currently married women are using a contraceptive method, with 42 percent using a modem method. Although modem methods account for 85 percent of overall use, there is still a substantial 8 percent of currently married women who rely on traditional methods. These figures are very similar to the contraceptive prevalence rate of 49 reported in the 1995 Health and Demographic Survey, which also recorded that 42 percent of married women were using modem methods (BBS, 1997b:23). The most popular method by far is the pill, which is used by 21 percent of currently married women. Use of the pill accounts for 42 percent of all contraceptive use in Bangladesh. Other commonly used methods are female sterilization (8 percent), injectables (6 percent), periodic abstinence (5 percent), and condoms (4 percent). The IUD, male sterilization, and withdrawal are each used by less than 2 percent of currently married women. 48 Table 4.7 Current use of contraception Percent distribution of currently married women and men by contraceptive method currently used, according to age, Bangladesh 1996-97 Modem method Traditional method Any Any modern Age method method Pill IUD CURRENTLY MARRIED WOMEN Number Female Male Menstrual Any Periodic Not of [nject- sterili- sterili- Nor- regu- trad. abstin- With- Other currently respon- ables Condom zation zation plant lation method ence drawal method using Total denis 10-14 15.6 9.1 4.8 0.0 0.3 3.9 0.0 0.0 0.0 0.0 6.5 3.5 2.3 0.8 84.4 100.0 143 15-19 32.9 27.8 17.9 1.0 4.4 4.3 0.0 0.1 0.2 0.0 5.0 3.2 1.7 0.1 67.1 100.0 1,252 20-24 43.1 37.6 24.2 1.5 6.4 3.2 1.7 0.4 0.2 0.0 5.5 3.0 2.0 0.4 56.9 100.0 1,655 25-29 52.5 46.0 25.2 2.4 8.5 4.3 4.5 1.0 0.2 0,0 6.5 3.9 1.8 0.7 47.5 100.0 1,812 30-34 63.1 54.0 26.9 2.4 7.8 5.2 I1.1 0.5 0.1 0.0 9.0 6.0 2.2 0.8 36.9 100.0 1,297 35-39 63.9 51.9 20.8 1.9 7.1 4.1 15.9 1.9 0.0 0.1 11.9 9.2 1.6 1.1 36.1 100.0 1,031 40-44 54.7 42.7 12.1 1.4 3.9 2.8 19.0 3.5 0.0 0.0 12.0 S.0 1.9 2.2 45.3 100.0 740 45-49 35.1 27.6 3.8 1.2 1.7 1.6 16.2 3.0 0.0 0.0 7.5 4.9 1.6 1.0 64.9 100.0 520 Total 49.2 41.6 20.8 1.8 6.2 3.9 7.6 1.1 0.1 0.0 7.7 5.0 1.9 0.8 50.8 100.0 8,450 CURRENTLY MARRIED MEN 15-19 * * * * * * * * * * * * * * 100.0 23 20-24 42.6 33.5 20.1 1.6 4.3 6.9 0.0 0.0 0.6 0.0 9.1 7.5 1.1 0.5 57.4 100.0 194 25-29 48.5 38.3 24.7 1.8 6.8 4.8 0.0 0.2 0.0 0.0 10.2 8.3 1.6 0.3 51.5 100.0 487 30-34 59.3 50.4 31.0 1.8 6.3 7.0 3.5 0.7 0.0 0.0 8.9 7.4 0.9 0.6 40.7 100.0 620 35-39 63.1 54.0 30.0 1.1 8.9 6.1 7.1 0.7 0.0 0.0 9.1 6.7 1.6 0.9 36.9 100.0 621 40-44 70.2 56.7 26.4 2.6 9.0 6.5 10.9 1.3 0.0 0.0 13.5 10.5 1.3 1.6 29.8 100.0 492 45-49 69.1 56.6 25.2 1.5 7.9 6.7 13.3 1.8 0.0 0.0 12.5 8.8 1.9 1.9 30.9 100.0 371 50-54 65.4 47.8 11.5 2.0 4.3 3.1 19.5 7.4 0.0 0.0 17.7 12.1 3.1 2.5 34.6 100.0 272 55-59 46.2 35.2 6.4 1.2 5.2 1.5 17.4 3.4 0.0 0.0 11.0 9.0 0.6 1.4 53.8 100.0 231 Total 59.6 48.5 24.5 1.7 7.1 5.7 7.9 1.6 0.0 0.0 11.1 8.5 1.5 I.I 40.4 100.0 3,312 Note: An asterisk indicates fewer than 25 unweighted cases. Men are more likely than women to report that they are currently using a family planning method--60 versus 49 percent among currently married men and women, respectively. Such a large discrepancy may be due to overreporting by men, either to appease the interviewer or because they were embarrassed to admit that they were not practicing family planning. It could also be due to underreporting by women who were using a family planning method but were too shy to report that they were. Although there is no clear basis to discard the information given by either women or men as unreliable, it seems that women are more likely to be the reliable reporters of contraceptive use as they are the actual users in most cases. Although men report higher use than women for all methods except withdrawal and the IUD, the largest differences are for the pill and periodic abstinence. The latter has been found in other DHS surveys and may be due to men's misunderstanding of the difference between periodic abstinence and abstinence for other reasons. Contraceptive use varies considerably by age. Women are most likely to use contraception when they are in their 30s. Almost two-thirds of currently married women age 30-39 report they are currently using a family planning method. The drop in current use among older women may reflect their declining fecundity--whether real or perceived--while lower levels of use among younger women probably are due to an unwillingness to use a method until they have a certain number of children or a desired sex composition. However, it is impressive that 1 in 3 married women age 15-19 is using a method, providing clear evidence that younger women have begun to appreciate the advantages of deliberately controlling childbirth early in marriage. Since 1993-94, contraceptive use has increased much more rapidly among women 15-19 than others, by 33 percent, from 25 to 33 percent in the 1996-97 BDHS. 49 There are also variations by age in the methods that women use. The pill is by far the most popular method among married women under age 20 and among women in their 20s and 30s as well. Among women in their 20s, injectables are the second most popular method after the pill. But with a gradual shift to long-term methods among older women, the popularity of female sterilization increases, becoming second to the pill by age 30-34 and the most widely used method among women in their 40s. Trends in Current Use of Family Planning The contraceptive prevalence rate has increased sixfold since 1975, from 8 to 49 percent of married women (Table 4.8 and Figure 4.1). In the three years since the 1993-94 BDHS, contraceptive use has increased by an impressive 10 percent, from 45 to 49 percent of married women, with the use of modem methods rising from 36 to 42 percent. Overall, there has been a steady growth in the contraceptive prevalence rate since 1975 with an average increase of about two percentage points a year. In terms of specific family planning methods, the dominant change in Bangladesh since the late 1980s has been a large increase in the number of couples using oral contraception. The proportion of married women relying on the pill increased considerably in the last five years, from 14 percent in 1991 to 21 percent in 1996-97 (Figure 4.2). Use of short-term methods like injectables and condoms has also increased, while use of long-term methods such as sterilization and the IUD has declined. Among traditional methods, use of periodic abstinence has hardly changed since 1993-94, while use of withdrawal has declined slightly during the same period. Thus, the proportional share that each method contributes to the overall use of contraception-----~own as the "method mix"- -has changed over time. For example, the pill now accounts for 42 percent of all contraceptive use, compared with 39 percent in 1993-94 and 35 percent in 1991 (Figure 4.3). On the other hand, the share contributed by female sterilization has dropped from 23 percent in 1991 to 18 percent in 1993-94 and 15 percent in 1996-97. Table 4.8 Trends in current use of contracentive methods Percentage of currently married women age 10-49 who are currently using specific contraceptive methods, selected sources, Bangladesh, 1975-1996 1975 1983 1985 1989 1991 1993-94 1996-97 Method BFS CPS CPS BFS CPS BDHS BDHS Any method 7.7 19.1 25.3 30.8 39.9 44.6 49.2 Any modern method 5.0 13.8 18.4 23.2 31.2 36.2 41.6 Pill 2.7 3.3 5.1 9.6 13.9 17.4 20.8 IUD 0.5 1.0 1.4 1.4 1.8 2.2 1.8 Injectables U 0.2 0.5 0.6 2.6 4.5 6.2 Vaginal methods 0.0 0.3 0.2 0.1 U U U Condom 0.7 1.5 1.8 1.8 2.5 3.0 3.9 Female sterilization 0.6 6.2 7.9 8.5 9.1 8.1 7.6 Male sterilization 0.5 1.2 1.5 1.2 1.2 1.1 1.1 Any traditional method 2.7 5.4 6.9 7.6 8.7 8.4 7.7 Periodic abstinence 0.9 2.4 3.8 4.0 4.7 4.8 5.0 Withdrawal 0.5 1.3 0.9 1.8 2.0 2.5 1.9 Other traditional methods 1.3 1.8 2.2 1.8 2.0 1.1 0.8 Number of women U 7,662 7,822 10,907 9,745 8,980 8,450 U = Unknown (no information) Source: 1975 BFS (Islam and Islam, 1993:43); 1983 CPS (Mitra and Kamal, 1985:159); 1985 CPS (Mitra, 1987:147); 1989 BFS (Huq and Cleland, 1990:64); 1991 CPS (Mitra et al., 1993:53); 1993-94 BDHS (Mitra et al., 1994:45) 50 Figure 4.1 Trends In Contraceptive Usa Among Currently Married Women 10-49 60 50 40 30 20 10 1975 49,2 1983 1985 1989 1991 1993-94 1996-97 mModern Methods BlTraditionsl Methods I BDHS 1996-97 F igure 4.2 T rends in Use o f Spec i f i c Cont racept ive Methods Among Currently Married Women Age 10-49 21 Injectables Pill Female SteriLization 6 0 5 10 15 20 Percent 25 BDHS 1996-97 5] 100 80 60 40 20 0 Percent Figure 4.3 Trends In ContraceptlveMethodMIx 1991 1993-94 1996-97 IS]Traditional IBSterilizatiorl r'~Condom EBlnjectables I IUD IBPJll Note: Perc~ us~g specific methods among currently marded women 10-49 who ,ate uslrlg 8 molhOd. BDHS 1996-97 Differentials in Current Use of Family Planning Differentials in current use of family planning by selected background characteristics are shown in Table 4.9 and Figure 4.4. They are useful to identify, among other things, the subgroups of the population that may be in need of more care and attention in the delivery of family planning services. The level of current contraceptive use is higher in urban than in rural areas (62 vs. 48 percent among women). The urban-rural gap has widened since 1993-94, with contraceptive use having increased more in urban than rural areas. The pill is the most popular method among both urban and rural women. The condom is the next most widely used method among urban couples, while female sterilization is the second most popular method for rural women. There is a sharp difference in condom use between urban (I 3 percent) and rural (3 percent) couples, probably reflecting wider availability and easier access to the method in the urban than rural areas. Differentials in current use of family planning by the six administrative divisions of the country are large. Sixty-two percent of married women in Khulna Division and 59 percent in Rajshahi Division are using a family planning method, compared with only 20 percent of women in Sylhet Division. Intermediate levels of use are reported for women in Dhaka (50 percent), Barisal (49 percent), and Chittagang (37 percent). There are no marked variations in the relative popularity of methods by division, except that injectables are more widely used in Khnlna and Barisal Divisions than elsewhere. In all divisions, use of modern methods accounts for at least 80 percent of all use. 52 Table 4.9 Current use of conttaceoBon by back£ro~nd chatacleristics Percent distribution of currently married women and men by contta~epfve method currently used, according to selected background characteristics, Bangladesh 1996-97 Modem method Traditional method Number Any Female Male Any Periodic Not of Background Any modern lnjecl- sterili- sterili- N~- trod. abstin- With- Other currently respon- characteristic method method Pill IUD ables Condom zation zafion plant method ence drawal method using Total dents CURRENTLY MARRIED WOMEN Residence Urban Rural Division Barisal Chthagong Dhaka Khulna Rajshahi Sylhet Education No education Primary incomp. Primary complete Secondary+ Number of living children None 1 2 3 4+ Total 62,1 52.6 22.2 2.8 5.7 13.2 7,9 0.7 0,0 9.5 5.0 3,5 1,0 37.9 I00.0 968 47.6 40.1 20.6 1.7 6.3 2.7 7.6 1.2 0.1 7.4 5.0 1,7 0.7 52.4 100.0 7.482 49.4 41.0 20.8 2.1 7.0 3.8 6.1 1.2 0.0 8.3 4,6 2.6 1.2 50.6 100.0 560 37.2 30,8 13.1 2.6 5.5 3.2 5.8 0.5 0.0 6.4 4.2 I.I 1.2 62.8 100.0 1,701 49.8 42.1 21.9 1.2 5.2 5.0 8.0 0.6 0,1 7.8 4.9 2.1 0.7 50.2 I00.0 2,656 61.9 51.0 26.6 2,4 9,1 3,8 7,7 1.2 0.2 10.9 7.0 3.3 0.5 38.1 100.0 1,024 58.6 51.0 26.3 1.5 6.8 3.6 10,1 2.4 0,2 7.6 5,3 1.6 0.7 41.4 100.0 2,049 20.1 16.0 5.4 1.5 5,1 1,4 2.6 0.0 0,0 4.1 3.7 0.4 0.0 79.9 I00.0 460 45.8 39.5 18.3 1.3 7.0 1.6 9,7 1.4 0.1 6.4 4.3 1,0 1,0 54.2 I00.0 4,502 51,2 43.9 22.5 1.2 8.3 2.7 7.9 1.3 0.0 7.3 4,4 2.3 0.6 48,8 100.0 1,470 51.1 41.9 23,7 2.6 4,8 4.9 4.8 L0 0.0 9.1 6.8 1.7 0.8 48.9 100.0 862 56,0 45.1 24.7 3,1 3.0 10.7 3.1 0.2 0.2 10.8 6.6 3.9 0.4 44.0 100.O 1.615 16.4 11.3 5.8 0,0 0.0 4.2 0.2 1.0 0.0 5.2 3.3 1.7 0.2 83.6 I00.0 1,006 42.3 35.6 22.5 1,9 5.0 4.5 1.5 0.I 0.1 6.7 4.2 2.1 0.3 57,7 100.0 1.631 88.1 50.9 27.4 2,2 7.1 5.4 7.6 I.I 0.2 7.2 4.2 2.5 0.5 41.9 100.0 1.803 59.5 51.0 24.0 2,2 8.0 3.7 12.0 1.0 0,1 8.4 5.7 2,0 0.8 40.5 100.0 1,423 54.6 45.4 19.3 1,9 7.9 2.5 11,9 1.8 0.1 9.2 6.4 1.3 1.4 45,4 1(30.0 2,588 49,2 41.6 20.8 1,8 6.2 3,9 7.6 1.1 0.1 7,7 5.0 1.9 0.8 50,8 I00.0 8,450 CURRENTLY MARRIED MEN Residence Urban 703 57.2 26.7 2.2 Rural 58.1 47.3 24.2 1.6 Division Barisal 59.0 47.1 26.3 1.0 Chiuagong 84.7 40.6 17.3 2.7 Dhaka 60.5 49,7 27.6 0.9 Khulna 68.1 54.8 28,9 2.8 Rajshahi 64.2 55.3 26.4 1.5 Sylhet 26.3 19.2 6.7 2.5 Education No education 53,3 44.4 20.8 0.8 Primary thcomp. 59,7 48.2 24.6 1.8 Primary complete 56.9 47.3 26.8 2,0 Secondary+ 69.2 55.0 29.3 3.0 Number of living children None 27.4 17.7 10,3 0.3 I 53.7 43.5 26.2 2.1 2 66.2 54.4 30.1 1.4 3 69.6 589 27,3 2.3 4+ 63.4 51.7 23.0 1.8 Total 59,6 48.5 24.5 1.7 4.7 14.8 8.3 0.4 0.0 13,5 10.0 2.6 0.9 29.3 100.0 400 7.4 4.5 7.9 1.7 0.0 10.8 8,3 1.3 1.1 41.9 100,0 2,912 7.8 5.1 4.7 2.1 0.0 11.9 8.9 1.6 1.4 41.0 I00.0 199 7,8 4,6 7.4 0.7 0.0 14.1 11.7 0.4 2.0 45,3 100.0 584 6.1 6,7 7.6 0.6 0A 10.8 8.8 1.2 0.9 39,5 100.0 1,056 8.7 5.5 7.3 1,7 0.0 13.3 8.6 4,1 0.5 31.9 I00.0 428 7.5 6.1 10.6 3,2 0.0 8.9 6.3 1,5 I.I 35.8 I00.0 877 3.0 3.2 3.0 0.7 0.0 7.1 6.4 0.4 0.4 73.7 100.0 168 &2 2.8 9.8 2.1 0.0 8.9 7.2 0.9 8.5 4.7 7. I 1.4 0.2 11.5 8.5 1.0 6.5 2.2 8.0 1.8 0.0 9,6 6.9 1,9 4.4 11.5 5.9 0.9 0.0 14.2 10.8 2.5 0.8 46.7 100.0 1,390 2.0 40.3 100.0 750 0.8 43.1 1000 204 0.9 30.8 100.0 968 0.2 6.6 0,0 0,3 0.0 9.7 8.1 1.3 0.3 72.6 I00.0 333 6.1 7.7 1.3 0.0 0.2 10.2 8.7 L3 0.2 46.3 100.0 618 7.1 6.7 7,6 1.4 0.0 11.8 8.9 2,5 0.5 33.8 I00.0 679 9.2 6.3 11.3 2.4 0.0 10.7 8.1 1.3 1.4 30,4 I00.0 574 8,5 3.5 12.4 2,4 0.0 11.7 8,5 1.1 2.1 36.6 100.0 1,108 7.1 5.7 7.9 1.6 0.0 11,I 8.5 1.5 I.l 40,4 I00.0 3.312 53 Figure 4.4 Percentage of Currently Married Women Using a Contraceptive Method by Background Characteristics RESIDENCE Urban Rural DIVISION Barisal Chittagon 9 Dhaka Khulna Rajshahl Sylhet 1 2 EDUCATION No Education Primary Incom. Primary Comp. Secondary+ 0 - - - ~'; 48 49 37 50 92 59 J ' l 46 : , 51 , 51 ~0 10 20 30 40 50 60 Percent 70 BDHS 1996-97 Current use differs by educational level of women, although the differentials are not as pronounced as in many countries. Forty-six percent of women with no formal education are currently using a method, compared with 51 percent of women with either incomplete or complete primary school and 56 percent of those with least some secondary education. Educational differentials in contraceptive use have narrowed since 1993-94, with no increase among women with secondary education and almost equal percentage point increases for women in all other educational categories. Method mix also varies by educational level. Among women in all educational categories, the pill is the most widely used method. The second most popular method among women with no education is female sterilization; among those with some primary education it is injectables; among those with completed primary education it is periodic abstinence; and among those with secondary education, the condom is the second most widely used method. It is interesting to note that more educated women are more likely to use traditional methods. These patterns are no doubt influenced by the fact that the more educated women tend to be younger and of lower parity than less educated women and therefore presumably less motivated to control their family size. Contraceptive use rates are also related to family size. As expected, fewer women use contraception before having a child. After the first child, contraceptive use increases sharply, reaching 60 percent among women with 3 children. Thereafter, use declines slightly to 55 percent of women with four or more children, possibly because of women's actual or perceived in fecundity at higher parities. Differentials in contraceptive use as reported by currently married men mirror those reported by married women, except that the levels of use are generally higher. As mentioned above, men are more likely than women to report use of the pill and periodic abstinence. A more precise way to compare discrepancies in contraceptive use reporting between men and women is to compare husbands and wives (see discussion of Table 4.11 below). 54 Table 4.10 indicates that differentials in contraceptive use by division are beginning to narrow somewhat, at least according to the old divisional boundaries. ~ Contraceptive use has increased steadily in all divisions since 1983; however, since 1993-94, it has increased relatively more rapidly in the combined divisions of Chittagong and Sylhet (formerly Chittagong Division) and in Dhaka Division than in Khulna/Barisal and Rajshahi Divisions (Figure 4.5). In Chittagong/Sylhet, contraceptive use increased by 15 percent, while the increase was 12 percent for Dhaka Division, 9 percent for Khulna/Barisal Division and only 7 percent for Rajshahi Division. Of course, the creation of Sylhet Division, which isolates the sections of the former Chittagong Division that have the lowest contraceptive use levels, results in wider divisional differences than existed previously. Table 4. l0 Trends in current use of family olannin~ methods bv division Percentage of currently married women age 10-49 who are currently using any method, any modem method, or any traditional method of family planning, by division, selected sources, Bangladesh, 1983-1996 Type of method/ 1983 1985 1989 1989 1991 1993-94 1996-97 Division CPS CPS CPS BFS I CPS BDHS BDHS Any method Chittagong/Sylhet 12.6 16.1 19.8 21.0 27.1 29.3 33.6 Dhaka 20.5 26.0 34.5 32.0 41.7 44.3 49.8 Khulna/Barisal 20.7 28.2 36.6 35.0 45.7 52.8 57.5 Rajshahi 22.6 30.3 34.7 38.0 46.1 54.8 58.6 Any modern method Chittagong/Sylhet 8.7 11.5 15.3 U 20.5 23.4 27.6 Dhaka 15.5 19.9 27.6 U 32.9 36.3 42.1 Khulan/Barisal 14.2 20.0 27.9 U 34.6 41.1 47.5 Rajshahi 16.1 21.5 26.7 U 37.2 45.9 51.0 Any traditional method Chittagong/Sylhet 3.9 4.7 4.5 U 6.6 5.9 5.9 Dhaka 5.0 6.1 6.9 U 8.9 8.0 7.8 Khulna/Barisal 6.5 8.2 8.7 U 11.1 11.7 10.0 Rajshahi 6.5 8.8 8.0 U 8.8 8.9 7.6 Note: Data from the 1993-94 and 1996-97 BDHS were recategorized to represent the previous four divisions. tU = Unknown (no information) Published data were presented in whole numbers; the decimal was added to balance the table. Source: 1983 CPS (Mitra and Kamal, 1985:188); 1985 CPS (Mitra, 1987:166); 1989 CPS (Mitra et al., 1990:113); 1989 BFS (Huq and Cleland, 1990:68); 1991 CPS (Mitra et al., 1993:56) In fact, the most important issue emerging from this analysis of family planning use is the extremely low level of contraceptive use in Sylhet Division. Further studies need be undertaken to investigate the reasons for low use of family planning in Sylhet in order to assist in designing program interventions to bring the division in line with the rest of the country. Because Sylhet and Barisal are relatively new divisions, the table is structured according to the original four divisions. 55 Figure 4.5 Trends in Contraceptive Use by Division 70 60 50 40 30 20 10 0 Percent of Married Women Using a Method Chittagong/ Sylhet Dhaka Khutna/ Barisal [[]1989 BF~; 1111993-94 BDHS D1996-97 BDHS I Rajshahi BDHS 1996-97 Contraceptive Use Reporting Among Married Couples It was pointed out above that the contraceptive prevalence rate among currently married men (60 percent) is considerably higher than that for currently married women (49 percent). Part of the discrepancy could be due to contraceptive use with non-marital partners, which is presumably higher among men than women. Another explanation could be marriages in which the spouses are not currently co-habiting, thus reducing the need for contraceptive use. Such a situation is likely to be more common among women than men, for example when men work overseas on a labor contract. However, misreporting and lack of communication between spouses is also a possible explanation. Fortunately, it is possible to link wives and husbands who were both interviewed and compare their individual responses about contraceptive use. Table 4.11 shows the extent of agreement (shown in italics on the diagonal) in reporting of contraceptive use between husbands and wives. Among the matched couples, 60 percent of husbands report that they are using a family planning method, compared with only 55 percent of their wives. The discrepancy is mostly observed in reporting of the use of the pill, condoms and periodic abstinence. Most of the discrepancy for these methods is due to couples in which the husbands say they are using these methods while their wives say they are not using any method at all. While at least some of the discrepancies between husbands and wives in reporting of contraceptive use could be due to extra-marital use, some may be due to misunderstanding of the method. For example, higher reporting of periodic abstinence use among men than women has been observed in many countries and may be due to confusion between periodic and long-term abstinence. Finally, underreporting of contraceptive use among women because of embarrassment or ignorance (e.g., condom use by husband without her knowledge) is also a possible explanation for the discrepancy. 56 Table 4.11 Comoarison of reverted contracentive use by svouses Percent distribution of couples according to wife's and husband's reported current contraceptive use status, Bangladesh 1996-97 Wife: current contraceptive method Female Male Periodic Husband: current Inject- sterili- sterili- abstin- With- Other Not contraceptive method Pill IUD ables Condom zation zation ence drawal method using Total Pill 21.7 0.1 0.3 0.1 0.0 0.0 0.4 0.3 0.0 2.3 25.2 IUD 0.0 1.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 1.7 lnjectables 0.2 0.1 6.2 0.0 0.1 0.0 0.0 0.0 0.1 0.8 7.5 Condom 0.2 0.0 0.0 3.5 0.0 0.0 0.6 0.2 0.0 1.0 5.6 Female sterilization 0.0 0.0 0.1 0.0 7.7 0.0 0.0 0.0 0.0 0.3 8.0 Male sterilization 0.0 0.0 0.0 0.0 0.2 1.3 0.0 0.0 0.0 O. 1 1.6 Periodic abstinence 0.6 0.1 0.1 0.1 0.0 0.0 3.2 0.5 0.0 3.8 8.3 Withdrawal 0.0 0.0 0.0 0.1 0.0 0.0 0.2 0.8 0.0 0.2 1.4 Other 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.6 0.4 1.1 Not using 0.7 0.1 0.3 0.3 0.2 0.0 1.2 0.4 0.2 36.1 39.5 Total 23.5 1.9 7.1 4.1 8.1 1.4 5.7 2.2 1.0 45.1 100.0 4.5 Number of Children at First Use The BDHS included a question for all women who had ever used a method as to how many l iving children they had when they first used a method. Table 4.12 shows the distribution of ever-married women by the number of l iving children they had when they first used a method, according to five-year age group. These data enable the examination of both periodic and cohort changes in the timing of the initiation of contraceptive use during the family building process. Table 4.12 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, and median number of children at first use, according to current age, Bangladesh 1996-97 Median Never Number of living children at time number of used of first use of contraception Number children contra- of at first Current age ception 0 1 2 3 4+ Missing Total women use 10-14 75.5 21.5 3.0 0.0 0.0 0.0 0.0 100.0 145 0.0 15-19 47.1 27.8 21.8 3.2 0.0 0.0 0.1 100.0 1,301 0.0 20-24 31.4 19.2 31.7 12.8 4.4 0.5 0.0 100.0 1,727 0.5 25-29 22.0 12.6 26.7 20.5 11.8 6.4 0.1 100.0 1,905 1.0 30-34 18.1 9.3 18.0 16.9 17.3 20.4 0.0 100.0 1,402 1.8 35-39 23.6 5.8 10.0 13.3 16.1 31.3 0.0 100.0 1,128 2.6 40-44 32.7 3.8 7.2 8.7 10.0 37.7 0.0 100.0 861 3.4 45-49 49.7 2.3 5.6 5.7 5.3 31.3 0.1 100.0 658 3.9 Total 30.8 13.2 19.8 12.6 9.3 14.2 0.0 100.0 9,127 1.1 57 Overall, 46 percent of women initiated contraceptive use when they had fewer than three living children, with 13 percent initiating use before having the first child, 20 percent after having the first child and 16 after having the second child. Younger cohorts of women have a tendency to initiate family planning use at lower parities than the older cohorts. For example, while less than 16 percent of women age 35 and older initiated family planning use before having two children, the proportion rises with younger cohorts, reaching 50 percent among women age 15-24 years. This probably reflects the fact that young women are more likely to use family planning to space births, while older women are more likely to initiate family planning use to limit births. This trend toward initiating family planning use at lower parities can also be seen by comparing data from the 1993-94 and 1996-97 BDHSs. For example, in 1993-94, 39 percent of women reported initiating contraceptive use when they had fewer than three children, compared with 46 percent in 1996-97. 4.6 Problems with Current Method Problems experienced in using family planning methods may reduce the effectiveness with which they are used or even lead to termination of use. An understanding of the problems users experience is, therefore, important in efforts to improve family planning service delivery in Bangladesh. In order to elicit information about problems associated with use of methods, women who were currently using modem family planning methods were asked if they were experiencing any problems in using their current method, and if so, what problems they were experiencing (Table 4.13). Table 4.1~ Problems with current method of contraceotion Percentage of current users of family planning who are having problems with their method of contraception, by specific method and type of problem, Bangladesh 1996-97 Contraceptive method Female Male Inject- sterili- sterili- Problem Pill IUD ables Condom zation zation Total Any problem 23.2 20.2 34.2 2.9 32.8 13.1 24.4 Spedfic problem Weight gain 0.1 0.8 0. l 0.0 0.3 0.0 0.2 Weight loss 1.4 0.4 2.2 0.4 5.8 3.5 2.3 Excessive bleeding 0.9 8.5 3.1 0.0 2.4 0.0 1.7 Hypertension 0.4 0.0 0.7 0.4 0.1 0.0 0.3 Headache 16.1 2.3 l 1.7 0.1 8.7 1.3 11.6 Nausea 6.1 0.0 2.6 0.0 0.8 0.0 3.6 No menstruation 0.9 1.0 17.7 0.0 0.9 0.0 3.3 Weak/tired 12.6 8.3 14.2 0.4 18.3 7.0 12.5 Dizziness 3.7 1.4 3.7 0.0 6.9 0.0 3.8 Husband disapproves 0.1 0.0 0.0 0.4 0.2 1.I 0.2 Other relative disapproves 0.0 0.0 0.0 0.0 0.2 0.0 0.0 Religion disapproves 0.0 0.0 0.0 0.0 0.1 0.0 0.0 Inconvenient to use 0.0 0.0 0.5 0,4 0.2 0.0 0.1 Sterilized, wants children 0.0 0.0 0.0 0,0 0.9 1.6 0.2 Abdominal pain 2.7 6.5 3.1 0.9 18.8 1.3 5.8 Other 3.4 5.4 7.0 1.5 5.9 2.2 4.3 Number of women t,759 150 526 329 691 93 3,561 Note: Total includes 10 Norplant users and 1 menstrual regulation user. 58 A sizeable proportion of women using injectables, female sterilization, the pill, and the IUD reported having problems with their methods. Common complaints are feeling weak or tired and having headaches or abdominal pain. For pill users the most commonly reported problem is headaches, while the most commonly reported problems among sterilized women are abdominal pain and feeling weak or tired. Injectable users cite amenorrhea (no menstruation) and feeling weak or tired as problems, while IUD users tend to complain of excessive bleeding, feeling weak or tired, and abdominal pain. Problems were rare among users of condoms and male sterilization, while non-health problems were rarely reported for any method. There has apparently been a decline in reported health problems with methods between the 1993-94 and 1996-97 BDHSs. Differences may be due to the use of slightly different questions in the two surveys, but they may also indicate that there has been at least some improvement in the quality of care in the delivery of family planning services. 4.7 Reasons for Selecting Methods Family planning methods vary in their effectiveness, side effects, convenience of use, and availability/accessibility, as well as in their suitability for an individual couple. A couple may elect to use a method because it is more effective in averting unwanted births and/or more convenient to use and/or for some other reasons. It is therefore useful to know why couples choose to use a particular method as opposed to another, in order to understand the relative advantages of the different methods. More importantly, the information is useful to understand why oral contraceptives have become the predominant method in recent years in Bangladesh. Reasons women give may also provide important insights into the process couples undergo in deliberately controlling fertility. These data are of particular importance in Bangladesh where women have at least heard about most of the methods (see Table 4.1) and thus are more able to make informed choices. Table 4.14 shows the distribution of current users of specific methods by the reasons they gave for choosing that method. Table 4.14 Reason for using current method of gont(~¢ption Percentage of current users of modem contraceptive methods citing various reasons they decided to use the method, by specific methods, Bangladesh 1996-97 Female Male Inject- sterili- sterili- Reason Pill IUD ables Condom zation zation Total FP worker recommended 8.1 15.7 12.2 3.3 13.5 9.7 9.7 Friend/relative recommended 7.1 8.4 9.8 3.1 10.1 17.4 8.1 Side effect of other methods 35.2 43.7 48.4 54.0 14.9 5.6 34.4 Method easy to use 41.2 33.4 38.0 34.2 6.0 4.7 31.8 Access/availability 21.5 7.6 17.3 10.0 3.1 1.3 15.1 Cost 8.1 8.1 4.7 4.7 2.1 2.9 6.0 Wanted permanent method 1.8 12.9 6.6 1.4 77.1 47.9 18.9 Husband preferred 26.8 13.3 16.8 53.5 27.7 66.2 28.5 Wanted more effective method 3.4 27.9 13.2 1.4 11.0 10.3 7.4 Fieldworker came to house 35.3 3.1 16.5 12.6 0.3 0.0 21.2 Other 4.6 6.0 4.1 6.0 10.0 6.9 5.9 Number of users 1,759 150 526 329 691 93 3,561 Note: Total includes 10 Norplant users and 1 menstrual regulation user. 59 The primary reason given for choosing the pill the most popular method of contraception--is that it is easy to use; two-fifths (41 percent) of pill users reported this reason. Two other predominant answers were that the fieldworker delivered the pill to their home (given by 35 percent of pill users) and that side effects of other methods caused them to choose oral contraception (also 35 percent of pill users). Other common reasons cited for pill users are husband's preference for the method (27 percent) and availability of the method (22 percent). The main reasons users of the IUD and injection selected their method are the side effects of other methods and the ease of using the method. Although a majority of condom users say that the possible side effects of other methods drew them to use condoms, husband's preference was an equally important reason. Not surprisingly, women who have been sterilized are most likely to say they chose the method because it was a permanent method; husband's preference is the next most common reason for women undergoing sterilization. However, for women whose husbands have been sterilized, the most frequently given response for choosing the method is husband's preference for the method, followed by the desire for a permanent method. The data suggest that substantial proportions of contraceptive users choose their method not so much because of the advantages of that method, but because of the problems they perceive or experience with other methods. For these women, selection of a method becomes a process of eliminating the other choices. Ease of use is, of course, another major criterion in method selection. The fact that husband' s preference is also commonly cited indicates that husbands have an important role in making decisions about family planning use . 4.8 Use of Social Marketing Brands Bangladesh has an active contraceptive social marketing program that distributes pills, condoms, and oral rehydration salts through a network of some 140,000 retail outlets (pharmacies, small shops, and kiosks) throughout the country. The Social Marketing Company carries several brands of oral contraceptives, namely Maya, Ovacon, Norquest, and Nordette 2. To obtain information on the number of users purchasing the social marketing brands, BDHS interviewers asked all respondents who were current pill users to show them a packet of the pills they were using. If the user had the packet available, the interviewer recorded the brand on the questionnaire. If not, the interviewer showed the woman a chart depicting all the major pill brands and asked the user to identify which brand she was currently using. Overall, 19 percent of pill users are using social marketing brands (Table 4.15). Almost 70 percent of pill users are using government-supplied brands---either Shuki or Combination-5 which are provided free of charge through government fieldworkers and clinics and at a nominal charge from the non- governmental service providers. Urban pill users are far less likely than rural users to use the government brands and more likely to use one of the social marketing brands; one-third of urban women using pills are using one of the social marketing brands. The percentage of pill users using a brand provided by government or non-governmental organizations (NGOs) has decreased substantially in the past few years, from 78 percent in 1993-94 to 69 percent in 1996-97 (Figure 4.6). The social marketing program's market share increased from 14 to 19 percent over the same time period. 2 The first three brands listed have been discontinued; however, it is possible that stocks still remain in retail outlets. 60 Table 4.15 Use of pill brands Percent distribution of current pill users by brand of pill used, according to urban-rural residence, Bangladesh 1996-97 Residence Pill brand Urban Rural Total Government Combination-5 9.0 6.6 6.9 Shuki 35.2 65.9 62.2 Social marketing Maya 10.2 4.9 5.6 Nordette 12.7 3,4 4.6 Ovacon 7.3 8.5 8.3 Norquest 2.4 0.5 0.7 Private Marvelon 6.7 0.6 1.3 Ovostat 8.9 3.7 4.3 Other Lyndiol 1,8 0.3 0.5 Ovral 1.3 1.0 1.0 Noriday 0,6 0.5 0.5 Other brand 3.5 2.2 2.4 Don't know/Missing 0.5 1,9 1.7 Total 100.0 100.0 100.0 Number of pill users 215 1,544 1.759 Figure4.6 Trends in Use of Types of Pill Brands, 1991-1997 100 80 60 40 20 0 1991 1993-94 1996-97 QOther/MJssing ] BIIprivate BSMC* ~Government • Social Marketing Company BDHS 1996-97 61 As mentioned above, 4 percent of currently married women in Bangladesh are using condoms as a method of family planning (see Table 4.7). To measure the impact of the social marketing program on condom use, women who said that they and their husbands used condoms were shown a chart depicting all the major condom brands and were asked which brand of condom they used. Men would presumably be a more reliable source of data on condom brands; however, due to the larger sample of women than men in the BDHS, and the fact that a major source of condoms is fieldworkers who may give them to the wife instead of the husband, the data shown in Table 4.16 are derived from women. Table 4.16 Use of condom brands Percent distribution of current condom users by brand of condom used, according to urban-rural residence, Bangladesh 1996-97 Residence Condom brand Urban Rural Total Raja ~ 13.5 27.6 22.1 Panther ~ 44.1 25.4 32.7 Sensation ~ 6.0 2.0 3.6 Majestic 0.4 0.0 0.1 Carex 4.4 1.8 2.8 Circle rubber 0.0 0.6 0.4 Sultan 2.8 1.8 2.2 Other government 10.1 16.5 14.0 Other 13.8 18.6 16.7 Don't know 4.9 5.7 5.4 Total 100.0 100.0 100.0 Number of users 128 201 329 Note: Table is based on women's reports. Social marketing brand It is apparent that condoms sold by the Social Marketing Company enjoy a high market share. The three social marketing brands together account for 58 percent of the condom market, with Panther alone accounting for 33 percent and Raja for an additional 22 percent. When women who could not name the brand of condom are excluded, the social marketing brands account for 62 percent of the market. The Panther brand of condom appears to be more popular among urban users, while Raja predominates among rural users. The proportion of overall condom use that is supplied through the Social Marketing Company has fluctuated over time, increasing from 64 percent in 1983 to 73 percent in 1986, then declining to 62 percent in 1989 and to 41 percent in 1991 before climbing again to 61 percent in 1993-94 and 62 percent in 1996-97 (omitting the "Don't know/Missing" category) (Mitra et al., 1993:72-74; Mitra et al., 1994:57). 4.9 Age at Sterilization and Sterilization Regret Table 4.17 shows the distribution of sterilized women by the age at which they had the procedure, according to the number of years prior to the survey the procedure was done. The information is useful in understanding when a Bangladeshi woman is likely to accept sterilization. It should be noted that since data on age at sterilization were derived from a question on the month and year of the operation, it is possible that the data are distorted by some systematic error in reporting, either the date of the operation or the date of birth and/or age of the woman. 62 Table 4.17 Timin~ of sterilization Percent distribution of sterilized women by age at the time of sterilization, according to the number of years since the operation, Bangladesh 1996-97 Age at time of sterilization Number Years since of Median operation <25 25-29 30-34 35-39 40-44 Total women age t <2 (34.4) (26.5) (13.0) (26.0) (0.0) 100.0 29 (26.8) 2-3 (22.2) (48.1) (16.8) (6.1) (6.8) 100.0 39 (28.1) 4-5 37.9 29.0 22.8 8.7 1.6 100.0 82 26.6 6-7 38.4 29.9 21.5 10.2 0.0 100.0 107 26.3 8-9 47.6 18.0 22.1 12.3 0.0 1(30.0 91 26.1 10+ 38.1 34.9 20.4 6.5 0.0 1(30.0 343 a Total 38.4 31.6 20.6 8.9 0.6 100.0 691 26.7 Note: Figures in parentheses are based on 25 to 49 women. 1 Median age was calculated only for women less than 40 years of age to avoid problems of censoring. a Not calculated due to censonng The data indicate that women deciding to have female sterilization generally have the procedure early in their reproductive years. Over two-thirds of sterilized women had the operation before age 30, while over one-third of the women were sterilized before age 25. Few sterilized women had the procedure when they were in their 40s. The median age at sterilization is 27. There has not been any significant change since 1993-94 in the median age at which women have the operation. Female and male sterilization together now account for 18 percent of all contraceptive use in Bangladesh (see Table 4.7). In the 1996-97 BDHS, as in the 1993-94 BDHS, women who had been sterilized or whose husbands had been sterilized were asked if they regretted having had the operation and, if so, why. The results are presented in Table 4.18. Although a similar question was asked of men, the data are not included here, due to smaller sample sizes. Although some level of regret is expected to occur with any permanent method of contraception, a high level could be viewed as an indication of poor quality of care in the sense that women and men who are sterilized at a young age and/or low parity or who are not adequately counselled are more likely to regret having the operation (Loaiza, 1995). Overall, 10 percent of women reported that they regretted that they or their husbands had been sterilized. This is considerably lower than the level of 16 percent reported in the 1993-94 BDHS, which implies that there may have been some improvement in the quality of care in providing the procedure. Changes in reporting regret may account for some of the decrease. Six in 10 women who regret sterilization say the reason is that they or their husbands wanted another child. Sterilization regret is slightly lower among urban than rural women (8 vs. 10 percent). There are also slight variations by administrative division and by education. However, as expected, a woman is more likely to regret having had the procedure if she has fewer children. While only 4 percent of women with four or more living children regret having had the operation, the proportion rises to 20 percent among those having two living children. Of course, the number of living children refers to the current number and not the number at the time of sterilization. Thus, many of those who regret having been sterilized include the unfortunate cases in which couples decide on sterilization and subsequently suffer the loss of one or more of their children. 63 Table 4.18 Sterilization remet Percentage of currently married women who are sterilized or whose husbands are sterilized who regret the operation, by reasons for regret and selected background characteristics, Bangladesh 1996-97 Reason for regretting sterilization Percentage Respondent who wants Husband Number Background regret the another wants Side Child Other of characteristic operation child child effects died reason women Residence Urban 8.4 5.7 1.3 0.8 0.0 0.6 89 Rural 10.2 5.7 0,5 1.1 1.6 1.3 695 Division Barisal 10.4 5,2 0.6 4,6 0.0 0.0 45 Chittagong 11.6 8.5 1.3 0,6 0,0 1.3 116 Dhaka 9.5 6.9 0.0 0.0 1,9 0.7 248 Khulna 8.7 2.7 0.5 0,0 2.2 3.3 98 Rajshahi 10.2 4,6 0.9 1.9 1,5 1.2 265 Sylhet * * * * * * 13 Education No education 10.7 5.1 0.8 1~3 1.8 1.6 535 Primary incomplete 9.7 7.9 0.0 1.0 0.8 0.0 141 Primary complete 4.1 2,1 0.0 0.0 0.0 2,0 55 Secondary+ 10,1 9.3 0.8 0,0 0.0 0.0 55 Number of living children <2 (42.6) (29.3) (0.6) (0.0) (8.4) (4.3) 49 2 20.0 11.9 2,4 1.7 2.7 1.3 165 3 5.6 2.2 0.0 1.4 1,2 0,8 195 4+ 3,6 1.7 0.1 0.8 0.0 1.0 375 Total 10.0 5.7 0.6 1.1 1.4 1.2 785 Note: Figures in parentheses are based on 25 to 49 women. An asterisk indicates fewer than 25 unweighted women. 4.10 Cost o f Cont racept ive Methods Although family planning services have been available free of charge from public sources for some time, there is increasing emphasis on ways to recoup program costs and move clients who can afford to pay into private services so as to maximize the sustainability of the program. In order to gauge current costs of contraceptive use, women who were either sterilized or were using pills, IUDS, or injectables were asked in the 1996-97 BDHS how much they paid for their method. For pills and injectables, the question referred to the cost of one packet (cycle) of pills and one injection, respectively. Table 4.19 shows the percent distribution of users by the amount paid according to method. Although the majority of users of all four methods obtained the method free of charge, the proportion of pill users obtaining free packets is lower (63 percent) than the proportion of IUD users (89 percent), injectable users (84 percent), or sterilization users (94 percent). Pill users are somewhat more likely to pay for their method now than in 1993-94; the proportion who received free packets has declined from 68 percent in 1993-94 to 63 percent in 1996-97. 64 Table 4.19 Cos[ of methods Percent distribution of current users of pill, IUD, injectables, and sterilization by cost of method, Bangladesh 1996-97 Inject- Sterili- Cost Pill IUD ables zation Free 63.0 89.0 84.1 93.7 < 5 taka 10.3 0.0 4.8 0.0 5 - 49 taka 23.2 7.0 10.3 0.3 50 - 99 taka 0.7 0.0 0.3 0.0 100+ taka 0.0 2.6 0.4 2.3 Don't know 2.7 1.4 0.2 2.6 Total 100.0 100.0 100.0 100.0 Mean cost (takas) for those paid 12.0 6.6 10.3 (686.2) Number of users 1,759 150 526 785 Note: Figures in parentheses are based on 25 to 49 women. 4.11 Source of Family Planning Services Sources of family planning methods play an important role in the promotion and maintenance of contraceptive use levels in the population. In order to ascertain the relative importance of different sources in Bangladesh, current users of modern methods of family planning were asked to report the place from which they most recently obtained their methods. Since women often do not know into which category the source they use falls (e.g., hospital, thana health complex, family welfare center, private clinic, etc.), interviewers were instructed to write the name of the source in the questionnaire. Team supervisors were in- structed to verify that the name and the type of source coded were consistent. Sources of family planning methods in Bangladesh are classifiable into five major categories: government facilities (including thana health complexes, family welfare centers, clinics, and hospitals), private medical sources (including private clinics, doctors, and pharmacies), other private sources, fieldworkers (which may be either government or non- government), and clinics run by non-governmental organizations. Table 4.20 and Figure 4.7 show the percentage of current users of modern methods who obtained their method from a specific source. Table 4.20 Source of suonlv for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply or information, according to specific methods, Bangladesh 1996-97 Contraceptive method Female Male All Inject- Con- sterili- sterili- modem Source of supply Pill IUD ables dom zation zation methods Public 6.1 78.7 56.5 4.9 89.8 91.6 35.2 Govemmeet hospital 0.2 16.0 3.6 1.3 30.4 43.7 8.6 Family welfare center 4.4 39.8 34.4 2.4 19.0 13.3 13.3 Thana health complex 1.1 18.0 8.8 1.2 40.3 34.6 11.5 Satellitc/EPl clinic 0.4 4.8 9.8 0.0 0.0 0.0 1.8 Medical private 20.9 2.5 2.9 36.7 2.4 0.0 14.7 Private clinic/doctor 0.1 2.5 0.5 0.7 2.4 0.0 0.8 Traditional doctor 0.3 0.0 1.4 0.4 0.0 0.0 0.4 Pharmacy 20.5 0.0 1.0 35.6 0.0 0.0 13.6 Other private 8.8 0.0 0.6 20.1 0.0 0.0 6.3 Shop 6.7 0.0 0.3 19.4 0.0 0.0 5.2 Friends/re at ves 2.1 0.0 0.3 0.7 0.0 0.0 1.1 Fleldworker/FWA 1 61.4 9.9 33.9 30.3 0.0 0.0 38.6 NGO clinic 0.4 3.1 1.3 0.4 2.0 0.0 1.0 Other 1.5 5.8 4.6 2.1 5.4 2,6 3.0 Don't know 0.8 0.0 0.0 5.0 0.4 5.8 1.1 Missing 0.1 0.0 0.2 0.4 0.1 0.0 0.1 Total 100.0 100.0 100.0 109.0 100.0 100.0 100.0 Number of users 1,759 150 526 329 691 93 3,559 l •Fwote : Total includes 10 Norplant users. A = Family Welfare Assistant (Government-sponsored fieldworker) 65 Figure 4.7 Distribution of Current Users of Contraception by Source of Supply Government 35% Private Medical 15% Other private 6% Oonlt know/Other ! Fieldworkers 39% BDHS 1996-97 Fieldworkers remain the largest source of family planning methods, followed by government facilities. Thirty-nine percent of current users of modem methods obtain their method from fieldworkers, while 35 percent obtain their method from government facilities, including government hospitals (9 percent), family welfare centers (13 percent), thana health complexes (12 percent), and satellite clinics (2 percent). Fifteen percent of modem method users get their methods from private medical sources such as pharmacies and private doctors and clinics, while 6 percent use non-medical private sources such as shops and friends. Only one percent of users rely on non-governmental clinics. Since 1993-94, there has been a slight decline in the proportions of users obtaining methods from fieldworkers and government facilities, with more couples procuring their methods from commercial sources, like pharmacies and shops. The proportion of users who buy their methods from pharmacies and shops rose to 19 percent in 1996-97 from 15 percent in 1993-94. This finding indicates that the number of users willing to pay for family planning supplies or services has been rising, which has beneficial implications for strategies aimed at achieving financial sustainability. The slight decline in the proportion of users who obtain their method from fieldworkers (from 42 percent in 1993-94 to 39 percent in 1996-97) is probably related to the slight decline in the coverage of fieldworkers' home visits (see Table 4.26). The source a woman uses to obtain contraceptive methods is related to the type of method she is using. The vast majority (61 percent) of pill users still receive their pills from fieldworkers, although an increasing proportion (27 percent) obtain supplies from pharmacies and shops, compared with 1993-94 (20 percent). On the other hand, most IUD users (79 percent) obtained their method from government facilities, such as family welfare centers and thana health complexes. Most users of injectables are served by government facilities (57 percent)---especially family welfare centers--although fieldworkers evidently supply one-third of injectables users. More than half (55 percent) of condom users say their method is obtained from pharmacies and shops, while just under one-third (30 percent) obtain condoms from fieldworkers. As expected, both female and male sterilizations are mainly performed in government facilities. 66 4.12 Contraceptive Discontinuation A key concern for family planning programs is the rate at which users discontinue use of contraception and the reasons for such discontinuation. Life table contraceptive discontinuation rates based on information collected in the 5-year, month-by-month calendar in the BDHS questionnaire are presented in Table 4.21. All episodes of contraceptive use between April 1991 (the first month of the Bengali year 1398) and the date of interview were recorded in the calendar, along with the main reason for any discontinuation of use during this period, Table 4.21 Contracentive discontinuation rates First-year contraceptive discontinuation rates due to method failure, desire for pregnancy, health reasons, or other reasons, according to specific methods, Bangladesh 1996-97 Reason for discontinuation Method To Side All Method become effects/ other All failure pregnant Health reasons I reasons Pill 2.9 7.0 24.2 10.3 44.4 IUD 0.0 2.5 35.5 3.4 41.3 lnjectables 1.3 5.1 35.6 9.0 51.0 Condom 6.4 10.3 11.4 36.7 64.8 Periodic abstinence 9.9 10.0 0.1 21.4 41.4 Withdrawal 4.8 10.3 16.6 28.4 60.0 Total 3.8 7.1 21.5 14.5 46.9 t Includes discontinoations with missing reasons The discontinuation rates presented here are based on all segments of use that started between April 1991 and three months prior to the date of interview, covering 3-62 months before the interview date for each woman. A segment is an uninterrupted period of use of a particular contraceptive method. Segments of use that began before the five-year period are excluded from computations of discontinuation rates, since inclusion of such segments complicates the analyses; moreover, their omission has little effect on discontinuation rates for short durations of less than two years. The month of interview and the two preceding months are ignored in order to avoid the bias likely to be introduced by an unrecognized pregnancy. The rates presented in Table 4.21 are cumulative one-year discontinuation rates and represent the proportion of users who discontinue use by 12 months after they start. The rates are calculated by dividing the number of discontinuations at each duration of use in single months by the number of months of exposure at that duration. The single-month rates are then cumulated to produce a one-year rate. In calculating rates, the reasons for discontinuation are treated as competing risks (net rates). The reasons are classified into four mutually exclusive and exhaustive categories: method failure (pregnancy), desire to become pregnant, side effects/health reasons, and all other reasons. Discontinuation rates are generally high in Bangladesh. According to the estimates computed for all reversible methods combined, nearly half (47 percent) of users stop using within 12 months of starting use. Not surprisingly, discontinuation rates for the condom (65 percent) and withdrawal (60 percent) are considerably higher than for injectables (51 percent), the pill (44 percent) and the IUD (41 percent). Discontinuation rates for periodic abstinence are relatively low (41 percent). 67 Overall, 4 percent of users stop using due to method failure (pregnancy), 7 percent because they want to become pregnant, 22 percent as a result of side effects or health concerns, and 15 percent because of other reasons. Side effects of the method or other health reasons are by far the most commonly reported reasons for discontinuing the pill, the IUD, and injectables. However, users of condoms and withdrawal are considerably less likely and users of periodic abstinence are completely unlikely to discontinue their method because of side effects or other health reasons. Other reasons are the main cause of discontinuation for these methods. Although discontinuation rates due to method failure appear generally low, women are more likely to become accidentally pregnant while using condoms, periodic abstinence and withdrawal than when using pills, IUDs, and injectables. Ten percent of women using periodic abstinence become pregnant within 12 months of starting the method. Discontinuation of use in order to become pregnant is also more common among users of the condom, periodic abstinence and withdrawal than among users of other methods. There has been little improvement in discontinuation rates since 1993-94. The rate for all reversible methods combined remained almost constant between 1993-94 (48 percent) and 1996-97 (47 percent), reflecting only slight changes in the rates for users of the pill, the IUD, periodic abstinence, and withdrawal. However, there has been some slight decline in discontinuation rates for injectables and condoms (from 58 to 51 for injectables and from 72 to 65 for condoms). Further information on reasons for contraceptive discontinuation is presented in Table 4.22. This table shows the percent distribution of all discontinuations occurring during the five years preceding the survey, regardless of whether they occurred during the first 12 months of use or not. For all reversible methods combined, side effects (37 percent) stands out as the most common reason for discontinuation, followed by the desire to get pregnant (21 percent). Method failure ranks third with about 1 in 10 segments of use being reported as interrupted due to accidental pregnancies. Looking at the patterns for specific methods, side effects is the most common reason for discontinuing use of the pill, IUD, and injectables. As expected, side effects is less frequently mentioned as a reason of discontinuation of condom and withdrawal use. Desire to become pregnant is an important reason for discontinuation for every reversible method and accounts for more discontinuations among users of the periodic abstinence, withdrawal, and condoms than any other reason. Husband's disapproval is a common reason for discontinuing use of the condom and withdrawal. It is also notable that 1 in 10 discontinuations of condoms is due to inconvenience in using the method. Method failure is an important reason for discontinuation of periodic abstinence, withdrawal, and condoms, accounting for 24 percent of discontinuations of periodic abstinence, 14 percent of withdrawal and 12 percent of condoms. Similarly, the desire to use more effective methods accounted for a not insignificant proportion of discontinuations of these methods. 4.13 Nonuse of Family Planning Future Use Intention to use contraception in the future provides an indication of potential demand for family planning services, and acts as a convenient summary indicator of disposition towards contraception among current nonusers. Intention not to use contraception in the future is useful in identifying "hard core" targets of the program. Thus, to obtain information about potential demand for family planning services, all currently married respondents who were not using contraception at the time of the survey were asked if they intended to use a method at any time in the future. Table 4.23 shows the distribution of the women and men by their intention to use in the future. For women, the distribution is given according to the number of living children. 68 Table 4.22 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the last five years by main reason for discontinuation, according to specific methods, Bangladesh 1996-97 Method Periodic Reason for Inject- absti. With- discontinuation Pill IUD ables Condom nenee drawal Other Total Became pregnant 6.9 0.0 1,8 11.7 24.0 14.0 (49.3) 9.0 To become pregnant 23,2 9.2 14.1 19.3 30.3 22.9 (8.6) 21.4 Husband disapproved 1.1 2.5 0.8 13,7 6,4 15,6 (0,0) 3.9 Side effects 43.5 68.3 58.7 11.6 0.5 17.4 (4.7) 36.7 Health concerns 4.9 7.6 6,2 5.5 0.3 2.5 (1.4) 4.7 Access/Availability 1.8 0.5 5.0 1.3 0.2 0.0 (4.4) 1.9 More effective method 1.6 0,7 0.2 %0 14.4 10.5 (6.8) 4.1 Inconvenient to use 1.1 1.1 0.4 10.3 2.0 3.5 (0.0) 2.3 Infrequent sex 4.7 0.0 2.6 5.3 4.7 2.8 (2.6) 4.2 Cost 0.3 0.0 0.1 0.3 0.0 0.0 (2.3) 0.2 Fatalistic 0,0 0.0 0,0 0.0 0,0 0.0 (0.0) 0.0 Menopause 0,3 0.5 0,3 0.0 1.3 0.0 (0.0) 0.4 Marital dissolution 1.0 0.0 0.3 0.2 0,5 0.0 (0,0) 0.6 Other 6.2 8.5 6.1 9.4 8,7 6.2 (9.6) 7.0 Missing 3.3 0.9 3.2 2.5 6,7 4.6 (10.4) 3.6 Total 100.0 100.0 100.0 100.0 100,0 100,0 100.0 100.0 Numberofdiscontinuations 2,750 217 714 628 524 262 48 5,153 Note: Figures in parentheses are based on 25 to 49 women. Table 4.23 Future use of contracention Percent distribution of currently married women and men who are not currently using a contraceptive method, by intention to use in the future, according to number of living children, Bangladesh 1996-97 Number of living children I Future intentions 0 1 2 3 Total Total for for 4+ women men Intend to use in next 12 months 19.3 46.5 49.9 51.8 39.3 41.9 40.0 Intend to use later 53.2 33,5 22.0 19.1 7.6 24.6 21.5 Unsure as to timing 2.6 1.9 2.2 1.3 0.8 1.7 2.2 Unsure as to intention 10.4 5.3 4,4 2.7 3.2 4.9 4.5 Do not intend to use 13.8 12.5 21.3 24.4 48.5 26.5 29.8 Missing 0.7 0.2 0.2 0.7 0.4 0.4 2.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women/men 623 1,007 774 641 1,243 4,289 1,337 More than 2 in 3 (68 percent) currently married female nonusers say that they intend to use family planning in the future, with 42 percent saying they intend to use within the next 12 months and 25 percent saying they intend to use later; 2 percent were not sure when they would start using contraception. Twenty-seven percent of female nonusers say they do not intend to practice family planning in the future, while 5 percent are unsure. Compared with women, intention to use family planning is only slightly less common among men, with 64 percent of currently married male nonusers saying they intend to use family planning in the future. Variations between women and men in the timing of intended use are also slight. 69 There has been little change since 1993-94 in intention to use in the future, either for the proportion intending to use or the timing of intended use. For example, the proportion of female nonusers intending to use in the future increased only slightly between 1993-94 (66 percent) and 1996-97 (68 percent). Similarly, the proportion who say they intend to use within the next 12 months has remained unchanged at 42 percent. The proportion intending to use family planning peaks at 82 percent among female nonusers with one child, dropping among nonusers with more children. The timing of the intention to use also varies with the number of living children. For example, the proportion of female nonusers who intend to use within the next 12 months is considerably lower among those with no living children than among those with children, while the proportion who say they intend to use after 12 months is highest among women with no children and declines steadily with the number of living children. Reasons for Nonuse Currently married respondents who were not using family planning at the time of the survey and who said that they did not intend to use it in the future were asked why they were not using. Table 4.23 presents data on the main reasons for not using family planning. Infecundity appears to be the primary reason for nonuse of contraception among women; 33 percent of female nonusers say they do not intend to use because of infecundity (either "menopausal", "had hysterectomy" or "subfecund"). The desire to have children is the next most common reason for nonuse (cited by 11 percent of nonusers), followed by infrequent sexual relations (10 percent), religious reasons (9 percent), husband' s opposition to family planning (9 percent), and side effects and other health concerns (7 percent). There are no significant variations in reasons for nonuse between the 1993-94 and 1996-97 B DHSs; apparent declines in the proportion of women citing "infecundity" as the main reason for nonuse are probably due to changes in the wording of the codes between the two surveys. There are significant differences in reasons for nonuse between women under age 30 and those 30 and above. The desire to have children (27 percent), husband's opposition (22 percent), and religion (17 percent) are the major reasons for younger women not intending to use contraception in the future. Older women usually cite reasons such as being menopausal or infecund (42 percent). There are no marked variations in the major reasons for nonuse among women and men, except that men are more likely than women to cite religion and the desire to have children as reasons for not intending to use contraception. Although men are also more likely to cite infecundity as a reason for nonuse, they are less likely than women to cite menopause or hysterectomy; consequently, there is little difference between women and men in the overall proportion who give inability to become pregnant as a reason for nonuse. Preferred Method Nonusers who said they intended to use family planning in the future were asked which method they preferred to use. The pill is the most popular method, with half (49 percent) of nonusers who intend to use in the future saying they would choose the pill (data not shown). One in 5 nonusers (21 percent) intend to use injectables. A substantial proportion of nonusers--nearly I out of 5 (I 9 percent)--were uncertain which method they would prefer to use. Compared with the 1993-94 BDHS, there have been no changes in method preferences, confirming the continuing dominance of the pill and injectables in the delivery of family planning services in Bangladesh. 70 Table 4.24 R¢asons for not usin~t contracention Percent distribution of currently married women and men who are not using a contra- ceptive method and who do not intend to use in the future, by main reason for not using, according to age, Bangladesh 1996-97 Women Men Age Age Reason for not using contraception 10-29 30-49 Total 15-29 30-54 Total Infrequent sex 2.7 12.7 10.4 (0.0) 7.9 7.3 Manopausal/hysterectomy 0.0 30.0 23.4 (0.0) 15.7 14.4 Subfecund/infecund 1.4 12.3 9.9 (0.0) 23.6 21.6 Want children 26.6 7.1 11.4 (54.9) 11.8 15.4 Respondent opposed 8.4 3.5 4.6 (7.9) 4.6 4.9 Partner opposed 22.0 5.3 9.0 (0.0) 0.8 0.7 Others opposed 0.2 0.2 0.2 (0.0) 0.0 0.0 Religion 16.9 7.3 9.4 (23.3) 19.9 20.2 Knows no method 0.0 0.2 0.2 (0.0) 1.2 1.1 Knows no source 0.0 0.3 0.2 (0.0) 0.9 0.8 Health concerns 3.1 3.3 3.3 (0.0) 1.1 1.0 Side effects 5.3 3.7 4.0 (2.5) 3.2 3.1 Inconvenient 0.2 0.1 0.2 (0.0) 0.3 0.3 Interferes with body 0.4 1.9 1.6 (0.0) 1.6 1.4 Other 11.2 11.3 11.3 (5.0) 6.9 6.8 Don't know 0.7 0.4 0.4 (6.4) 0.0 0.5 Missing 0.9 0.4 0.5 (0.0) 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women/man 252 885 1,137 34 365 399 Note: Figures in parentheses are based on 25 to 49 men. 4.14 Family Planning Messages In order to gauge the extent of family planning information and education activities, respondents in the 1996-97 BDHS were asked i f they had heard or seen a message about family planning on the radio, television, newspaper or magazine, or a billboard or poster in the month before the survey. Table 4.25 presents the distribution of ever-married women and currently married men who had heard such a message, according to background characteristics. As might be expected in the sociocultural context of Bangladesh, more men than women are exposed to family planning messages through the mass media. Nearly 70 percent of men and slightly over 40 percent of women reported that they had heard or seen a family planning message in one or more of the four media. For women, radio is a more effective means of receiving family planning messages than television, newspapers, or billboards. This is hardly surprising given the limited electric coverage and low female literacy in the country. More than one-third (36 percent) of women said they had heard a family planning message on the radio in the month before the interview, compared with 1 in 5 (20 percent) who had seen a message on television. Only 5 percent of women reported having read a family planning message in a newspaper or magazine, while 6 percent reported having seen a message on a billboard or poster in the month prior to the interview. 71 Table 4.25 ExPosure to family olannin2 messages Percent distribution of ever-married women 10-49 and currently married men 15-59 by exposure to family planning (FP) messages in the media (heard/saw a message about familyplanning) during the month preceding the interview, according to selected background characteristics, Bangladesh 1996-1997 Type of media At least Number of Background Newspaper/ Billboard/ one FP women/ characteristic Radio Television magazine poster message None Total men EVER-MARRIED WOMEN Age 10-14 39.2 12.0 2.4 4.8 40.4 59.6 100.0 145 15-19 42,2 20,0 4.6 5.2 48.9 51.1 I00.0 1,301 20-24 41.3 23.3 4.9 6.3 47.6 52.4 100.0 1,727 25-29 37,5 22.4 6.7 6.5 43.8 56.2 100.0 1,905 30-34 35,0 21.3 5.1 5.9 41.5 58.5 100.0 1,402 35-39 33,7 17.8 6.5 6.0 39.0 61.0 100.0 1,128 40-44 29,0 16.0 4.9 3.6 35.1 64.9 100.0 861 45-49 24,2 I 1.5 2.9 2. l 26,7 73.3 100.0 658 Residence Urban 44,9 56.4 20.7 18.5 66.5 33.5 100.0 1,063 Rural 35,2 15.1 3.3 3.8 39.0 61.0 100.0 8.064 Division Barisal 39.1 18,2 6.6 4.6 42.2 57.8 100.0 598 Chittagong 40.4 24.5 6.8 7.9 48.1 51.9 100.0 1,836 Dhaka 34.0 22.7 6.8 5.9 41.6 58.4 100.0 2,882 Khulna 35.8 18.8 3.7 5.1 40.7 59.3 100.0 1,107 Rajshahi 37.4 15.6 3.1 4.0 41.4 58.6 100.0 2.198 Sylhet 27.7 10.9 2.7 3.3 30.6 69.4 100.0 506 Education No education 25.0 9.2 0,2 1.3 28.2 71.8 100.0 4,983 Primary incomplete 39.5 17.3 1.2 3.7 44.7 55.3 100.0 1,572 Primary complete 46.9 25.8 4.3 6.5 55.4 44.6 100.0 913 Secondary+ 61.4 51.5 25.1 19.3 74.5 25.5 100.0 1,659 Total 36.3 I9.9 5.3 5.5 42.2 57.8 100.0 9,127 CURRENTLY MARRIED MEN Alg5e- 19 * * * * * * 100,0 23 20-24 66.9 53.1 13.2 29.3 73.8 26.2 I00.0 194 25-29 67.1 53.7 18.1 35.1 77.2 22.8 100.0 487 30-34 60.3 51.9 21.7 34.8 71.8 28.2 100.0 620 35-39 57.7 47.0 19.1 33.5 70.0 30.0 100.0 62I 40~44 60.2 46.0 23.3 34.5 70.9 29.1 100.0 492 45-49 53.4 38.0 19.3 31.2 61.5 38.5 100.0 371 50-54 49.5 33.0 20.7 30.2 59.3 40.7 100.0 272 55.59 41.2 26,2 15.2 21.1 53.5 46.5 100.0 231 Residence Urban 69.3 74.2 50.9 59.3 85.7 14.3 100.0 400 Rural 56.6 41.6 15.3 28.7 66.3 33.7 100.0 2,912 Division Barisal 67.5 43.5 23.1 40.5 76.2 23.8 100.0 199 Chittagong 55.2 46.6 21.2 44.3 72.4 27.6 100.0 584 Dhaka 59.1 47.8 24.7 32.1 68.8 31.2 100.0 1,056 Khulna 67.2 54.4 20.2 38.3 75.7 24.3 100.0 428 Rajshahi 55.7 41.6 13.4 23.2 64.8 35.2 100.0 877 Sylhet 39.9 28.4 8.4 16.2 48.1 51.9 100.0 168 Education No education 45.2 28.7 0.5 15.5 54.1 45.9 100.0 1,390 Primary incomplete 56.0 42.5 7.4 26.7 68.1 31.9 100.0 750 Primary complete 63.9 52.8 17.7 25.6 75.3 24.7 100.0 204 Secondary+ 77.0 70.6 56.7 62.5 88,7 11.3 100.0 968 Total 58.1 45.6 19,6 32.4 68.7 31.3 100.0 3,312 Note: An asterisk indicates fewer than 25 unweighted men. 72 Men were much more likely than women to receive family planning messages through any of the mass media, although there is no difference between men and women in the order of importance of the various media. Fifty-eight percent of men had heard a family planning message on the radio in the month prior to the survey, while 46 percent had seen a message on television. Even billboards and newspapers and magazines are important means of communicating to men, with 1 in 3 men having received family planning messages from the former and 1 in 5 from the latter. Although high, family planning communication coverage appears to have declined somewhat. In the 1993-94 BDHS, 47 percent of ever-married women reported having received family planning messages through the media in the month before the interview. By 1996-97, this proportion had declined to 42 percent, with relatively fewer women reporting having heard family planning messages on the radio than in 1993-94 (36 vs. 42 percent). Exposure to family planning messages through the other media has only changed slightly. Exact comparison of data from the two surveys is complicated by the fact that the 1993-94 survey did not inquire specifically about newspapers and magazines. Exposure to family planning messages through the mass media varies by background characteristics of respondents. Generally, exposure to messages on family planning decreases with age among both men and women. Urban respondents are more likely to have been exposed to a media message than their rural counterparts. For example, only 39 percent of rural women saw or heard a message, compared with 67 percent of urban women. Higher urban than rural exposure is true for all four types of media. Differences in media exposure by division are not large, except for Sylhet, where both men and women have significantly less exposure to mass media messages on family planning than their counterparts in the other divisions. As expected, exposure to family planning messages through the mass media is positively correlated with educational level. Only 28 percent of uneducated women and 54 percent of uneducated men reported having heard a family planning message, compared with 75 percent of women and 89 percent of men who had secondary education. 4.15 Family Planning Outreach Services A crucial element of the Bangladesh family planning program is its universal system of fieldworkers. Some 40,000 village-level fieldworkers--supported by government (Family Welfare Assistant or FWA) and non-governmental organizations--visit couples in their homes to provide contraceptive information, supplies and referrals. This approach was necessitated by the fact that many women are restricted by custom to their homes or the nearby area. Fieldworkers supply both pills and condoms. In part to increase the accessibility of other, more clinical methods, the government implemented a system of satellite clinics. Under this system, staff from the health centers at the union headquarters visit selected villages at pre-scheduled times to set up temporary clinics. The clinics include basic health services, such as health and nutrition education, antenatal care, screening for high-risk pregnancies, and family planning advice and supplies. A key staff person in this system is the Family Welfare Visitor (FWV), who is able to give contraceptive injections and insert IUDs. In order to assess the extent of coverage of both fieldworkers and satellite clinics, the BDHS included questions about both services. Although satellite clinics have a clear name in English, there is no easy term to use in Bangla and interviewers therefore tried to describe the clinic. Thus, the quality of the data depend on the ability of respondents to understand the definition. In the 1996-97 BDHS, women were asked whether they had been visited by a family planning fieldworker in the six months prior to the survey and if not, whether they had had any contact with a fieldworker. Table 4.25 shows the results for currently married women. The table also shows, for women visited, the mean number of visits they received in the six-month period. The percentage of visited women who received supplies or methods is also given in the table. 73 Table 4.26 Contact with family olannin2 fieldworkers Percentage of currently married women who reparted being visited by ar having contact with a family planning (FP) fieldworker in the six months prior to the survey, and, of those, the mean number of times visited and the percentage who received supplies, by selected background characteristics and contraceptive use status, Bangladesh 1996-97 Percentage of currently married women who had contact with a family planning fieldworker Among currently married women who had contact with a FP fieldworker: Mean Percent Visited Not Number number who Number Background in last 6 visited, of af received af characteristic months but contact women visits supplies women Age 10-14 12.7 0.9 143 * * 19 15-19 29.7 3.1 1,252 2.6 38.9 411 20-24 36.6 2.5 1,655 2.8 43,4 647 25-29 43.3 3.4 1,812 2.8 45.7 845 30-34 42.2 4.3 1,297 2.9 49.9 602 35-39 37.0 2.7 1,031 3.0 47.3 410 40-44 24.9 1.2 740 3.2 34.5 193 45-49 15.8 1.0 520 2.8 22.7 87 Residence Urban 37.2 2.9 968 2.7 35.3 389 Rural 34.9 2.8 7,482 2.9 45.1 2,825 Division Barisal 36.3 3.2 560 3. l 40.6 22 l Chittagong 28.1 3.0 1,701 2.7 31.3 530 Dhaka 33.5 2.7 2,656 2.8 44.2 963 Khulna 42. l 3.5 1,024 2.8 50.0 466 Rajshahi 42.9 2.7 2,049 3.0 49.5 933 Sylhet 20.2 1.8 460 2.7 35.5 101 Education No education 32.8 2.9 4,502 2.8 46.4 1,607 Primary incomplete 37.6 3.0 1,470 2.9 45.0 598 Primary complete 38.2 3.2 862 3.1 43.8 357 Secondary+ 38.1 2.4 1,615 2.8 37.0 653 Number of living children None 15.8 0.7 1,006 2.5 22.8 166 1 34.6 3.2 1,631 2.7 40.6 616 2 41.3 4.0 1,803 2.8 47.5 816 3 42.2 2.8 1,423 2.8 46.2 639 4+ 35.0 2.7 2,588 3.0 45.2 977 Contraceptive use status Using any methad 48.1 4.3 4,161 2.9 60.3 2,181 Pill 66.9 5.0 1,759 2.9 78.5 1,266 1UD 39.6 4.7 150 2.9 10.7 67 Injectables 55.3 9.8 526 2.9 57.7 343 Condom 50.0 3.0 329 3.1 48.9 174 Female sterilization 13.0 1.5 643 3.0 1.3 93 Male sterilization 13.6 0.0 93 * * 13 Periodic abstinence 33.9 1.6 425 2.9 12.4 151 Withdrawal 30.0 3.4 158 2.8 16.4 53 Other 27.1 2.5 77 * * 23 Not using any method 22.7 1.4 4,289 2.7 9.5 1,033 Total 35.2 2.8 8,450 2.8 43.9 3,214 Note: An asterisk indicates fewer than 25 unweighted women. 74 One in 3 currently married women (35 percent) reported having been visited by a fieldworker in the six months preceding the survey, while an additional 3 percent said they had contact with a fieldworker. Thus, 38 percent of women had either been visited or had contact with a fieldworker. The mean number of fieldworker visits in the six months was 3. Of those visited, 44 percent said they had received family planning supplies. The fact that only one-third of married women are being visited by fieldworkers is cause for concern, since virtually the entire country is covered by fieldworkers. Moreover, although questions about fieldworkers' home visits were asked in slightly differing ways in the 1993-94 and 1996-97 BDHSs, there is clear evidence that fieldworker coverage has deteriorated. In the 1993-94 BDHS, 38 percent of women reported having been visited by a fieldworker in the six months prior to the survey to talk about family planning or to give them methods. This proportion dropped to 35 percent in 1996-97. Fieldworkers are less likely to visit young women (age under 20) and older women (age 40 and above), presumably because they are either more likely to want to get pregnant or to be either infecund or sterilized. Urban women are only slightly more likely than rural women to have been visited in the previous six months. Fieldworker visitation coverage varies significantly by division. Only 20 percent of women in Sylhet Division and fewer than 30 percent of those in Chittagong Division reported having been visited by a fieldworker, compared with around 34-36 percent of women in Dhaka and Barisal Divisions and 42-43 percent of those in Khulna and Rajshahi Divisions. Differences by education of women are small; however, a smaller proportion of women with no children reported that they had been visited by a family planning fieldworker in the six months before the survey, implying that fieldworkers target women with more children. As might be expected, women who were using contraception were substantially more likely than nonusers to be visited by a fieldworker (48 vs. 23 percent). Although fieldworkers are instructed to visit all the households in their assigned area, it is likely that many nonusers are either pregnant, attempting to get pregnant, opposed to family planning, or menopausal, and thus, do not present as urgent a need as others. Among users, coverage is higher for users of the pill, injection, and condoms, while it is understandably lower for those who have been sterilized. Among women who were visited by a fieldworker, there are minimal differences in either the mean number of visits over the six months prior to the survey or in the proportion who received family planning supplies, except that women in Rajshahi and Khulna Divisions are more likely to receive supplies than women in other divisions, as are women who are using supply methods such as the pill, injectables, and condoms. Table 4.27 presents data on the extent of recognition of satellite clinics and their coverage. Seven in 10 ever-married women interviewed in the 1996-97 BDHS said that there was a satellite clinic in their community, while more than half (57 percent) of those reporting a clinic said that they had ever visited the clinic. Almost all of these women (94 percent) were aware that the clinic provided immunization services for children; but only 19 percent said that the clinic provided family planning methods and only 6 percent said it provided child growth monitoring. A high 77 percent mentioned other services. It is possible that, instead of reporting all the services that the satellite clinic provided, the women mistakenly reported only the service for which they attended the clinic. Since 1993-94, both awareness and coverage of satellite clinics have improved. In 1993-94, only 54 percent of ever-married women reported a satellite clinic in their community, compared with 70 percent in 1996-97. Similarly, among those who reported a satellite clinic, the proportion who ever visited the clinic rose from 49 to 57 percent. There has also been improvement in the awareness of specific services provided at satellite clinics, with the exception of child growth monitoring. 75 Tabl¢ 4.27 Satellite clinics Percentage of ever-married women who reported a satellite clinic in their community in the last three months, the percentage who visited a clinic, and the percentage who reported various types of services provided at the clinic, by selected background characteristics, Bangladesh 1996-97 Of those reporting Of those who visited a clinic, a clinic: percent reporting various services: Percent reporting Number Percent a clinic of ever- who Number Family Don't Number Background in corn- married visited of planning lmmuni- Child know/ of characteristic munity women clinic women methods zation growth Other Missing women Age 10-14 52.7 145 28.1 76 * * * * * 21 15-19 67.5 1,301 53.0 878 15.9 92.6 6.0 76.1 0.0 465 20-24 70.6 1,727 69.5 1,220 19.0 94.4 5.0 78.4 0.1 848 25-29 72.4 1,905 68.5 1,379 19.9 94.6 6.6 78.6 0.0 945 30-34 71.7 1,402 58.0 1,004 21.0 93.4 5.8 77.5 0.2 583 35-39 69.4 1,128 47.5 783 19.0 95.2 5.1 75.7 0,0 372 40-44 69.4 861 39.4 597 22.6 87.2 l l . l 75.8 0.0 235 45-49 62.4 658 28.3 410 17.4 97.2 6.3 70.6 0.5 l l6 Residence Urban 47.6 1,063 49.3 506 16.5 93.7 6.7 68.1 0.0 250 Rural 72.5 8,064 57.1 5,843 19.5 93.7 6.1 77.9 0.1 3,336 Division Barisal 72.2 598 62.2 431 28.9 95.1 5.8 81.2 0.0 268 Chittagong 62.2 1,836 52.3 1,142 19.5 90.7 5.4 69.1 0.0 597 Dhaka 66.5 2,882 54.4 1,916 18.9 94.6 6.9 75.8 0.0 1,043 Khulna 76.1 1,107 61.1 843 14.0 93.6 4.5 80.4 0.4 515 Rajshahi 77.4 2,198 58.5 1,702 19.4 95.2 6.7 80.5 0.0 996 Sylhet 62.3 506 53.0 315 22.2 88.1 5.7 80.1 0.4 167 Education No education 70.2 4,983 57.4 3,498 17.1 93.6 5.0 77.2 0.0 2,007 Primary incomplete 73.4 1,572 60.3 1,154 22.6 95.1 6.3 79.0 0.0 696 Ptimary complete 73.5 913 56.7 671 22.9 94.0 6.5 78.5 0.3 380 Secondary+ 61.9 1,659 48.9 1,027 21.1 92.3 10.0 74.2 0.2 502 Total 69.6 9,127 56.5 6,349 19.3 93.7 6.1 77.2 0.1 3,585 Note: An asterisk indicates fewer than 25 unweighted women. Younger and older women are less likely than women in the middle age groups to know of a satellite clinic in the community and, among those who do know, they are less likely to have visited the facility. Satellite clinics are more common in rural (73 percent) than urban (48 percent) areas; however, among those who know of a satellite clinic in their community, there is less of an urban-rural gap in the likelihood of women visiting the clinic. Clinics are more common in Khulna and Rajshahi Divisions than in the other divisions. Women in these divisions, as well as women in Barisal Division, are also more likely to visit the clinic when they know of it. Surprisingly, women with at least some secondary education are less likely than other women to know of a satellite clinic in the community; moreover, they are less likely to visit such a clinic when they do know of one. This pattern may be due to the fact that more educated women tend to live in urban areas and they are also more likely to have other resources such as private doctors and clinics available to them. 76 4.16 Couples' Communication and Attitudes Toward Use of Family Planning While husband-wife communication about family planning and agreement to use contraception is not necessary for adoption of certain methods, its absence may be a serious impediment to use. Interspousal communication is therefore an important intermediate step along the path to eventual adoption and sustained use of contraception. Lack of discussion may reflect a lack of personal interest, hostility to the subject, or a customary reticence in talking about sex-related matters. In order to gain insight about spousal communication regarding family planning, currently married respondents in the 1996-97 BDHS were asked how often they had talked to their spouse about family planning in the three months prior to the survey. Data for currently married, non-sterilized women are shown in Table 4.28. Table 4.28 Discussion of family olannin~ with husband Percent distribution of currently married non-sterilized women who know a contraceptive method by the number of times they discussed family planning with their husband in the three months preceding the survey, according to current age, Bangladesh 1996-97 Number of times family planning discussed Number Once or More than of Age Never twice twice Missing Total women 10-14 56.8 29.2 14.0 0.0 100.0 142 15-19 45.5 38.0 16.4 0.1 100.0 1,249 20-24 44.1 34.8 21.0 0.1 100.0 1,619 25-29 42.0 38.0 19.8 0.1 100.0 1,713 30-34 44.9 34.9 20.0 0.1 100.0 1,146 35-39 50.0 34.0 15.5 0.4 100.0 847 40-44 67.9 22.9 9.2 0.0 100.0 574 45-49 84.1 12.8 3.0 0.2 100.0 420 Total 48.8 33.8 17.3 0.2 100.0 7,710 Almost half of women said they had not talked to their husband about family planning in the three months preceding the survey, while one-third had discussed it once or twice, and 17 percent had discussed it more than twice. Older women were least likely to have discussed family planning with their husband. Use of family planning is facilitated when both husband and wife approve of its use. Table 4.29 shows the percent distribution of couples by approval of family planning, according to selected background characteristics. Overall, in 90 percent of the couples, both husband and wife approve of family planning, and in 1 percent, both disapprove. In 4 percent of couples, the wife approves but the husband does not, while in 3 percent, the husband approves but the wife does not. Variations in the data by background characteristics are small except in Sylhet Division, where couples are far less likely to approve of family planning use (64 percent) and also less likely to agree with each other on the subject. Sylhet is the only division in which wives are substantially more likely to approve of family planning use than their husbands. Because both men and women interviewed in the BDHS were asked whether they approved of family planning and, if married, whether they thought their spouse approved of family planning, it is possible to examine the extent to which husbands and wives report accurately on each other's attitudes. Table 4.30 shows the percent distribution of couples by husband' s and wife' s attitude toward family planning, according to their spouse's perception of their attitude. 77 Table 4.29 Attitudes of couples toward family t~lannin2 Percent distribution of couples by approval of family planning, according to age difference between spouses and background characteristics, Bangladesh 1996-97 Age Wife Husband Percent difference/ Both approves, approves, Don't in Number Background Both disap- husband dis- wife dis- know/ agree- of characteristic approve prove approves approves Missing Total merit couples Age difference Wife older (91.9) (0.0) (5.6) (0.0) (2.5) 100.0 (91.9) 40 Husband 0-4 yrs. older 91.9 1.0 3.7 2.6 0.8 100.0 92.9 392 Husband 5-9 yrs. older 89.9 1.2 2.9 3.4 2.6 100.0 91.1 1,273 Husband 10-14 yrs. older 90.0 1.1 4.3 2.2 2.4 100.0 91.1 947 Husband 15+ yrs. older 84.2 1.9 6.6 3.6 3.7 100.0 86.1 376 Residence Urban 95.9 0.2 1.6 1.0 1.3 100.0 96.1 362 Rural 88.6 1.4 4.3 3.2 2.6 100.0 90.0 2,666 Dlvtalon Barisal 89.8 0.9 4.6 2.2 2.6 100.0 90.7 186 Chittagung 84.0 1.4 5.1 5.1 4.3 1(30.0 85.5 536 Dhaka 90.7 0.7 3.7 2.7 2.2 100.0 91.4 948 Khulna 94.4 0.0 2.0 2.0 1.6 100.0 94.4 394 Rajshahi 94.4 0.4 1.9 1.6 1.8 100.0 94.8 801 Sylbet 64.0 10.8 15.6 6.8 2.7 100.0 74.9 163 Education Both spouses uneducated 84.7 2.4 5.3 4.0 3.7 100.0 87.0 981 Wife educated, husband none 90.4 0.7 4.2 2.3 2.4 100.0 91.1 301 Husband educated, wife none 87.0 1.1 5.0 3.5 3.3 100.0 88.1 651 Both have some education 95.0 0.4 2.0 1.8 0.8 100.0 95.4 1,095 Total 89.5 1.2 3.9 2.9 2.4 100.0 90.7 3,028 Note: Figures in parentheses are based on 25-49 unweighted cases. The data indicate that when husbands and wives report that their spouse approves of family planning, they are generally accurate. For example, in 97 percent of cases in which wives reported that their husband approved of family planning, the husbands also said they approved. Similarly, in 96 percent of the couples in which the husband said his wife approved of family planning, she also said she approved. However, when husbands and wives report that their spouse disapproved of family planning, in 70 to 73 percent of cases, the opposite is true, that is, the spouse actually approves of family planning. Caution should be used in drawing a conclusion from these data that there is a considerable lack of communication between spouses about attitudes towards family planning. It is likely that at least some respondents report more favorable attitudes toward family planning than they in fact hold, perhaps in an attempt to please the interviewer or to appear more sophisticated. 78 Table 4.30 Percention of ~pouse's attitude ~oward familv vlannine Percent distribution of couples by husband's and wife's actual attitude toward family planning, according to their spouse's perception of their attitude, Bangladesh 1996-97 Perception Spouse's actual attitude Number Disap- of Approves proves Unsure Total couples Wife's perception of husband's attitude Approves 96.5 3.0 0.5 100.0 2,605 Disapproves 73.3 22.7 4.1 100.0 298 Don't know 79.4 15.0 5.5 100.0 124 Total 93.5 5.5 1.0 100.0 3,028 Husband's perception of wife's attitude Approves 96.1 2.8 1.1 100.0 2,728 Disapproves 69.7 24.3 6.0 100.0 150 Don't know 82.9 12.2 4.9 100.0 150 Total 94.1 4.4 1.5 100.0 3,028 79 CHAPTER 5 OTHER PROXIMATE DETERMINANTS OF FERTILITY 5.1 Introduction This chapter addresses the principal factors other than contraception that affect a woman's risk of becoming pregnant: nuptiality and postpartum amenorrhea and abstinence from sexual relations. Marriage is a primary indicator of exposure of women to the risk of pregnancy, and is, therefore, important for understanding fertility patterns. Populations in which age at marriage is low also tend to experience early childbearing and high fertility; hence, trends in age at marriage can help to explain trends in fertility levels. Measures of other proximate determinants of fertility are the duration of postpartum amenorrhea and postpartum abstinence, which can delay exposure to the risk of pregnancy during the early months after a birth. In the BDHS, only women who had ever been married were interviewed with the individual questionnaire. However, a number of the tables presented in this chapter are based on all women, i.e., both ever-married and never-married women. In constructing these tables, the number of ever-married women interviewed in the survey is multiplied by an inflation factor that is equal to the ratio of all women to ever- married women as reported in the household questionnaire. This procedure expands the denominators in the tables so that they represent all women. The inflation factors are calculated by single years of age and, where the results are presented by background characteristics, single-year inflation factors are calculated separately for each category of the characteristic. It is important to take note of the definition of marriage that was used in the BDI--IS. In Bangladesh, it is common for a woman to wait several months or even years after formal marriage before going to live with her husband. Since the researchers who designed the BDHS were interested in marriage mainly as it affects exposure to the risk of pregnancy, interviewers were instructed to ask the questions about marriage not in the sense of formal marriage, but as cohabitation. 5.2 Current Marital Status Data on the marital status of female respondents at the time of the survey are shown in Table 5.1. Overall, 34 percent of women age 10-49 have never married, 62 percent are currently married, and 5 percent are either widowed or divorced. The proportion who have never married falls sharply from 95 percent of women age 10-14 to less than 1 percent of women over age 30. As expected, the proportion widowed increases with age of women; 12 percent of women age 40-44 and 18 percent of those 45-49 are widowed. The proportion divorced is low and relatively even across age groups (2-4 percent). Table 5.2 shows the trend in the proportion of women reported as never married by age group from previous surveys in Bangladesh. It is evident that the proportion of women under age 25 who have never married has increased. Since 1975, the proportion of women age 15-19 who have not yet married has increased from 30 to 50 percent (Figure 5.1). The proportion never married at ages 20-24 also rose from 5 to 17 percent. The proportion never married above age 25 is so small that changes over time are difficult to detect. 81 Table 5.1 Current marital status Percent distribution of women by current marital status, according to age, Bangladesh 1996-97 Current marital status Never Age married Married Widowed Divorced Total Number 10-14 95.2 4.7 0.0 0.1 100.0 3,035 15-19 49.8 48.3 0.2 1.7 1130.0 2,592 20-24 17.2 79.3 0.9 2.6 100.0 2,087 25-29 3.4 91.9 1.6 3.0 100.0 1,973 30-34 0.5 92.0 3.6 3.9 100.0 1,409 35-39 0.0 91.3 5.7 2.9 100.0 1,129 40-44 0.0 86.0 11,5 2.5 I00.0 861 45-49 0.0 79.0 18.3 2.7 I00.0 658 Total 33.6 61.5 2.8 2.1 100.0 3,743 Note: Figures may not add to 100.0 due to rounding. Table 5.2 Trends in t~rooortion never married Percentage of women who have never married, by age group, as reported in various surveys, Bangladesh 1975-96 1975 1983 1985 1989 1989 1991 1993-94 1996-97 Age BFS CPS CPS BFS CPS CPS BDHS BDHS 10-14 91.2 98.0 98.7 96.2 96.4 98.5 95.2 95.2 15-19 29.8 34.2 47.5 49.0 45.8 46.7 50.5 49.8 20-24 4.6 4.0 7.1 12.0 9.3 12.3 12.4 17.2 25-29 1.0 0.7 1.0 2.3 1.6 2.8 2.2 3.4 30-34 0.2 0.4 0.1 0.3 0.5 0.5 0.3 0.5 35-39 0.4 0.1 0.5 0.1 0.3 0.0 40-44 0.1 0.1 0.2 0.2 0.3 0.7 0.0 45-49 0.0 0.1 0.1 0.1 0.2 0.0 - = Less than 0.1 percent Sources: 1975 BFS (MHPC, 1978:49); 1983, 1985, 1989 and 1991 CPSs (Mitra et al., 1993:24); 1989 BFS (Huq and Cleland, 1990:43); 1993-94 BDHS (Mitra et al., 1994:72) 5.3 Age at First Marriage Table 5.3 shows the percentage of women who have ever been married by exact ages, as well as the median age at first marriage, according to women's current ages. Although the intention was to obtain information on the age at which the respondent started to live with her husband, it is likely that some women, especially older women, reported the age at which they were formally married, which in many cases is several years before cohabitation. To the extent that this occurred, it would lead to underestimates of the age at first cohabitation. Overall, about 60 percent of Bangladeshi women were married by the time they were age 15. The median age at first marriage among women 20-49 is 14 years. Data in the last column of Table 5.3 imply there has been a slow but steady increase over the past 25 years in the age at which Bangladeshi women first marry. The median age at marriage has increased from 13.3 among women currently age 45-49 to 15.3 for 82 those age 20-24 years. However, comparison of data from the 1993-94 and 1996-97 BDHS surveys show that the median age at marriage among women has remained constant at 14. Since data from the Bangladesh Bureau of Statistics also show a steady rise in the mean age at marriage over the past 15 years (BBS, 1997a: 143), it is likely that fluctuations in the reported age at marriage in one or both BDHS surveys have masked the upward trend. Percenl 6o 50 4o 3 ( 3o 2o 10 o 1975 n / Figure 5.1 Trends in Proportion Never Married Among Women 15-19 and 20-24 49 j / d I I 1 3 1985 1989 49 81 50 17 1993-94 1990-97 BDHS 1996-97 Table 5.3 Age at first marrial~e Percentage of women who were first married by specific exact age and median age at first marriage, according to current age, Bangladesh 1996-97 Percentage who were first married by exact age; Current age 12 15 18 20 22 Percentage Median who have Number age at never of first 25 marr ied women marriage 15-19 3.1 33.1 NA NA NA NA 49.8 2,592 a 20-24 5.4 46.8 68.5 77.1 NA NA 17.2 2,087 15.3 25-29 9.1 57.2 81.4 88.3 91.6 94.9 3.4 1,973 14.5 30-34 12.8 62.6 86.4 92.4 95.9 98.6 0.5 1,409 14.1 35-39 14.0 69.7 89.5 94.2 96.2 99.0 0.0 1,129 13.7 40-44 23.3 73.5 93.6 96.7 98.3 99.2 0.0 861 13.4 45-49 27.7 76.9 92.7 96.7 98.3 99.4 0.0 658 13.3 Median for women 20-49 12.5 60.5 82.3 88.5 91.6 93.8 5.4 8,116 14.2 Median for women 25-49 15.0 65.3 87.0 92.5 95.1 97.6 1.2 6,029 13.9 • A = Not applicable Omitted because less than 50 percent of the women in the age group x to x+4 were first married by age x. 83 Table 5.4 presents the median age at first marriage by selected background characteristics for women age 20-49 years. The table shows large differentials in marriage behavior patterns, It can be seen that in each age group, urban women marry later than their rural counterparts, with an overall difference of two years in the median age at marriage among women 20-49 (16 vs. 14, respectively). Women in Rajshahi and Khulna Divisions have relatively early median ages at marriage, while those in Sylhet and Chittagong Divisions marry the latest. A woman's age at marriage is highly correlated with her education level. The median age at marriage increases with the level of education for all age groups of women in Bangladesh. For example, the median age at first marriage for women age 20-49 increases steadily from 13.6 among women with no education to 17.7 for women with some secondary education. These findings correspond to those from the 1993-94 BDHS i Mitra et al., 1994:75). Table 5.4 Median a2e at first marriage Median age at first marriage among women age 20-49 years, by selected age groups, and selected background characteristics, Bangladesh 1996-97 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 19.0 16.0 15.2 14.7 14.7 14.9 16.0 15.3 Rural 15.0 14.3 14.0 13.6 13.3 13.2 14.0 13.8 Division Barisal 15.9 15.0 14.9 14.2 13.9 14.2 14.8 14.6 Chittagong 16.9 15.1 14.8 14.0 14.0 13.7 15.1 14.5 Dhaka 15.2 14.3 13.8 13.5 13.2 13.1 14.0 13.7 Khulna 15.0 14.2 13.7 13.5 13.1 13.1 13.9 13.7 Rajshahi 13.9 I3.7 I3.6 13.6 12.9 12.5 13.6 13.5 Sylhet 17.6 16.2 15.3 14.5 14.5 13.9 15.5 15.1 Education No education 14.1 13.8 13.7 13.5 13.2 12.9 13.6 13.5 Primary incomplete 14.3 14.1 13.8 13.4 13.3 13.6 13.8 13.7 Primary complete 15.0 14.9 14.5 14.5 13.6 14.6 14.6 14.5 Secondary+ 19.6 17.8 16.6 15.8 15.6 15.8 17.7 16.7 All women 15.3 14.5 14.1 13.7 13.4 13.3 14.2 13.9 Note: The median age for women 15-19 could not be determined because less than 50 percent had married by age 15 in most of the subgroups shown. 5.4 Postpartum Amenorrhea and Insusceptibility The risk of pregnancy following a birth is largely influenced by two factors: breastfeeding and sexual abstinence. Postpartum protection from conception can be prolonged by breastfeeding through its effect on the length of amenorrhea (the period prior to the return of menses). Protection can also be prolonged by delaying the resumption of sexual relations. Women are defined as insusceptible if they are not exposed to the risk of pregnancy, either because they are amenorrheic or abstaining following a birth. The percentage of children whose mothers are postpartum amenorrheic, abstaining, and postpartum insusceptible is shown in Table 5.5 by the number of months since birth. These distributions are based on current status data, i.e., on the proportion of births occurring x months before the survey for which mothers 84 are still amenorrheic, abstaining or insusceptible. The estimates of the median and mean durations shown in Tables 5.5 and 5.6 are calculated from the current status proportions at each time period. The data are grouped in two-month intervals to minimize fluctuations in the estimates. The period of postpartum amen- orrhea is considerably longer than the period of postpartum abstinence and is by far the major determinant of the length of postpartum insusceptibility to pregnancy. By 6-7 months following birth, 56 percent of women are still amenorrheic, while only 7 percent are still abstaining. Similarly, at 12-13 months postpartum, 37 percent of women are amenorrheic, compared with 2 percent still abstaining, The mean dura- tion of postpartum amenorrhea is 11 months; that of postpartum abstinence is 4 months. The combination of these two factors means that Bangladeshi women are insusceptible to the risk of pregnancy- - either due to amenorrhea or to absti- nence for an average of 12 months after giving birth. There may have been a slight decline in the duration of amenorrhea over the last few years; the mean length of postpartum amenorrhea fell from 12 as calculated from the 1989 BFS, the 1991 CPS and the 1993-94 BDHS data to 11 in the 1996-97 BDHS (Huq and Cleland, 1990:87; Mitra et al., 1993:97; Mitra et al., 1994:77). Table 5.6 shows median durations of postpartum amenorrhea, abstinence, and insusceptibility by various background characteristics. Differences are small, except that women with more education Table 5.5 Posmartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Bangladesh 1996-97 Number Months Amenor- lnsus- of since birth rheic Abstaining ceptible births < 2 97.3 81.3 98.7 190 2-3 78.9 22.4 81.2 263 4-5 65.9 7.0 66.8 196 6-7 56.3 6.8 58.3 180 8-9 49.6 4.0 50.4 185 10-11 44.2 6.3 47.5 224 12-13 36.5 2.4 37.4 224 14-15 26.7 3.8 29.5 257 16-17 23.8 3.9 27.1 176 18.19 14.1 l.l 15.2 165 20.21 12.0 2.6 14.6 166 22-23 9.6 1.9 11.2 180 24-25 4.6 3.7 7.8 275 26~27 4.4 1.9 5.8 224 28-29 3.5 0.5 4.0 169 30-31 1.2 2.2 3.4 170 32-33 1.2 2.3 3.5 177 34-35 2.6 3.1 5.7 215 Total 30.4 8.9 32.4 3,637 Median 8.4 1.9 9.0 Mean 10.9 3.5 I 1.6 Prevalence/ Incidence mean I 10.8 3.1 11.5 The prevalence-mc dence mean ts borrowed from epldermology and is defined as the number of children whose mothers are amenorrheic (prevalence) divided by the average number of births per month (incidence). have shorter durations of postpartum amenorrhea and insusceptibility than women with no education and women in Sylhet Division have longer periods of postpartum amenorrhea and insusceptibility than other women. The median duration of postpartum abstinence is 2 months for all subgroups of women; this finding is compatible with the Musl im tradition of abstaining for 40 days following birth. 85 Table 5,6 Median duration of nostnartum insusceotibilitv by backgrot~nd characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics. Bangladesh 1996-97 Postpartum Number Background Postpartum Postpartum insuscep- of characteristic amenorrhea abstinence tibility women Age <30 8.1 1.9 8.6 2,894 30+ 10.0 2.3 10.3 744 Residence Urban 5.6 1.8 5.7 328 Rural 8.8 1.9 9.4 3,309 Division Barisal 7.0 2.1 8,0 239 Chittagong 8.0 2.0 8.9 911 Dhaka 7.5 1.9 7.7 1,124 Khulna 7.1 1.9 8.0 346 Rajshahi 9.3 1.8 9.5 766 Sylhet I 1.0 2.3 11.6 250 Education No education 10.6 2.1 10.8 2,051 Primary incomplete 7.6 1.7 8.0 608 Primary complete 5.5 1.8 6.1 364 Secondary+ 6.7 1.9 7.0 614 Total 8,4 1.9 9.0 3,637 Note: Medians are based on current status. 86 CHAPTER 6 FERTILITY PREFERENCES Several questions were asked in the BDHS concerning women's and men' s fertility preferences. The aim of this part of the interview was to determine how many children respondents would prefer to have and to establish the extent of unmet need for contraception and the number of unwanted or mistimed births. The BDHS questionnaire included questions on: 1) whether respondents wanted another child, 2) if so, how long they would like to wait to have the next child, and 3) how many children they would want in total if they could start afresh. The usefulness of data on fertility preferences has been controversial. Critics consider the data misleading because of the fact that information gathered from individual respondents does not take into account the effect of social pressures or attitudes of other family members, particularly the husband or wife, whose opinions on reproductive behavior may be very influential. Another objection expressed by critics is that fertility preferences may change with time. Others maintain that results obtained from these questions are important for assessing the extent to which unwanted or mistimed pregnancies occur and the effect of prevention of such pregnancies. Data on fertility preferences can provide an indication of the direction of future fertility to the extent that individuals and couples will act so as to achieve their preferred family sizes. 6.1 Desire for More Children In the BDHS, currently married women and men were asked "Would you like to have (a/another) child or would you prefer not to have any (more) children?" Interviewers were instructed to use the words in parentheses depending on whether the respondent had children or not. Pregnant respondents were asked if they wanted another child after the one they were expecting. Respondents who said they did want to have another child were then asked how long they would like to wait before the birth of the next child. Table 6.1 shows the percent distribution of currently married women and men by desire for another child, according to the number of living children. Almost half (49 percent) of currently married women age 10-49 in Bangladesh say they want no more children, and an additional 9 percent have been sterilized (Table 6.1 and Figure 6.1). Thirty-six percent of women want to have a child at some time in the future; however, the vast majority of these women (22 percent of all married women) say they would like to wait two or more years before having their next birth. Only 13 percent of women say they want to have a child soon and 3 percent are undecided about whether they want another. Thus, the vast majority of women want either to space their next birth or to limit childbearing altogether. These women can be considered to be potentially in need of family planning services. Results for currently married men are similar to those for women. Not surprisingly, the desire for additional children drops progressively as the number of living children increases (Table 6.1 and Figure 6.2). Sixty percent of married women with no children want to have a child within two years, compared with no respondents with six or more children. Conversely, the percentage of women who want no more children or who are sterilized rises from 3 percent for women with no children to 86 percent for those with six or more children. 87 Table 6.1 Fertility oreferences by number of livin~ children Percent distribution of currently married women age 10-49 and currently married men age 15-59 by desire for more children, according to number of living children, Bangladesh 1996-97 Desire for children Number of living children I 0 1 2 3 4 5 6+ Total WOMEN Have another soo~ 59.5 20.6 8.0 4.7 1.0 1.6 0.0 12.5 Have another later" 29.2 63.0 20.4 8.0 2.7 2.0 0.4 21.7 Have another, undecided when 3.5 3.6 2.1 1,1 0.7 0.5 0.1 1.8 Undecided 2.1 1.7 4.2 3.0 2.4 1.9 1.8 2.6 Want no more 1.8 8,3 55.1 68.1 73.8 73.1 76.5 49.1 Sterilized 1.5 1.6 8.6 12.5 15.8 14.5 9.5 8.7 Declared infecund 2.3 1.1 1.5 2.7 3.6 6.3 11.7 3.4 Missing 0.1 0.1 0.0 0.1 0.0 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 Number of women 788 1,697 1,821 1,487 I, I10 671 876 8,450 MEN Have another soon. z 52.4 20.1 8.1 4.7 3.2 1.9 0.8 12.2 Have another later" 40.6 58.9 18.9 9.8 3.2 1.8 0.3 21.3 Have another, undecided when 3.8 5.2 3.3 2.0 I. 1 0.4 0.3 2.6 Undecided 1.7 3.0 5.3 3.4 3.5 5.9 3.3 3.8 Want no more 0.5 10.2 54.9 65.6 69.7 70.3 76.5 48.7 Sterilized 0.3 1.3 9.0 13.8 17.4 14.9 11.7 9.5 Declared infecund 0.6 1.4 0.4 0.7 2.0 4.8 6.9 2.0 Missing 0.0 0.0 0.1 0.0 0.0 0,0 0.3 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 i00.0 1130.0 Number of men 333 618 679 574 458 284 366 3,312 Includes current pregnancy 2 Want next birth within two years 3 Want to delay next birth for two or more years The desire for additional children declined noticeably in Bangladesh over the past decade. In 1991, 45 percent of married women with two children wanted to have another child in the future (Mitra et al., 1993:84); in the 1996-97 BDHS the proportion is only 31 percent. Conversely, the percentage of women with two children who want no more children or are sterilized has risen from 48 percent in 1991 to 64 percent in 1996-97. Recently, changes in fertility preferences have been less pronounced. Overall, the proportion of married women who want no more children or are sterilized increased from 57 percent in 1993- 94 to 58 percent in 1996-97. Table 6.2 shows the percent distribution of currently married women by desire for children according to age. As expected, the proportion of women who want no more children increases with age. Ten percent of women age 15-19 want no more children or have been sterilized, compared with 72 percent of women age 45-49 years. In contrast, the proportion who want to delay their next birth declines with age, as does the proportion of women who want the next birth within two years. The proportion who report themselves to be unable to have more children (infecund) is I percent or less among women under 35, but rises to over one- quarter of women age 45-49. It is possible to compare the fertility preferences of husbands and wives to assess the extent to which they agree. For the 3,028 matched couples in which both the wife and her husband were interviewed in the BDHS, the data show that the vast majority of married couples agree on whether or not they want to have more children. As shown in Figure 6.3, in over half of the couples, both the wife and husband say they want 88 no more children, while in 28 percent, they both say they do want more children. Among couples who disagree, the proportion in which the husband wants more and his wife doesn't (6 percent) is almost equal to the proportion in which the husband does not want more and his wife does (5 percent). Figure 6.1 Fertil~y Preferences Among Currently Married Women 10-49 }ter 22% no~ yrs} W~t no mo~$ ~l~dmrt 58% ~ child soon 13% within ~ yrs} Figure 6.2 Percentage of Currently Married Women and Men Who Want No More Children by Number of Living Children Per~ ]0 ~0 ~o tO 0 Bang}arJ~sh O 1 2 3 Nut#oar of LMng CI'~J#re~ 4 5 8+ BOH8 1996-97 89 Table 6.2 Fertility preferences by age Percent distribution of currently married women age 10-49 by desire for more children, according to age, Bangladesh 1996-97 Desire for Age of woman children 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon I 35.7 24,0 17.0 13.4 7.9 4.9 3.0 0.8 12.5 Have another later 2 49.3 60.1 39.5 15.8 4.7 1.1 0.4 0.0 21.7 Have another, undecided when 4.4 3.5 2.5 1.9 1.3 1.1 0.2 0.0 1.8 Undecided 7.2 2.3 3.5 3.8 1.9 2.0 1.2 0.4 2.6 Want no more 2.5 10.1 35.2 59.4 71.6 69.0 60.5 52.8 49.1 Sterilized 0.0 0.1 2.1 5.5 11.6 17.8 22.5 19.2 8.7 Declared infecund 0.0 0.0 0.0 0.3 1.0 4.0 12.2 26.7 3.4 Missing 0.9 0.1 0.2 0.0 0.0 0.1 0.0 0.0 0.1 Total 100.0 100.0 1(30.0 100.0 100.0 100.0 100.0 100.0 I00.0 Number of women 143 1,252 1,655 1,812 1,297 1,031 740 520 8,450 1 Want next birth within 2 years 2 Want to delay next birth for 2 or more years Figure 6.3 Fertility Preferences Among Married Couples Neither wants more children 51% Infecund/ Undecided 10~ Wife wants more husband doesn't 5% Husband wants more wife doesn't 6% Both want more children 28% BDHS 1996-97 90 The proportion of women who want no more children is an important and easily understood measure of fertility preference. Table 6.3 and Figure 6.4 show the percentage of currently married women who want no more children by number of l iving children and selected background characteristics. Urban women are slightly more likely than rural women to want to limit family size at lower parities. For example, 68 percent of urban women with two children say that they do not want another child, compared with 63 percent of rural women. However, differences are not large and the urban-rural differential in desire for more children seems to have narrowed since 1993-94. Tablf ¢).~ Desire to limit childbeadn~ Percentage of currently married women age 10-49 who want no more children, by number of living children and selected background characteristics, Bangladesh 1996-97 Number of living children t Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban Rural Division Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Education 1.6 15.8 67.7 86.8 94.3 91.0 83.5 57.9 3.5 9.0 63.1 79.7 89.0 87.4 86.1 57.8 0.0 10.1 64.4 77.7 89.9 88.5 91.4 57.6 3.0 4.1 46.8 68.2 86.3 83.4 89.2 55.4 4.2 12.6 65.7 82.2 90.4 87.7 84.1 58.8 4.3 12.7 72.1 85.7 93.3 93.6 89.5 60.6 2.5 9.7 71.1 90.8 93.6 94.0 86.1 60.3 3.7 6.2 40.0 58.7 72.4 77.0 72.5 44.7 No education 6.2 11.6 64.6 79.0 88.1 85.4 84.3 63.3 Primary incomplete 3.0 8.6 61.3 80.7 93.5 90.0 92.3 58.1 Primary complete 1.2 7.0 54.3 80.3 86.2 (91.4) 88.5 51.2 Secondary+ 1.0 9.4 68.3 86.3 93.6 96.7 82.6 45.9 Total 3.3 9.9 63.8 80.5 89.6 87.6 85.9 57.8 Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 ~nweighted cases. Includes current pregnancy Regionally, women in Chittagong Division and especially those in Sylhet Division are more pronatalist than those in the other divisions. Less than half of women with two children in Chittagong and Sylhet Divisions want to stop childbearing, compared with two-thirds or more of those in the other divisions. The relationship between educational level and the proportion wanting no more children (Table 6.3) is erratic; at some parities, better educated women are more likely to want no more children than those with less education, while at other parities, the opposite is true. 6.2 Need for Family Planning Services One of the concerns of family planning programs is to estimate the number of women or couples who are in need of services as well as the potential demand for services. The concept of unmet need for family planning has evolved to define this indicator. Fecund women who are currently married and who say either they do not want any more children or that they want to wait two or more years before having another child, but are not using contraception, are con sidered to have an unmet need for family planning.t Women who are using family planning methods are said to have a met need for family planning. Women with unmet and met For an exact description of the calculation, see footnote 1, Table 6.4. 91 need constitute the total demand for family planning. Table 6.4 presents data on unmet need, met need, and total demand for family planning, according to whether the need is for spacing or limiting births. Figure 6.4 Percentage of Married Women with Two Children Who Want No More Children by Background Characteristics RESIDENCE Urban Rural DIVISION Barisal Chittagong Dhaka Khulna Rajshahi Sylhet EDUCATION No education Prim. incomplete prim. complete Secondary+ 0 20 40 60 80 Percent BDHS t 996-97 One in 6 married women (16 percent) in Bangladesh has an unmet need for family planning services (see Table 6.4, column 3)--8 percent for spacing purposes and 8 percent for limiting births. Combined with the 49 percent of married women who are currently using a contraceptive method, the total demand for family planning comprises two-thirds of married women in Bangladesh. Therefore, if all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate would be increased from 49 to 67 percent of married women. Currently, 76 percent of the demand for family planning is being met (see Table 6.4, next-to-last column). As expected, unmet need for spacing purposes is higher among younger women, while unmet need for limiting childbearing is higher among older women. The net result is that, except among the oldest age groups, unmet need varies little by age. The level of unmet need among rural women (17 percent) is higher than that of urban women (10 percent). It is highest among women in Chittagong and Sylhet Divisions (21 percent each), intermediate in Barisal (18 percent) and Dhaka ( 17 percent) Divisions, and lowest in Khulna and Rajshahi Divisions (11 percent each). Unmet need is slightly lower among women with some secondary schooling than among less educated or uneducated women. Unmet need has declined recently, from 19 percent of currently married women in 1993-94 to 16 percent in 1996-97 (Mitra et al., 1994:86). The decline has been largest in Chittagong/Sylhet Division where it decreased from 27 percent of women in 1993-94 to 21 percent in 1996-97 (see Figure 6.5). In addition to the data on unmet need, one of the more striking findings in Table 6.4 is the variations in the percentage of the total demand that is being satisfied by current use. In Sylhet Division, only half of 92 the potent ia l total demand is current ly be ing satisf ied, compared wi th 86 percent in Khu lna Div is ion . Another way o f look ing at this is to say that in Sy lhet Div is ion, the level o f unmet need is as large as the level o f current cont racept ive use, whi le in Khu lna Div is ion, not only is the level o f unmet need re lat ively smal l , but the fami ly p lann ing use rate is high. Table 6,4 Need for family plannin~ services Percentage of currently married women with unmet need for family planning, met need for family planning, and the total demand for family planning services, by selected background characteristics, Bangladesh 1996-97 Met need for Unmet need for family planning 2 Total demand for Percentage family planning I (currently using) family planning 3 of demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fled women Age 10-14 21.3 0.g 22.1 14.8 0.8 15.6 37.5 1.6 39.1 43.6 143 15-19 17.8 0.9 18.7 29.6 3.3 32.9 49.0 4.4 53.4 65.0 1,252 20-24 13.5 3.9 17.4 24.4 18.7 43.1 39.5 22.9 62.4 72.2 1,655 25-29 7.1 11.3 18.4 13.0 39.5 52.5 21.2 51.5 72.7 74.7 1,812 30-34 3.3 12.5 15.8 3.7 59.4 63.1 7.5 73.5 81.0 80.5 1,297 35-39 1.5 12.4 13.9 1.5 62.4 63.9 3.0 75.6 78.5 82.2 1,031 40-44 0.5 9.9 10.3 0.2 54.4 54.7 0.7 64.6 65.3 84.2 740 45-49 0.2 4.5 4.6 0.0 35.1 35.1 0.2 39.5 39.7 88.3 520 Residence Urban 5.2 4.7 9.9 18.9 43.2 62.1 25.0 48.3 73.3 86.5 968 Rural 8.3 8.3 16.6 12.2 35.4 47.6 21.4 44.3 65.7 74.8 7,482 Division Barisal 9.3 9.0 18.3 14.6 34.8 49.4 24.8 44.4 69.2 73.6 560 Chittagong 10.6 10.6 21.2 8.7 28.5 37.2 20.2 40.2 60.4 64.9 1,701 Dhaka 7.6 8.9 16.5 13.5 36.4 49.8 21.6 45.6 67.2 75.4 2,656 Khulna 5.9 4.6 10.6 16.7 45.2 61.9 23.4 50.2 73.7 85.6 1,024 Rajshahi 6.2 4.9 l l .2 15.5 43.1 58.6 23.2 48.9 72.1 84.5 2,049 Sylhet 10.1 11.2 21.4 3.9 16.2 20.1 14.8 27.5 42.3 49.6 460 Education No education 6.9 9.6 16.5 8.3 37.6 45.8 16.2 48.0 64.1 74.3 4,502 Primary incomplete 8.6 7.7 16.4 13.7 37.5 51.2 23.0 45.8 68.7 76.2 1,470 Pdmary complete 9.5 6.3 15.8 18.0 33.1 51.1 28.0 39.6 67.6 76.7 862 Secondary+ 9.2 4.3 13.4 22.7 33.3 56.0 33.0 37.9 70.9 81.1 1,615 Total 7.9 7.9 15.8 13.0 36.3 49.2 21.8 44.8 66.6 76.2 8,450 l Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning but say they want to wait two or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning but want no more children. Excluded from the unmet need category are menopausal or infecund women and unmarried women who have not had sexual intercourse in the four weeks prior to the interview. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 . . . . Total demand includes pregnant or amenorrheJc women who became pregnant while using a method (method failure); they account for 1.5 percent of currently married women. 93 Figure 6.5 Trends in Unmet Need for Family Planning by Division 30 25 20 15 10 5 0 Percent of Married Women With Unmet Need 19 Bangladesh Barisal Chittagong/ Dhaka Khulna Rajshahi Sylhet 1~11993-94 111996-971 BDHS 1996-97 6.3 Ideal Family Size In order to assess ideal fertility preferences, the BDHS included two questions for both women and men. Respondents who had no children were asked, "If you could choose exactly the number of children to have in your whole life, how many would that be?" For those who had children, the question was rephrased as follows: "If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?" These questions on ideal family size aimed at two things: first, among respondents who have not started childbearing, the dataprovide an idea of the total number of children they will have in the future (to the extent that they are able to realize their fertility desires). Second, among older, higher parity respondents, these data provide a measure of the level of unwanted fertility. It should be noted that some respondents, especially those for whom fertility control is an unfamiliar concept, may have had difficulty answering this hypothetical question. The data in Table 6.5 indicate that the vast majority of respondents were able to give a numeric answer to this question. Only 6 percent of ever-married women and 7 percent of currently married men gave a non-numeric answer such as "it is up to God," "any number," or "don't know." Those who gave numeric responses generally want to have small families. Among ever-married women, 60 percent prefer a two-child family and another 21 percent consider a three-child family ideal, while less than 1 percent said they would choose to have six or more children. Data are similar for married men. These results are evidence of how widespread the two-child norm has become in Bangladesh. Among women and men with two or fewer children, 70 percent say they think two children are ideal. Overall, the mean ideal family size is 2.5 children among women and 2.4 among men, another indication that men are not more pronatalist than women. 94 Table 6.;5 Ideal and actual number of children Percent distribution of ever-married women and currently married men by ideal number of children, and mean ideal number of children for ever-married women and for currently married women and men, according to number of living children, Bangladesh 1996-97 Number of living children I Ideal number of children 0 1 2 3 4 5 6+ Total WOMEN 0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1 2.9 4.6 1.3 1.1 0.8 0.5 0.4 1.9 2 70.9 72.7 69.8 51.5 54.0 44.4 33.4 59.5 3 12.8 13.6 19.3 30.8 17.3 29.3 27.1 20.8 4 6.0 4.4 5.3 11.1 20.9 13.0 22.0 10.5 5 0.2 0.7 0.4 1.0 0.9 4.1 1.2 1.0 6+ 0.0 0.2 0.2 0.3 0.3 0.3 2.4 0.5 Non-numeric response 7.1 3.8 3.7 4.1 5.9 8.3 13.5 5.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of woman 906 1,864 1,938 1,576 1,163 723 957 9,127 Mean ideal number for: Ever-married women 2.2 2.2 2.3 2.6 2.7 2.8 3.0 2.5 Number of women 842 1,794 1,867 1,512 1,095 663 827 8,600 Currently married women 2.2 2.2 2.3 2.6 2.7 2.8 3.0 2.5 Number of women 738 1,636 1,754 1,430 1,044 616 758 7,975 MEN 1 2.0 2 69.2 3 18.9 4 3.6 5 0.2 0.4 6+ 0.0 0.3 Non-numeric response 6.0 3.3 Total 100.0 100.0 Number of men 333 618 Mean ideal number for: Currently married men 2.3 2.2 Number of men 313 597 6.6 2.1 3.5 1.6 1.3 0.9 2.9 67.0 68.3 49.9 53.8 38.1 33.3 56.5 18.1 23.1 32.2 ~.5 32.6 32.8 25.4 4.2 3.0 7.8 10.3 12.8 15.9 7.4 0.2 0.4 1.8 3.6 1.6 0.9 0.2 0.2 0.5 0.0 1.3 0.3 3.2 5.9 7.5 11.7 14.2 6.5 100.0 100.0 100.0 100.0 100.0 100.0 679 574 458 284 366 3,312 2.3 2.5 2.6 2.8 2.9 2.4 657 540 424 251 314 3,096 qote: The means exclude respondents who gave non-numeric responses. Includes current pregnancy Although there was a distinct downward trend in the preferred family sizes during the late 1970s and 1980s, there has been little change in recent years. The mean ideal family size declined from 4.1 among currently married women in 1975, to 2.9 in 1989 (Huq and Cleland, 1990:53) and to 2.5 in 1993-94 (Mitra et al., 1994:88). However, it has remained constant at 2.5 between 1993-94 and 1996-97. As expected, the ideal number of children increases with the number of l iving children, f rom 2.2 among childless women to 3.0 among women with six or more children and from 2,3 among childless men to 2.9 among those with six or more children. There are several possible explanations for the relationship between ideal and actual number of children. First, to the extent that they are able to implement their preferences, respondents who want larger families will tend to actually have them. Second, those who have larger families may tend to rationalize their family size by reporting their actual number of children as their ideal number. Finally, respondents with larger families, being older, on average, than those with smaller families, may have larger ideal family sizes, because of attitudes they acquired 20 to 30 years ago. 95 Despite the likelihood that some rationalization of large families occurs, it is common for respondents to report ideal family sizes lower than their actual number of children. For example, 72 percent of women with four children report fewer than four children as their ideal number and 87 percent of those with 5 children state an ideal number of children less than five. These proportions are similar to those reported for 1993-94. Table 6.6 shows the mean ideal number of children for ever-married women interviewed in the 1996- 97 BDHS by age group and selected background characteristics. The mean ideal number of children increases with age from 2.1 among women age 10-14 to 2.8 among women age 45-49. Rural women have slightly higher family size norms than urban women; this differential is reflected in every age group. Regionally, the largest mean ideal family size is found among women in Sylhet Division (2.9 children); this is also true at every age group. Women in Chittagong Division have ideal family size desires only slightly lower than in Sylhet Division. Women in Khulna and Rajshahi Divisions have the lowest mean ideal family size (2.3 children). Ideal family size is correlated with the level of education attained. Women with no education want the largest families (2.6 children), while women with some secondary education want the smallest (2.2 children); this is true for every age group, though the differences are small for some age groups. Table 6.6 Mean ideal number of children bv backeround characteristics Mean ideal number of children for ever-married women, by age and selected background characteristics, Bangladesh 1996-97 Background Age characteristic 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban * 2.1 2.2 2.2 2.3 2.4 2.4 2.5 2.3 Rural 2.2 2.3 2.4 2.4 2.5 2.7 2.8 2.8 2.5 Division Barisal * 2.3 2.3 2.4 2.6 2.7 2.9 2.7 2.5 Chittagong * 2.7 2.7 2.7 2.8 2.9 2.8 3.2 2.8 Dhaka (2.1) 2.2 2.3 2.4 2.4 2.6 2.7 2.7 2.4 Khulna * 2.1 2.3 2.1 2.4 2.4 2.6 2.6 2.3 Rajshahi (2.1) 2.2 2.2 2.3 2.4 2.5 2.5 2.7 2.3 Sylhet * 2.7 2.7 2.8 2.8 3. l 3.2 3.3 2.9 Education No education 2.2 2.4 2.5 2.5 2.6 2.7 2.8 2.9 2.6 Primary incomplete (2.2) 2.3 2.4 2.4 2.5 2.7 2.6 2.8 2.5 Primary complete (2.1) 2.3 2.4 2.4 2.4 2.6 2.5 2.6 2.4 Secondary+ * 2.2 2.2 2.2 2.2 2.3 2.5 2.3 2.2 Total 2.1 2.3 2.4 2.4 2.5 2.6 2.7 2.8 2.5 Note: Figures in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 6.4 Ferti l i ty P lanning There are two ways of estimating levels of unwanted fertility from the BDHS data. One is based on responses to a question as to whether each birth in the five years before the survey was planned (wanted then), mistimed (wanted, but at a later time), or unwanted (wanted no more children). These data are likely to result in underestimates of unplanned childbearing, since women may rationalize unplanned births and declare them as planned once they are born. Another way of measuring unwanted fertility utilizes the data 96 on ideal family size to calculate what the total fertility rate would be if all unwanted births were avoided. This measure may also suffer from underestimation to the extent that women are unwilling to report an ideal family size lower than their actual family size. Data using these two approaches are presented below. Table 6.7 shows the percent distribution of births in the five years before the survey by whether the birth was wanted then, wanted later, or not wanted. Overall, about one-third of births in Bangladesh can be considered as unplanned--20 percent as mistimed (wanted later) and 11 percent as unwanted (Figure 6.6). The proportion of unplanned births increases directly with the birth order of the child. Almost half of all fourth and higher order births were unplanned, with more than one-quarter being unwanted at the time of conception. Similarly, a much larger proportion of births to older women are found to be unplanned--well over half of births among women in their late 30s and 40s. Table 6.7 Fertility olanning status Percent distribution of births in the five years preceding the survey and current pregnancies, by fertility planning status, according to birth order and mother's age, Bangladesh 1996-97 Planning status of birth Birth order Number and mother's Wanted Wanted Not of age then later wanted Missing Total births Birth order 1 84.2 15.3 0.2 0.3 100.0 1,874 2 75.3 23.4 1.2 0.2 100.O 1,597 3 68.2 22.5 9.0 0.3 100.O 1,11O 4+ 52.2 19.3 28.2 0.4 1(30.0 2,298 Age at birth <20 78.7 20.0 1.0 0.3 100.0 2,199 20-24 72.0 22.1 5.6 0.3 1130.0 2,217 25-29 62.1 18.8 18.8 0.3 100.0 1,403 30-34 54.4 17.1 28.2 0.3 100.0 673 35-39 45.6 11.2 43.0 0.2 1130.0 293 40-49 41.5 13.2 45.3 0.0 100.0 95 Total 68.9 19.7 11.2 0.3 100.0 6,880 Note: Birth order includes current pregnancy. Table 6.8 presents "wanted" fertility rates calculated using the second approach to measuring un- wanted fertility. The wanted fertility rate is calculated in the same manner as the total fertility rate, but un- wanted births are excluded from the numerator. For this purpose, unwanted births are defined as those which exceed the number considered ideal by the respondent. (Women who do not report a numeric ideal family size are assumed to want all their births.) This rate represents the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been prevented. A comparison of the total wanted fertility rate and the actual fertility rate suggests the potential demographic impact of the elimination of unwanted births. The wanted fertility rate in Bangladesh as a whole is 2.1 births per woman, 1.2 children less than the actual total fertility rate of 3.3. This implies that the total fertility rate is almost 60 percent higher than it would be if unwanted births were avoided. The gap between the wanted and actual total fertility rates is slightly larger among rural than urban women. There is also a larger gap between the wanted and actual fertility rates for women with no education or only primary education than for those with secondary education. It is interesting to note that if women's fertility desires could be met, the total fertility rate in all divisions except Chittagong and Sylhet would be below the replacement level of 2.1 children per woman. 97 Figure 6.6 Percentage of Births by Planning Status Wanted then 69% ~ot wanted 11% Wanted later 20% Note: refers to births In the 5 yeals before the survey BDHS 1996-97 Table 6.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Bangladesh 1996-97 Total wanted Total Background fertility fertility characteristic rate rate Residence Urban 1.5 2.1 Rural 2.2 3.4 Division Barisal 2.0 3.3 Chittagong 2.6 4.1 Dhaka 2.0 3.2 Khulna 1.8 2.5 Rajshahi 1.8 2.8 Sylhet 2.9 4.2 Education No education 2.5 3.9 Primary incomplete 2.1 3.3 Primary complete 2.1 3.0 Secondary+ 1.6 2.1 Total 2.1 3.3 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 3.2. 98 CHAPTER 7 INFANT AND CHILD MORTALITY 7.1 Introduction Rates of infant and child mortality reflect a country's level of socioeconomic development and quality of life. This chapter examines the mortality of children under five in Bangladesh. Specifically, information is provided regarding levels, trends, and differentials in neonatal, postneonatal, infant, and child mortality, as well as information on patterns of fertility associated with high mortality risk. Mortality estimates are disaggregated by sex, socioeconomic and demographic characteristics, division, and other factors in order to identify segments of the population requiring special attention. This information is useful for monitoring and evaluating population and health programs and policies. Estimates of childhood mortality are based on information from the birth history section of the questionnaire administered to individual women. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live with the mother, the number who live elsewhere and the number who have died). For each of these births, information was then collected on the sex, the month and year of birth, survivorship status and current age, or, if the child had died, the age at death. This information is used to directly estimate mortality rates. In this report, mortality in early childhood is measured using the following five rates: Neonatal mortality: the probability of dying within the first month of life; Postneonatal mortality: the difference between infant and neonatal mortality; Infant mortality: the probability of dying before the first birthday; Child mortality: the probability of dying between the first and fifth birthday; Under-five mortality: the probability of dying between birth and fifth birthday. All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000 children surviving to 12 months of age. Examination of data relating to child mortality does not indicate that there are any serious biases in reporting (Appendix Tables C.5 and C.6). 7.2 Levels and Trends in Infant and Child Mortality Neonatal, postneonatal, infant, child, and under-five mortality rates are shown in Table 7.1 for five- year periods preceding the survey. Under-five mortality for the most recent five-year period (which roughly corresponds to the years 1992-1996) is 116 per 1,000 births. This means that 1 in 9 children born in Bangladesh dies before reaching the fifth birthday. The infant mortality rate is 82 deaths per 1,000 births and the child mortality rate is 37 per 1,000 children age one year. During infancy, the risk of death in the first month of life (48 per 1,000) is greater than in the next 11 months (34 per 1,000). 99 Table 7.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey, Bangladesh 1996-97 Years Approximate Neonatal Posmeonatal Infant Child Under-five preceding reference mortality mortality mortality mortality mortality survey period (NN) (PNN) (iqo) (4ql) (sqo) 0-4 1992-96 48.4 33.8 82.2 36.5 115.7 5-9 1987-91 60.2 35.9 96.0 47.2 138.7 10-14 1982-86 74.5 42.1 116.6 63.4 172.6 The estimates in Table 7.1 suggest that child survival in Bangladesh has improved since the mid- 1980s. Under-five mortality has declined by one-third from 173 deaths per 1,000 births in the period 10-14 years before the survey (approximately 1982-86) to 116 for the period 0-4 years before the survey. The pace of decline was faster for child mortality than for infant mortality; the child mortality rate declined by 42 percent (from 63 per 1,000 births 10-14 years before the survey to 37 per 1,000 during the period 0--4 years before the survey), while the infant mortality rate declined by 30 percent over the same period (from 117 to 82 per 1,000 births). It is interesting to note that neonatal mortality rates have fallen more sharply than postneonatal mortality in the recent past. Further evidence of a decline in childhood mortality comes from a comparison of these data with rates from the 1993-94 B DHS (Figure 7.1). The comparison shows that the under-five mortality rate has declined by 13 percent, from 133 for the period 1989-93 to 116 for the period 1992-96 (Mitra et al., 1994:92). Over the same period, infant mortality has declined by six percent, from 87 to 82. 140 120 100 80 60 40 20 0 Deaths per 1,000 Infant Mortality Figure 7.1 Trends in Infant and Child Mortality 1989-93 to 1992-1996 Child Mortality Under-five Mortality BDHS t 996-97 100 Additional data sources can be called upon to establish the overall quality and consistency of the 1996-97 BDHS estimates. Table 7.2 and Figure 7.2 show infant mortality rates from the two BDHSs, the 1989 Bangladesh Fertility Survey (BFS), and the vital registration system for the period 1985 to 1995. Infant mortality rates have declined from around 110 or more per 1,000 births in the mid-1980s to 82 in the five years before the 1996-97 BDHS. The vital registration system data suggest slightly lower infant mortality rates (less than 80 per 1000) for 1994 and 1995. While estimates fluctuate somewhat, this comparison indicates an unambiguous and steady improvement in infant survival over the last decade. Table 7.2 Trends in infant mortality Infant mortality rates from selected sources, Bangladesh, 1985-95 Data source 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996-97 BDHS I 96 82 1993-94 BDHS I 112 87 1989 BFS l l i 113 84 Vital registration (BBS) 112 116 113 116 98 94 92 88 84 77 71 Estimates placed in year representing mid-point of 5-year estimate Source: Huq and Cleland, 1990:116: Mitra et al, 1994: 93; BBS, 1997:144 Figure 7.2 Infant Mortality Rates from Selected Sources, 1985-1995 Deaths per 1,000 Live Births 125 lO0 76 5O I I I I 1985 1987 1989 1991 1993 1995 +Vital registration • 1989 BFS .m-1993-94 BDHS -t.1996-97 BDHS BDHS 1996-97 I01 Consistent with the national experience, the Matlab area of Bangladesh has also enjoyed a decline in childhood mortality. Between 1987-91 and 1992-95, under-five mortality fell f rom about 138 to 124 per 1,000 in the comparison area t of Matlab (ICDDR,B, 1995:7), a less rapid decline than that observed at the national level using the BDHS data (i.e. from 139 to 116 per 1,000). 7.3 Soc ioeconomic D i f fe rent ia l s in In fant and Ch i ld Mor ta l i ty The risk of early childhood death is higher in some subgroups of the population than in others. Differentials in childhood mortality rates by selected background characteristics are presented in Table 7.3. The table focuses on basic socioeconomic characteristics, including urban-rural residence, administrative division of the country, and mother's educational level. A 10-year period is used to calculate the mortality estimates in order to have a sufficient number of cases in each category. Table 7.3 Infant and child mortality by background characteristics Infant and child mortality rates for the 10-year period preceding the survey, by selected background characteristics, Bangladesh 1996-97 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortality mortality characteristic (NN) (PNN) (Iqo) (4ql) (sqo) Residence Urban 40.6 32.1 72.7 25.3 96.2 Rural 56.0 35.2 91.2 43.7 130.9 Division Barisal 53.1 33.1 86.3 36.4 119.5 Chittagong 42.0 34.7 76.8 59.0 131.3 Dhaka 52.0 38.8 90.8 43.8 130.7 Khulna 51.8 23.3 75.2 12.5 86.8 Rajshahi 64.3 30.3 94.6 34.9 126.2 Sylhet 85.2 52.7 138.0 47.8 179.1 Education No education 57.8 40.2 98.0 51.6 144.5 Primary incomplete 56.3 31.2 87.5 33.9 118.4 Primary complete 44.9 28.3 73.1 29.0 100.0 Secondary+ 45.0 19.9 64.8 14.5 78.3 Medical maternity care 1 No antenatal or delivery care 52.6 37.3 89.9 Either antenatal or delivery care from a doctor or nurse 33.7 27.3 61.0 Both antenatal and delivery care from a doctor or nurse (27.3) (24.0) (51.3) Total 54.6 34.9 89.6 41.9 127.8 1 Refers to births in the five years before the survey - = Non-calculable Children in the rural areas of Bangladesh experience a 36 percent higher risk of dying before age f ive than urban children (131 vs. 96 per 1,000 births, respectively--see Figure 7.3). The urban-rural differential is greatest at ages 1 to 4 years and smallest during the postneonatal period. Infant mortality rates are 73 per 1,000 live births in urban areas and 91 in rural areas. For a descr ption of ICDDR,B's demographic surveillance system, see Section 3.4. 102 Figure 7.3 Under-Five Mortality by Background Characteristics RESIDENCE Urban Rural DIVISION Serisal Chittagong Dhaka Khulna Rajshahi Sylhet EDUCATION No education Primary incorn. Primary comp. Secondary+ 96 120 t31 131 87 -- - -~ - 1 2 6 ~ 1 7 9 145 0 50 100 150 200 Deaths per 1,000 Live Births Note: Rates am for the 10-year pedod pfecedklg survey BDHS 1996-97 Differences in under-five mortality by division are marked, from a high of 179 per 1,000 in Sylhet to 87 per 1,000 in Khulna. Much of the variation in under-five risk stems from varying rates during the l- to 4-year age period. For example, Khulna and Chittagong Divisions have almost identical infant mortality levels but after the first birthday mortality is nearly 5 times higher in Chittagong. Sylhet and Dhaka Divisions also have child mortality rates exceeding 40 per 1,000. On the other hand, Sylhet's exceptionally high under-five mortality rate is largely due to poor survival during the neonatal period (85 per 1,000) and postneonatal period (53 per 1,000). Differences in early childhood mortality by education of the mother are large. Children born to mothers who have no education are almost twice as likely to die before their fifth birthday as those born to mothers who have at least some secondary education (145 vs. 78 per 1,000 births, respectively). This educational advantage is most pronounced at ages I to 4 years and least apparent during the neonatal period. Table 7.3 also shows the relationship between antenatal care and delivery assistance by a trained medical person, on one hand, and infant mortality on the other. Mortality among children whose mothers had neither antenatal care nor assistance at the time of delivery is noticeably highest (90 per 1,000), followed by mortality among children whose mothers received either antenatal or delivery care (61 per 1,000). As expected, infant mortality is lowest (51 per 1,000) for the small proportion of children whose mothers received antenatal care and were assisted at delivery by a trained medical professional (doctors, nurses, midwives and family welfare visitors). 7.4 Demographic Differentials in Infant and Child Mortality The relationship between early childhood mortality and various demographic variables is examined in Table 7.4 and Figure 7.4 for the 10-year period preceding the survey. The results show that, as expected, male children are more likely to die in infancy than female children (95 for males vs. 84 for females). The 103 difference is especially pronounced in the neonatal period, whereas postneonatal mortality rates are almost identical for males and females. The gender differential reverses during ages 1 to 4 years, so that female mortality exceeds male mortality by some 27 percent. This pattern suggests that there may be gender-related differences in child rearing practices or in treatment of illnesses during childhood that favor boys over girls (Hill and Upchurch, 1995). Table 7.4 Infant and child mortality by demo2rat~hic characteristics Infant and child mortality rates for the 10-year period preceding the survey, by selected demographic characteristics, Bangladesh 1996-97 Neonatal Posmeonatal Infant Child Under-five Demographic mortality mortality mortality mortality mortality characteristic (NN) (PNN) (Jqo) (4ql) (sqo) Sex of child Male 60.3 34.7 95.0 36.9 128.4 Female 49.0 35.2 84.2 47.0 127.2 Age of mother at birth < 20 70.2 35.9 106.1 43.6 145.0 20-29 46.6 32.7 79.3 41.2 117.2 30-49 47,3 39.9 87.2 41.1 124.7 Birth order 1 73.4 34.9 108.4 35.9 140.4 2-3 49.8 29.0 78.8 40.7 116.2 4-6 46.2 36.2 82.4 47.2 125.7 7+ 47.5 54.0 101.5 46.2 143.0 Previous birth interval <2yrs 75.6 60.5 136.1 59.1 187.2 2-3 yrs 40.7 29.7 70.4 41.9 109.4 4 yrs + 36.1 19.4 55.5 29.4 83.3 The relationship between infant mortality and mother's age at birth shows the expected U-shaped pattern with higher mortality for children of younger and older mothers. For example, the infant mortality rate for children of mothers who were less than age 20 at the time of the child's birth (106 per 1,000) is one- third higher than the rate for children whose mothers were 20-29 at the time they gave birth (79 per 1,000). Among the children of mothers age 30-49, the infant mortality rate is again high (87 per 1,000). This pattern is limited to risk during infancy; mortality during ages I to 4 years is apparently not associated with mother's age at birth. Birth order is closely linked with mother's age so it is not surprising that mortality risks are elevated among first births (which are predominantly to younger mothers) and births of order seven or higher (which are generally to older mothers). Data from the 1996-97 BDHS show that the under-five mortality rate is 140 per 1,000 live births for first births, 116 for second and third births, 126 for birth orders 4-6, and 143 for seventh and higher births. The most striking finding is seen in the relationship between mortality rates and the length of the interval between births. The data show that short birth intervals significantly reduce a child's chances of survival. Under-five mortality is 2.2 times higher for children with a preceding birth interval of less than 2 years than for children with a preceding interval of four years or more (187 compared with 83 per 1,000). This relationship persists in all the age groups examined, but is most pronounced during the postneonatal period. This finding supports the importance of child-spacing practices as a means of reducing mortality of young children. 104 Figure 7.4 Under-Five Mortality by Selected Demographic Characteristics AGEOFMOTHER < 20 20-29 30-49 BIRTH ORDER 1 2-3 4-6 7+ PRIOR BIRTH INTERVAL < 2years 2-3 years 4+ years 0 50 100 150 Deaths per 1,000 Live Births 200 Note: Rates are for the 10-year pedod preCeding survey BDHS 1996-97 7.5 High-Risk Fertility Behavior Certain patterns of childbearing are associated with elevated levels of infant and child mortality. Typically, infants and children have a greater probability of dying early if they are born to mothers who are especially young or old, if they are born after a short birth interval, or if they are of high birth order. Data to examine these relationships are presented in Table 7.5, which shows the distribution of births in the five years preceding the survey and of currently married women according to these categories of increased risk. In this analysis, a mother is classified as "too young" if she is less than 18 years of age and "too old" if she is over 34 years of age. A "short birth interval" is defined as a birth occurring less than 24 months after a previous birth, and a child is of "high birth order" if the mother had previously given birth to three or more children (i.e., if the child is of birth order 4 or higher). First births, although often at increased risk, are not placed in a high-risk category since they are not considered an avoidable risk. Table 7.5 is further divided into two categories, with births falling into single high-risk categories (such as those born to mothers below the age of 18 or over the age of 34, those born within 24 months of a previous birth and those of birth order higher than three) and those failing into multiple high-risk categories (e.g., those born within 24 months of a previous birth to mothers who are below the age of 18, or children of birth order greater than 3 who are born to mothers who are over 34 years, etc.). The results indicate that well over half (58 percent) of children born in the five years before the survey have an elevated risk of dying; 45 percent of births are in a single high-risk category, while 13 percent are in a multiple high-risk category. The results also show that the most common high-risk category is high birth order. Looking at the single-risk categories, 23 percent of children are at increased risk because they are fourth births or higher, while 17 percent are born to mothers younger than 18 years and 5 percent are born less than two years after a prior birth. Among multiple risk categories, 6 percent of children are of birth order 4 or higher and were born less than two years after a previous birth. 105 Table 7.5 High.risk fertility behavio r Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality, and the percent distribution of currently mamed women at risk of conceiving a child with an elevated risk of mortality, by category of increased risk, Bangladesh 1996-97 Births in 5 years preceding the survey Percentage of currently Risk Percentage Risk married a category of births ratio women Not in any high-risk category 30.0 1.00 28.3 Unavoidable risk: first births 12.1 1.21 5.6 Single high-risk category Mother's age < 18 17.4 1.44 6.0 Mother's age > 34 0.2 * 2.4 Birth interval < 24 months 4.8 1.37 7.5 Birth order > 3 22.7 1.12 19.4 Subtotal 45.1 1.28 35.2 Multiple high-risk category c Age <18 & birth interval <24 mo 1.8 2.26 2.2 Age >34 & birth interval <24 mo 0.1 * 0.0 Age >34 & birth order >3 4.7 1.26 19.6 Age >34 & birth interval <24 & birth order >3 0.5 (3.10) 1.4 Birth interval <24 & birth order >3 5.7 2.23 7.7 Subtotal 12.8 1.90 30.9 In any high-risk category 58.0 1.42 66.1 Total 100.0 100.0 Number 6,230 8,450 Note: Risk ratio is the ratio of the proportion dead of births in a specific high-risk category to tbe pmportion deed of births not in any high-risk category. Figures in parentheses are based on 25-49 births; an asterisk indicates that a figure is Rased on fewer than 25 women and has been suppressed. Women were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth ~ess than 15 months ago, and latest birth of order 3 or higher. c Includes sterilized women Includes the combined categories Age <18 and birth order >3 The second column of Table 7.5 indicates the relative risk of mortality of children born in the five years before the survey by comparing the proportion dead in each high-risk category with the proportion dead among children not in any high-risk category. Young age at birth is a significant risk factor, especially when coupled with a short birth interval (multiple-risk ratio of 2.26). High birth order also raises mortality risk substantially when combined with a short birth interval (multiple-risk ratio of 2.23). Fortunately, however, only a small proportion of recent births fails into this multiple-risk category, so that even though the fertility behavior results in much higher risk of death for the child, few children are subject to that higher risk. Of greater practical importance is that 19 percent of births in Bangladesh are exposed to a higher risk of death because the mother is under 18 years. Delays in marriage and childbearing could lead to improved child survival prospects. 106 Column 3 of Table 7.5 shows the distribution of currently married, non-sterilized women by risk category into which a currently conceived birth would fall. Two in 3 (66 percent) currently married women are at risk of conceiving a child with an elevated risk of dying. Three in 10 women are at risk due to multiple risk factors while 35 percent are at risk due to a single factor. The most likely risks are due to high birth order (19 percent), giving birth after a short interval (8 percent) or at a young age (6 percent). The table also indicates that 20 percent of women are potentially at risk of having a child of high birth order when they are over age 34, which places the child at a 26 percent increased risk of early death. 107 CHAPTER8 MATERNAL AND CHILD HEALTH This chapter presents findings on various issues related to maternal and child health (MCH); including antenatal care and delivery assistance, immunization, childhood illnesses and their treatment. This information can be used to identify groups of women and children who are "at risk" because of nonuse of MCH services. The information will assist policy-makers in the planning of appropriate strategies to improve the health of this most vulnerable population group. The findings presented here are based on data obtained from women who had had a live birth in the five years preceding the BDHS survey. 8.1 Antenatal Care A well-designed and implemented antenatal care program facilitates detection and treatment of problems during pregnancy, such as anemia and infections, and provides an opportunity to disseminate health messages to women and their families. In addition, this early contact with the health care system can improve the timely and appropriate use of delivery care services. Prevalence and Source of Antenatal Care Table 8.1 shows the percent distribution of births in the five years preceding the survey by source of antenatal care received during pregnancy, according to maternal and background characteristics. Interviewers were instructed to record all persons a woman may have seen for care, but in this report, only the provider with the highest qualifications is considered if more than one person was seen. The data indicate that many mothers in Bangladesh do not receive antenatal care. For births that occurred in the five years before the survey, nearly three-quarters (71 percent) of mothers received no antenatal care during pregnancy (Figure 8.1). Those who do receive care tend to receive it from doctors (20 percent) or nurses, midwives, and family welfare visitors (7 percent). Less than 1 percent of pregnant women receive antenatal care from traditional birth attendants (dai). The survey results show that there are sharp differences in antenatal care coverage among subgroups in Bangladesh. Antenatal care is much more common for births to younger women and those of lower birth order. The urban-rural differential in the percentage of births for which the mother had at least one antenatal care visit is quite large. Fifty-eight percent of urban births had received antenatal care from a medically trained person, compared with only 23 percent of rural births. Differences in antenatal care coverage by division are small. Mothers in Sylhet Division are the least likely to receive antenatal care; for only 18 percent of births did mothers have at least one antenatal care visit. However, differences by education level of the mother are substantial: while only 16 percent of births to women with no education receive care during pregnancy, the level increases to 61 percent of births for women with at least some secondary school. Doctors are the most common antenatal care providers among younger women, mothers with lower birth order, respondents who live in urban areas, and those with some secondary education. On the other hand, antenatal care is uncommon for births to older women, higher-order births, and rural births. The level of antenatal care coverage in Bangladesh has remained virtually unchanged since the 1993- 94 BDHS when mothers of 26 percent of births received antenatal care from a medically trained person. 109 Table 8.1 Antenatal care Percent distribution of live births in the five years preceding the survey by source of antenatal care daring pregnancy, according to selected background characteristics, Bangladesh 1996-97 Antenatal care provider I Nurse/ Number Background Trained 2 Birth Other/ of characteristic Doctor midwife attendant 3 Missing No one Total births Mother's age at birth < 20 20.4 6.8 0.2 1.9 70.7 100.0 1,997 20-34 19.8 6.7 0.3 2.1 71.1 100.0 3,890 35+ 12.4 7.4 0.0 2.2 78.0 100.0 343 Birth order 1 28.2 7.0 0.2 1.9 62.7 100.0 1,677 2-3 20.2 7.7 0.2 2.3 69.7 100.0 2,459 4-5 15.0 5.5 0.2 2.4 76.9 100.0 1,187 6+ 8.2 5.5 0.2 1.3 84.7 100.0 907 Residence Urban 48.9 9.1 0,5 4.6 36.9 100.0 557 Rural 16.7 6.6 0.2 1.8 74.8 100.0 5,673 Division Barisal 19.2 7.2 0.3 1.8 71.4 100.0 408 Chittagnng 22.7 8.3 0.4 1.4 67.2 100.0 1,541 Dhaka 21.1 5.0 0.0 1.5 72.3 100.0 1.902 Khulna 20.1 7.0 0.4 2.7 69.8 100.0 614 Rajshahi 15.2 8.6 0.2 3.1 72.9 100.0 1,331 Sylhet 15.0 2.8 0.0 2.5 79.7 100.0 434 Mother's education No education 10A 5.7 0.2 2.0 82.0 I00.0 3,591 Primary incomplete 17.9 8.0 0.1 2.4 71.7 100.0 1,053 Primary complete 28.0 5.9 0.4 1.8 63.9 100.0 618 Secondary+ 51.3 10.1 0.2 2.1 36.3 100.0 968 Total 19.6 6.8 0.2 2.0 71.4 100.0 6,230 2~iote: Figures are for births in the period 0-59 months preceding the survey. f the respondent mentioned more than one provider, only the most qualified provider is considered. Includes family welfare visitors 3 Traditional midwife Attitudes Towards Antenatal Care In an attempt to identify whether ignorance of the importance of antenatal care is a factor in the low levels of use in Bangladesh, ever-married women interviewed in the 1996-97 BDHS were asked whether they thought that women should have a medical checkup when they are pregnant, even if they are not sick. The vast majority of women appear to recognize that antenatal care is beneficial; 85 percent answered the question aff irmatively (Table 8.2), Older women, rural women, those who live in Sylhet Division, and less educated women are slightly less likely to see the advantages of antenatal care. These results imply that some other factor--perhaps cost or accessibility of services--accounts for the low antenatal care coverage. Number and Timing of Antenatal Visits Antenatal care is important to both the mother and child. The number and t iming of antenatal care visits are considered to be important in preventing an adverse pregnancy outcome. Care is most effective if the visits are started early during pregnancy and continue at regular intervals throughout the pregnancy. 110 Figure 8.1 Percent Distribution of Births by Antenatal and Delivery Care ANTENATAL CARE Doctor ~ 20 Nur~tMIdvhfe ~ 7 No One . . . - 71 TETANUS VACCINATION I N°n° One TWO or Mote 59 PLACE OF DELIVERY Heaith FabllltYHome DELIVERY ASSISTANCE Doctor ~ Nurse/Midwife Trained Untrained TBA 57 Raia6ve/Othet NO One 1 0 20 40 60 80 100 Percent Note: Based on blahs in the five years preceding the survey; TBA = traditional blah attendant BDHS 1996-97 Table 8.2 Opinion on medical checkups Percent distribution of ever-married women age 10-49 by whether they think pregnant women should have medical checkups, according to background characteristics, Bangladesh 1996-97 Medical checkups needed? Number Background Don't know/ of characteristic Yes No Missing Total women Age < 20 85.5 11.8 2.6 100.0 3,197 20-34 85.3 10.9 3.7 100.0 5,442 35+ 79.0 15.3 5.6 100.0 488 Residence Urban 94.2 4.4 1.3 100.0 1,063 Rural 83,9 12.4 3.7 I00.0 8,064 Division Barisal 85.0 11.5 3.4 100.0 598 Chittagong 82.5 13.8 3.7 100.0 1,836 Dhaka 85.7 10.1 4.2 100.0 2,882 Khulna 83.3 12.9 3.8 100.0 1,107 Rajshahi 89.6 8.1 2.2 100.0 2,198 Sylhet 75.0 21.8 3.1 100.0 506 Education No education 80.1 14.9 4.9 100.0 4,983 Primary incomplete 86.9 9.8 3.2 100.0 1,572 Primary complete 89.2 9.5 1.3 100.0 913 Secondary+ 95.8 3.6 0.6 100.0 1,659 Total 85.1 11.4 3.4 100.0 9,127 111 It is generally recommended that antenatal care visits be made monthly for the first 7 months, fortnightly in the 8th month, and then weekly until birth. If the first visit is made at the third month of pregnancy, this schedule translates to a total of about 12 to 13 visits. Data on the number and timing of visits made by pregnant women are given in Table 8.3. As mentioned above, for a large majority of births, mothers do not obtain any antenatal care. Among those who do obtain care, the median number of visits is only 1.7, far fewer than the recommended 12 visits. On average, pregnant women who seek antenatal care do so initially shortly before the fifth month of pregnancy. Still, for roughly one-quarter of women who do receive antenatal care, the first visit occurs in the sixth month of pregnancy or later--too late to receive the full benefits of the services. Tetanus Toxo id Vacc inat ions Tetanus toxoid injections are given during pregnancy for prevention of tetanus among newborns. Neonatal tetanus is a fatal disease caused by a pathogen transmitted under unhygienic conditions at childbirth. For full protection, it is recommended that pregnant women receive two doses of the toxoid. However, if a woman was vaccinated during a previous pregnancy, she may only require one booster dose during a subsequent pregnancy. Five doses are considered to provide lifetime protection. In order to estimate the extent of tetanus toxoid coverage during pregnancy, the BDHS collected data for each birth in the five years before the survey as to whether the mother had received tetanus toxoid vaccinations during pregnancy and, if so, the number of injections. Table 8.3 Number of antenatal care visits and staee of nre~nancv Percent distribution of live births in the five years preceding the survey by number of antenatal care visits, and by the stage of pregnancy at the time of the first visit, Bangladesh 1996-97 Characteristic Percent Number of visits 0 71.4 1 8.8 2-3 13.6 4+ 5.8 Don't know/missing 0.4 Total 100.0 Median number of visits 1.7 Number of months pregnant at time of first visit No antenatal care 71.4 <6 months 20.4 6-7 months 5.8 8+ months 2.1 Don't know/missing 0.3 Total 100.0 Median number of months pregnant at first visit 4.9 Number of births 6,230 Note: Figures are for births in the period 0-59 months preceding the survey. These results are presented in Table 8.4. The data may underestimate the actual extent of protection from tetanus, since women were asked about vaccination during specific pregnancies. Women who had received prior vaccinations may not have received additional injections because they were considered unnecessary. The data indicate that tetanus toxoid coverage is relatively widespread in Bangladesh. Overall, 59 percent of births in the five years before the survey were to mothers who received two or more tetanus toxoid injections during pregnancy, while 15 percent were to mothers who received one injection. One-fourth of births did not benefit from any tetanus toxoid vaccination during pregnancy. Tetanus toxoid coverage is lower for births to older mothers (age 35 and over), births of higher order, births in rural areas, births in Sylhet Division, and births to less educated women. It is highest for births to women with at least some secondary education and women in urban areas. Higher coverage for lower order births and for younger mothers may be explained, in part, by the fact that higher parity mothers and older mothers may have received all the required doses of the toxoid during previous pregnancies. Differentials by division show that coverage is highest in Khulna Division and lowest in Sylhet Division. There is a strong positive relationship between the mother's education and tetanus toxoid coverage. The proportion of births whose mothers received two or more tetanus toxoid doses during pregnancy increases from 53 percent among women with no education to 76 percent among those with secondary school. 112 Table 8.4 Tetanus toxoid vaccinations and mc, dical testing Percent distribution of live births in the five years preceding the survey by number of tetanus toxoid injections during pregnancy and percentage for which the mother had her blood pressure checked and urine tested during pregnancy, according to background characteristics, Bangladesh 1996-97 Number of tetanus toxoid injections Two Blood Number Background One doses Don't know/ pressure Urine of characteristic None dose or more Missing Total taken tested births Mother's age at birth < 20 20.7 12.7 66.4 0.2 100.0 24.3 13.5 1,997 20-34 25.4 16.9 57.4 0.3 100.0 25.1 14.0 3,890 35+ 45.9 12.3 41.6 0.2 100.0 15.4 8.4 343 Birth order 1 17.2 9.9 72.6 0.3 100.0 31.4 19.9 1,677 2-3 20.7 18.3 60.8 0,2 1130.0 26.5 14.3 2,459 4-5 32.2 16.7 50.7 0.4 100.0 18.5 8.6 1,187 6+ 41.7 15.4 42.7 0.2 100.0 12.8 6.2 907 Residence Urban 10.4 15.7 73.9 0.0 100.0 55.3 42.7 557 Rural 26.4 15.3 58.0 0.3 100.0 21.2 10.7 5,673 Division Barisal 23.4 18.0 58.0 0.6 100.0 22.6 13.3 408 Chittagnng 26.8 16.9 55.8 0.5 100.0 26.9 12.9 1,541 Dhaka 26.0 13.3 60.5 0.2 10O.0 24.1 15.4 1,902 Khulna 14.7 18.2 66.4 0.7 100.0 27.0 14.5 614 Rajshahi 22.7 14.5 62.8 0.0 100.0 23.1 12.1 1,331 Sylhet 37.3 13.9 48.5 0.3 100.0 17.2 I 1.2 434 Mother's education No education 32.5 14.1 53.1 0.3 100.0 14.4 6.6 3,591 Primary incomplete 21.9 19.0 58.8 0.3 100.0 22.9 9.8 1,053 Primary complete 14.0 14.7 71.1 0.2 100.0 32.8 17.4 618 Secondary+ 7.6 16.2 76.0 0.2 100.0 57.3 40.8 968 Total 25.0 15.3 59.4 0.3 100.0 24.3 13.5 6,230 Note: Figures are for births in the period 0-59 months preceding the survey. Although there has been no change in recent years in antenatal care coverage, the proportion of pregnant women receiving tetanus toxoid injections has risen substantially. For births occurring in roughly 1991-93, 66 percent of the mothers received at least one tetanus toxoid injection during pregnancy (Mitra et al., 1994:102), while by 1992-96, the proportion had increased to 75 percent. Table 8.4 also shows that for nearly 1 in 4 births, the mother's blood pressure was taken during pregnancy. For 14 percent of births, a sample of the mother's urine was taken for analysis. 8.2 Delivery Care An important element in reducing health risks for mothers and children is to increase the proportion of babies that are delivered in health facilities under medical supervision. Proper medical attention and hygienic conditions during delivery can reduce the risk of infections and facilitate management of 113 complications that can cause death or serious illness for the mother or the newborn. In this section, two topics related to delivery are discussed--place of delivery and type of assistance during delivery. Place of Delivery Table 8.5 presents the distribution of births in the five years prior to the survey by place of delivery. Almost all births (95 percent) in Bangladesh occur at home. However, use of health facilities for delivery is much more common in urban areas (23 percent of births), among mothers with some secondary education (17 percent), and among mothers who received at least four antenatal care visits (34 percent). Differentials by age of the mother, birth order, and division are small. Table 8.5 Place of delivery Percent distribution of births in the five years preceding the survey by place of delivery, according to selected background characteristics, Bangladesh 1996-97 Place of delivery Number Background Health At Don't know/ of characteristic facility home Missing Total births Mother's age at birth < 20 3.4 95.4 1.1 100.0 1,997 20-34 4.5 94.6 1.0 10O.0 3,890 35+ 3.3 96.6 0.1 100.0 343 Birth order 1 7.8 90.9 1.4 100.0 1,677 2-3 3.6 95.4 1.1 100.0 2,459 4-5 2.0 97.2 0.8 100.0 1,187 6+ 1.3 98.5 0.2 100.0 907 Residence Urban 23.0 74.4 2.5 100.0 557 Rural 2.2 97.0 0.8 100.0 5,673 Division Barisal 3.5 95.1 1.3 I00.0 408 Chittagong 2.5 96.2 1.3 100.0 1,541 Dhaka 6.5 92.3 1.2 I(30.0 1,902 Khulna 6.2 93.1 0.7 I(30.0 614 Rajshahi 2.3 97.2 0.4 I00.0 1,331 Sylhet 2.0 97.6 0.5 100.0 434 Mother's education No education 1.2 98.0 0.8 100.0 3,591 Primary incomplete 2.0 96.9 1.1 100.0 1,053 Primary complete 4.4 94.6 1.0 100.0 618 Secondary+ 16.8 82.0 1.2 100.0 968 Antenatal care visits None i.l 98.4 0.5 100.0 4,446 1-3 visits 5.5 93.3 1.2 100.0 1,396 4 or more visits 34.1 63.4 2.6 100.0 364 Total 4.1 95.0 1.0 100.0 6,230 Note: Figures are for births in the period 0-59 months preceding the survey. Total includes 24 births for which antenatal care data are missing. 114 Assistance During Delivery Table 8.6 shows the percent distribution of births in the five years before the survey by type of assistance during delivery, according to background characteristics. If the mother was assisted by more than one type of provider, only the most qualified person is recorded in the table. Sixty-five percent of births in Bangladesh are assisted by traditional birth attendants (dai), with 8 percent being assisted by trained dais and 57 percent by untrained dais. Another one-fourth of births are assisted by relatives and friends, t Eight percent of births are assisted by medically trained personnel---either doctors (5 percent) or nurses, midwives and family welfare visitors (3 percent). Table 8.6 Assistance during delivery Percent distribution of births in the five years preceding the survey by type of assistance during delivery, according to selected background characteristics, Bangladesh 1996-97 Assistance during delivery Nurse/ Don't Number Background Trained Train~ Untralqed Relative/ No know/ of characteristic Doctor midwife TBA' TBA' Other one Missing Total births Mother's age at birth < 20 4.8 2.6 7.0 56.7 28.0 0.6 0.2 100.0 1,997 20-34 5.6 2.9 7.9 57.2 24.8 1.5 0.2 100.0 3,890 35+ 3.8 3.1 5.8 60.1 23.3 3.9 0.0 100.0 343 Birth order 1 9.8 4.5 7.9 53.8 23.3 0.5 0.2 100.0 1,677 2-3 4.5 2.8 8.2 55.0 28.2 1.1 0.2 100.0 2,459 4-5 3.0 1.6 6.5 59.7 27.3 1.6 0.4 100.0 1,187 6+ 1.8 1.5 6.0 65.9 21.4 3.3 0.2 100.0 907 Residence Urban 24.1 10.6 9.6 41.1 14,3 0.2 0.0 100.0 557 Rural 3.4 2.1 7.3 58.7 26.9 1.5 0.2 100.0 5.673 Division Barisal 5.7 2.8 11.5 60.3 18.5 0.7 0,5 100.0 408 Chittagong 2.9 4.9 8.5 66,9 15.9 0.6 0.3 100.0 1,541 Dhaka 7.2 1.9 %3 54.7 27.2 1.5 0.2 100.0 1,902 Khulna 10.3 4.0 4.0 56.0 24.9 0.5 0.4 100.0 614 Rajshahi 3.2 1.7 7.3 46,6 38.6 2.6 0.0 100.0 1,331 Sylhet 3.6 1.6 6.1 64.4 23.0 1.1 0.3 100.0 434 Mother's education No education 1.8 1.1 5.2 61.6 28.3 1.8 0,2 100,0 3,591 Primary incomplete 3.4 2.0 10.5 55.7 27.5 0.6 0.2 100.0 1,053 Primary complete 6.5 3.9 7.6 58.6 21.9 1.2 0.2 100.0 618 Secondary+ 19.0 9.6 12.6 41.4 17.0 0.4 0.1 100.0 968 Antenatal care visits None 1.9 0.9 5.6 61.1 28.9 1.5 0.0 100.0 4,446 1-3 visits 7.5 6.4 12.7 53.2 19.2 1.0 0.0 100.0 1,396 4 or more visits 37.3 12.7 10.3 25.9 13.2 0.6 0.0 100.0 364 Total 5.2 2.8 7.5 57.2 25.7 1.3 0.2 100.0 6,230 Note: Figures are for births in the period 0-59 months preceding the survey. If the respondent mentioned more than one attendant, only the most qualified attendant was considered in this table. Total includes 24 births for which antenatal care data ~re missing. Traditional birth attendant It is entirely possible that some women report traditional birth attendants as "friends", since the distinction may be slight. 115 There are only minor differences in the type of assistance at delivery according to the age of the mother and the birth order of the child. As might be expected, births in urban areas are more likely to be assisted by medical personnel (doctors, nurses, midwives, or family welfare visitors) than rural births (35 vs. 6 percent). Similarly, a higher proportion of births to women with at least some secondary school are assisted by medical personnel (29 percent) than births to women with no education (3 percent). Not surprisingly, the more antenatal visits a woman makes when pregnant, the greater the likelihood that her baby will be delivered with assistance from medically trained staff. For mothers who received no antenatal care, only 3 percent of their births were supervised by doctors, nurses, midwives, or family welfare visitors, compared with 50 percent of mothers who had four or more antenatal visits. Also of interest in Table 8.6 is the relatively high proportion of births in Khulna Division that are assisted by doctors, nurses, midwives, or family welfare visitors. There has been little change over time in the proportion of births assisted by medical personnel. Data from the 1993-94 BDHS show that about 10 percent of births were assisted at delivery by a doctor, nurse or midwife (Mitra et al., 1994:105). According to 1996-97 BDHS, the analogous figure is about 8 percent. 8.3 Childhood Vaccination The Expanded Programme on Immunization (EPI) follows the international guidelines recommended by the World Health Organization (WHO). The guidelines recommend that all children receive a BCG vaccination against tuberculosis; three doses of DPT vaccine for the prevention of diphtheria, pertussis (whooping cough), and tetanus; three doses of polio vaccine; and a vaccination against measles. WHO recommends that children receive all of these vaccines before their first birthday and that the vaccinations be recorded on a health card given to the parents. In the BDHS, mothers were asked to show the interviewer the health cards of all children born in the five years before the survey. The interviewer copied from the card the date each vaccine was received. If a child never received a health card or if the mother was unable to show the card to the interviewer, the mother was asked to recall whether the child had received BCG, polio, DPT (including the number of doses for polio and DPT), and measles vaccinations. Mothers were able to produce health cards for only 42 percent of children age 12-23 months, which represents a small decline from the level of 46 percent obtained in the 1993-94 BDHS. Vaccination Coverage Information on vaccination coverage is presented in Table 8.7, according to the source of information used to determine coverage, i.e., the vaccination card or mother's report. Data are presented for children age 12-23 months, thereby including only those children who have reached the age by which they should be fully vaccinated. The first indicator shows the proportion of these children who had been vaccinated at any age up to the time of the survey. These results are presented according to the source of the information used to determine coverage, i.e., vaccination record or mother's report. The second indicator shows the proportion of children who had been vaccinated by age 12 months, the age at which vaccination coverage should be complete. According to information from both the vaccination records and mothers' recall, only 54 percent of Bangladeshi children 12-23 months can be considered to be fully immunized. Although the level of coverage for BCG and the first two doses of DPT and polio exceeds 80 percent, the proportion who go on to receive the third dose of these two vaccines falls off sharply, to 69 percent for the third dose of the DPT vaccine and 116 to only 62 percent for the third dose of the polio vaccine (Figure 8.2); dropout rates 2 between the first and third doses of DPT and of polio are thus 18 and 28 percent, respectively. Seventy percent of children age 12-23 months have received the measles vaccine. Only 12 percent have received no vaccinations, Table 8.7 Vaccinations bv source ofinforrnation Percentage of children 12-23 months who had received specific vaccines at any time before the survey, by whether the information was from a vaccination card or from the mother, and the percentage vaccinated by 12 months of age, Bangladesh 1996-97 : Percentage of children who received: Number Background of characteristic BCG DPTI DPT2 DPT3 Poliol Polio2 Polio3 Measles All I None children Vaccinated at any time before the survey Vaccination card 42.1 42.2 40.0 37,1 42.1 40.0 37.5 35.5 34.0 0.0 457 Mother's report 44.1 42.7 39.2 32.2 44.9 40.4 24.8 34.4 20.1 11.9 625 Either source 86.2 84.9 79.2 69,3 86.9 80.4 62.3 69.9 54.1 12.0 1,082 Vaccinated by 12 months of age 84.2 82.6 77.1 66.5 84.3 78.1 60.1 61.2 46.9 14.0 1,082 Note: For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. Children who are fully vaccinated (i.e., those who have received BCG, measles, and three doses of DPT and polio). Figure 8.2 Percentage of Children 12-23 Months Who Have Received Specific Vaccinations 100 80 60 40 20 0 Percent 65 BCG 1 2 3 OPT 67 m t 2 Polio 8O imm 70 62 Measles All None Note: Based on health cat(~ information and mothers' reports BDHS 1996-97 : Dropout rate = (Dose 1 - Dose 3) * 100 / Dose 1 117 As mentioned earlier, it is recommended that children complete the schedule of immunizations during their first year of life, i.e., by 12 months of age. Table 8.7 shows that, among children age 12-23 months at the time of interview, 47 percent had been fully vaccinated before their first birthday. With regard to specific vaccines, children were least likely to have received the third doses of polio and the measles vaccine by age 12 months. Dif ferent ia ls in Vacc inat ion Coverage Table 8.8 shows vaccination coverage rates among children age 12-23 months by selected background characteristics, including the child's sex and birth order, urban-rural residence, division, and the mother's education level. The figures refer to the proportion of children receiving the vaccinations at any time up to the date of the survey and they are based on information from both the vaccination records and mothers' reports. The table includes information on the proportion of children for whom a vaccination record was shown to the interviewer. Table 8.8 Vaccinations bv back2round characteristics Percentage of children 12-23 months who had received specific vaccines by the time of the survey (according to the vaccination card or the mother's report) and the percentage with a vaccination card, by selected background characteristics, Bangladesh 1996-97 Percentage of children who received: Percent with DPT Polio vacci- Number Background nation of characteristics BCG 1 2 3+ 1 2 3+ Measles All ~ None card children Sex Male 87.0 86.0 81.2 70.4 88.2 82.9 64.7 71.9 55.8 10.7 43.1 563 Female 85.3 83.7 77.0 68.1 85.6 77.7 59.8 67.8 52.2 13.3 41.3 520 Birth order 1 89.4 88.5 81.2 72.7 89.6 84.2 65.4 73.6 55.8 9.2 49.3 321 2-3 86.8 86.6 79.7 69.5 88.5 79.6 63.0 70.1 55.4 l 1.2 43.6 45 l 4-5 85.2 83.6 81.1 72.0 84.3 79,0 59.7 67.8 52.5 13.6 36.2 174 6+ 77.9 72.7 70.3 57.0 78.8 75.9 56.3 63.3 47.9 19.0 28.6 136 Residence Urban 91.9 91.0 88.1 75.0 92.8 86.2 65.2 79.7 58.2 6,7 47.3 83 Rural 85.7 84.4 78.4 68.8 86.4 79.9 62.1 69.1 53.7 12.4 41.8 999 Division Barisal 91.1 91.1 86.6 76.4 93.8 86.6 71.8 77.5 62.4 6.2 53.3 75 Cbittagong 82.2 81.2 75.0 63.8 82.8 74.2 58.7 65.5 51.0 15.5 37.1 258 Dhaka 82.7 81.4 75.4 65.9 84.0 78.4 60.1 64.8 49.3 14.9 38.2 316 Khulna 96.9 95.7 92.8 85.5 96,9 95.9 74.0 87A 68.3 3.1 59.5 122 Rajshahi 91.2 89.3 83.7 74.1 91.4 84.8 64.9 74.9 58.0 7.3 42.5 236 Sylhet 76.5 75.2 65.7 53.8 76.3 65.2 47.8 56.0 41.5 22.4 36.9 75 Mother's education No education 80.0 78.9 72.8 62.7 81.2 74.0 57.2 63.2 49.7 17.3 35.8 624 Primary incomplete 93.0 92.1 86.6 75.3 94.0 87.9 66.0 76.1 56.6 5.9 54.4 191 Primary complete 94,0 89.8 81.9 68.9 93.2 86.3 64.8 69.2 49A 5.3 40.3 96 Secondary+ 96.8 95.9 92.3 86.7 96.2 91.8 75.6 87.8 70,1 3.2 53.1 171 All children 86.2 84.9 79.2 69.3 86.9 80.4 62.3 69.9 54.1 12.0 42.2 1,082 Note: The DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine since mothers ~ere specifically asked whether the child had received polio vaccine. Children who are fully vaccinated (i.e., those who have received BCG, measles and three doses of DPT and polio). 118 The data indicate that boys are somewhat more likely than girls to receive basic immunizations. For most vaccinations, the difference is small, with about 2-5 percent more boys than girls receiving the immunization. Overall, 56 percent of boys receive all of the recommended immunizations, compared with 52 percent of girls (Figure 8.3). Figure 8.3 Percentage of Children Age 12-23 Months Who Have Received All Vaccinations by Background Characteristics TOTAL GENDER Male Female RESIDENCEDIvISIoNUrbanRural t Barisal Chittaqong I D~aka Khulna Raishahi Sylhet EDUCATION No Education Primary Incomp. m Primary Cornp. m Secondary+ m O 54 56 52 54 56 51 68 68 5O 57 _~ - 49 70 20 40 60 Percent 80 BDHS 1996-97 Children of birth order 6 and above are less likely than children of lower birth orders to receive the basic childhood immunizations. The difference is particularly wide for the third dose of DPT which is given to about 57 percent of children of birth order 6 and above, compared with 73 percent of first-born children. The vaccination program has been more successful in urban areas, even though more than half of the children in rural areas have been fully immunized. There are sharp differences in vaccination coverage by division. Children in Khulna and Barisal Divisions are more likely to be fully immunized than children in other divisions, whereas those in Dhaka and Sylhet Divisions lag behind the national average. Only 42 percent of the children in Sylhet Division are fully immunized, compared with 68 percent of those in Khulna Division. Although some of the regional differences are due to lower proportions of children in Dhaka and Sylhet Divisions receiving initial vaccinations such as BCG and the first dose of DPT, much of the difference is due to higher dropout rates between the first and third doses of DPT and polio and especially to lower proportions who receive the measles vaccine. As expected, the proportion of children who receive all the recommended vaccinations increases with the education level of the mother, from 50 percent among children of mothers with no education to 70 percent among those whose mothers have at least some secondary education. 119 Trends in Vaccination Coverage The current survey collected vaccination data using the same methodology used in the 1993-94 BDHS, providing an ideal opportunity to look at trends in coverage over the last three years. Comparison of vaccination coverage levels estimated from the two surveys suggests a slight worsening in recent years. The proportion fully immunized among children age 12-23 months has declined from 59 percent in 1993-94 to 54 percent in 1996-97. However, a more detailed examination of the data by vaccine type indicates that this trend is entirely due to a decline in the proportion receiving the third dose of polio vaccine--from 67 percent in 1993-94 to 62 percent in 1996-97 (Figure 8.4). Coverage for all other vaccines has increased slightly since 1993-94 (Mitra et a1.,1994:108). 100 80 60 40 20 0 Figure 8.4 Trends in Vaccination Coverage Among Children Age 12-23 Months BCG 1 2 3 1 2 3 Measles All DPT Polio [ 1993- ,,1996-97 I BDHS 1996-97 The 1996-97 BDHS data on vaccination can also be compared with similarly collected data from the Health and Demographic Survey (DHS) fielded in 1995 (BBS, 1997b:22). The DHS data show that 65 percent of children aged 12-23 months were fully vaccinated, significantly higher than the 54 percent from the 1996-97 BDHS. Although the two surveys show almost identical levels of coverage for the first two doses of DPT and polio, the DHS reports much higher coverage for the third doses of these two vaccines, as well as for BCG and measles. It is unclear what might cause these discrepancies. 8.4 Childhood Illness and Treatment Two illnesses that are major contributors to high childhood mortality in Bangladesh are discussed in this section. These are acute respiratory infection and diarrhea. Estimates of the prevalence of these illnesses and fever, as well as data concerning types of treatment, are presented. Data are also presented on the extent of use of Vitamin A supplementation capsules. Vitamin A deficiency is associated with increased rates of serious morbidities and early childhood mortality. 120 Acute Respiratory Infection Acute respiratory infection (ARI) is one of the major causes of morbidity and mortality among children in Bangladesh. A follow-up study on causes of death of children identified in the 1993-94 BDHS found that 23 percent of infant deaths and 25 percent of deaths among children age 1-4 years were attributable to ARI (Baqui, et al. 1997). Common symptoms associated with severe respiratory infection include fever, cough, and difficult or rapid breathing. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths from respiratory infections. The prevalence of symptoms of ARI was estimated in the BDHS by asking mothers if their children under age five had been ill with coughing accompanied by short, rapid breathing 3 during the two weeks preceding the survey. Mothers whose children had experienced these symptoms were asked what they had done to treat the illness. It bears mentioning that reports of disease prevalence are inherently imprecise, since they are based on a mother's subjective assessment. Information on the prevalence and treatment of ARI is presented in Table 8.9. The BDHS results indicate that almost 1 in 3 children under five were reported to have been ill with a fever during the two weeks preceding the survey, with prevalence peaking at age group 6-23 months. Differentials by background characteristics are small. Altogether, 13 percent of children under five years had a cough with rapid breathing in the two weeks before the survey. ARI is most common under age one and diminishes in prevalence with increasing age, from about 18 percent at 0-11 months to just 7 percent at age 48-59 months. There are only minimal differences in reported ARI prevalence by other background and demographic factors. Overall, one-third (33 percent) of children who have symptoms of ARI are taken to a health facility for treatment? Younger children are more likely than older children to be taken to a health facility when ill with ARI, as are boys rather than girls. Children of educated mothers are more likely to be taken to a health facility when sick with ARI than those whose mothers had less education. Likewise, children in Rajshahi Division who have symptoms of AR! are more likely to be taken to a health facility than those in Sylhet Division. Looking only at children under three, the prevalence of respiratory illness has declined from 24 percent in 1993-94 (Mitra et al., 1994:111 ) to 15 percent in 1996-97. The proportion taken to a health facility has increased from 28 percent in 1993-94 to 36 percent in 1996-97. Childhood Diarrhea Dehydration as a result of diarrhea is a frequent cause of death in young children. The administration of oral rehydration therapy (ORT) is a simple means of countering the effects of dehydration. ORT involves giving the child a solution prepared by mixing water with commercially prepared packets of 3 Cough and short, rapid breathing are signs and symptoms of pneumonia. The BDHS estimate of ARI prevalence corresponds to an estimate of the prevalence of children who need treatment for presumed pneumonia and does not include other ARI-related conditions (coughs and colds, wheezing, ear infection, and streptococcal sore throat) covered under the WHO guidelines for ARI case management. 4 Health facilities include government hospitals, family welfare centers, thana health complex, satellite clinics, community health workers, private doctors, and private clinics. 121 Table 8.9 Prevalence and treatment of acute resoiratorv infection Percentage of children under five years who were ill with a fever or with a cough accompanied by rapid breathing during the two weeks preceding the survey, and the percentage of those with a cough who were taken to a health facility, by selected background characteristics, Bangladesh 1996-97 Percentage Of those of with cough, Percentage children percentage of with taken to children cough a health Number Background with and rapid facility or of characteristic fever breathing provider" children Child's age < 6 months 33.0 17.5 42.0 621 6-11 months 41.9 17.8 39.1 560 12-23 months 38.7 14.8 34.0 1.082 24-35 months 31.1 12.9 30.3 1,123 36-47 months 24.9 11.1 32.2 1,156 48-59 months 22.8 7.4 16.8 1,111 Sex Male 30.7 13.3 36.6 2,821 Female 31.2 12.3 29.0 2,833 Birth order 1 31.8 13.6 39.2 1,508 2-3 32.2 13.2 29.1 2,260 4-5 28.7 10.7 29.0 1,082 6+ 29.0 13.0 35.8 804 Residence Urban 31.3 ] 1,8 44.9 516 Rural 30.9 12.9 31.8 5.138 Division Bafisal 28.0 10.4 32.7 367 Chittagong 35.7 15.2 35.5 1,403 Dhaka 28.7 12.9 30.6 1,729 Khulna 24.9 12.5 30.2 567 Rajshahi 34.1 11.8 37.0 1,213 Sylhet 25.2 9.5 21.1 376 Mother's education No education 30.5 12.5 27.3 3,220 Primary incomplete 30.5 13.5 31.6 952 Primary complete 31.9 15.6 39.7 572 Secondary+ 32.3 11.5 50.2 910 Total 30.9 12.8 32.9 5,654 i Includes government hospital, family welfare center, thana health complex, satellite clinic, community health worker, private doctor, and private clinic. oral rehydration salts (ORS---also called khabar or packet saline) or a homemade solution made from sugar, salt and water (also called labon gur). Oral rehydration therapy was developed in Bangladesh over 30 years ago by what is now called the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). ORS packets are currently available through health facilities and at shops and pharmacies in Bangladesh, many of which are distributed by the Social Marketing Company. 122 In the BDHS, mothers of children under age five were asked if their children had had diarrhea in the two-week period before the survey, I f the child had had diarrhea, the mother was asked about what she had done to treat the diarrhea, i f anything. Since the prevalence of diarrhea varies seasonally, the results pertain only to the pattern during the period November-March when the BDHS interviewing took place. Table 8.10 indicates that 8 percent of children under five years of age were reported as having had diarrhea in the two weeks prior to the BDHS interview. Only 1 percent of children under f ive had bloody diarrhea (a sign of dysentery) in the two weeks prior to the survey. Table 8.10 Prevalence of diarrhea Percentage of children under five years who had diarrhea and diarrhea with blood in the two weeks preceding the survey, by selected background characteristics, Bangladesh 1996-97 Diarrhea in the preceding 2 weeks Number Background All Diarrhea of characteristic diarrhea with blood children Child's age < 6 months 4.2 0.6 621 6-11 months 14.0 2.1 560 12-23 months 11.6 1.7 1,082 24-35 months 7.6 1.6 1,123 36-47 months 6.3 1.3 1,156 48-59 months 3.9 1.3 1,111 Sex Male 7.5 1.3 2,821 Female 7.8 1.5 2,833 Birth order I 8.7 1.6 1,508 2-3 7.7 1.5 2,260 4-5 7.5 1.4 1,082 6+ 5.4 1.1 804 Residence Urban 8.0 0.6 516 Rural 7.6 1.5 5,138 Division Barisal 3.1 0.6 367 Chittagong 8.7 1.7 1,403 Dhaka 7.7 1.3 1,729 Khulna 8.7 1.5 567 Rajshahi 7.0 1.4 1,213 Sylhet 7.8 2.1 376 Mother's education No education 6.9 1.3 3,220 Primary incomplete 10.1 2.1 952 Primary complete 6.9 1.0 572 Secondary+ 8.1 1.7 910 Total 7.6 1.4 5,654 Note: Figures are for children born in the period 0-59 months preceding the survey. 123 Diarrhea is more common among children age 6-23 months than among older or younger children. This pattern is believed to be associated with increased exposure to the illness as a result of both weaning and the greater mobility of the child as well as to the immature immune system of children in this age group. Differences in the prevalence of diarrhea according to other background characteristics are small. Treatment of Diarrhea Twenty-two percent of children under five whose mothers reported that they had had diarrhea in the two weeks before the survey were taken to a health facility for consultation (Table 8.11). Nearly half (48 Table 8.11 Treatment of diarrhea Among children under five years who had diatThea in the two weeks preceding the survey, the percentage taken for treatment to a health facility or provider, the percentage who received oral rehydration therapy (either solution prepared from ORS packets or recommended home fluids) and increased fluids, the percentage who received neither oral rehydtatlon therapy nor incauJsed fluids, and the percentage receivin 8 other treatments, by background characteristics, Bangladesh 1996-97 Background :haxacteristic Percentage Oral rehydration Other treatments taken to therapy (OR'r) Neither a health In- ORT nor Home No Number facility or ORS ORS or creased increased Pill or Injec- remedy/ treat- Mis- of provider I packets RHF RHF fluids fluids syrup tion Other ment sing children Child's age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Division Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Mother ' s education No education Primary incomplete Primary complete Secondary+ Total * * * * * * * * * * * 26 24.5 30.3 19.6 42.6 45.1 37.4 35.1 1.3 15.7 12.7 0.0 78 28.0 60.8 37.8 74.8 59.6 16.7 46.5 2.8 6.4 4.5 0.5 126 20.5 48.0 30.5 64,9 60.6 22.4 30. I 1.4 8.1 6.4 0.7 85 10.4 44.6 17.0 52,1 56.4 27.7 25.7 2.2 6.5 4.5 1.6 72 (19.3) (50.8) (33.9) (65.7) (63.1) (20.9) (34.1) (0.0) (5.7) (8.0) (2.9) 43 24.1 50.3 27.1 60.9 55.5 26.3 35.0 1.0 10.9 6.9 1.4 210 20.3 46.1 29.0 61.0 55.8 24.7 34.2 2.3 8.6 9.0 0.3 220 22.3 44.3 31.4 59.3 56.9 27.0 34.4 1.7 8.7 9.8 1.3 132 24.7 50.6 27.6 62.8 56.1 23.1 39.4 2.0 9.2 4.3 1.1 175 21.7 50.2 25.4 59.7 58.8 26.2 27.1 0.0 9.5 13.3 0.0 81 (12.7) (46.1) (24.9) (60.9) (44.3) (29.0) (29.5) (3.7) (15.4) (7.4) (0.0) 43 26.4 71.2 17.1 76.5 62.3 16.4 24.6 0.0 10.7 1.6 4.4 41 21.7 45.7 29.3 59.3 54.9 26.4 35.7 1.9 9.6 8.6 0.5 389 * * * * * * * * * * * I I 21.5 48.2 30.5 65.6 54.6 27.5 39.6 1.2 11.7 10.8 0.0 121 22.6 48.8 26.6 55,3 57.1 25.7 31.3 0.9 8.4 7.9 2.2 134 (22.0) (51.4) (27.4) (67.8) (49.4) (25.6) (29.6) (0.0) (9.2) (9.8) (0.0) 49 24.8 46.7 29.8 61.6 58.7 20.4 35.8 4.8 10.8 3.6 0.0 85 16.9 46.6 23.0 52.7 52.0 31.1 37.2 2.0 6.7 4.7 2.0 29 22.3 48.8 22.8 57.5 55.3 28.3 29.4 1.7 8.4 9.6 0.8 222 23.0 42.0 38.3 63.1 51.5 24.9 39.9 2.7 9.3 4.3 1.8 96 (31.7) (43.8) (27.4) (6t.4) (59.6) (25.3) (38.2) (2.6) (12.1) (10.4) (0.0) 39 15.6 56.4 31.2 68.3 60.0 17.7 41.5 0.0 13.2 6.5 0.0 73 22.2 48.1 28.1 61.0 55.7 25.5 34.6 1.7 9.7 8.0 0.8 431 Note: Figures in parentheses ate based on 25-49 unweighted cases; an astedsk indicates that the number is based on fewer than 25 children and has been suppressed. ORS = Oral rehydrafon salts : RHF = Recommended home fluid (laban gur) I Includes govemrnent hospital, family welfare center, thana health complex, satellite clinic, community health worker, private doctor, and private clinic. 124 percent) were given solution made from ORS packets, while 28 percent were given a recommended homemade fluid (RHF or labon gur), and more than half (56 percent) were given more fluids than usual. If oral rehydration therapy is defined broadly to include ORS, labon gur, and increased fluids, then 74 percent of children with diarrhea received some sort of oral rehydration treatment, while 26 percent received neither ORS, labon gur, nor increased fluids. Thirty-five percent of children with diarrhea were given some kind of pill or syrup to treat the disease, while 10 percent were given home remedies or herbs. About 1 in 12 children with diarrhea was given nothing to treat the diarrhea. Younger children are more likely to be taken to a health facility when they have diarrhea than older children. Female children with diarrhea are slightly less likely than male children to be taken to a health facility, but are as likely as boys to be treated with ORS or labon gur. The data indicate important differences in the treatment of diarrhea cases by urban-rural residence. Not only are urban children with diarrhea more likely than rural children to be taken to a health facility, but they are also more likely to be treated with ORS packets and increased fluids of any kind. Recommended homemade fluid or labon gur--presumably more accessible for rural households--is given to rural children (29 percent) more often than their urban counterparts (17 percent). Differences in the treatment of diarrhea by division are small. The proportion of children with diarrhea who are taken to a health facility is highest in Rajshahi Division (25 percent) and lowest in Sylhet Division (17 percent). Recommended homemade fluid for treating diarrhea appears to be used more commonly in Chittagong and Rajshahi Divisions (30-31 percent) than in the other divisions (23-27 percent). Children of mothers with at least some secondary education are less likely to be taken to a health facility when they have diarrhea than children whose mothers are less educated, but they are more likely to be treated with ORS packets or by increased fluids in general. The BDHS also directly investigated the extent to which mothers made changes in the amount of fluids that a child received during a diarrheal episode. To obtain these data, mothers who had a child under age five with diarrhea during the two-week period prior to the survey were asked whether they had changed the amount that the child was given to drink during the diarrheal episode. The data indicate that 31 percent of children with diarrhea were given the same amount of fluids as usual and 56 percent received more fluids than usual; 11 percent received less fluids than usual (data not shown). These results suggest that, although the benefit of increasing fluid intake during a diarrheal episode is quite widely understood in Bangladesh, about 1 in 9 mothers still engages in the dangerous practice of curtailing fluid intake when their children have diarrhea. In order to obtain an idea of trends in the prevalence of diarrhea and use of ORS, it is necessary to compare children under age three, since the 1993-94 BDHS only asked these questions for children under three. The data show a slight decline in the prevalence of diarrhea (13 percent of children under three in 1993-94 and 9 percent in 1996-97) and virtually no change in the use of ORS (50 percent in 1993-94 and 49 percent in 1996-97). Using data from the national level Diarrheal Morbidity and Treatment Survey, Mitra and Islam (1996:13) also reported a decline in prevalence of diarrhea among children under five children from 23 percent in 1987-88 to 20 percent in 1994-95 among rural children and from 24 to 16 percent among urban children. Men's Perceived Need to Use Health Services for Diarrhea or Cough in Children In many households, men are significant players in the decision to take a sick child for treatment. In the BDHS, all male respondents with a child under five were asked what signs or symptoms of diarrhea or cough would indicate that a child should be taken to a health facility or health worker. This information can be used to identify appropriate communication materials that can be used to reach men. 125 Overall, the large majority (88 percent) of men report that 'repeated watery stools' is the major sign of severe diarrhea, followed by 'repeated vomiting' (73 percent) (Table 8.12). One in 6 men reported 'any watery stool', ' fever' , and 'getting sicker' as signs that would prompt a visit to a health care provider. Table 8.12 Men who revort signs and svmntoms of disease Percentage of currently married men age 15-59 with a child bern in the five years before the survey who report that specific signs or symptoms of diarrhea or cough indicate that a child should be taken to a health facility or health worker, by residence and education, Bangladesh 1996-97 Residence Education No Primary Primary Signs/symptoms Urban Rural education incomplete complete Secondary+ Total Diarrhea signs Repeated watery stools 91.0 87.6 88.1 87.0 87.7 88.5 87.9 Any watery stools 13.7 17.2 15.4 20.0 17.2 18.3 16.8 Repeated vomiting 73.5 72.4 71.9 75.2 68,5 74.0 72.5 Any vomiting 10.2 9.3 8.8 8.4 9.2 12.5 9.4 Blood in stools 1.7 2.4 2.6 2.6 1.7 1.4 2.3 Fever 17.0 16.6 17.7 13.9 15.4 16.1 16.6 Marked thirst 10.8 9.1 9.2 8.3 9.3 10.3 9.3 Not eating/drinking 7.9 7.1 7.2 6.0 10.0 7.1 7.2 Geuing sicker/sick 25.3 15.5 17.4 12.2 19.2 16.3 16.5 Not getting better 1.7 1.0 1.1 0.5 2.0 1.2 1.1 Other 8.1 6.3 6.4 5.5 9.0 6.3 6.5 Does not know 0.8 0.4 0.3 0.2 0.8 0.7 0.4 Cough signs Rapid breathing 23.7 29.5 29.4 29.7 28.8 26.6 28.9 Difficult breathing 37.2 34.6 36.6 30.3 32.5 35.2 34.9 Noisy breathing 26.0 23.3 21.1 25.4 28.8 27.5 23.6 Fever 74.2 74.3 74.6 73.0 71.3 76.3 74.3 Unable to drink 4.3 5.4 5.1 6.6 5.0 4.9 5.3 Not eating/driaking 16.5 12.6 12.6 11.8 16.3 13.9 13.0 Getting sicker/sick 29.4 21.9 23.7 18.6 24.2 22.7 22.7 Not getting better 0.2 1.9 2.2 0.6 0.8 1.5 1.7 Number of rnsn 203 1,736 1,105 326 182 327 1,939 Three-fourths of men reported 'fever' and one-third of men reported 'difficult breathing' as signs or symptoms of the severity of a cough, while one-fourth of men reported 'rapid breathing', 'noisy breathing', and 'sickness' as the sign of cough that would indicate use of health services. Vitamin A Supplementation Vitamin A deficiency is the leading cause of preventable childhood blindness, as well as being a major contributing factor to the severity of several other childhood causes of morbidity and mortality. Moreover, vitamin A has been found to be essential to the proper functioning of the immune system. In Bangladesh, over one million children have clinically evident vitamin A deficiency (ICDDR,B, 1995). Research has concluded that the provision of sufficient vitamin A in a deficient population can reduce child deaths by 23 percent (HKI, 1995). Deficiency of this crucial micronutrient can be avoided by giving children supplements of vitamin A by capsule, usually every six months. In an effort to address the chronic lack of vitamin A in the population, the government of Bangladesh since 1973 has conducted a national, high-dose capsule-distribution program for all children age 6-71 months (HKI, 1995). The capsules are distributed twice a year (in April-May and October-November) by government and non-government organizations. In addition, during specified National Immunization Days, vitamin A capsules are given to children age 1 to 126 5 years. In the 1996-97 BDHS, mothers of children under age five were asked if their children had taken a vitamin A capsule in the past 6 months; in any case of confusion, interviewers showed mothers a sample of a vitamin A capsule. The BDHS data indicate that two-thirds of children under five had received at least one capsule of vitamin A in the six months before the survey (Table 8.13). Differences by background characteristics are minimal, except that children living in Sylhet Division were less likely, while those living in Barisal Division were more likely to have received a vitamin A supple- ment. In order to obtain an assessment of trends in vitamin A supplementation coverage it is necessary to focus on children under age three, since the 1993-94 BDHS only asked the question for children under three years of age. The data show a large increase in coverage--from 49 percent of children under three in 1993-94 to 68 percent in 1996-97. Helen Keller Interna- tional's Nutritional Surveillance Project confirms the rapid expansion of vitamin A supplementation; data show a rise in the proportion of children age 1-4 years who received a capsule in the previous six months from around 50 percent in the early 1990s to 88 percent in Jur_.e 1995 (HKI, 1995). Given that the latter figure excludes children under age one and refers to a point in time some 18 months before the BDHS data, the two results are not necessarily inconsistent. Table 8.13 Treatment with vitamin A caosules Percentage of children under five years who received a vitamin A capsule in the six months preceding the survey, by selected background characteristics, Bangladesh 1996-97 Received Number Background vitamin A of charactedstic capsule children Child's age <6 months 27.5 621 6-11 months 64.6 560 12-23 months 73.0 1,082 24-35 months 75.3 1,123 36-47 months 71.6 1,156 48-59 months 70.1 1,111 Sex Male 67.2 2,821 Female 66.3 2,833 Birth order 1 66.0 1,508 2-3 68.7 2,260 4-5 63.8 1,082 6+ 66.6 804 Residence Urban 71.9 516 Rural 66.2 5,138 Division Barisal 77.8 367 Chittagong 66.5 1,403 Dhaka 62.7 1,729 Khulna 68.2 567 Rajshahi 73.7 1,213 Sylhet 50.8 376 Mother's education No education 63.9 3,220 Primary incomplete 66.6 952 Primary complete 74.9 572 Secondary+ 71.7 910 Total 66.8 5,654 127 CHAPTER 9 INFANT FEEDING, CHILDHOOD AND MATERNAL NUTRITION This chapter covers two related topics: infant feeding (including initiation of breastfeeding, patterns and duration of breastfeeding, and introduction of complementary weaning foods) and nutritional status of young children and their mothers. Height and weight measurements of the respondent's children under the age of five years and those of the mother were taken to determine their nutritional status. 9.1 Breastfeeding and Supplementation Infant feeding has an impact on both the child and the mother. Feeding practices are important determinants of children's nutritional status, and many studies have shown the beneficial effects of breastfeeding on nutritional status, morbidity, and mortality of young infants. Exclusive breastfeeding (i.e,, only breast milk) is recommended during the first 4-6 months of a child's life because it limits exposure to disease agents as well as providing all of the nutrients a baby requires. Breastfeeding also has an indirect effect on the postpartum fecundity of mothers. In particular, more frequent breastfeeding is associated with longer periods of postpartum amenorrhea, which in turn are related to longer birth intervals, and thus lower fertility levels. Prevalence of Breastfeeding Table 9.1 shows the proportion of children born in the five years before the survey who were ever breastfed and the percentage who started breastfeeding within one hour and one day of birth. Almost all Bangladeshi children (97 percent) are breastfed for some period of time, regardless of background characteristics of the child or the mother. Previous research confirms the universality of breastfeeding in Bangladesh (Mitra et al., 1994:116). An important dimension related to breastfeeding is the timing of its initiation. Early initiation of breastfeeding is beneficial for mothers and children. From the mother's perspective, early suckling stimulates the release of a hormone that helps the uterus to contract. From the child's perspective, the first breast milk (colostrum) is important, since it is rich in antibodies. In Bangladesh, although almost all babies are breastfed at some time, only 13 percent are put to the breast within one hour of birth and less than half (45 percent) of children are put to the breast within the first day of life. Infants born to urban mothers, those in Sylhet Division, those whose mothers have some secondary education, and those born in a health facility with medically trained assistance have a slightly greater chance of receiving breast milk within the first day of life. Timing of Introduction of Supplementary Foods The timing of introduction of complementary foods in addition to breast milk has important implications for the child and the mother. Breast milk is uncontaminated and contains all the nutrients needed by children in the first few months of life. In addition, it provides some immunity to disease through the mother's antibodies. Early supplementation, especially under unhygienic conditions, can result in infection with foreign organisms and lower immunity to disease. The timing of introduction of food supplements also has an impact on the length of the mother's postpartum amenorrhea. Early initiation of supplementation results in earlier resumption of the mother's menstrual periods, since supplementation reduces infants' dependence on breast milk and the frequency of suckling. 129 Table 9.1 Initial breastfeedin~ Percentage of children born in the five years preceding the survey who were ever breastfed, and the percentage who started breastfeeding within one hour of birth and within one day of birth, by selected background characteristics, Bangladesh 1996-97 Percentage who started breastfeeding: Percentage Within Within Number Background ever 1 hour 1 day of characteristic breastfed of birth of birth children Sex Male 95.8 14.0 46.3 3,108 Female 97.5 12.5 43.5 3,122 Residence Urban 96.4 19.1 55.3 557 Rural 96.7 12.7 43.8 5,673 Division Barisal 97.2 9.7 49.5 408 Chittagong 97.8 12.0 47.2 1,541 Dhaka 96.0 14.1 44.3 1,902 Khulna 96.4 10.5 40.1 614 Rajshahi 96.1 13.9 40.4 1,33 l Sylhet 96.5 19.0 54.8 434 Mother's education No education 96.6 11.3 41.5 3,591 Primary incomplete 96.2 13.6 45.2 1,053 Primary complete 96.5 15.5 49.1 618 Secondary/Higher 97.3 18.5 54.1 968 Assistance at delivery Health professional 94.5 21.8 62.1 503 Traditional midwife 96.9 12.3 44.7 4,027 Other or none 96.7 13.0 40.6 1,687 Place of delivery Health facility 93.1 23.3 63.4 253 At home 96.8 12.9 44.1 5.917 All children 96.6 13.2 44.8 6,230 Note: Total includes 13 children for whom information on assistance at delivery is missing and 60 children for whom information on place of delivery is missing. Mothers were asked about the current breastfeeding status of all children under age f ive and, if the child was being breastfed, whether various types of liquid or solid foods had been given to the child "yesterday" or" last night." Children who are exclusively breastfed are defined as receiving breast milk only, while full breastfeeding is defined as receiving breast milk and plain water only. The results shown in Table 9.2 indicate that babies are breastfed for a long time; even among children 12-13 months old, 97 percent are still receiving breast milk. However, the data indicate that supplementation of breast milk with other liquids and foods begins early in Bangladesh. Among newborns less than two months of age, most are either exclusively breastfed (57 percent) or fully breastfed (12 percent); however, 30 percent of these very young babies are already receiving complementary foods or liquids. Among those age 2-3 months, one-third are being given supplements. 130 Table 9.2 Breastfeedin~ status Percent distribution of living children by current breastfeeding status, according to child's current age in months, Bangladesh 1996-97 Percentage of living children who are: Breastfeeding and: Number Not Exclusively Plain of breast- breast- water Supple- living Age in months feeding fed only ments Total children 0-1 1.1 57.0 12.3 29.6 100.0 185 2-3 0.5 46.4 19.5 33.6 100.0 252 4-5 0.6 31.3 12.8 55.2 1130.0 184 6-7 2.3 9.0 17.4 71.2 100.0 168 8-9 2.1 7.2 23.5 67.2 100.0 179 10-11 2.6 4.3 17.3 75.8 100.0 213 12-13 2.7 2.7 11.2 83.4 100.0 202 14-15 3.3 2.2 10.3 84.2 100.0 235 16-17 6.0 0.0 7.4 86.7 100.0 171 18-19 6.7 0.4 5.7 87.2 100.0 153 20-21 5.1 0.7 3.5 90.8 100.0 157 22-23 15.4 0.0 6.0 78.6 100.0 164 24-25 24.3 0.5 4.2 71.0 100.0 250 26-27 34.0 0.6 1.3 64.1 100.0 204 28-29 33.6 0.8 1.7 63.9 100.0 155 30-31 43.5 0.0 1.3 55.1 100.0 159 32-33 41.3 0.4 1.3 57.0 100.0 160 34-35 44.8 0.0 2.5 52.7 100.0 197 36-37 64.7 0.0 0.5 34.8 100.0 253 38-39 72.6 0.5 0.6 26.3 100.0 209 40-41 84.1 0.0 0.0 15.9 100.0 161 0-3 months 0.8 50.9 16.4 31.9 100.0 437 4-6 months 1.1 24.8 14.6 59.5 100.0 276 7-9 months 2.2 6.8 21.4 69.6 100.0 255 Note: Breastfeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no supplements. Among older children, it is the lack of complementary feeding that is a problem. Among children age 10-11 months- -when supplements other than breast milk are generally considered necessary for adequate nutrit ion--the data show that one-fifth of children are being given only breast milk or breast milk and water. Duration of Breastfeeding Data on the median duration and frequency of breastfeeding are presented in Table 9.3. The estimates of mean and median duration of breastfeeding are based on current status data, that is, the proportion of children born in the four years before the survey who were being breastfed at the time of the survey, as opposed to retrospective data on the length of breastfeeding of older children who are no longer breastfed. The prevalence/incidence mean is also provided for possible comparison with other data sources. The median duration of breastfeeding in Bangladesh is 33 months, with no major variations by background characteristics (Figure 9.1). The only exception is that babies in Chittagong Division are breastfed for shorter durations (median of 25 months) than those in Khulna and Rajshahi Divisions (36 and 35 months, respectively). 131 Table 9.3 Median duration and freouencv of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and full breastfeeding among children under four years of age, and the percentage of children under six months of age who were breastfed six or more times in the 24 hours preceding the interview, according to background characteristics, Bangladesh 1996-97 Children under 6 months Median duration in months I Number of Breastfed children 6+ times Any Exclusive Full under in Number Background breast- breast- breast- 4 years preceding of characteristic feeding feeding feeding 2 of age 24 hours children Sex Male 33.7 1.4 3.3 2,173 97.0 319 Female 31.7 1.6 4.3 2,204 97.3 302 Residence Urban 32.8 1.5 3.5 387 94.2 69 Rural 32.8 1.5 3.8 3,990 97.5 552 Division Barisal 29.6 0.7 1.7 286 95.2 42 Chittagong 24.6 2.8 5.1 1,080 99.4 179 Dhaka 33.0 0.7 3.0 1,351 97.5 188 Khulna 35.5 0.6 0.7 423 95.3 46 Rajshahi 35.4 2.5 3.5 925 95.6 126 Sylhet 29.0 1.9 4.3 311 95.1 40 Education No education 33.4 1.9 4.4 2,481 97.1 334 Primary incomplete 34.0 1.8 3.1 735 98.4 109 Primary complete 27.6 0.7 1.0 445 100.0 57 Secondary+ 29.5 1.2 3.6 717 94.9 122 Assistance at delivery Health professional 31.1 0.5 0.6 364 95.2 50 Traditional midwife 32.5 1.7 3.7 2,831 97.4 428 Other or none 33.5 1.9 4.5 1,178 97.7 142 3.7 4,377 97.2 621 Total 32.8 1.5 Mean 29.9 3.7 6.6 Prevalence/Incidance 3 24.9 2.7 5.3 t Medians and means are based on current status 2 Either exclusive breastfeeding or hreastfeeding and plain water only 3 Prevalence-incidence mean There has been an apparent decline in the median duration of breastfeeding since 1993-94 when it was over 36 months (Mitra et al., 1994:120). It should be noted that although the medians are calculated from smoothed data, they are still dependent on the point at which the proportions breastfeeding dip below 50 percent and are therefore somewhat volatile. Thus, although some decline in breastfeeding duration is no doubt real, it may not be as rapid as it appears. The early introduction of supplements is reflected in the short duration of exclusive breastfeeding (median duration of 2 months). Few children who are supplemented receive only plain water in addition to breast milk and thus, the median duration of full breastfeeding is also quite short (4 months). 132 Figure 9.1 Median Duration of Breasffeeding BANGLADESH RESIDENCE Urban Rural DIVISION Barisal Chittagong Dhaka Khulna Rajshahi Sylhet EDUCATION No education Primary incomp. Primary comp. Secondary+ 33 33 33 ~.~ ~ ~ ,~,%'~ ~,,~ ~ ' : '~ ~ :~','>,~".~ 25 10 20 Months 28 g0 3O 33 34 BDHS 1996-97 The duration of postpartum amenorrhea is affected by both the length of time spent breastfeeding and the frequency of breastfeeding. The child's health and nutritional status are also affected by the frequency of breastfeeding. Almost all children under the age of six months (97 percent) were reported to have been breastfed at least six times in the 24 hours preceding the survey. Differences among subgroups are minor. 9.2 Children's Nutritional Status In addition to questions about breastfeeding and weaning foods, the 1996-97 BDHS included an anthropometric component, in which all children under five and their mothers were both weighed and measured. Each interviewing team carried two scales and one measuring board. The scales were lightweight, bathroom-type scales with a digital screen designed and manufactured under the authority of UNICEF, which generously assisted the survey organizers with their importation into Bangladesh. The boards were manufactured in Dhaka with assistance from staff at the Dhaka office of Helen Keller International. Children younger than 24 months were measured lying down on the board ( recumbent lengthi. while standing height was measured for older children. Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children of a given age with respect to height and weight. In an,.' large population, there is variation in height and weight; this variation approximates a normal distribution. Use of a standard reference population as a point of comparison facilitates the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. One of the most commonly used reference populations, and the one used in this report, is the U.S. National Center for Health Statistics (NCHS) standard, which is recommended for use by the World Health Organization (WHO). 133 Three standard indices of physical growth that describe the nutritional status of children are presented: Height-for-age (stunting) Weight-for-height (wasting) Weight-for-age (underweight) Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. Height-for-age is a measure of linear growth. A child who is below minus two standard deviations (-2 SD) from the median of the NCHS reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting the cumulative effect of chronic malnutrition. If the child is below minus three standard deviations (-3 SD) from the reference median, then the child is considered to be severely stunted. A child between -2 SD and -3 SD is considered to be moderately stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and may also be caused by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population; a stunted three-year-old child could look like a well-fed two- year-old. Weight-for-height measures body mass in relation to body length and describes current nutritional status. A child who is below minus two standard deviations (-2 SD) from the reference median for weight- for-height is considered to be too thin for his/her height, or wasted, a condition reflecting acute malnutrition. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or recent episodes of illness causing loss of weight and the onset of malnutrition. As with stunting, wasting is considered severe if the child is more than three standard deviations below the reference mean. Severe wasting is closely linked to an elevated risk of mortality. Prevalence of wasting may vary considerably by season; data from Helen Keller International indicate that acute malnutrition is most pronounced in August-October in Bangladesh and least severe in December- February, just after the main harvest (HKI, n.d.). Weight-for-age is a composite index of height-for-age and weight-for-height and, thus, does not distinguish between acute malnutrition (wasting) and chronic malnutrition (stunting). A child can be underweight for his age because he is stunted, wasted or both. Weight-for-age is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as underweight. In the reference population, only 2.3 percent of children fall below minus two standard deviations (-2 SD) for each of these three indices. In the survey, all surviving children born since April 1991 were eligible for height and weight measurement. Of the 5,654 children eligible for measurement (age 0-59 months at the time of the survey), 85 percent were weighed and measured. The reason most commonly reported for not measuring a child was that the child was not at home. Of the children who were both weighed and measured, 6 percent were considered to have implausibly low or high values for height-for-age or weight-for-height. The following analysis focuses on the 4,787 children age 0-59 months for whom complete and plausible anthropometric data were collected. Table 9.4 shows the percentage of children who are classified as malnourished according to height-for-age, weight-for-height, and weight-for-age indices, by the child's age and selected background characteristics. 134 Table 9.4 Nutriti9nal status of children by demo~anhic characteristics Percentage of children under five years of age who are classified as malnourished according to three anthmpometric indices of nutritional status: halght-for-age, weight-for-height, and weight-for-age, by demographic characteristics, Bangladesh 1996-97 Demographic characteristic Height-for-age Weight-for-height Weight-for-age (stunting) (wasting) (underweight) Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below be ow of -3 SD -2 SD t -3 SD -2 SD t -3 SD -2 SD 1 children Age of child < 6 months 2.6 14.0 4.7 11.7 3.8 15.0 477 6-11 months 8.0 30.9 6.3 20.7 16.0 46.7 493 12-23 months 31.8 60.6 6.1 29.4 30.0 64.6 941 24-35 months 34.4 60.2 3.3 15.9 26.2 62.2 953 36-47 months 34.3 65.3 2.2 13.3 19.5 62.2 972 48-59 months 34.7 64.9 1.4 14.0 17.9 62.0 951 Sex of child Male 26.7 54.3 3.9 18.6 18.8 54.6 2,383 Female 29.4 55.0 3.5 16.8 22.4 58.0 2,404 Birth order 1 23.0 48.4 3.6 17.1 17.1 50.9 1,249 2-3 27.9 53.7 2.9 17.2 19.4 55.4 1,914 4-5 29.9 58.6 4.0 18.2 23.0 59.7 934 6+ 35.0 63.3 5.5 19.8 27.3 64.4 690 Birth interval First birth 23.0 48.4 3.6 17.1 17.1 50.9 1,249 < 24 months 35.4 62.0 3.5 17.1 24.9 62.3 565 24-47 31.7 59.4 3.5 17.9 23.1 60.2 1,909 48+ 23.4 49.5 4.2 18.6 18.2 52.7 1,064 All children 28.0 54.6 3.7 17.7 20.6 56.3 4,787 Note: Figures are for children born in the period 0-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as malnourished if their z-scores are below minus two or minus three standard eeviations (-2 SD or -3 SD) from the median of the reference population. Includes children who are below -3 SD Just over half (55 percent) of children under five are considered to be short for their age or stunted, while 28 percent are severely stunted (<-3 SD). The figures are high and suggest chronic food insecurity and/or repeated illnesses. Stunting is evident even among children under age 6 months (14 percent) (Figure 9.2). The prevalence of stunting increases as children get older, up to a high of 65 percent among three- and four-year-old children. Prevalence of stunting varies little by sex of the child; however, it rises with birth order. Stunting is also related to the length of the preceding birth interval; children born less than 24 months after a prior birth are considerably more likely to be stunted (62 percent) than those born after an interval of 48 months or more (50 percent). Eighteen percent of children under five are underweight for their height, or wasted, and 4 percent are severely wasted. Wasting is highest for children age 12-23 months. Variations in the level of wasting by other demographic characteristics of the child are minimal. 135 Figure 9.2 Percentage of Children under Five Who Are Stunted, According to Demographic Characteristics BANGLADESH AGE OF CHILD < 6 months 6-11 months 12-23 months m 24-35 months 36-47 months 48-59 months BIRTH ORDER 1 2-3 4-5 6+ BIRTH INTERVAL < 24 months 24-47 months 4S+ months 0 58 14 31 61 6O 65 65 48 54 59 63 I 62 I 69 I 5O 10 20 30 40 50 60 70 Percent Note: Stunted children are those whose height-for-age Z-score is below -2 standard deviations from the median of the reference populatk~n. BDHS 1996-97 Fifty-six percent of the children are considered to be underweight (low weight-for-age) and 21 percent are classified as severely underweight. As with the other two nutrition indicators, children under 6 months are least likely to be underweight, probably due to the positive effects of breastfeeding. After 6 months of age, the proportion of children who are underweight rises substantially to 65 percent among those 12-23 months and remains at 62 percent among older children. The likelihood of being underweight varies little by sex of the child, but rises with birth order and diminishes with length of the previous birth interval. Data on these same three indicators are presented in Table 9.5 by background characteristics of the children. A much higher percentage of children in rural areas are stunted, wasted, and underweight than in urban areas. For example, 56 percent of rural children are stunted, compared with 39 percent of urban children (Figure 9.3). Differences by division show that children in Sylhet Division are somewhat more likely and those in Khulna Division somewhat less likely to be malnourished. As expected, children of more educated mothers are less likely to be either stunted or underweight; proportions wasted show little difference by education of mother. Few other sources of nationally representative data on children' s nutrition status exist in Bangladesh. Data from the 1992 Child Nutrition Survey show that 46 percent of children age 6-71 months are stunted and 7 percent are wasted; however, it is unclear what definitions were used (BBS, 1997b:22). Data from Helen Keller International' s Nutritional Surveillance Project--although not nationally representative--are collected routinely from some 16,000 rural children in 41 thanas. In 1996, they show average levels of stunting (i.e., < -2 S D) of 60 percent among rural children age 6-59 months (HKI, 1996). Although this is higher than the level of 56 percent for rural children found in the BDHS, the two sources would be closer if the surveillance data included children under 6 months, who are less likely to be stunted. The average wasting rate from the surveillance project was 11 percent in December 1996, lower than the BDHS level of 18 percent for rural children. 136 Table 9.5 Nutritional status of children by backaround charactedstics Percentage of children under five years of age who are classified as malnourished according to three anthropometdc indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by background characteristics, Bangladesh 1996-97 Background characteristic Height-for-age Weight-for-height Weight-for-age (stunting) (wasting) (underweight) Percentage Percentage Percentage Percentage Percentage Percentage Number below be ow below be ow below below of -3 SD -2 SD t -3 SD -2 SD I -3 SD - 2 SD I children Residence Urban 16.9 39.4 1.7 12.8 14.2 41.9 448 Rural 29.2 56.2 3.9 18.2 21.3 57.8 4,339 Division Barisal 31.4 59.9 3.7 13.5 18.9 55.4 317 Chittagung 31.5 54.4 5.1 21.3 25.2 60.0 1,175 Dhaka 28.6 55.8 3.3 15.5 21.5 54.8 1,494 Khulna 19.4 46.5 2.3 17.5 15.7 49.8 479 Rajshahi 23.4 53.4 3.0 17.5 16.0 55.5 1,017 Sylhet 37.8 61.4 4.7 20.9 24.1 64.0 305 Mother's education No education 33.2 60.8 3.9 19.4 25.0 63.2 2,667 Primary incomplete 28.2 58.7 3.9 15.9 19.4 55.0 831 Primary complete 24.5 52.5 3.7 14.7 16.6 50.9 495 Secondary+ 12.7 30.9 2.9 15.9 9.9 38.3 794 Total 28.0 54.6 3.7 17.7 20.6 56.3 4,787 Note: Figures are for children born in the period 0-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as malnoudshed if their z-scores are below minus two or minus three ~tandard deviations (-2 SD or -3 SD) from the median of the reference population. Includes children who are below -3 SD 9.3 Nutritional Status of Mothers All mothers of children bum since April 1991 were also weighed and measured. The objective was to determine the nutritional status of women of reproductive age. However, since weighing and measuring all women would add considerably to the length and cost of the fieldwork, it was decided to limit the anthropometric section to women with young children who would be measured anyway) Women were weighed and measured using the same scales and measuring boards used for the children. The information was used to construct the following indicators of mothers' nutritional status: • Mean height (in centimeters) • Body mass index. Women who were pregnant at the time of the survey and those who had delivered a baby in the two months before the interview were excluded from the tables on weight and body mass index. 1 Interviewers were instructed to weigh and measure all women who had a birth since April 1991, regardless of whether or not the child was living. 137 Figure 9.3 Percentage of Children under Five Who Are Stunted, According to Socioeconomic Characteristics RESIDENCE Urban Rural DIVISION Barical Chittagong Dhaka Khulna Rajshahi Sylhet EDUCATION No education Primary incomp. Primary comp. Secondary+ 0 39 56 47 53 61 161 I 59 . . . . . . . . . . J 53 131 10 20 30 40 50 60 70 Percent Note: Stunted children are thc4e who6e height-for-age Z-score is below -2 standard davlatlons from the median of the reference pOpulation. BDHS 1996-97 Height is used to identify mothers at nutritional risk. Height of women can be used to predict the risk of difficulty in delivering children, given the association between height and size of the pelvis. Also, the risk of giving birth to low-weight newborns is higher among women of small stature. Although the cut- off point at which the mother can be considered at risk varies between populations, it probably falls in the range of 140-150 centimeters. Indices of body mass are used to assess thinness or obesity. The most commonly used index is the body mass index or BMI (also referred to as the Quetelet index), which is defined as weight in kilograms divided by the square of the height in meters (kg/m2). The main advantage of the BMI is that it does not require a reference table from a well-nourished population. For the BMI, a cut-off point of 18.5 has been recommended for defining thinness, or acute malnutrition. Obesity has not been defined clearly in terms of the scale, though a BMI or 25.0 or above is usually considered obese. Table 9.6 presents the mean height, body mass index (BMI), and Z-score for mothers by background characteristics. For each indicator, the proportion falling below the cut-off points is also presented. The average height of mothers in Bangladesh, 150 centimeters, is above the cut-off point of 145 centimeters; however, 17 percent of mothers are shorter than the cut-off point. Over half (52 percent) of mothers are acutely malnourished (i.e., BMI < 18.5). There are few differences in these indicators by background characteristics, except that more educated mothers tend to be slightly taller and heavier than less educated mothers. Also, a higher proportion of rural than urban mothers fall below the 18.5 cut-off for BMI. The fact that half of Bangladeshi mothers can be considered acutely malnourished and almost one- fifth are so short as to increase the risk of difficult childbirth is one of the most disturbing findings from the survey. These levels are far higher than comparable data from other countries (see Figure 9.4). 138 Table 9.6 Nutritional status of mothers by background characteristics Among mothers of children under five years, mean height and percentage of womeo 2 shorter than 145 centimeters, mean body mass index (BMI) and the percentage of women whose BMI is less than 18.5 (kg/m), by selected background characteristics, Bangladesh 1996-97 Height BMI Z-score Number Number Number Background Percent of Percent of Below of characteristic Mean <145 cm women Mean <18.5 women Mean - 2SD women Age 15-19 149.9 18.7 762 18.6 50.1 654 -1.5 26.0 647 20-24 150.2 18.3 1,314 18.7 53.6 1,155 -1.5 26.8 1,149 25-29 150.5 15.5 1,238 19.1 49.2 1,079 -1.7 41.4 1,069 30-34 150.4 16.3 642 19.0 53.0 579 -2.0 56.0 570 35-49 149.8 18.3 482 18.6 56.3 440 -2.3 67.3 429 Residence Urban 150.7 16.1 438 20.4 35.8 392 -1.2 24.0 385 Rural 150.2 17.4 4,019 18.6 53.8 3,529 -1.8 41.2 3,491 Division Barisal 149.9 19.0 304 18.8 52.8 264 -1.7 37.1 262 Chittagong 150.5 15.3 1,012 18.9 52.0 867 -1.7 41.7 857 Dhaka 150.2 17.3 1,395 18.9 51.8 1,229 -1.7 39.4 1,216 Khulna 150.8 15.9 487 19.0 47.6 445 -1.6 34.7 440 Rajshahi 150.0 18.4 985 18.6 52.4 889 -1.7 37.8 879 Sylhet 149.6 21.4 274 18.3 59,6 226 -2.0 50.5 222 Education No education 149.8 19.4 2,441 18.4 57.7 2,124 -1.9 46.3 2,090 Primary incomplete 150.2 15.1 764 18.7 49.7 682 -1.7 37.1 676 Primary complete 150.5 18.6 465 18.9 51.4 413 -1.6 33.0 412 Secondary/Higher 151.6 12.0 786 20.0 37,7 701 -1.3 25.3 698 Total 150.2 17.3 4,457 18.8 52.0 3,921 -1.7 39.5 3,877 Note: Table includes only women who had a birth in the five years preceding the survey. The BMI index excludes pregnant women and those who are less than two months postpartum. Figure 9.4 Percentage of Mothers Shorter Than 145 cm or with Low Body Mass Index (BMI), Selected Countries HEIGHT< 14SCM Zambia Egypt TartzaDia Philippines Nepal Ba~lgladesh BMI < 18,5 Egypt TanZania Zambia Philippines Nep=l Bangladesh 0 ~ I 0 ~ 1 5 10 20 30 40 50 Pemem BDHS 1996-97 139 CHAPTER 10 KNOWLEDGE OF AIDS Although acquired immunodeficiency syndrome (AIDS) is not widespread in Bangladesh, several questions were included in the 1996-97 BDHS to ascertain the level of awareness about this fatal disease. Knowledge of means of avoiding AIDS can help prevent its spread. Both ever-married women and currently married men were asked if they had ever heard of AIDS and, if so, where they had learned the most about AIDS. They were then asked if they knew of anything a person could do to avoid getting AIDS. Finally, respondents were asked whether they thought it was possible for a healthy looking person to have the AIDS virus and whether they thought that people with AIDS almost never, sometimes, or almost always died from the disease. The vast majority of Bangladeshi adults have evidently never heard of AIDS. Only 19 percent of ever-married women and 33 percent of currently married men had heard of it (Table 10.1 and Figure 10.1). By far the most striking differentials in awareness of AIDS are by urban-rural residence and education. Urban women are four times more likely to have heard of AIDS than their rural counterparts (58 vs. 14 percent), while women with some secondary school are ten times more likely to know of AIDS than uneducated women (59 vs. 6 percent). Similar patterns exist for men. The major sources of information about AIDS are television and radio, the latter being more prominent among men. Newspapers and friends and relatives are also sources of information. Respondents who said they had heard of AIDS were asked if there was any way to avoid getting it. As shown in Table 10.2, a substantial proportion of women (41 percent) and men (27 percent) said there is no way to avoid AIDS. Even among those who said there are means of avoiding AIDS, two-thirds of women and half of men say they don't know of any specific ways. Urban respondents are considerably better informed about the disease than rural respondents; however, in general, the data show that little is known about AIDS in Bangladesh. This conclusion is corroborated by results of a 1996 reproductive health study among adolescents age 15-19 in which only 36 percent of respondents could cite one symptom of AIDS (Haider et al., 1997:22). Knowledge of symptoms was considerably lower among currently married women and men than among single respondents. S u rprisingly, respondents appear to be relatively well informed on two other issues concerning AIDS. Over 2 in 3 women and 4 in 5 men who have heard of AIDS know that a healthy-looking person can have AIDS (Table 10.3). Sizeable proportions also realize that AIDS is a fatal disease; 61 percent of women and 69 percent of men say that people with AIDS almost always die of the disease. 141 Table 10.1 Knowledge of AIDS and sources of AIDS information: women Percentage of ever-married women and currently married men who have ever heard of AIDS, percentage who have received information about AIDS from specific sources, and mean number of sources of information about AIDS, by background characteristics, Bangladesh 1996-97 Ever heard Background of characteristic AIDS Radio TV Sources of AIDS information Mean Com- Friend/ number News- Pare- Health Mosque/ manhy Rela- Work other Num- of paper phlet worker church School meeting tire place source bet sources I EVER-MARRIED WOMEN Age 15-19 17.2 7.6 11.7 2.6 0.6 0.4 0.0 0.I 0.I 6.8 0.0 1.5 1,446 1.8 20-24 19.7 8.8 14.4 3.8 1.6 0.6 0.0 0.2 0.I 7.6 0.2 2.2 1,727 2,0 25-29 20.2 9.2 14.5 5.7 1.2 0.6 0.0 0.0 0.2 6.6 0.5 1.8 1,905 2.0 30-39 19.1 7.3 13.0 4,8 0.7 0.9 0.0 0.0 0.I 7.9 0.6 1.4 2,530 1.9 40-49 16.5 7.1 I0.8 3.7 1.4 0.2 0.0 0.I 0.0 6.8 0.3 2.3 1,518 2.0 Marital status Currently in union 19.1 8.2 13.4 4.5 1.1 0.6 0.0 0.1 0.1 7.3 0.3 1.9 8,450 2.0 Formerly in union 13.7 5. I 8.7 1.6 0.4 0.3 0.0 0.0 0.0 6.4 0,6 0,6 677 1.7 Residence Urban 58.4 19.0 51.3 21.0 5,3 1.3 0.0 0.2 0.0 21.2 1.2 4.1 1,063 2.1 Rural 13,5 6.6 8.0 2.1 0.5 0.5 0.0 0.1 0.1 5,3 0.2 1.5 8,064 1.8 Division Barisal 19.4 11.5 12.8 4.5 I.I 0.7 0.I 0.I 0.I 4.9 0.3 1.5 598 1.9 Cbittagong 20.3 9.0 15.2 4.3 1.0 0.5 0.0 0.I 0.0 7.9 0.3 2.1 1,836 2.0 Dbaka 25.4 9.7 19.2 6.8 1.7 0.7 0.0 0.1 0.1 10.2 0.4 2.3 2,882 2.0 Kbulna 17.7 7.1 11.0 2.8 0.7 0.8 0.0 0.0 0.2 7.9 0.5 1.4 1,107 1.8 Rajshabi 9.9 4.8 5.6 2.1 0.6 0.4 0.0 0.1 0.1 3.6 0.3 1.2 2,198 1.9 Sylbet 14.9 6.9 7.4 2.1 0.4 0.9 0.0 0.1 0.2 3.8 0.2 1.6 506 1.6 Education No education 6.4 2,0 3.4 0.0 0.0 0.2 0.0 0.0 0.1 3. I 0. I 0.9 4,983 1.5 pdmary incompieta 12.8 4.1 6.3 0.3 0.1 0.9 0.0 0.0 0.1 5.5 0.2 2.0 1,572 1.5 primary complete 23.8 10A 17.0 2.1 1.0 0.7 0.0 0.0 0.0 8.8 0.1 2.7 913 1.8 Secondary/+ 58.6 28.6 46.2 22.0 5.1 1.4 0.0 0.5 0.2 20.1 1.4 3.9 1,659 2.2 Total 18.7 8.0 13.0 4.3 1.1 0.6 0.0 0.1 0.1 7.2 0.3 1.8 9,127 2.0 CURRENTLY MARRIED MEN Age 15-19 * * * * * * * * * * * * 23 2.2 20-24 25.0 18.2 15.6 7.8 2.8 1.5 0.0 0.0 0.4 13.1 1.9 2.2 194 2.5 25-29 36.9 25.0 23.7 14.9 5.7 2.2 0.0 0.5 0.0 16.0 3.2 3.5 487 2.6 30-39 35.9 22.7 25.1 16.6 4.3 1.6 0.2 0.0 0.4 15.9 3.7 3.1 1,241 2.6 40-49 33.0 22.9 22.0 16.6 4.2 2.3 0.2 0.0 0.0 13.3 3.9 2.8 863 2.7 50-64 26.3 16.0 16.4 14.3 2.1 0.4 0.0 0.0 0.6 10.4 2.3 2,0 503 2.5 Residence Urban 71.6 44.7 58.8 50.4 14.4 1.8 0.3 0.1 0.0 31.5 10.6 4.8 400 3.0 Rural 27.8 18.6 17.1 10.6 2.6 1.7 0.1 0.1 0.3 11.8 2.3 2.6 2,912 2.4 Division Badsal 35.7 25.4 19.2 17.0 5.3 3.6 0.3 0.3 1.4 9.3 0.8 1.6 199 2.4 Cbittagong 41.3 26.7 29.6 20.3 4.8 2.2 0.0 0.0 0.0 23.3 5.1 5.0 584 2.8 Dhaka 37.0 7A.I 25.8 19.9 5.5 1.3 0.2 0.2 0.1 14.8 3.4 3.7 1,056 2.7 Khulna 40.1 27.1 26.0 13.7 2.6 1.7 0.0 0.1 0.8 18.3 6,6 3.3 428 2.5 Rajshahi 20.9 13.8 13.1 8.6 2.5 1.5 0.1 0.0 0.1 7.7 1.5 0.7 877 2.4 Sylhet 22.6 13.6 13.5 7.8 1.7 1.6 0.0 0.0 0,4 7.6 1.1 1.5 168 2.2 Education No education I1.0 6.4 5.8 0.2 0.1 0.5 0.1 0.0 0.2 5,3 0.8 0.6 1,390 1.8 Primary incomplete 25.6 15.6 14.5 3.8 0.7 1.3 0.1 0.0 0.2 12.3 1.7 3.1 750 2.1 Primary complete 33,0 17.2 19.0 9.2 1.9 0.8 0.0 0.0 0,0 15.4 3.6 3.6 204 2.1 Secondary+ 70.6 49.6 52.1 47.5 12.7 3.9 0.2 0.3 0.4 28.1 8,2 5.7 968 3.0 Total 33.1 21.8 22.1 15.4 4.0 1.7 0.1 0.1 0.3 14.2 3.3 2.8 3,312 2.6 ' Mean number of sources is based on respondents who have heard of AIDS. 142 Figure 10.1 Percentage of Women and Man Who Have Ever Heard of AIDS, Accordlng to Background Characterlstlcs RESIDENCE Urban Rural DIVISION Badsal Chlttagong Dhnka Khulna Rajshahi Sylhet EDUCATION No Education Primary Incomp. Primary Comp. Secondary+ 0 41 ¢0 20 40 60 [DWomen =aMen] 80 BDHS 1996-97 Table 10.2 Knowledge of ways to avoid HIV/AIDS Percentage of ever-married women and currently married men who have heard of AIDS and who know of specific ways to avoid HIV/AIDS and percentage with misinformation, by background characteristics, Bangladesh 1996-97 Background characteristic Ways to avoid AIDS Percent- Have Avoid Avoid age with No only sex sex Use Avoid Don't any Number way to Abstain Use one with with sterile Avoid Avoid rues- know ntis- of avoid from con- sex prosti- homo- syr- trans- kiss- quite Other any infer- women/ AIDS sex dams partner tutes sexuals inges fusions ing bites ways way marion I men EVER-MARRIED WOMEN Residence Urban 34.0 8.2 8.8 20.9 19.4 0.9 13.1 5.9 1.0 1.5 5.5 56.5 2.5 621 Rural 45.3 4.6 5.6 9.3 10.0 0.5 5.4 2.2 0.9 1.1 3.3 76.0 1.9 1,087 Marital status Currendymarried 41.1 6.3 6.8 13.6 13.5 0.6 8.4 3.7 1.0 1.3 3.9 68.6 2.2 1,616 Formerly married 42.0 0,0 6.3 12.6 12.1 0,6 5.1 1.2 0.0 0.5 6.2 74.4 0.5 93 Total 41,2 5.9 6.8 13.5 13,4 0.6 8,2 3,5 0.9 1,3 3,9 68.9 2.1 1,708 CURRENTLY MARRIED MEN Residence Urban 16,1 4,1 27.5 24.5 59.4 2.8 23,8 11.9 4.5 2.3 18,1 31,2 6.5 286 Rural 31.3 2.0 14.1 13.5 33.3 1.3 8.7 4.3 0.9 2.3 8.8 57.8 2,6 810 Total 27.3 2.6 17.6 16.4 40.1 1.7 12,6 6.3 1.8 2,3 11,2 50.9 3.6 1,096 I Includes avoiding mosquito bites and avoiding kissing. 143 Table 10.3 Awareness of AIDS-related health issues Percent distribution of ever-married women and currently married men who have heard of AIDS by responses to questions on AIDS-related health issues, Bangladesh 1996-97 Can a healthy-looking person have the AIDS vires? Is AIDS a fatal disease? Don't Don't Number of Background know/ Almost Some- Almost know/ women/ characteristic Yes No missing never times always missing Total men Ever-married women 67.8 13.6 18.6 1.1 19.5 60.6 18.8 100.0 1,708 Currently married men 81.5 7.6 10.9 0.4 17.2 68.8 13.6 100.0 1,096 144 CHAPTER 11 AVAILABILITY OF HEALTH AND FAMILY PLANNING SERVICES As part of the 1996-97 BDHS, a separate team of interviewers conducted a Service Availability survey in each of the sample points selected for the larger survey. The Service Availability survey was designed to elicit data on background characteristics of the selected sample points (e.g., distance to thana headquarters, distance to schools, post office, etc.), as well as information about the types of family planning and health services that are available either within or near the sample point. The main reason for conducting the Service Availability survey was to be able to distinguish sample points covered by government family planning fieldworkers from those covered by fieldworkers supported by non-governmental organizations. This in turn allows an assessment of the coverage of public versus private fieldworker programs. As in the 1993-94 BDHS, the 1996-97 survey utilized a questionnaire to collect general information about the sample point (Community Questionnaire), which was administered to a group of residents from the selected sample point. In most cases, informants were members or the chairmen of the union council, village heads, male teachers, imams, and female opinion leaders. A total of 1,458 people were interviewed to collect the community-level data, an average of 4.7 informants per sample point. 1 Some community characteristics can be expected to have an effect on family planning and health service utilization. Such factors as distance to schools, markets, post offices, and health and family planning centers are ways of measuring the general level of development of the area. Table 11.1 presents the distribution of ever-married women by distance to various types of schools and services, according to urban-rural residence. Almost half of women live within five miles of the thana headquarters, while only 13 percent live within five miles of the district headquarters. Schools, post offices, markets, and pharmacies are generally widespread; at least 70 percent of women live within one mile of a religious school, a primary school, a high school, a post office, a daily or weekly market, and a pharmacy. Cinemas and rural dispensaries are less widespread, with only about one-quarter of women living within a mile of these services. It is somewhat surprising that health clinics and family welfare centers appear to be more accessible than dispensaries. Forty-three percent of women live within one mile of a family welfare center, while only 20 percent live as close to the much larger thana health complex. Overall, public services appear to be widely available, with urban women living closer to most services than their rural counterparts. Table 11.2 shows the availability of various income-generating organizations such as mothers clubs, the Grameen Bank, and cottage industries. The availability of these income-generating programs may influence women's reproductive behavior either because they increase the women's socioeconomic status or because they include some family planning component. The data indicate that half of ever-married women in Bangladesh live in communities that have mothers' clubs, whereas only about 1 in 3 women live in communities with a Grameen Bank program. Very few women live in areas with cottage industries, however, 70 percent have co-operative societies in their communities and 59 percent have income-generating projects. Finally, 19 percent of women have access to television in their communities. Mothers' clubs and Grameen Bank programs are less available to urban than to rural women; television sets are, however, more accessible to urban women. Three sample points were not covered in the Service Availability Survey, leaving 310 points out of the 313 covered in the main survey. 145 Table 11.1 Distanceto nublic services Percent distribution of ever-married women age 10-49 by distance to selected public services, according to urban.rural residence, Bangladesh 1996-97 Number of miles to public service Don't Type of know/ facility 0-1 2-4 5+ Missing Total Urban areas Thana headquarters 75.7 19.3 5.0 0.0 100.0 District headquarters 45.6 24.4 30.0 0.0 100.0 Religious school 96.3 3.7 0.0 0.0 100.0 Primary school 100.0 0.0 0.0 0.0 100.0 High school 100.0 0.0 0.0 0.0 100.0 Post office 92.4 7.6 0.0 0.0 100.0 Daily market 98.6 1.4 0.0 0.0 100.0 Weekly market 61.7 15.5 4.6 18.2 100.0 Cinema hall 92.9 6.0 1.1 0.0 100.0 Rural dispensary 56.8 9.6 6.2 27.4 100.0 Pharmacy 98.6 1.4 0.0 0.0 100.0 Health clinic 89.3 8.0 2.7 0.0 100.0 Family welfare center 53.4 30.1 16.5 0.0 100.0 Thana health complex 61.9 28.9 9.2 0.0 100.0 Rural areas Thana beadquaners 10.0 30.3 59.7 0.0 100.0 District headquarters 1.8 4.2 94.0 0.0 100.0 Religious school 85.2 13.6 1.2 0.0 100.0 Primary school 98.5 1.5 0.0 0.0 100.0 High school 70.8 27.2 1.9 0.0 100.0 Post office 68.2 29.8 1.9 0.0 100.0 Dally market 65.3 31.6 3.1 0.0 100.0 Weekly market 76.6 21.3 1.7 0.4 100.0 Cinema hall 15.1 36.4 48.5 0.0 100.0 Rural dispensary 21.0 34.5 22.6 21.9 100.0 Pharmacy 76.5 22.3 1.2 0.0 100.0 Health clinic 46.5 44.8 8.8 0.0 100.0 Family welfare center 41.9 48.6 8.5 1.1 I00.0 Thana health complex 14.9 31.8 53.3 0.0 100.0 Total Thana headquarters 17.6 29.1 53.3 0.0 100.0 District headquarters 6.9 6.5 86.6 0.0 100.0 Religious school 86.5 12.4 1.1 0.0 100.0 Primary school 98.7 1.3 0.0 0.0 100.0 High school 74.2 24.1 1.7 0.0 100.0 Post office 71.0 27.2 1.7 0.0 10O.0 Daily market 69.1 28.1 2.8 0.0 100.0 Weekly market 74.9 20.6 2.0 2.5 100.0 Cinema hall 24.1 32.9 43.0 0.0 100.0 Rural dispensary 25.1 31.6 20.7 22.6 100.0 Pharmacy 79.1 19.8 1.1 0.0 100.0 Health clinic 51.4 40.5 8.1 0.0 100.0 Family welfare center 43.2 46.4 9.4 1.0 100.0 Thana health complex 20.3 31.5 48.2 0.0 100.0 Comparison with data from the 1993-94 BDHS suggest that co-operative societies and income- generating activities have expanded greatly. The former survey found that only 15 percent of ever-married women lived in communities with co-operative societies and 4 percent in areas with income-generating programs. By 1996-97, these proportions had increased to 70 and 59 percent, respectively. Grameen Bank programs have also increased, from covering only 14 percent of women in 1993-94 to 29 percent in 1996-97. Since these increases are so sizeable, it is possible that changes in the wording of the questions and/or misunderstanding on the part of either interviewers or community informants are factors. 146 Table 11.2 Presence ofinceme-ueneratin2 organizations in cluster Percentage of ever-married women age 10-49 by presence of specific income-generating organizations in their communities, and access to television, Bangladesh 1996-97 Residence Organization Urban Rural Total Mothers' club 45.7 50.6 50.0 Grame~in Bank 7.9 31.7 29.0 BSCIC' 23.2 4.9 7.0 Co-operative society 87.9 67.5 69.8 NGO income-generating activity 58.9 59.2 59.2 Access to television set 32.0 17.0 18.7 IBangledesh Small Cottage Industry Corporation Table 11.3 provides information on the presence of health and family planning fieldworkers and their services, based on reports from community informants. Health and family planning services are available to the majority of women in Bangladesh; 95 percent of ever-married women live in com- munities with family planning fieldworkers, 91 percent live in an area covered by a satel- lite clinic and 87 percent of women live in communities covered by health workers. Moreover, 53 percent of women are close to a shop that sells family planning methods. Among women for whom a satellite clinic is available, 55 percent live in communit ies with clinics that provide the pill, 38 percent have clinics that distribute condoms, 17 percent live near clinics that insert IUDs, and 35 percent have injectables. According to the community informants, most satellite clinics provide immunizations, vitamin A supplementation, and tetanus injections. Child growth monitoring, oral rehydration packets (ORS), and antenatal care appear to be either less commonly provided at satellite clinics and/or less likely to be known or reported by the community informants. Table 11.3 Presence of health and family nlanninu workers and services in the community Percent of ever.married women age 10-49 living in communities covered by family planning (FP) fieldworkers, satellite clinics, and health workers, according to division and urban-rural residence, Bangladesh 1996-97 Division Residence Fieldworkers/ Services Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Urban Rural Total Family planning fieldworker in community Someone who sells FP from home Shop selling FP in community Satellite clinic in community 96.7 97.9 95.4 92.5 98.2 75.5 98.9 94.7 95.2 10.2 2.5 6.3 5.0 6.4 7.0 6.2 5.6 5.7 47.3 60.3 58.7 76.4 36.3 17.0 82.6 48.7 52.6 88.3 91.7 87.5 88.4 96.4 95.4 72.3 93.6 91.1 Of those with satellite clinic, percent with clinics supplying: Pill 36.8 64.3 49.1 61.1 58.5 46.9 29.4 57.7 55.1 Condom 34.3 37.8 34.1 48.8 39,2 28.2 19.0 39.4 37.5 IUD 21.4 9.1 18.3 16.1 18,9 18.4 3.5 17.8 16.5 Injectables 33.4 33.0 29.0 41.4 44.6 19.9 20.8 36,4 35.0 Immunization 90.9 90.3 92.3 86.8 91.8 92.1 94.1 90.7 91.0 ORS packets 22,5 23.8 17.0 39.0 27.0 20.7 8.9 25.6 24.0 Vitamin A 95,4 84.3 84.3 95.5 89.4 79.1 86.7 87.4 87.3 Weighing children 13,5 8.3 9.5 1.0 14.5 7.7 8.0 9.9 9.7 Checking pregnant women 23.8 50,1 33.7 16.3 41.9 50.7 39.6 37,3 37.5 Tetanus injections 55.6 60.9 66.5 67.3 60.6 67.4 68.9 62.7 63.3 Health worker In community 90.2 85.2 79.8 97.0 91.8 80.6 67.7 89.1 86.6 Number of women 598 1,836 2,831 1,073 2,198 506 1,050 7,991 9,041 Note: Table excludes women in three clusters for which community data are missing 147 Differences in the availability of these services by division are not large, except for shops that sell family planning. These tend to be more widespread in Khulna, Chittagong, and Dhaka Divisions and scarce in Sylhet Division. Sylhet Division is also disadvantaged in terms of family planning fieldworker coverage; only 75 percent of women live in communities with fieldworkers, compared with 98 percent in Rajshahi and Chittagong Divisions. As expected, shops that sell family planning are more widely available in urban than in rural areas. However, the opposite is true for satellite clinics, which are more common in rural areas. One of the major reasons for implementing the study on availability of services was to gauge the relative coverage of family planning fieldworkers provided by government versus non-governmental organizations (NGOs). Unlike the 1993-94 BDHS, the 1996-97 survey did not involve interviewing family planning fieldworkers or family welfare visitors. That approach had relied on the ability to classify each sample point as having either government or NGO-supported family planning fieldworkers; however, it was sometimes difficult to know if all the fieldworkers who may be operating in an area were contacted and some areas were classified as having both government and NGO workers. The approach used in the 1996-97 survey was to obtain information from the district family planning offices about the names of the NGOs which operated family planning projects in the district and in which thanas they operated. Information was then collected at the thana-level family planning office as to whether the specified NGO or any other NGOs were operating and if so, in which unions. Finally, visits were made to the local offices of all NGOs that were identified in order to corroborate the information and determine whether the exact area comprising the specific BDHS sample point was covered by the NGO program. Those sample points which were identified as having NGO family planning activities and which the community informants indicated were covered by family planning fieldworkers were classified as 'NGO fieldworker'. Sample points not covered by NGOs, but with a fieldworker were classified as 'Government fieldworker only'. It is possible that some areas are covered by both government and NGO workers; if so, they are classified as 'NGO fieldworker' in this analysis. Data in Table 11.4 indicate that government fieldworkers predominate. Seventy-five percent of ever- married women in Bangladesh live in communities in which only a government fieldworker operates, while 21 percent live in communities with an NGO fieldworker and 5 percent live in communities with no fieldworkers. Changes over time are difficult to interpret since in the 1993-94 BDHS, some communities were classified as having both NGO and government fieldworkers. However, it does seem clear that coverage of government fieldworkers has declined. In the 1993-94 survey, 82 percent of women lived in communities covered by only government family planning fieldworkers; by 1996-97, that proportion had dropped to 75 percent (Mitra et al., 1994:132). The proportion of women in areas not covered by any fieldworker has increased from less than 1 percent to about 5 percent. Table 11.4 Presence of ~overnment and non-~overnmental family planning fieldworkers Percent distribution of ever-married women age 10-49 by presence of family planning fieldworker supported by government, non-government organizations (NGO), or neither, according to division and urban-rural residence, Bangladesh 1996-97 Division Residence Type of fieldworker Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Urban Rural Total Government fieldworker only 69.8 75.1 74.3 83.3 75.3 59.8 55.9 77.1 74.6 NGO fieldworker 26.9 22.8 21.2 9.2 22.9 15.8 43.0 17.6 20.6 No fieldworker 3.3 2.1 4.6 7.5 1.8 24.5 1.1 5.3 4.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 598 1,836 2,831 1,073 2,198 506 1,050 7,991 9,041 148 REFERENCES Arnold, Fred. 1990. Assessment of the quality of birth history data in the Demographic and Health Surveys. In An assessment of DHS-I data quality, 81-111. DHS Methodological Reports No. 1. 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Washington, D.C.: The World Bank. 152 APPENDIX A SAMPLE IMPLEMENTATION Table A.I,1 Samole imolementation: women Percent distribution of households and eligible women in the DHS sample by results of the interviews and household, eligible women, and overall response rates, according to division and residence, Bangladesh 1996-97 Division Residence Result Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Urban Rural Total Selected households Completed (C) 94.8 94.8 94.7 96,5 96.4 95.1 92.7 95.9 95.4 Household present but 0.4 0.5 0.7 0.6 0,5 0.6 0.4 0.6 0.6 no competent respondent 0.0 0.1 0.0 0,0 0,0 0.0 0.0 0.0 0.0 at home (HP) 0.1 0.2 0.2 0.2 0.1 0.1 0.1 0.1 0.1 Refused (R) 0.0 0.2 0.2 0.4 0.1 0.1 0.5 0.1 0.2 Dwelling not found (DNF) 1.8 1.5 1,4 1.2 1.3 1.8 1.7 1.4 1.4 Household absent (HA) 1.8 2.5 2.2 0.8 1,4 1.8 4.2 1.3 1.8 Dwelling vacant (DV) 1.0 0.2 0.5 0.2 0.2 0.6 0.5 0.4 0.4 Dwelling destroyed (DD) 0.0 0.2 0.1 0.2 0.0 0.0 0.0 0.1 0.1 Total percent 100.0 100.0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 Number 930 1,292 2,570 1,061 2,350 896 1,462 7,637 9,099 Household response rate (HRR) 1 99.4 99.0 98.9 98.8 99.3 99.2 99.0 99.1 99.1 Eligible women Completed (EWC) 97.7 97.5 98.0 97.7 97.9 97.3 97.0 97.9 97.8 Not at home (EWNH) 2.0 1.8 1.4 1.6 1.4 1.3 2.2 1.4 1.5 Postponed (EWP) 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 Refused (EWR) 0,0 0,4 0.3 0.3 fi.0 0.4 0.2 0.2 0.2 Partly completed (EWPC) 0.0 0.1 0.0 0.0 fi.0 0.1 0.1 0.0 fi.0 Incapacitated (EWI) 0.3 0.1 0.2 0.2 0.2 0.5 0,1 0.3 0.2 Other (EWO) 0.0 0.1 0.0 0.2 0.4 0.2 0.3 0.2 0.2 Total percent 100.0 100.0 100.0 100.0 1130.0 100.0 100.0 100.0 100.0 Number 959 1,394 2,581 1,109 2,363 929 1,494 7,841 9,335 Eligible woman response rate (EWRR) 2 97.7 97.5 98.0 97.7 97.9 97.3 97.0 97.9 97.8 Overall resl~onse rate (ORR) 3 97.2 96.5 96.9 96.6 97.2 96.5 96.0 97.0 96.9 Note: The household response rate is calculated for completed households as a proportion of the sum of completed households, those with no competent respondent at home, refused, and dwelling not found. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated and "other." The overall response rate is the product of the household and woman response rates. Using the number of households falling into specitic response categories, the household response rate (HRR) is calculated as C C+HP+R+DNP 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC EWC + EWNH + EWP + EWR + EWPC + EWl + EWO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR 155 TableA. l .2 Samnleimnlemantation: men Percent distribution of households and eligible men in the DHS sample by results of the interviews and household, eligible men, and overall response rates, according to division and residence, Bangladesh 1996-97 Division Residence Result Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Urban Rural Total Selected households Completed (C) 94.5 94.4 95.1 95.9 96.6 94.2 92.1 95.9 95.3 Household present but no competent respondent 0.4 0.3 0.7 0.6 0.5 0.7 0.3 0.6 0.5 at home (HP) 0.0 0.0 0.2 0.4 0.1 0.0 0.1 0. I 0.1 Refused (R) 0.0 0.3 0.3 0.8 0.1 0.2 0.8 0.2 0.3 Dwelling not found (DNF) 2.8 2.0 1.5 1.3 0.8 2.4 2.6 1.4 1.6 Household absent (HA) 1.5 2.5 1.9 0.8 1.5 2.0 3.7 1.3 1.7 Dwelling vacant (DV) 0.9 0.3 0.5 0.2 0.3 0.4 0.4 0.4 0.4 Dwelling destroyed (DD) 0.0 0.2 0.0 0.2 0.0 0.0 0.0 0.1 0.0 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 470 647 1,293 532 1,181 451 737 3,837 4,574 Household response rate (HRR) t 99.6 99.3 98.8 98.3 99.3 99.1 98.7 99.1 99.0 Eligible men Completed (EMC) 92.1 87.2 95.2 90.9 94.3 91.0 90.8 93.0 92.7 Not at home (EMNH) 7.9 10.9 3.8 8.2 5.3 8.4 8.1 6.2 6.5 Postponed (EMP) 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.1 0.1 Refused (EMR) 0.0 0.0 0.2 0.2 0.1 0.0 0.3 0.1 0.1 Partly completed (EMPC) 0.0 0.2 0.1 0.0 0.0 0.0 0.0 0.1 0.1 Incapacitated (EMI) 0.0 0.8 0.5 0.4 0.0 0.6 0.7 0.3 0.4 Other (EMO) 0.0 0.8 0.1 0.2 0.2 0.0 0.0 0.3 0.2 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 342 476 1,014 452 995 332 589 3,022 3,611 Eligible man response rate (EMRR) 2 92.1 87.2 95.2 90.9 94.3 91.0 90.8 93.0 92.7 Overall response rate (ORR) 3 91.7 86.6 94.0 89.4 93.6 90.1 89.6 92.2 91.8 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found. The eligible man response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated and "other." The overall response rate is the product of the household and man response rates. i Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C+HP+R+DNF 2 Using the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as~ EMC EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 3 The overall response rate (ORE) is calculated as: ORR = HRR * EMRR 156 APPENDIX B ESTIMATES OF SAMPLING ERRORS APPENDIX B ESTIMATES OF SAMPLING ERRORS The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the BDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the BDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the BDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the BDHS is the ISSA Sampling Error Module. This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below with the standard error being the square root of the variance: (mh 2)) 1 -f ~ mh ~'~ 2 Zh var(r) - h=t mh l 2-,i=t Zhi - mh in which Zhi = Yh i - r .Xh i , and z h = Yh- r .xh 159 where h mh Yh~ xh~ f represents the stratum which varies from 1 to H, is the total number of enumeration areas (EAs) selected in the h th stratum, is the sum of the values of variable y in the i th EA in the h th stratum, is the sum of the number of cases in the i s EA in the h ~ stratum, and is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the ZDHS, there were 312 non-empty clusters. Hence, 313 replications were created. The variance of a rate r is calculated as follows: SE2(R) = var ( r ) - 1 k E( r i - r ) 2 k(k -1 ) i=t in which r i = k r - (k -1 ) r ( i ) where r rt0 k is the estimate computed from the full sample of 313 clusters, is the estimate computed from the reduced sample of 312 clusters (i th cluster excluded), and is the total number of clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result i fa simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the BDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for the six divisions. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B. 1. Tables B.2 to B. 10 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R-2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant since there is no known unweighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for children ever born to married women aged 15-49) can be interpreted as follows: the overall average from the national sample is 3.301 and its standard error is .03. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.301±2x.03. There is a high probability (95 percent) that the true average number of children ever born to all women aged 15 to 49 is between 3.241 and 3.361. 160 Sampling errors are analyzed for the national sample and for two separate groups of estimates: (1) means and proportions, and (2) complex demographic rates. The relative standard errors (SE/R) for the means and proportions range between 0 percent and 18.2 percent with an average of 3.8 percent; the highest relative standard errors are for estimates of very low values (e.g., currently using male sterilization among currently married women who were currently using a contraceptive method). If estimates of very low values (less than 10 percent) were removed, than the average drops to 2.3 percent. So in general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small, 2.4 percent. However, for the mortality rates, the average relative standard error is somewhat higher, 5.9 percent. There are differentials in the relative standard error for the estimates of sub-populations. For example, for the variable with secondary education or higher, the relative standard errors as a percent of the estimated mean for the whole country, for the rural areas, and for Chittagong are 3.8 percent, 4.7 percent, and 8.6 percent, respectively. For the total sample, the value of the design effect (DEFT) averaged over all variables is 1.25, which means that due to multi-stage clustering of the sample variance is increased by a factor of 1.56 over that in an equivalent simple random sample. 161 Table B. 1 List of selected variables for sampling errors, Bangladesh 1996-97 Variable Description Base population WOMEN No education Proportion With secondary education or higher Proportion Currently married Proportion Children ever born Mean Children ever born to women over 40 Mean Children surviving Mean Knowing any contraceptive method Proportion Knowing any modem contraceptive method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modem method Proportion Currently using pill Proportion Currently using IUD Proportion Currently using injections Proportion Currently using condom Proportion Currently using female sterilization Proportion Currently using male sterilization Proportion Currently using rhythm Proportion Currently using withdrawal Proportion Using public sector source Proportion Want no more children Proportion Want to delay at least 2 years Proportion I deal number of children Mean Mothers received tetanus injection Proportion Mothers received medical care at birth Proportion Had diarrhea in the last 2 weeks Proportion Treated with ORS packets Proportion Sought medical treatment Proportion Having health card. seen Proportion Received BCG vaccination Proportion Received DPT vaccination (3 doses) Proportion Received polio vaccination (3 doses) Proportion Received measles vaccination Proportion Fully immunized Proportion Weight-for-height (< -2 SD) Proportion Height-for-age (< -2 SD) Proportion Weight-for-age (< -2 SD) Proportion Total fertility rate (3 years) Rate Neonatal mortality rate Rate Posmeonatal mortality rate Rate Infant mortality rate Rate Child mortality rate Rate Under-five mortality rate Rate MEN No education Proportion With secondary education or higher Proportion Knowing any contraceptive method Proportion Knowing any modem contraceptive method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modem method Proportion Currently using pill Proportion Currently using IUD Proportion Currently using injections Proportion Currently using condom Proportion Currently using female sterilization Proportion Currently using male sterilization Proportion Currently using rhythm Proportion Currently using withdrawal Proportion Want no more children Proportion Want to delay at least 2 years Proportion Ideal number of children Mean Ever-married women 10-49 Ever-married women 10-49 Ever-married women 10-49 Currentl t married women 15-49 Currentl : married women 40-49 Currentl r married women 15-49 Currentl ¢ married women 10-49 Currentl r married women 10-49 Currentl t married women 10-49 Currentl r married women 10-49 Currentl r married women 10-49 Currentl r married women 10-49 Currentl ~ married women 10-49 Currentl ~ married women 10-49 Currentl, mamed women 10-49 Currentl, married women 10-49 Currentl, married women 10-49 Currentl, married women 10-49 Currantl, married women 10-49 Current users of modem method Currently married women 10-49 Currently married women 10-49 Ever-married women 10-49 Births in last 3 years Births in last 3 years Children under 3 Children under 3 with diarrhea in last 2 weeks Children under 3 with diarrhea in last 2 weeks Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 1-35 months Children 1-35 months Children 1-35 months Women-years of exposure to child-bearing Number of births exposed to death Number of births exposed to death Number of births exposed to death Number of births exposed to death Number of births exposed to death Currently marred men 15-59 Currently married men 15-59 Currently married men 15-59 Currently mamed men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently maraed men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men 15-59 Currently married men t5-59 162 Table B.2 Samolin2 errors - National samole, Banaladesh 1996-97 Number of cases Standard Design Rela0ve Confidence limits Value error Unweighted Weighted effect error VaiSable (R) (SE) (N) (WN) (DEFI') (SE/R) R-2SE R+2SE WOMEN No educafon 0.546 0.010 9127 9127 1.847 0.018 0.526 0.566 With secondary education or higher 0.182 0.007 9127 9127 1.664 0.038 0.168 0.196 Currently married 0.926 0.003 9127 9127 1.142 0.003 0.920 0.932 Children ever born 3.301 0.030 8306 8307 1.111 0.009 3.241 3.361 Children ever born to women over 40 3.247 0.029 8450 8450 1.077 0.009 3.189 3.305 Children surviving 2.755 0.024 8306 8307 1.118 0.009 2.707 2.803 Knowing any contraceptive method 1.000 0.000 8450 8450 1,117 0.000 1.000 1.000 Knowing any modern contraceptive method 1,000 0.000 8450 8450 1.117 0.000 1.000 1.000 Ever used any contraceptive method 0.722 0.007 8450 8450 1.404 0.010 0.708 0.736 Currently using any method 0.492 0.008 8450 8450 1.419 0.016 0.476 0.508 Currently using a modern method 0,416 0.007 8450 8450 1.346 0.017 0.402 0.430 Curcently using pill 0.208 0.006 8450 8450 1.261 0.029 0.196 0.220 Currently using IUD 0.018 0.002 8450 8450 1.105 0.111 0.014 0.022 Currently using injections 0.062 0.004 8450 8450 1.349 0.065 0.054 0.070 Curcently using condom 0.039 0.002 8450 8450 1.143 0.051 0.035 0.043 Currently using female sterilization 0.076 0.004 8450 8450 1.398 0.053 0.068 0.084 Currently using male sterilization 0.011 0.002 8450 8450 1.404 0.182 0.007 0.015 Currently using rhythm 0.050 0.003 8450 8450 1.326 0.060 0.044 0.056 Currently using withdrawal 0.019 0.002 8450 8450 1.056 0.105 0.015 0.023 Using public sector source 0.352 0.010 3552 3561 1.283 0.028 0.332 0.372 Want no more children 0.491 0.006 8450 8450 1.126 0.012 0.479 0.503 Want to delay at least 2 years 0.217 0.005 8450 8450 1,062 0.023 0.207 0.227 Ideal number of children 2.479 0.013 8590 8600 1.526 0.005 2.453 2.505 Mothers received tetanus injection 0.747 0.011 6189 6230 1.727 0,015 0.725 0.769 Mothers received medical care at birth 0.081 0.005 6189 6230 1.316 0.062 0.071 0.09 I Had diarrhea in the last 2 weeks 0.076 0.005 5600 5654 1.348 0.066 0.066 0.086 Treated with ORS packets 0.481 0.032 409 431 1.257 0.067 0.417 0.545 Sought medical treatraent 0.222 0.019 409 431 0.944 0.086 0.184 0.260 Having health card, seen 0.422 0.019 1080 1082 1.273 0.045 0.384 0.460 Received BCG vaccination 0.862 0.015 1080 1082 1.390 0.017 0.832 0.892 Received DPT vaccination (3 doses) 0.693 0.019 1080 1082 1.344 0.027 0.655 0.731 Received polio vaccination (3 doses) 0.623 0.019 1080 1082 1.302 0.030 0.585 0.661 Received measles vaccination 0.699 0.017 1080 1082 1.236 0.024 0.665 0.733 Fully immunized 0.541 0.019 1080 1082 1.221 0.035 0.503 0.579 Weight-for-height 0.177 0.007 4736 4787 1.200 0.040 0.163 0.191 Height-for-age 0.546 0.008 4736 4787 1.040 0.015 0.530 0.562 Weight-for-age 0.563 0.009 4736 4787 1.165 0.016 0.545 0.581 Total fertility rate (3 years) 3.268 0.078 NA 29225 1.417 0.024 3.112 3.424 Neonatal mortality rate (0-4 years) 48.391 2.894 6402 6440 1.014 0.060 42.603 54.179 Posmeonatal mortality rate (0-4 years) 33.836 2.603 6418 6457 1.105 0.077 28.630 39.042 Infant mortality rate (0-4 years) 82.227 3.615 6420 6459 0.997 0.044 74.997 89.457 Child mortality rate (0-4 years) 36.508 2.762 6511 6554 I.I 15 0.076 30.984 42.032 Under-five mortality rate (0-4 yeats) 115.733 4.575 6531 6574 1.078 0.040 106.583 124.883 MEN No education 0.420 0.012 3312 3312 1.357 0.029 0,396 0.444 With secondary oducation or higher 0.292 0.011 3312 3312 1.329 0.038 0.270 0.314 Knowing any contraceptive method 0.999 0.001 3312 3312 1.154 0.001 0.997 1.000 Knowing any modern contraceptive method 0.998 0.001 3312 3312 1.135 0.001 0.996 1.000 Ever used any contraceptive method 0.754 0.010 3312 3312 1.298 0.013 0.734 0.774 Cunen0y using any melhod 0.596 0.011 3312 3312 1.252 0.018 0.574 0.618 Curren0y using a modem method 0.485 0.010 3312 3312 1.116 0.021 0.465 0.505 Currently using pill 0.245 0.008 3312 3312 1.084 0.033 0.229 0.261 Currently using IUD 0.017 0.002 3312 3312 1.053 0.118 0.013 0.021 Currently using injections 0.071 0.005 3312 3312 1.218 0.070 0.061 0,081 Curcently using condom 0.057 0.004 3312 3312 1.084 0.070 0.049 0.065 Currently using female sterilization 0.079 0.006 3312 3312 1.213 0.076 0.067 0.091 Curren0y using male sterilization 0.016 0.003 3312 3312 1.323 0.188 0.010 0.022 Currently using rhythm 0.085 0.006 3312 3312 1.191 0.071 0.073 0.097 Currently using withdrawal 0.015 0,002 3312 3312 0.897 0.133 0.011 0.019 Want no more children 0.487 0.010 3312 3312 1.095 0.021 0.467 0.507 Want to delay at least 2 years 0.213 0.008 3312 3312 1.087 0.038 O. 197 0.229 Ideal number of children 2.447 0.019 3097 3095 1.333 0.008 2.409 2.485 NA = Not applicable 163 Table B.3 Samolinn errors - Urban sample s Bangladesh 1996-97 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0,355 0.015 1449 1063 1.207 0.042 0.325 0.385 With secondary education or higher 0.422 0.015 1449 1063 1,127 0.036 0,392 0.452 Currently married 0.910 0.010 1449 1063 1.312 0.011 0.890 0.930 Children ever born 2.664 0.059 1311 956 1,067 0.022 2.546 2.782 Children ever born to women over 40 2.637 0.058 1328 968 1.063 0.022 2.521 2.753 Children surviving 2.340 0.045 1311 956 0.977 0.019 2.250 2.430 Knowing any contraceptive method 1.000 0.000 1328 968 Und 0.000 1.000 1.000 Knowing any modern contracep, method 1.000 0.000 1328 968 Und 0.000 1.000 1.000 Ever used any contraceptive method 0.857 0.012 1328 968 1.290 0.014 0,833 0.881 Currently using any method 0.621 0.016 1328 968 1.175 0,026 0.589 0,653 Currently using a modern method 0.526 0.016 1328 968 1.186 0.030 0.494 0.558 Currently using pill 0.222 0.015 1328 968 1.314 0.068 0.192 0.252 Currently using IUD 0.028 0.004 1328 968 0.955 0.143 0.020 0.036 Currently using injections 0.057 0.009 1328 968 1.477 0.158 0.039 0.075 Currently using condom 0.132 0.012 1328 968 1.258 0.091 0.108 0.156 Currently using female sterilization 0,079 0.009 t 328 968 1.179 0.114 0.061 0.097 Currently using male sterilization 0.007 0.002 1328 968 0.938 0.286 0.003 0.011 Currently using rhythm 0.050 0.005 1328 968 0.915 0.100 0.040 0.060 Currently using withdrawal 0.035 0.006 1328 968 1.172 0.171 0.023 0.047 Using public sector source 0.227 0.022 680 514 1.364 0.097 0.183 0.271 Want no more children 0.492 0,015 1328 968 1.123 0.030 0,462 0.522 Want to delay at least 2 years 0,227 0,011 1328 968 0.921 0,048 0.205 0.249 Ideal number of children 2.265 0.022 1419 1045 1.257 0.010 2.22t 2.309 Mothers received tetanus injection 0.896 0.014 802 557 1,087 0,016 0.868 0,924 Mothers received medical care at birth 0.348 0,020 802 557 1.038 0.057 0.308 0.388 Had diarrhea in the last 2 weeks 0.080 0.012 738 516 1.182 0.150 0,056 0.104 Treated with ORS packets 0.712 0.056 53 41 0.914 0.079 0.600 0.824 Sought medical treatment 0.264 0.079 53 41 1.337 0,299 0,106 0.422 Having health card, seen 0.473 0.048 128 83 1.022 0,101 0.377 0.569 Received BCG vaccination 0.919 0,027 128 83 1.046 0.029 0.865 0.973 Received DPT vaccination (3 doses) 0,750 0.045 128 83 1.116 0.060 0.660 0.840 Received polio vaccination (3 doses) 0.652 0.049 128 83 1.089 0.075 0.554 0.750 Received measles vaccination 0.797 0.040 128 83 1.052 0.050 0.717 0.877 Fully immunized 0.582 0.052 128 83 1,125 0.089 0.478 0.686 Weight-for-height 0.128 0.016 635 448 1.154 0.125 0.096 0.160 Height-for-age 0.394 0.026 635 448 1.271 0.066 0,342 0.446 Weight-for-age 0,419 0.028 635 448 1.375 0.067 0.363 0.475 Total fertility rate (3 years) 2.105 0.109 NA 3818 1.056 0.052 1.887 2.323 Neonatal mortality rate (0-9 years) 40.646 5.450 1756 1221 1.056 0.134 29.746 51.546 Postneonatal mortality rate (0-9 years) 32.103 5.597 t757 1223 1.137 0.174 20.909 43.297 Infant mortality rate (0-9 yeers) 72.749 7.652 1757 1223 1.121 0.105 57.445 88.053 Child mortality rate (0-9 years) 25.331 5.184 1768 1228 1.252 0,205 14.963 35.699 Under-five mortality rate (0-9 years) 96.237 9.414 1769 1229 1.189 0.098 77.409 115.065 MEN No education 0.208 With secondary education or higher 0.619 Knowing any contraceptive method 1.000 Knowing any modern contracep, method 1.000 0,023 532 400 1.285 0.I l l 0,162 0.026 532 400 1.257 0.042 0.567 0.000 532 400 Und 0.000 1.000 0.000 532 400 Und 0.000 1.000 Ever used any contraceptive method 0.870 0.017 532 400 l.170 0.020 0.836 Currently using any method 0.707 0.025 532 400 1.253 0.035 0.657 Currently using a modern method 0.572 0.026 532 400 1.198 0.045 0.520 Currently using pill 0.267 0.023 532 400 1.221 0.086 0.221 Currently using IUD 0.022 0.006 532 400 0.957 0.273 0.010 Currently using injections 0,047 0,012 532 400 1.295 0.255 0.023 Currently using condom 0.148 0.019 532 400 1.237 0.128 0.110 Currently using female sterilization 0.083 0.015 532 400 1.232 0.181 0.053 Currently using male sterilization 0,004 0.003 532 400 1.117 0.750 0.000 Currently using rhythm 0.100 0.013 532 400 0.993 0,130 0.074 Currently using withdrawal 0.026 0.005 532 400 0.755 0.192 0.016 Want no more children 0.475 0.027 532 400 1.254 0.057 0.421 Want to delay at least 2 years 0,266 0~025 532 400 1.306 0,094 0.216 Ideal number of children 2.218 0.035 519 391 1.311 0.016 2.148 0.254 0.671 1.000 1.000 0.904 0.757 0.624 0.313 0.034 0.071 0.186 0.113 0.010 0.126 0,036 0.529 0,316 2.288 NA = Not applicable Und = Undefined 164 Table B.4 Sampling errors - Rural sample~ Bangladesh 1996-97 Number of cases Standard Design Relative Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) Confidence limits R-2SE R+2SE WOMEN No education 0.571 0.011 7678 8064 1.883 0.019 0.549 0.593 With secondary education or higher 0.150 0.007 7678 8064 1.747 0.047 0.136 0.164 Currently married 0.928 0.003 7678 8064 1.111 0.003 0.922 0.934 Children ever born 3.384 0.033 6995 7350 1.109 0.010 3.318 3.450 Children ever born to women over 40 3.326 0.032 7122 7482 1.072 0.010 3.262 3.390 Children surviving 2.809 0.027 6995 7350 1.126 0.010 2.755 2.863 Knowing any contraceptive method 1.000 0.000 7122 7482 1.090 0.000 1.000 1.000 Knowing any modern contracep, method 1.000 0.000 7122 7482 1.090 0.000 1.000 1.000 Ever used any contraceptive method 0.705 0.008 7122 7482 1.403 0.011 0.689 0.721 Currently using any method 0.476 0.008 7122 7482 1.436 0.017 0.460 0.492 Currently using a modern method 0.401 0.008 7122 7482 1.373 0.020 0.385 0.417 Currently using pill 0.206 0.006 7122 7482 1.255 0.029 0.194 0.218 Currently using IUD 0.017 0.002 7122 7482 1.151 0.118 0.013 0.021 Currently using injections 0.063 0.004 7122 7482 1.323 0.063 0.055 0.071 Currently using condom 0.027 0.002 7122 7482 1.175 0.074 0.023 0.031 Currently using female sterilization 0.076 0.004 7122 7482 1.402 0.053 0.068 0.084 Currently using male sterilization 0.012 0.002 7122 7482 1.390 0.167 0.008 0.016 Currently using rhythm 0.050 0.003 7122 7482 1.348 0.060 0.044 0.056 Currently using withdrawal 0.017 0.002 7122 7482 1.035 0.118 0.013 0.021 Using public sector source 0.373 0.011 2872 3046 1.231 0.029 0.351 0.395 Want no more children 0.491 0.007 7122 7482 1.126 0.014 0.477 0.505 Want to delay at least 2 years 0.216 0.005 7 t 22 7482 1.066 0.023 0.206 0.226 Ideal number of children 2.509 0.015 7171 7555 1.533 0.006 2.479 2.539 Mothers received tetanus injection 0.733 0.012 5387 5673 1.725 0.016 0.709 0.757 Mothers received medical care at birth 0.054 0.005 5387 5673 1.491 0.093 0.044 0.064 Had diarrhea in the last 2 weeks 0.076 0.005 4862 5138 1.344 0.066 0.066 0.086 Treated with ORS packets 0.457 0.034 356 389 1.260 0.074 0.389 0.525 Sought medical treatment 0.217 0.020 356 389 0.896 0.092 0.177 0.257 Having health card, seen 0.418 0.020 952 999 1.274 0.048 0.378 0.458 Received BeG vaccination 0.857 0.016 952 999 1.378 0.019 0.825 0.889 Received DPT vaccination (3 doses) 0.688 0.020 952 999 1.338 0.029 0.648 0.728 Received polio vaccination (3 doses) 0.621 0.020 952 999 1.296 0.032 0.581 0.661 Received measles vaccination 0.691 0.018 952 999 1.224 0.026 0.655 0.727 Fully immunized 0.537 0.020 952 999 1.214 0.037 0.497 0.577 Weight-for-height 0.182 0.007 4101 4339 1.186 0.038 0.168 0.196 Height-for-age 0.562 0.008 4101 4339 1.025 0.014 0.546 0.578 Weight-for-age 0.578 0.009 4101 4339 1.144 0.016 0.560 0.596 Total fertility rate (3 years) 3.433 0.087 NA 25501 1.411 0.025 3.259 3.607 Neonatal mortality rate (0-9 years) 56.016 2.481 11747 12371 1.068 0.044 51.054 60.978 Posmeonatal mortality rate (0-9 years) 35.220 2.097 11762 12388 1.139 0.060 31.026 39.414 lnfant mortality rate (0-9 years) 91.237 3.131 11764 12390 1.084 0.034 84.975 97.499 Child mortality rate (0-9 years) 43.674 2.624 11850 12484 1.208 0.060 38.426 48.922 Under-five mortality rate (0-9 years) 130.926 4.071 11869 12504 1.195 0.031 122.784 139.068 MEN No education 0.449 With secondary education or higher 0.248 Knowing any contraceptive method 0.999 Knowing any modern contracep, method 0.998 0.013 2780 2912 0.011 2780 2912 0.001 2780 2912 0.001 2780 2912 Ever used any contraceptive method 0.738 0.011 2780 2912 Currently using any method 0.581 0.012 2780 2912 Currently using a modern method 0.473 0.010 2780 2912 Currently using pill 0.242 0.009 2780 2912 Currently using IUD 0.016 0.003 2780 2912 Currently using injections 0.074 0.006 2780 2912 Currently using condom 0.045 0.004 2780 2912 Currently using female sterilization 0.079 0.006 2780 2912 Currently using male sterilization 0.017 0.003 2780 2912 Currently using rhythm 0.083 0.006 2780 2912 Currently using withdrawal 0.013 0.002 2780 2912 Want no more children 0.488 0.010 2780 2912 Want to delay at least 2 years 0.206 0.008 2780 2912 Ideal number of children 2.481 0.021 2578 2705 1.360 0.029 0.423 0.475 1.346 0.044 0.226 0.270 1.127 0.001 0.997 1.000 1.108 0.001 0.996 1.000 1.296 0.015 0.716 0.760 1.241 0.021 0.557 0.605 1.102 0.021 0.453 0.493 1.066 0.037 0.224 0.260 1.064 0.188 0.010 0.022 1.196 0.081 0.062 0.086 1.064 0.089 0.037 0.053 1.199 0.076 0.067 0.091 1.296 0.176 0.011 0.023 1.212 0.072 0.071 0.095 0.933 0.154 0.009 0.017 1.069 0.020 0.468 0.508 1.054 0.039 0.190 0.222 1.326 0.008 2.439 2.523 NA = Not applicable 165 Table B.5 Sampling errors - Barisal~ Bangladesh 1996-97 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.300 0.033 937 With secondary education or higher 0.222 0.035 937 Currently married 0.937 0,005 937 Children ever born 3.316 0.123 864 Children ever born to women over 40 3.260 0.121 879 Children surviving 2.782 0.097 864 Knowing any contraceptive method 1.000 0.000 879 Knowing any modern contracep, method 1.000 0.000 879 Ever used any contraceptive method 0.760 0.027 879 Currently using any method 0.494 0.027 879 Currently using a modern method 0.410 0.028 879 Currently using pill 0.208 0.022 879 Currently using IUD 0.021 0.005 879 Currently using injections 0.070 0.011 879 Currently using condom 0.038 0.009 879 Currently using female sterilization 0.061 0.010 879 Currently using male sterilization 0.012 0,004 879 Currently using rhythm 0.046 0.011 879 Currently using withdrawal 0.026 0.005 879 Using public sector source 0.408 0.043 370 Want no more children 0.503 0.025 879 Want to delay at least 2 years 0.242 0.020 879 Ideal number of children 2.495 0.045 911 Mothers received tetanus injection 0.760 0.036 641 Mothers received medical care at birth 0.085 0.025 641 Had diarrhea in the last 2 weeks 0.031 0.006 575 Treated with ORS packets 0.406 0.108 18 Sought medical treatment 0.178 0.096 18 Having health card, seen 0.533 0.052 115 Received BCG vaccination 0.911 0.040 115 Received DPT vaccination (3 doses) 0.764 0.048 115 Received polio vaccination (3 doses) 0.718 0.040 115 Received measles vaccination 0.775 0.053 115 Fully immunized 0.624 0.045 115 Weight-for-height 0.135 0.023 497 Height-for-age 0.599 0.022 497 Weight-for-age 0.554 0.036 497 Total fertility rate (3 years) 3.314 0.231 NA Neonatal mortality rate (0-9 years) 53.136 6.493 1398 Posmeonatal mortality rate (0-9 years) 33.115 5.968 1399 Infant mortality rate (0-9 years) 86.252 7.325 1400 Child mortality rate (0-9 years) 36.363 4.260 1406 Under-five mortality rate (0-9 years) 119.478 7.093 1409 MEN No education 0.305 0.047 With secondary education or higher 0.392 0.058 Knowing any contraceptive method 1.000 0.000 Knowing any modern contracep, method 1.000 0.000 Ever used any contraceptive method 0.773 0.036 Currently using any method 0.590 0.034 Currently using a modern method 0.471 0.026 Currently using pill 0.263 0.026 Currently using IUD 0.010 0.006 Currently using injections 0.078 0.016 Currently using condom 0.051 0.016 Currently using female sterilization 0.047 0.014 Currently using male sterilization 0.021 0.009 Currently using rhythm 0.089 0.020 Currently using withdrawal 0.016 0.008 Want no more children 0.541 0.030 Want to delay at least 2 years 0.225 0.027 Ideal number of children 2.448 0.059 598 2.173 0.110 0.234 0.366 598 2.551 0.158 0.152 0.292 598 0.658 0.005 0.927 0.947 550 1.476 0.037 3.070 3.562 560 1.456 0.037 3.018 3.502 550 1.416 0.035 2.588 2.976 560 Und 0.000 1.000 1.000 560 Und 0.000 1.000 1.000 560 1.891 0.036 0.706 0.814 560 1.572 0.055 0.440 0.548 560 1.714 0.068 0.354 0.466 560 1.601 0.106 0.164 0.252 560 1.114 0.238 0.011 0.031 560 1.250 0.157 0.048 0.092 560 1,335 0.237 0.020 0.056 560 1.192 0.164 0.041 0.081 560 1.066 0.333 0.004 0.020 560 1.537 0.239 0.024 0,068 560 0.854 0.192 0.016 0.036 234 1.697 0.105 0.322 0.494 560 1.488 0.050 0.453 0.553 560 1.400 0.083 0.202 0.282 580 1.751 0.018 2.405 2.585 408 1.857 0.047 0.688 0.832 408 2.103 0.294 0.035 0.135 367 0.799 0.194 0.019 0.043 11 0.862 0.266 0,190 0.622 11 1.049 0.539 0,000 0.370 75 1.114 0.098 0.429 0.637 75 1.523 0.044 0.831 0.991 75 1.221 0.063 0.668 0.860 75 0.972 0.056 0.638 0.798 75 1.367 0.068 0.669 0.881 75 1.012 0.072 0.534 0.714 317 1.549 0.170 0.089 0.181 317 0.999 0.037 0.555 0.643 317 1.541 0.065 0.482 0.626 1918 1.273 0.070 2.852 3.776 892 0.967 0.122 40.150 66.122 892 0.971 0.180 21.179 45.051 893 0.832 0.085 71.602 100.902 897 0.881 0,117 27.843 44.883 899 0.759 0.059 105.292 133.664 315 200 1.806 0.154 0.211 0.399 315 200 2.094 0.148 0.276 0.508 315 200 Und 0.000 1.000 1.000 315 200 Und 0.000 1.000 1.000 315 200 1.531 0.047 0.701 0.845 315 200 1.228 0.058 0.522 0.658 315 200 0.938 0.055 0.419 0.523 315 200 1.042 0.099 0.211 0.315 315 200 1.051 0.600 0.000 0.022 315 200 1.041 0.205 0.046 0.110 315 200 1.327 0.314 0.019 0.083 315 200 1.173 0.298 0.019 0.075 315 200 1.064 0.429 0.003 0.039 315 200 1.268 0.225 0.049 0.129 315 200 1.149 0.500 0.000 0.032 315 200 1.071 0.055 0.481 0.601 315 200 1.165 0.120 0.171 0.279 300 189 1.421 0.024 2.330 2.566 NA = Not applicable Und = Undefined 166 Table B.6 Sampling errors - Chittagong~ Bangladesh 1996-97 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0,510 0.027 1359 1836 1.975 0.053 0.456 0.564 With secondary education or higher 0.232 0.020 1359 1836 1.757 0,086 0.192 0.272 Currently married 0.927 0.008 1359 1836 1.195 0.009 0.911 0.943 Children ever born 3.685 0.080 1248 1686 1,059 0.022 3.525 3.845 Children ever born to women over 40 3.654 0.075 1259 1701 1.000 0.021 3.504 3,804 Children surviving 3.069 0.057 1248 1686 0.958 0.019 2.955 3.183 Knowing any contraceptive method 0.999 0~001 1259 1701 1.034 0.001 0.997 1.000 Knowing any modern contracep, method 0.999 0.001 1259 1701 1.034 0.001 0.997 1.000 Ever used any contraceptive method 0.637 0.021 1259 1701 1.551 0.033 0.595 0.679 Currently using any method 0.372 0.021 1259 1701 1,509 0,056 0.330 0.414 Currently using a modern method 0.308 0.018 1259 1701 1.359 0.058 0.272 0.344 Currently using pill 0.131 0.013 1259 1701 1.351 0.099 0.105 0,157 Currently using IUD 0.026 0.005 1259 1701 1.006 0.192 0.016 0.036 Currently using injections 0.055 0.008 1259 1701 1.183 0.145 0.039 0.071 Currently using condom 0.032 0.007 1259 1701 1,449 0.219 0.018 0.046 Currently using female sterilization 0.058 0.010 1259 1701 1.458 0.172 0.038 0.078 Currently using male sterilization 0.005 0.002 1259 1701 0,897 0.400 0.001 0.009 Currently using rhythm 0.042 0.006 1259 1701 1.133 0.143 0.030 0.054 Currently using withdrawal 0.011 0.003 1259 1701 1,072 0.273 0.005 0.017 Using public sector source 0.420 0.023 415 532 0.957 0.055 0,374 0.466 Want no more children 0.491 0.016 1259 1701 1.113 0.033 0.459 0.523 Want to delay at least 2 years 0.220 0.012 1259 1701 1.010 0.055 0.196 0.244 Ideal numbar of children 2,775 0,048 1234 1659 1.778 0.017 2.679 2.871 Mothers received tetanus injection 0.728 0,030 1122 1541 1.883 0.041 0.668 0.788 Mothars received medical care at birth 0.078 0.013 1122 1541 1.519 0,167 0.052 0.104 Had diarrhea in the last 2 weeks 0.087 0.014 1022 1403 1.491 0.161 0.059 0.115 Treated with ORS packets 0.482 0.080 87 121 1.405 0.166 0,322 0.642 Sought medical treatment 0.215 0.034 87 121 0.742 0.158 0,147 0,283 Having health card. seen 0.371 0.039 187 258 1.116 0.105 0,293 0,449 Received BCG vaccination 0.822 0.029 187 258 1.047 0.035 0,764 0.880 Received DPT vaccination (3 doses) 0.638 0.040 187 258 1.158 0,063 0,558 0.718 Received polio vaccination (3 doses) 0,587 0.046 187 258 1.281 0.078 0,495 0.679 Received measles vaccination 0.655 0.041 187 258 1.165 0.063 0,573 0,737 Fully immunized 0.510 0,044 187 258 1.196 0.086 0.422 0.598 Weight-for-height 0.213 0.017 855 1175 1.196 0.080 0.179 0.247 Height-for-age 0.544 0.016 855 1175 0.950 0.029 0,512 0.576 Weight-for-age 0.600 0.017 855 1175 0.977 0.028 0.566 0.634 Total fertility rate (3 years) 4.061 0,175 NA 6233 1,215 0.043 3.711 4.411 Neonatal mortality rate (0-9 years) 42.042 4.877 2382 3255 1.139 0.116 32.288 51.796 Posmeonatal mortality rate (0-9 years) 34.742 4.649 2383 3257 1.094 0.134 25.444 44.040 Infant mortality rate (0-9 years) 76.783 6.019 2383 3257 1.036 0.078 64.745 88.821 Child mortality rate (0-9 years) 59.024 6.123 2408 3292 0.997 0.104 46.778 71.270 Under-five mortality rate (0-9 years) 131.276 9.526 2409 3294 1.237 0.073 112.224 150.328 MEN No education 0.349 With secondary education or higher 0.315 Knowing any contraceptive method 0.997 Knowing any modern contracep, method 0.997 0.033 411 584 1.382 0,095 0.283 0.415 0.031 411 584 1,352 0.098 0.253 0.377 0.003 411 584 1.027 0.003 0,991 1.000 0.003 411 584 1.027 0,003 0.991 1.000 Ever used any contraceptive method 0.690 0.027 411 584 1.189 0.039 0.636 0.744 Currently using any method 0,547 0.032 411 584 1.305 0.059 0.483 0.611 Currently using a modern method 0.406 0.022 411 584 0.920 0.054 0.362 0,450 Currently using pill 0.173 0.026 411 584 1.393 0.150 0,121 0.225 Currently using IUD 0.027 0,007 411 584 0.899 0.259 0.013 0.041 Currently using injections 0.078 0.014 411 584 1.052 0.179 0.050 0.106 Currently using condom 0.046 0.013 411 584 1.256 0.283 0,020 0.072 Currently using female sterilization 0.074 0,015 411 584 1.185 0.203 0,044 0.104 Currently using male sterilization 0.007 0.004 411 584 1.025 0.571 0.000 0,015 Currently using rhythm 0.117 0.019 411 584 1.173 0,162 0.079 0.155 Currently using withdrawal 0.004 0,003 411 584 0,962 0,750 0.000 0.010 Want no more children 0.473 0.025 411 584 1.031 0,053 0.423 0.523 Want to delay at least 2 years 0.229 0.021 411 584 1,000 0.092 0.187 0.271 Ideal number of children 2.697 0.066 370 522 1.316 0.024 2.565 2.829 NA = Not applicable 167 Table B.7 Sampling errors - Dhaka. Bangladesh 1996-97 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.576 0.018 2529 With secondary education or higher 0.188 0.009 2529 Currently married 0.922 0.006 2529 Children ever born 3.279 0.052 2290 Children ever born to women over 40 3.220 0.052 2334 Children surviving 2.723 0.047 2290 Knowing any contraceptive method 1.000 0.000 2334 Knowing any modern contracep, method 1.000 0.000 2334 Ever used any contraceptive method 0.742 0.011 2334 Currently using any method 0.498 0.014 2334 Currently using a modern method 0.421 0.014 2334 Currently using pill 0.219 0.009 2334 Currently using IUD 0.012 0.002 2334 Currently using injections 0.052 0.006 2334 Currently using condom 0.050 0.004 2334 Currently using female sterilization 0.080 0.008 2334 Currently using male sterilization 0.006 0.002 2334 Currently using rhythm 0.049 0.005 2334 Currently using withdrawal 0.021 0.003 2334 Using public sector source 0.328 0.018 1005 Want no more children 0.501 0.010 2334 Want to delay at least 2 years 0.210 0.008 2334 Ideal number of children 2.432 0.021 2400 Mothers received tetanus injection 0.738 0.020 1665 Mothers received medical care at birth 0.091 0.007 1665 Had diarrhea in the last 2 weeks 0.077 0.008 1512 Treated with ORS packets 0.488 0.050 118 Sought medical treatment 0.226 0.040 118 Having health card, seen 0.382 0.038 275 Received BCG vaccination 0.827 0.035 275 Received DPT vaccination (3 doses) 0.659 0.042 275 Received polio vaccination (3 doses) 0.60i 0.038 275 Received measles vaccination 0.648 0.036 275 Fully immunized 0.493 0.038 275 Weight-for-height 0.155 0.011 1306 Height-for-age 0.558 0.014 1306 Weight-for-age 0.548 0.018 1306 Total fertility rate (3 years) 3.177 0.130 NA Neonatal mortality rate (0-9 years) 52.008 4.341 3639 Postneonatal mortality rate (0-9 years) 38.835 3.551 3648 Infant mortality rate (0-9 years) 90.843 5.396 3648 Child mortality rate (0-9 years) 43.812 4.172 3675 Under-five mortality rate (0-9 years) 130.675 6.725 3684 MEN No education 0.430 0.019 With secondary education or higher 0.315 0.018 Knowing any contraceptive method 1.000 0.000 Knowing any modern contracep, method 0.999 0.001 Ever used any contraceptive method 0.746 0.020 Currently using any method 0.605 0.021 Currently using a modern method 0.497 0.020 Currently using pill 0.276 0.014 Currently using IUD 0.009 0.003 Currently using injections 0.061 0.010 Currently using condom 0.067 0.008 Currently using female sterilization 0.076 0.011 Currently using male sterilization 0.006 0.003 Currently using rhythm 0.088 0.009 Currently using withdrawal 0.012 0.003 Want no more children 0.480 0.017 Want to delay at least 2 years 0.216 0.016 Ideal number of children 2.448 0.033 2882 1.855 0.031 0.540 0.612 2882 1.180 0.048 0.170 0.206 2882 1.073 0.007 0.910 0.934 2606 1.036 0.016 3.175 3.383 2656 1.022 0.016 3.116 3.324 2606 1.166 0.017 2.629 2.817 2656 Und 0.000 1.000 1.000 2656 Und 0.000 1.000 1.000 2656 1.191 0.015 0.720 0.764 2656 1.389 0.028 0.470 0.526 2656 1.347 0.033 0.393 0.449 2656 1.089 0.041 0.201 0.237 2656 0.839 0.167 0.008 0.016 2656 1.238 0.115 0.040 0.064 2656 0.933 0.080 0.042 0.058 2656 1.338 0.100 0.064 0.096 2656 0.939 0.333 0.002 0.010 2656 1.158 0.102 0.039 0.059 2656 1.147 0.143 0.015 0.027 1137 1.197 0.055 0.292 0.364 2656 0.962 0.020 0.481 0.521 2656 0.995 0.038 0.194 0.226 2731 1.324 0.009 2.390 2.474 1902 1.636 0.027 0.698 0.778 1902 0.901 0.077 0.077 0.105 1729 1.212 0.104 0.061 0.093 134 1.067 0.102 0.388 0.588 134 1.000 0.177 0.146 0.306 316 1.298 0.099 0.306 0.458 316 1.548 0.042 0.757 0.897 316 1.488 0.064 0.575 0.743 316 1.289 0.063 0.525 0.677 316 1.254 0.056 0.576 0.720 316 1.268 0.077 0.417 0.569 1494 1.057 0.071 0.133 0.177 1494 0.982 0.025 0.530 0.586 1494 1.312 0.033 0,512 0.584 9203 1.302 0.041 2.917 3.437 4170 1.072 0.083 43.326 60.690 4181 1.046 0.091 31.733 45.937 4181 1.064 0,059 80.051 101.635 4212 1.141 0.095 35.468 52.156 4223 1.159 0.051 117.225 144.125 950 1056 1.201 0.044 0.392 0.468 950 1056 1.225 0.057 0.279 0.351 950 1056 Und 0.000 1.000 1.000 950 1056 1.013 0.001 0.997 1.001 950 1056 1.416 0.027 0.706 0.786 950 1056 1.327 0.035 0.563 0.647 950 1056 1.209 0.040 0,457 0.537 950 1056 0.959 0.051 0.248 0.304 950 1056 0.872 0.333 0.003 0.015 950 1056 1.336 0.164 0.041 0.081 950 1056 0.945 0.119 0.051 0.083 950 1056 1.253 0.145 0.054 0.098 950 1056 1.013 0.500 0.000 0.012 950 1056 1.014 0.102 0.070 0.106 950 1056 0.990 0.250 0.006 0.018 950 1056 1.020 0.035 0.446 0.514 950 1056 1.162 0.074 0.184 0.248 883 980 1.330 0.013 2.382 2.514 NA = Not applicable UOd = Undefined 168 Table B.8 Sampling errors - Khulna~ Bangladesh 1996-97 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEBT) (SE/R) R-2SE R+2SE WOMEN No education 0.479 0.014 1084 With secondary education or higher 0.193 0.015 I084 Currently married 0.924 0.010 1084 Children ever born 2.992 0.087 985 Children ever born to women over 40 2.939 0.088 1003 Children surviving 2.612 0.074 985 Knowing any contraceptive method 1.000 0.000 1003 Knowing any modern contracep, method 1.000 0.000 1003 Ever used any contraceptive method 0.807 0.012 1003 Currently using any method 0.619 0.016 1003 Currently using a modern method 0.510 0.019 1003 Currently using pill 0.266 0.019 1003 Currently using IUD 0.024 0.007 1003 Currently using injections 0.091 0.011 1003 Currently using condom 0.038 0.006 1003 Currently using female sterilization 0.077 0.011 1003 Currently using male sterilization 0.012 0.004 1003 Currently using rhythm 0.070 0.012 1003 Currently using withdrawal 0.033 0.006 1003 Using public sector source 0.299 0.026 519 Want no more children 0.517 0.015 1003 Want to delay at least 2 years 0.213 0.012 1003 Ideal number of children 2.285 0.029 1051 Mothers received tetanus injection 0.846 0.015 595 Mothers received medical care at birth 0.143 0.017 595 Had diarrhea in the last 2 weeks 0.087 0.009 549 Treated with ORS packets 0.514 0.068 46 Sought medical treatment 0.220 0.063 46 Having health card, seen 0.595 0.056 117 Received BCG vaccination 0.969 0.015 117 Received DPT vaccination (3 doses) 0.855 0.035 117 Received polio vaccination (3 doses) 0.740 0.041 117 Received measles vaccination 0.871 0.028 117 Fully immunized 0.683 0.043 117 Weight-for-height 0.175 0.019 464 Height-for-age 0.465 0.023 464 Weight-for-age 0.498 0.022 464 Total fertility rate (3 years) 2.520 0.130 NA Neonatal mortality rate (0-9 years) 51.840 6.405 1314 Posmeonatal mortality rate (0-9 years) 23.325 4.382 1316 Infant mortality rate (0-9 years) 75.165 7.180 1317 Child mortality rate (0-9 years) 12.543 2.987 1317 Under-five mortality rate (0-9 years) 86.765 6.974 1321 MEN No education 0.389 0.021 406 With secondary education or higher 0.305 0.025 406 Knowing any contraceptive method 1.0{30 0.000 406 Knowing any modern contracep, method 1.000 0.000 406 Ever used any contraceptive method 0.853 0.017 406 Currently using any method 0.681 0.020 406 Currently using a modern method 0.548 0.023 406 Currently using pill 0.289 0.024 406 Currently using IUD 0.028 0.011 406 Currently using injections 0.087 0.015 406 Currently using condom 0.055 0.011 406 Currently using female sterilization 0.073 0.017 406 Currently using male sterilization 0.017 0.006 406 Currently using rhythm 0.086 0.014 406 Currently using withdrawal 0.041 0.006 406 Want no more children 0.509 0.024 406 Want to delay at least 2 years 0.223 0.015 406 Ideal number of children 2.264 0.054 395 1107 0.930 0.029 0.451 0.507 1107 1.214 0.078 0.163 0.223 1107 1.230 0.011 0.904 0.944 1005 1.226 0.029 2.818 3.166 1024 1.243 0.030 2.763 3.115 1005 1.218 0.028 2.464 2.760 1024 Und 0.000 1.000 1.000 1024 Und 0.000 1.000 1.000 1024 0.943 0.015 0.783 0.831 1024 1.059 0.026 0.587 0.651 1024 1.203 0.037 0.472 0.548 1024 1.355 0.071 0.228 0.304 1024 1.421 0.292 0.010 0.038 1024 1.211 0.121 0.069 0.113 1024 0.937 0.158 0.026 0.050 1024 1.299 0.143 0.055 0.099 1024 1.143 0.333 0.004 0.020 1024 1.509 0.171 0.046 0.094 1024 1.015 0.182 0.021 0.045 529 1.277 0.087 0.247 0.351 1024 0.933 0.029 0.487 0.547 1024 0.925 0.056 0.189 0.237 1073 1.323 0.013 2.227 2.343 614 0.922 0.018 0.816 0.876 614 1.085 0.119 0.109 0.177 567 0.764 0.103 0.069 0.105 49 0.924 0.132 0.378 0.650 49 1.053 0.286 0.094 0.346 122 1.244 0.094 0.483 0.707 122 0.982 0.015 0.939 0.999 122 1.102 0.041 0.785 0.925 122 1.019 0.055 0.658 0.822 122 0.900 0.032 0.815 0.927 122 1.010 0.063 0.597 0.769 479 1.108 0.109 0.137 0.213 479 1.002 0.049 0.419 0.511 479 0.939 0.044 0.454 0.542 3453 1.121 0.052 2.260 2.780 1357 0.976 0.124 39.030 64.650 1359 1.006 0.188 14.561 32.089 1361 0.924 0.096 60.805 89.525 1361 0.952 0.238 6.569 18.517 1365 0.882 0.080 72.817 100.713 428 0.862 0.054 0.347 0.431 428 1.073 0.082 0.255 0.355 428 UOd 0.000 1.000 1.000 428 Und 0.000 1.000 1.000 428 0.957 0.020 0.819 0.887 428 0.857 0.029 0.641 0.721 428 0.947 0.042 0.502 0.594 428 1.053 0.083 0.241 0.337 428 1.289 0.393 0.006 0.050 428 1.093 0.172 0.057 0.117 428 0.994 0.200 0.033 0.077 428 1.317 0.233 0.039 0.107 428 1.023 0.353 0.005 0.029 428 0.990 0.163 0.058 0.114 428 0.651 0.146 0.029 0.053 428 0.983 0.047 0.461 0.557 428 0.710 0.067 0.193 0.253 415 1.518 0.024 2.156 2.372 NA = Not applicable Und = Undefined 169 Table B.9 Sampling errors - Rajshahi, Bangladesh 1996-97 Value Variable (R) Number of cases Standard Design Relative Confidence limits error Unweighted Weighted effect error (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.610 0,018 2314 With secondary education or higher 0.131 0.013 2314 Currently married 0.932 0.005 2314 Children ever born 3.057 0.055 2111 Children ever born to women over 40 2.995 0.052 2154 Children surviving 2.554 0.044 2111 Knowing any contraceptive method 1.000 0.001 2154 Knowing any modern contracep, method 1.000 0.001 2154 Ever used any contraceptive method 0.796 0.012 2154 Currently using any method 0,586 0.013 2154 Currently using a modern method 0,510 0.011 2154 Currently using pill 0,263 0.011 2154 Currently using IUD 0,015 0,003 2154 Currently using injections 0,068 0.009 2154 Currently using condom 0,036 0,004 2154 Currently using female sterilization 0.101 0.009 2154 Currently using male sterilization 0.024 0.006 2154 Currently using rhythm 0.053 0.007 2154 Currently using withdrawal 0.016 0,002 2154 Using public sector source 0.348 0,020 1102 Want no more children 0.478 0.013 2154 Want to delay at least 2 years 0,226 0.009 2154 Ideal number of children 2,328 0,018 2266 Mothers received tetanus injection 0,773 0.016 1396 Mothers received medical care at birth 0,049 0.008 1396 Had diarrhea in the last 2 weeks 0.070 0,009 1272 Treated with ORS packets 0,467 0.063 88 Sought medical treatment 0.248 0.035 88 Having health card, seen 0.425 0.042 251 Received BCG vaccination 0.912 0.026 251 Received DPT vaccination (3 doses) 0.741 0.035 251 Received polio vaccination (3 doses) 0.649 0.040 251 Received measles vaccination 0.749 0.029 251 Fully immunized 0.580 0.033 25 l Weight-for-height 0.175 0.014 1070 Height-for-age 0.534 0.016 1070 Weight-for-age 0.555 0.016 1070 Total fertility rate (3 years) 2.784 0.112 NA Neonatal mortality rate (0-9 years) 64.349 4.357 3158 Posmeonatal mortality rate (0-9 years) 30.251 4.126 3160 Infant mortality rate (0-9 years) 94.601 6.178 3160 Child mortality rate (0-9 years) 34.941 4.516 3184 Under-five mortality rate (0-9 years) 126.237 7.574 3186 MEN No education 0.480 0.025 With secondary education or higher 0.243 0.017 Knowing any contraceptive method 1.000 0.000 Knowing any modern contracep, method 1.000 0.000 Ever used any contraceptive method 0.829 0.014 Currently using any method 0.642 0.017 Currently using a modern method 0.553 0.017 Currently using pill 0.264 0.012 Currently using IUD 0.015 0.004 Currently using injections 0.075 0.010 Currently using condom 0.061 0.008 Currently using female sterilization 0.106 0.010 Currently using male sterilization 0.032 0.009 Currently using rhythm 0.063 0.011 Currently using withdrawal 0.015 0.004 Want no more children 0.491 0.020 Want to delay at least 2 years 0.198 0.014 Ideal number of children 2.311 0.024 2198 1.796 0.030 0.574 0.646 2198 1.829 0.099 0.105 0.157 2198 0.981 0.005 0,922 0.942 2006 1.113 0.018 2.947 3.167 2049 1.055 0.017 2.891 3.099 2006 1.079 0.017 2.466 2.642 2049 1.038 0.001 0.998 1.000 2049 1.038 0.001 0,998 1.000 2049 1.375 0.015 0.772 0.820 2049 1.207 0.022 0.560 0.612 2049 1.019 0.022 0.488 0,532 2049 1,152 0.042 0,241 0.285 2049 1,039 0.200 0,009 0,021 2049 1,570 0.132 0,050 0,086 2049 1.069 0.111 0.028 0.044 2049 1.317 0.089 0.083 0.119 2049 1.700 0.250 0,012 0.036 2049 1.381 0.132 0,039 0.067 2049 0.806 0.125 0.012 0.020 1054 1.398 0.057 0.308 0,388 2049 1.248 0.027 0.452 0,504 2049 1.018 0,040 0.208 0.244 2152 1.312 0.008 2.292 2,364 1331 1.291 0.021 0.741 0.805 1331 1.375 0.163 0,033 0.065 1213 1.254 0.129 0.052 0,088 85 1.145 0.135 0.341 0.593 85 0.765 0.141 0.178 0.318 236 1.325 0.099 0,341 0.509 236 1.425 0.029 0,860 0.964 236 1.251 0.047 0.671 0.811 236 1.325 0.062 0.569 0.729 236 1.037 0.039 0.691 0.807 236 1.049 0.057 0.514 0.646 1017 1.226 0.080 0.147 0.203 1017 1.038 0.030 0.502 0.566 1017 1.047 0.029 0.523 0.587 6684 1,242 0.040 2.560 3.008 3011 0.930 0.068 55.635 73.063 3013 1.291 0.136 21.999 38.503 3013 1.076 0.065 82.245 106.957 3034 1.225 0.129 25.909 43.973 3036 1.121 0.060 1II.089 141.385 934 877 1.512 0.052 0.430 0.530 934 877 1.184 0.070 0.209 0.277 934 877 Und 0.000 1.000 1.000 934 877 Und 0.000 1.1300 1.000 934 877 1.113 0.017 0.801 0.857 934 877 1.108 0.026 0.608 0.676 934 877 1.059 0.031 0.519 0.587 934 877 0.808 0.045 0.240 0.288 934 877 0.930 0.267 0.007 0.023 934 877 1.178 0.133 0.055 0.095 934 877 0.993 0.131 0.045 0.077 934 877 1.002 0.094 0.086 0.126 934 877 1.537 0.281 0.014 0.050 934 877 1.341 0.175 0.041 0.085 934 877 0.992 0.267 0.007 0.023 934 877 1.211 0.041 0.451 0.531 934 877 1.097 0.071 0.170 0.226 911 855 1.102 0.010 2.263 2.359 NA = Not applicable Und = Undefined 170 Table B, 10 Sampling errors - Sylhet, Bangladesh 1996-97 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE WOMEN No education 0.665 0.033 904 506 2.111 0.050 0,599 0.731 With secondary education or higher 0.112 0,021 904 506 2.046 0.188 0.070 0.154 Currently married 0.909 0.013 904 506 1.351 0.014 0.883 0.935 Children ever born 3.744 0.096 808 453 0.955 0.026 3.552 3.936 Children ever born to women over 40 3.693 0.097 821 460 0.969 0.026 3.499 3.887 Children surviving 2.952 0.076 808 453 0.958 0.026 2.800 3.104 Knowing any contraceptive method 0.997 0.003 821 460 1.464 0.003 0.991 1.000 Knowing any modern contracep, method 0.997 0.003 821 460 1.464 0.003 0.991 1.000 Ever used any contraceptive method 0.360 0.028 821 460 1.687 0,078 0,304 0,416 Currently using any method 0.201 0.024 821 460 1.697 0.119 0.153 0.249 Currently using a modern method 0.160 0.023 821 460 1.805 0.144 0.114 0.206 Currently using pill 0.054 0.011 821 460 1.408 0.204 0.032 0.076 Currently using IUD 0.015 0.005 821 460 1,149 0.333 0.005 0.025 Currently using injections 0.051 0.012 821 460 1.567 0.235 0.027 0.075 Currently using condom 0.014 0,004 821 460 1.10S 0.286 0.006 0.022 Currently using female sterilization 0.026 0,011 821 460 1.917 0,423 0.004 0.048 Currently using male sterilization 0.000 0.000 821 460 Und Und 0,000 0.000 Currently using rhythm 0.037 0.009 821 460 1,406 0.243 0.019 0.055 Currently using withdrawal 0.004 0.002 821 460 0,937 0.500 0.000 0.008 Using public sector source 0.492 0.058 141 75 1.375 0.118 0.376 0.608 Want no more children 0.422 0.019 821 460 1.088 0.045 0.384 0.460 Want to delay at least 2 years 0.191 0,019 821 460 1.393 0.099 0.153 0,229 Ideal number of children 2.883 0.079 728 404 2.051 0,027 2.725 3.041 Mothers received tetanus injection 0.624 0.041 770 434 1.958 0,066 0.542 0.706 Mothers received medical care at birth 0.052 0.012 770 434 1.305 0.231 0.028 0.076 Had diarrhea in the last 2 weeks 0.078 0,012 670 376 1.138 0.154 0.054 0.102 Treated with ORS packets 0.466 0.065 52 29 0.925 0.139 0.336 0.596 Sought medical treatment 0.169 0.072 52 29 1,386 0.426 0.025 0.313 Having health card, seen 0.369 0.050 135 75 1.200 0.I 36 0.269 0.469 Received BCG vaccination 0.765 0.041 135 75 I. I I0 0.054 0.683 0.847 Received DPT vaccination (3 doses) 0.538 0.047 135 75 1.083 0.087 0.444 0.632 Received polio vaccination (3 doses) 0.478 0.051 135 75 1.177 0.107 0.376 0.580 Received measles vaccination 0.560 0.059 135 75 1.381 0.105 0.442 0.678 Fully immunized 0.415 0.050 135 75 1.169 0.120 0.315 0.515 Weight-for-height 0.209 0.022 544 305 1.254 0.105 0.165 0.253 Height-for-age 0.614 0.029 544 305 1.352 0.047 0.556 0.672 Weight-for-age 0.640 0.019 544 305 0.906 0.030 0.602 0.678 Total fertility rate (3 years) 4.198 0.246 NA 1770 1.397 0.059 3.706 4.690 Neonatal mortality rate (0-9 years) 85.244 9,769 1612 908 1,206 0.115 65.706 104.782 Postneonatal mortality rate (0-9 years) 52.722 6.114 1613 908 1.046 0,116 40.494 64.950 Infant mortality rate (0-9 years) 137,966 12.203 1613 908 1.301 0.088 113.560 162.372 Child mortality rate (0-9 years) 47.753 6.349 1628 917 1.072 0.133 35.055 60.451 Under-five mortality rate (0-9 years) 179.130 13,518 1629 917 1,312 0.075 152.094 206.166 MEN No education 0,497 0.039 296 168 1.342 0.078 0.419 0.575 With secondary education or higher 0.183 0,032 296 168 1.419 0.175 0.119 0.247 Knowing any contraceptive method 0.985 0.010 296 168 1.434 0.010 0.965 1.000 Knowing any modern contracep, method 0.985 0,010 296 168 1.434 0.010 0,965 1.000 Ever used any contraceptive method 0.353 0,039 296 168 1.402 0.110 0,275 0.431 Currently using any method 0.263 0.027 296 168 1.064 0.103 0.209 0.317 Currently using a modern method 0.192 0.029 296 168 1.247 0.151 0.134 0,250 Currently using pill 0.067 0.015 296 168 1,046 0.224 0.037 0.097 Currently using IUD 0.025 0,013 296 168 1.399 0.520 0.000 0.051 Currently using injections 0.030 0.012 296 168 1.238 0.400 0.006 0.054 Currently using condom 0.032 0.015 296 168 1.494 0.469 0,002 0.062 Currently using female sterilization 0.030 0.013 296 168 1.350 0.433 0.004 0.056 Currently using male sterilization 0.007 0.005 296 168 1.078 0.714 0.000 0.017 Currently using rhythm 0,064 0.013 296 168 0.938 0.203 0.038 0.090 Currently using withdrawal 0,004 0,004 296 168 1.049 1.000 0.000 0.012 Want no more children 0,436 0.023 296 168 0.797 0.053 0,390 0.482 Want to delay at least 2 years 0.174 0.022 296 168 1.017 0.126 0.130 0.218 Ideal number of children 2,906 0.103 238 134 1.498 0.035 2.700 3.112 NA = Not applicable Und = Undefined 171 Table B.I 1 Sampling errors of differences between contraceptive orevalence rates from the 1993-94 and 1996-97 BDHSs (for the 301 clusters common to both surveys). Bangladesh 1996-97 Coeffici- Standard Value Standard Value Standard ant of Differ- error in error in error cone- ence difference Variable 1993-94 1993-94 1996-97 1996-97 lation (R) SE (SE/R) R-2SE R+2SE Confidence interval Currently using a method Total 0.446 0.007 0.495 0.008 0.7065 0.049 0.006 0.122 0.037 0.061 Urban 0.544 0.014 0.622 0.016 0.3707 0.078 0.017 0.218 0.044 0.112 Rural 0.433 0.008 0.478 0.009 0.7514 0.045 0.006 0.133 0.033 0.057 Barisal 0.477 0.021 0.494 0.027 0.7152 0.017 0.019 1.118 -0.021 0.055 Chittagong/Sylhet 0.293 0.017 0.345 0.018 0.7428 0.052 0.013 0.250 0,026 0.078 Dhaka 0.443 0.013 0.498 0.014 0.6036 0.055 0.012 0.218 0,031 0.079 Khulna 0.553 0.017 0,619 0.016 0.2005 0.066 0,021 0.318 0,024 0.108 Rajshahi 0.548 0.012 0,586 0.013 0.4216 0.038 0.013 0.342 0.012 0.064 Currently using a modern method Total 0.362 0.007 0,418 0.007 0.6629 0.056 0.006 0.107 0.044 0.068 Urban 0.446 0.014 0,527 0.016 0.2753 0.081 0.018 0.222 0,045 0.117 Rural 0.351 0.008 0.404 0.008 0.7188 0.053 0.006 0.113 0,041 0.065 Barisal 0.378 0.021 0.410 0.028 0.6284 0.032 0.022 0.688 -0.012 0.076 Chittagong/Sylbet 0.234 0.016 0.284 0.016 0.7657 0.050 0.011 0.220 0.028 0.072 Dhaka 0.363 0.013 0.421 0.014 0.4987 0.058 0.014 0.241 0.030 0.086 Khuloa 0.428 0.022 0.510 0,019 0.4330 0.082 0.022 0,268 0.038 0.126 Rajshahi 0,459 0.012 0.510 0,011 0.4245 0.051 0,012 0.235 0.027 0.075 172 APPENDIX C DATA QUALITY TABLES Table C.I Household aan distribution Single-year age distribution of the de facto household population by sex (weighted), Bangladesh 1996-97 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent <1 592 2.7 610 2.7 37 151 0.7 210 0.9 1 560 2.5 526 2.3 38 208 0.9 240 1.1 2 562 2.5 584 2.6 39 72 0.3 193 0.9 3 563 2.6 598 2.7 40 627 2.8 241 1.1 4 571 2.6 577 2.6 41 81 0.4 172 0.8 5 541 2.5 552 2.5 42 188 0.9 167 0.7 6 652 3.0 662 2.9 43 79 0.4 156 0.7 7 670 3.0 659 2.9 44 74 0.3 159 0.7 8 703 3.2 696 3.1 45 528 2.4 160 0,7 9 658 3.0 653 2.9 46 96 0.4 155 0.7 10 710 3.2 704 3.1 47 70 0.3 139 0,6 11 542 2.5 522 2.3 48 150 0.7 154 0.7 12 709 3.2 721 3.2 49 34 0.2 75 0.3 13 536 2.4 522 2.3 50 358 1.6 76 0,3 14 555 2.5 575 2.6 51 50 0.2 131 0.6 15 552 2.5 570 2.5 52 111 0.5 168 0,7 16 516 2.3 629 2.8 53 56 0.3 121 0.5 17 415 1.9 475 2.1 54 48 0.2 113 0.5 18 500 2.3 547 2.4 55 283 1.3 252 1.1 19 286 1.3 402 1.8 56 57 0.3 123 0.5 20 493 2.2 532 2.4 57 53 0.2 94 0.4 21 243 1.1 411 1.8 58 74 0.3 87 0.4 22 363 1.6 433 1.9 59 33 0.1 65 0.3 23 224 1.0 401 1.8 60 219 1.0 284 1.3 24 279 1.3 409 1.8 61 38 0.2 57 0.3 25 518 2.3 490 2.2 62 82 0.4 63 0.3 26 342 1.5 446 2.0 63 61 0.3 29 0.1 27 278 1.3 392 1.7 64 35 0.2 31 0.1 28 321 1.5 362 1.6 65 294 1.3 178 0,8 29 163 0.7 306 1,4 66 40 0.2 33 0.1 30 673 3.0 369 1.6 67 38 0.2 25 0,1 31 125 0.6 296 1.3 68 38 0.2 19 0.1 32 362 1.6 330 1.5 69 17 0.1 5 0.0 33 170 0.8 240 1.1 70+ 650 2.9 396 1.8 34 112 0.5 224 1.0 DlCd 35 820 3.7 299 1.3 missing 8 0.0 10 0.0 36 192 0.9 221 1.0 Total 22,073 100.0 22,526 100.0 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. 175 Table C.2 A~e distribution of eligible and interviewed women Percent distribution of the de facto household population of women age 5-54, and of interviewed women age 10-49, and the percentage of eligible women who were interviewed (weighted) by five-year age groups, Bangladesh 1996-97 Age Household population of women Women Total Ever-married interviewed Number Percent Number Percent Number Percent Percent interviewed (weighted) 5-9 3,223 . . . . . . 10-14 3,045 21.7 130 1.4 127 1.4 98.0 15-19 2,623 18.7 1,305 14.0 1,282 14.0 98.2 20-24 2,185 15.6 1,793 19.2 1,760 19.3 98.2 25-29 1,996 14.2 1,922 20.6 1,894 20.7 98.5 30-34 1,458 10.4 1,447 15,5 1,413 15.5 97.6 35-39 1,163 8.3 1,163 12.5 1,135 12.4 97.6 40-44 894 6.4 893 9.6 867 9,5 97.1 45-49 683 4.9 682 7.3 657 7.2 96.3 50-54 610 10-49 14,047 9,335 9,134 97.8 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Bangladesh 1996-97 Percentage Number missing of Subject Reference group information cases Birth date Births in last 15 years Month only 0.7 19,674 Month and year 0.0 19,674 Age at death 0.1 2,670 Age/date at first union I 0.5 9,127 0.3 9,127 Deaths to births in last 15 years Ever-married women Respondent's education Ever-married women Anthropometry 2 Living children age 0-59 months Height missing 9.0 5,654 Weight missing 6.4 5,654 Height or weight missing 9.4 5,654 Diarrhea in last 2 weeks Living children age 0-59 months 0.5 5,654 I Both year and age missing 2 Child not measured 176 Table C.4 Births by calendar years Distribution of births by calendar years for living (L), dead (D), and all CP) children, according to reporting completeness, sex ratio at birth, and ratio of births by calendar year, Bangladesh 1996-97 Percentage with Sex ratio Number of births complete birth date I at birth 2 Calendar ratio 3 Male Female Year L D T L D T L D T L D T L D T L D T 97 69 4 73 100.0 100.0 100.0 92.9 83.2 92.4 NA NA NA 33 2 35 36 2 38 96 1,168 64 1,232 100.0 100.0 100.0 99.7 188,0 102.9 NA HA HA 583 42 625 585 22 607 95 1,091 100 1,191 99.9 100.0 99.9 105.1 80,8 102.8 94.9 105.6 95.7 559 45 604 532 55 587 94 1,132 125 1,257 100.0 100.0 100.0 98.0 84,9 96.6 101.3 100.5 101.2 560 57 618 572 68 640 93 1,145 149 1,294 100.0 100.0 100.0 97.2 120,3 99.6 102.5 109.6 103.3 564 81 646 581 67 648 92 1,101 146 1,247 100.0 99.6 100.0 100.1 89.7 98.9 98.0 92.6 97.3 851 69 620 550 77 627 91 1,101 167 1,269 100.0 99.0 99.9 97.8 107.5 99.0 92.3 94.8 92.6 544 87 631 557 81 638 90 1,286 207 IA93 99.4 97.4 99.1 93.1 105.5 94.8 108.7 110.3 108.9 620 106 726 666 lOl 766 89 1,264 208 1,472 99.3 99.6 99.3 98.1 90.7 97.0 98.4 102.1 98.9 626 99 725 638 109 747 88 1,284 201 1,484 99.3 97.6 99.0 102.7 98.6 102.1 NA NA NA 650 100 750 633 101 734 93-97 4,606 442 5,047 100.0 100.0 100.0 99.8 105.7 100.3 NA NA NA 2,300 227 2,527 2,305 215 2,520 88-92 6,035 930 6,965 99.6 98.6 99.4 98.3 98.3 98.3 NA HA NA 2,991 461 3,452 3,044 469 3,512 83-87 5,532 1,085 6,617 99.2 97.8 98.9 103.0 112.4 104.5 HA HA HA 2,807 574 3,381 2,725 511 3,236 78-82 3,927 1,052 4,979 99.1 96.2 98.5 110.5 100.4 108.3 NA NA HA 2,061 527 2,589 1,865 525 2,390 <78 4,499 IA77 5,976 98.8 96.0 98.1 109.6 107.1 109.0 NA NA NA 2,353 764 3,117 2,146 713 2,859 All 24,599 4,985 29,584 99.3 97.3 99.0 103.5 104.9 103.8 NA NA NA 12,514 2,552 15,066 12,085 2,433 14,518 NA = Not applicable I Both year and month of binh given 2 (Bm/Br)* 100, where B m and Bf are the numbers of male and female births, Iespectively 3 [2 Bx/(Bx.l+Bx, t )], 100, whei'¢ B x is the number of births in calendar yearx 177 Table C.5 Reoonin~ ofa~e at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods preceding the survey, Bangladesh 1996-97 Number of years preceding the survey Age ~ death Total (in days) 0-4 5-9 10-14 15-19 0-19 <1 52 80 65 59 256 1 46 67 59 59 231 2 7 22 21 11 61 3 28 37 34 43 142 4 14 15 20 20 68 5 19 20 26 18 83 6 7 19 32 28 87 7 22 41 50 42 154 8 3 15 20 15 54 9 7 20 18 6 50 10 7 14 13 13 47 11 7 10 7 9 33 12 7 15 12 10 45 13 1 5 4 3 13 14 7 9 6 5 28 15 10 12 18 14 53 16 7 3 3 5 17 17 3 6 1 6 16 18 5 7 5 4 21 19 3 1 1 1 6 20 2 6 5 7 21 21 4 4 17 5 29 22 5 2 8 5 20 23 2 0 1 2 5 24 1 0 0 1 1 25 0 1 5 2 8 26 5 1 1 0 6 27 1 3 0 0 5 28 4 1 2 5 12 29 3 1 0 1 6 30 0 1 1 0 2 31+ 1 2 5 4 12 Percente[u'ly neonatal 60.0 59.4 56.3 59.8 58.7 Total 0-30 288 438 457 398 1,582 I (0-6 days/0-30 days) * 100 178 Table C.6 Reoorting ofa2e at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods preceding the survey, Bangladesh 1996-97 Number of years preceding the survey Age at death Total (in months) 0-4 5-9 10-14 15-19 0-19 <1 a 288 438 457 398 1,582 1 47 37 53 43 179 2 24 23 31 26 104 3 27 52 47 28 154 4 9 14 15 18 56 5 21 20 26 24 91 6 19 29 25 19 93 7 15 14 20 9 57 8 14 20 8 11 54 9 7 18 II 15 51 10 1 17 12 4 34 11 8 5 8 10 31 12 10 17 26 19 72 13 l 4 3 l 9 14 0 9 3 1 14 15 2 6 1 1 II 16 2 3 5 2 12 17 4 1 2 l 8 18 20 38 38 29 126 19 0 2 3 1 5 20 0 l 0 1 2 21 0 0 0 2 2 22 0 1 1 2 4 23 0 0 1 0 1 24+ 0 3 2 7 12 Missing 0 l 0 l 2 l year 12 15 32 18 78 Percent neonatal b 59.9 63.8 64.1 65.9 63.6 Total 0-11 480 687 714 605 2385 a b Includes deaths under 1 month reported m days (Under 1 month/under 1 year) * 100 179 APPENDIX D PERSONS INVOLVED IN THE 1996-97 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY APPENDIX D PERSONS INVOLVED IN THE 1996-97 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY Mr. Anil Chandra Singha, Director General, NIPORT---Chairman Technical Review Committee Mr. A.K.M. Rafiquz Zaman, ex-Director General, NIPORT--Chairman Mr. Md. Sirajul Islam, Director General, Directorate of Family Planning Mr. Luqueman Ahmed, Joint Chief (Planning), Ministry of Health and Family Welfare Mr. M.A. Taller, Director (Administration), Directorate of Family Planning Mr. Sharnsul Alam, Director, MIS, Directorate of Family Planning Dr. Zakir Hossain, Director (PHC), Directorate of Health Services Mr. Dabir Uddin Ahmed, Assistant Chief, Population Planning Wing, Planning Commission Mr. Shahadat Hossain, Project Director, Health and Demographic Survey, Bang. Bureau of Statistics Mr. A.N.M.A. Salim Khan, Director (Training), NIPORT Prof. M. Kabir, Department of Statistics, Jahangeernagar University Prof. Ataharul Islam, Department of Statistics, Dhaka University Prof. Barkat-e-Khuda, Project Director, MCH-FP Extension Project (Rural), ICDDR,B Dr. Allen Gray, Program Associate, The Population Council Dr. M. Alauddin, Country Representative, Pathfinder International Mr. Khalid Hasan, Research Manager, Social Marketing Company Mrs. Mofaweza Khan, Executive Director, Concerned Women for Family Planning Ms. Anne Cross, Demographic and Health Surveys, Macro International Inc., USA Dr. Syed Jahangeer Haider, Executive Director, Research Evaluation Associates for Development Md. Najmul Huq, Chairman, Center for Population and Development Mr. S.N. Mitra, Executive Director, Mitra and Associates Prof. Abul Barkat, Adviser, University Research Corporation (Bangladesh) Mr. Alain Mouchiroud, Representative, United Nations Population Fund (UNFPA) Dr. Gay Alexander, The World Bank/Dhaka Mr. Habibur Rahman, Associate Advisor (MIOR), GTZ-NIPORT Project Dr. Mehtabunisa Currey, Health and Pop. Aid Management Office, Overseas Development Admin. Dr. Nancy Gerein, Director, Canadian Int'l Dev't Agency Monitoring and Technical Advisory Unit Mr. Sk. Ali Noor, Head, Research and Evaluation, Office of Population and Health, USAID/Bang. Dr. Kanta Jamil, Demographer, Office of Population and Health, USAID/Bangladesh Dr. Ahmed A1-Sabir, Director (Research), NIPORT--Member Secretary Technical Task Force Dr. Ahmed A1 Sabir, Director (Research), NIPORT----Chairman Dr. Kanta Jamil, Johns Hopkins University and USAID/Bangladesh Prof. Barkat-e-Khuda, Project Director, MCH-FP (Extension) Project, ICDDR,B Dr. Alien Gray, Program Associate, The Population Council/Dhaka Mr. S.N. Mitra, Executive Director, Mitra and Associates Ms. Anne Cross, Demographic and Health Surveys, Macro International Inc., Maryland, USA 183 Technical and Administrative Staff Country Coordinator Dr. Ahmed AI-Sabir Associate Coordinator Mr. Subrata K. Bhadra Ms. Shahin Sultana Project Director Mr. S. N. Mitra Deputy Project Director Mr. Shahidul Islam Assistant Project Directors Mr. A.B. Siddique Mozumder Mr. Jahangir Hossain Sharif Project Managers Mr. N. C. Barman Mr. Marful Alam Mr. S. Fuad Pasha Ms. Sayera Banu Ms. Rekha Saha Macro International Staff Ms. Annie Cross, Country Monitor Dr. Tulshi Saha, Country Monitor Ms. Thanh Le, Sampling Specialist Mr. Albert Themme, Data Processing Specialist Mr. Daniel Vadnais, Dissemination Specialist Dr. Sidney Moore, Editor Dr. George Bicego, Country Monitor (Report Editor/Reviewer) Dr. Pav Govindasamy, Country Monitor (Report Reviewer) Ms. Celia Siebenmann, Document Production Specialist Family Welfare Volunteer Training Institute/RTC Staff Mr. Humayun Kabir, Barguna Ms. Shaheena Alam, Dhaka Mrs. Rita Farhanaz, Chandpur Mr. Makbul Murshid, Tangail Mr. Faridul Huq, Dinajpur Mr. Abdus Samad Talukder, Bogra Mr. Md. Rejaul Kabir, Khulna Dr. Debashis Paul, Kushtia Dr. Harichand Shil, Faridpur Mr. Giyas Uddin Ahmed, Rangamati Mr. Md. Hafizul Alam, Sylhet 184 Field Officers Mr. Monir Hossain Bhuiyan Mr. Masud Karim Reza Quality Control Officers Mr. Abdul Quiyume Mr. Nazim Uddin Mr. Sanjoy Bhowmik Mr. Anisur Rahman Ms. Gitasree Mukherjee Listin~ Suoervisors Mr. Sanjoy Bhowmik Mr. Sankar Chandra Banik Listers Mr. Zaber Uddin Mr. Ratindra Nath Das Mr. Kazi Manzur Murshed Mr. Majibul Haque Talukder Mr. Quazi Emrul Quais Mr. Rafiqul Islam Mr. Sirajul Islam Mr. Faruquzzaman Mr. Abul Bashar Mr. Ohiduzzaman Mr. Shafiqul Islam Mr. Atiqur Rahman Mr. Golam Mostafa Mr. Jyoti Biplab Roy Mr. Feroz Alam Mr. Aminul Islam Mr. Tapan Mandal Male Supervisors Mr. Kamruzzaman Mr. Abu Mohammad Hossain Mr. Asadullah (Tuku) Mr. Abdullah Bhuiyan Mr. Hipjur Alam Munshi Mr. Partha Sharathi Goswhami Mr. Monoj Kumer Edbor Female Sm~ervisors Ms. Rehana Banu Ms. Nahida Akter Ms. Anjue Ara Khatun Field Staff Ms. Nargis Akter Ms. Nazma Sultana Ms. Shakera Khatun Ms. Shamsun Nahar Yeasmin Ms. Nipu Rani Mitra Ms. Nargis Ara Begum Mr. Habibur Rahamn Mr. S.M. Hasan-A1 Mamun Mr. Nazmul Haque Sarker Mr. Gias Uddin Mr. Eliash Khan Mr. Nazrul Islam Mr. Samir Ranjan Howlader Mr. Zakir Hossain Mr. Kazi Md. Shafiqur Rahman Mr. Golam Ahmed Siddique Mr. Prodip Biswas Mr. Santosh Kumer Banik Mr. Shariful Islam Mr. Monirul Islam Mr. Abdur Rouf Mr. Abu Sarwar Bhuiyan Mr. Zulfiqarul Islam Mr. Almas Sikder Mr. Mainul Morshed Mr. Habibur Rahman Mr. Nurul Afsar Mr. Azheml Islam Mr. Saiful Islam Mr. Ishawar Chandra Dhali Ms. Farida Yeasmin Ms. Shahina Akter(1) Ms. Lutfa Jahan Ms. Monira Khatun 185 Ms. Shahina Akter(2) Ms. Nasima Akter Chowdhury Ms. Anarkoli Male Interviewers Mr. Kabir Ahmed Mr. Abdus Salam Miah Mr. Alauddin Sikder Mr. Rabiul Karim Mr. Habibur Rahman (Kabir) Mr. Ruhul Amin Mollah Mr. Sk. Nasiruzzaman Mr. Anis Ahmed Mr. Sirajul Islam Mr. Abu Baker Siddique Mr. Majedur Rashid Mr. Gias Uddin Mr. Khalid Shams Female Interviewers Ms. Aloka Rani Adhikary Ms. Taj Nahar Khanam Amily Ms. Sultana Rajia Ms. Shahina Sultana Ms. Monjuma Akter Ms. Salma Parveen (Joly) Ms. Ulfatun Nessa Ms. Nahida Parveen Ms. Sanjida Khanam Ms. Karar Shanaj Pervin Ms. Salma Pervin Ms. Farida Akhter Ms. Nilufa Akter Ms. Nazma Akhter (Bristi) Ms. Umme Salma Akhter Ms. China Khatun Ms. Susoma Ferdous Ms. Saleha Khatun Ms. Shirin Akhter Ms. Kamrunnahar Ms. China Akter Ms. Yeasmin Begum Ms. Sayda Khatun Ms. Roushan Jahan Ms. Hasina Afroj Ms. Jobeda Nahar Ms. Sheuly Parveen Ms. Halima Akter Ms. Moksuda Pervin Ms. Dolena Begum Ms. Pala Biswas Mr. Kala Chand Das Mr. Nazmul Karim Mr. Abdul Majid Mr. Sutradhar Ranjit Kumer Mr. Sarker Abdul Alim Mr. S.M. Hasan-al-Mahmood Mr. Tarequzzaman Mr. Abdul Wahab Khan Mr. Mojibul Azad Mr. Gofran Uddin Bhuiyan Mr. Anamul Hoque Alamgir Mr. Mukter Hossain Mr. Matiur Rahman Ms. Gita Rani Roy Ms. Monjuara Yesmin Ms. Majeda Begum Ms. Ayesa Begum Ms. Shahanaj Begum Ms. Nilufa Ferdous (Nila) Ms. Towhida Akhter Ms. Khadiza Akter Ms. Khaleda Parveen Ms. Saifun Nahar Ms. Khaleda Ferdous Ms. Habiba Hawa Ms. Minara Begum Ms. Salina Akter Ms. Kazi Parveen Ms. Anowara Begum (Moni) Ms. Rebaka Sultana Ms. Anjumanara Khanam Ms. Nibedita Mitra Ms. Sukla Barua Ms. Taj Sultana Ms. Rita Begum Ms. Mousumi Ahemed Ms. Mousumi Hafiz Ms. Rehana Begum Ms. Dilara Begum Ms. Kulsum Khanam (Kabita) Ms. Lutfun Nahar Ms. Tahmina Jahan Ms. Fatema Begum 186 Ms. Jannath Ferdous Begum Ms. Kazi Ismat Ara Ms. Amala Biswas Ms. Rokeya Momotaz Ms. Rafeza Khatun Ms. Dulali Biswas Logistical Assistants Mr. Mojibur Rahman Mr. Sahidul Islam Mr. Shaha Alam Mr. Golam Mostafa Mr. Panna Mollah Mr. Monir Hossain Ms. Nahida Akter Ms. Rukshana Arifa (Rokxy) Ms. Shamima Akhter Ms. Parveen Akter (Shilpi) Ms. Tanjila Towfiqa Chowdhury Ms. Ayesha Akter (Bithi) Ms. Nasima Akhter Mr. Alam Hossain Mr. Hamnur Rashid Mr. Mizanur Rahman Mr. Khaiml Islam Mr. Jahangir Hossain Mr. Rofiqul Islam (~omDuter Prom'ammers Mr. Shishir Paul Data Entry Operators Mr. Suyeb Hossain Mr. Eskander Ali Mr. Chandan Kumer Sen Mr. Ovizit Kumer Roy Validators/Office Editors Mr. Diponkar Roy Mr. Faisal Ahmed Khan Mr. Janak Chandra Deb Data Processing Staff Mr. Haradhan Sen Mr. Shahinur Rahman Mr. Syed Anwar Hossain Mr. Amolendu Deb Mr. Ajoy Datta Mr. Ashfaqur Rahman Data Dissemination Staff Mr. Subrata K. Bhadra Mr. A.K.M. Abdullah Administrative Staff Mr. A.F.M. Salim, Deputy Director (Administration) Mr. Bimal Chandra Datta, Accounts Officer Mr. Akram Hossain, Accounts Officer Mr. Golam Sarwar, Store-keeper Mr. Aslamuzzaman, Registration Officer Mr. Jaynal Abdin, Typist Mr. Shah Alam, Typist Mr. Numzzaman, Driver Peon/Messenger Mr. Wazed All Ms. Rokshana Begum 187 APPENDIX E QUESTIONNAIRES 4/02/97 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 1996-97 HOUSEHOLD SCHEDULE D IV IS ION DI STR ICT THANA UNION/WARD V ILLAGE/MOHALLA/BLOCK CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DHAKA/CHITTAGONG=I , SMALL CITY=2, TOWN=3, V ILLAGE=4 . NAME OF HOUSEHOLD HEAD IS HOUSEHOLD SELECTED FOR MEN'S SURVEY? (YES=l; NO=2) . . . INTERVIEWER V IS ITS DATE INTERVIEWER'S NAME RESULT * NEXT V IS IT : DATE T IME 3 1 2 F INAL V IS IT DAY MONTH** YR 1 CODE RESULT !!!iiiiiiiiiii!i!! * RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT T IME OF V IS IT 3 ENT IRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD 4 POSTPONED 5 REFUSED 6 DWELL ING VACANT OR ADDRESS NOT A DWELL ING 7 DWELL ING DESTROYED 8 DWELL ING NOT FOUND 9 OTHER (SPECIFY 9 9 TOTAL NUMBER[----- 3 OF V IS ITS TOTAL IN HOUSEHOLD1 1 I TOTAL EL IG IBLE WOMEN TOTAL EL IG IBLE MEN L INE NO. OF RESP. TO HOUSE- HOLD SCHEDULE NAME DATE * MONTH: F IELD EDITED BY OFF ICE EDITED BY KEYED BY [ KEYED BY 01 JANUARY 02 FEBRUARY 03 MARCH 04 APRIL 05 MAY 06 JUNE 07 JULY 08 AUGUST 09 SEPTEMBER i0 OCTOBER ll NOVEMBER 191 12 DECEMBER HOUSEHOLD SCHEDULE Now we would Like some information about the people who usually Live in your household or who are staying with you now. IO.'INE I VISIToRsUSUAL RESIDENTS AND r ELATIONSHIPHOUSEHOLD.TO HEAD OF RESIDENCE SEX AGE I IF AGEDEDUCATION6 YEARS OR OLDER I ~RITALI--STATUS BILWOMELI Please give me the names of the persons who usually live in your household and guests of the house- hold who stayed here last night, starting with the head of the household, (1) (2) ~hat is the Does Did Is How old Has re lat ionsh ip (NAME) ;(NAME) (NAME) is CNAME) ~f (NAME) to usuall s leep ~ le (NAME)? ever the head live here or been ~f the here? Last female to ~ousehotd? night? ? school? (3) I (7) (8) ~ ~ ~ I ( 9 ) i (10) (11) YES NO 'ES NO ' M F IN YEARS t'ES NO Ol ~ 12 12 12~12 03 ~ 12 12 1 2 ~ 2 oo ~ 12 12 12~•12 o, ~ 12 12 ~•2 o~ ~ 1212 12~12 07 ~ I 2 I 2 2 oB ~ 1212 1 2 ~ 2 09 2 2 1 2 1 2 i 1 2 IF ATTENDED SCHOOL What is the highest LESS Level of school (NAME) attended? What is the highest Is class (NAME) (NAME) s t i l l in completed school? at that level?** (12) I LEVEL CLASS YES NO ~- , I ~- , 921-, i JHUSBAND'S HANIS ! LINE ELIGI- NUMBER BILITY AGED 10 CIRCLE WRITE IF YEARS OR" LINE THE LINE HOUSE- 1F AGED ABOVE NUMBER NUMBER HOLD OF ALL OF THE CHOSEN THAN Has EVER- HUSBAND FOR 25 (NAME) MARRIED OF THOSE MENJS YEARS ever WOMEN IN (15). SURVEY, been AGE CIRCLE married? 10-49 IF NOT LINE YEARS, MARRIED NUMBER OR IF OF ALL HUSBAND EVER- NOT IN MARRIED HOUSE- MEN AGE HOLD, 15"59. WRITE '00'. (13) (14) (15) (16) (17) YES NO 1 2 1 2 01 1 2 1 2 02 1 2 1 2 03 1 2 1 2 04 1 2 1 2 05 1 2 1 2 06 1 2 1 2 07 1 2 1 2 08 1 2 1 2 09 1 2 1 2 10 ~ 01 , ~]~ 02 ~ 03 ! ~ 04 ~ 05 ~ 06 • 07 ~ _ ,, 09 2 L~o HOUSEHOLD SCHEDULE CONTINUED i I ~ 1 J R _ (1_.~._~ I (2) (3) (7) (8) (9) (10) (11) (12) i (13) i (14) I I I I I I ~ 1 i ~ES NO ~'ES NO M F IN YEARS rES NO LEVEL CLASS YES NO YES NO 11 ~ 2 2 2FF 1 2F]FT12 2 12 ~ 2 2 2FT 1 2 ~FF 12 2 ~ F1FF 13 2 2 2 2 1 2 2 14 ~ 2 2 2 :~ 2 AFT 12 2 • • - , i 16 2 2 2 2 1 2 2 1, f -~ 2 2 2F -~12 n 12 2 ! TICK HERE IF CONTINUATION SHEET USED F~ Just to make sure that I have a complete Listing: 4) 5) 6) Are there any other persons such as smaLL chiLdren or infants that we have not listed? In addition, are there any other peopte who may not be members of your famity, such as domestic servants, IcxJgers or friends who usually live here? Do you have any guests or temporary visitors staying here, or anyone else who slept here Last night? * COOES FOR 0.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01= HEAD 05= GRANDCHILD 02= WIFE OR HUSBAND 06= PARENT 03= SON OR DAUGHTER 07= PARENT-IN-LAW 04= SON OR DAUGHTER-IN-LAW 08= BROTHER OR SISTER 09= OTHER RELATIVE 10 = ADOPTED/FOSTER CHILD 11 = NOT RELATED 98= DOES NOT KNOW (15) [ (16) I (17) 11 ~ 11 i 12 ~ 12 , 13 M 13 L ! 14 ~ 14 i 15 ~ 15 i 16 ~ 16 17 ~ 17 i 18 ~ 18 19 ~ 19 i 20 ~ 20 YES F--~ = ENTER EACH IN TABLE YES [~ = ENTER EACH IN TABLE YES ~ ~ ENTER EACH IN TABLE ** COOES FOR 0.12 LEVEL OF EDUCATION: 1= PRIMARY 2= SECONDARY 3= COLLEGE/UNIVERSITY 8= DOES NOT KNOW NO D NO F-1 NO E] CLASS: O0=LESS THAN 1 YEAR COMPLETED 98=DOES NOT KNOW NO. QUESTIONS AND FILTERS 18 What i s the source o f water your househo ld uses fo r d i shwash ing? CODING CATEGORIES PIPED WATER PIPED INSIDE DWELLING . . . . . . . . . 11 PIPED OUTSIDE DWELLING . . . . . . . . 12 WELL WATER TUBEWELL . . . . . . . . . . . . . . . . . . . . . . 21 SURFACE WELL/OTHER WELL . . . . . . . 22 SURFACE WATER POND/TANK/LAKE . . . . . . . . . . . . . . . . 31 RIVER/STREAM . . . . . . . . . . . . . . . . . . 32 RAINWATER . . . . . . . . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) SKIP 19 What i s the source o f d r ink ing water fo r members o f your househo ld? PIPED WATER PIPED INSIDE DWELLING . . . . . . . . . 11 PIPED OUTSIDE DWELLING . . . . . . . . 12 WELL WATER TUBEWELL . . . . . . . . . . . . . . . . . . . . . . 21 SURFACE WELL/OTHER WELL . . . . . . . 22 SURFACE WATER POND/TANK/LAKE . . . . . . . . . . . . . . . . 31 RIVER/STREAM . . . . . . . . . . . . . . . . . . 32 RAINWATER . . . . . . . . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) 20 What kind of to i le t fac i l i ty does your househo ld have? SEPTIC TANK/MODERN TOILET . . . . . . . 11 PIT TOILET/LATRINE WATER SEALED/SLAB LATRINE . . . . . 21 PIT LATRINE . . . . . . . . . . . . . . . . . . . 22 OPEN LATRINE . . . . . . . . . . . . . . . . . . 23 HANGING LATRINE . . . . . . . . . . . . . . . 24 NO FACILITY/BUSH/FIELD . . . . . . . . . . 31 OTHER 96 (SPECIFY) 21 Where do adu l t women in your househo ld usua l ly de fecate? SEPTIC TANK/ME~)ERN TOILET . . . . . . . 11 PIT TOILET/LATRINE WATER SEALED/SLAB LATRINE . . . . . 21 PIT LATRINE . . . . . . . . . . . . . . . . . . . 22 OPEN LATRINE . . . . . . . . . . . . . . . . . . 23 HANGING LATRINE . . . . . . . . . . . . . . . 24 NO FACILITY/BUSH/FIELD . . . . . . . . . . 31 OTHER 96 (SPECIFY) 22 Where do ch i ld ren in your househo ld usua l ly de fecate? SEPTIC TANK/MODERN TOILET . . . . . . . 11 PIT TOILET/LATRINE WATER SEALED/SLAB LATRINE . . . . . 21 PIT LATRINE . . . . . . . . . . . . . . . . . . . 22 OPEN LATRINE . . . . . . . . . . . . . . . . . . 23 HANGING LATRINE . . . . . . . . . . . . . . . 24 NO FACILITY/BUSH/FIELD . . . . . . . . . . 31 OTHER 96 (SPECIFY) NO CHILDREN . . . . . . . . . . . . . . . . . . . . . 97 oo,, our 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' I 24 YES NO Does your househo ld have: ALmirah (wardrobe)? A table, chair or bench? A watch or c lock? A cot or bed? A rad io that i s work ing? A te lev i s ion that i s work ing? A b icyc le? ALMIRAH . . . . . . . . . . . . . . . . . . . . 1 2 TABLE/CHAIR/BENCH . . . . . . . . . . 1 2 WATCH/CLOCK . . . . . . . . . . . . . . . . 1 2 COT/BED . . . . . . . . . . . . . . . . . . . . 1 2 RADIO . . . . . . . . . . . . . . . . . . . . . . I 2 TELEVISION . . . . . . . . . . . . . . . . . I 2 BICYCLE . . . . . . . . . . . . . . . . . . . . 1 2 I I I 25 J Does any member of your household own agricultural J YES . I J I l and? J NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 4 194 NO. 26 QUESTIONS AND FILTERS In the Last 2 weeks, has anyone in your household been to any hea l th fac i l i ty or been to see a doctor or nurse for any reason? CODING CATEGORIES I SKIP YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J NO . 2 ~29 ! 27 Where d id he or she go? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . 12 THANA HEALTH COMPLEX . . . . . . . . . 13 SATELLITE/EPI CLINIC . . . . . . . . . 14 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . 23 OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . 31 FRIENDS/RELATIVES . 32 FIELDWORKER, FWA . 41 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . 98 28 What was the reason for the visit? PREVENTIVE SERVICES IMMUNIZATION . . . . . . . . . . . . . . . . . . 11 FAMILY PLANNING . . . . . . . . . . . . . . . 12 ANTENATAL CHECKUP . . . . . . . . . . . . . 13 CURATIVE SERVICES ILLNESS . . . . . . . . . . . . . . . . . . . . . . . 21 ACCIDENT . . . . . . . . . . . . . . . . . . . . . . 22 OTHER 96 (SPECIFY) 29 MAIN MATERIAL OF THE ROOF. RECORD OBSERVATION. NATURAL ROOF KATCHA (BAMBOO/THATCH) . . . . . . . . 11 RUDIMENTARY ROOF TIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 FINISHED ROOF CEMENT/CONCRETE . . . . . . . . . . . . . . . 31 OTHER 96 (SPECIFY) 30 MAIN MATERIAL OF THE WALLS. RECORD OBSERVATION. NATURAL WALLS JUTE/BAMBOO/MUD (KATCHA) . . . . . . 11 RUDIMENTARY WALLS WOOD . . . . . . . . . . . . . . . . . . . . . . . . . . 21 FINISHED WALLS BRICK/CEMENT . . . . . . . . . . . . . . . . . . 31 TIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 OTHER 96 (SPECIFY) 31 MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION. NATURAL FLOOR EARTH/BAMBOO (NATCNA) . . . . . . . . . 11 RUDIMENTARY FLOOR WOOD . 21 FINISHED FLOOR (PUKKA) CEMENT/CONCRETE . . . . . . . . . . . . . . . 31 OTHER 96 (SPECIFY) I I 32 IS THIS HOUSEHOLD IN A BOSTI (SLUM)? | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I RECORD OBSERVATION. 195 5 196 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 1993-94 WOMAN QUEST IONNAIRE D IV IS ION D ISTRICT THANA UNION V ILLAGE/MOHALLA/BLOCK CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . DHAKA/CHITTAGONG=I , SMALL CITY=2, NAME OF HOUSEHOLD HEAD NAME AND L INE NUMBER OF WOMAN TOWN=3, V ILLAGE=4. INTERVIEWER V IS ITS 1 2 3 F INAL V IS IT DATE INTERVIEWER'S NAME RESULT * NEXT VISIT: DATE T IME DAY MONTH** YR 1 CODE RESULT mmwmmmmmmmmmwwwwmQ • •mmmmmmwwwm i f , ww•mmmmmmwwww• J im 9 9 TOTAL NUMBER[ - - - OF V IS ITS ~___ * RESULT CODES: i COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER (SPECIFY) NAME DATE F IELD EDITED BY OFF ICE EDITED BY KEYED~__~BY I KEYED BY MONTH: 01 JANUARY 05 MAY 09 SEPTEMBER 02 FEBRUARY 06 JUNE i0 OCTOBER 03 MARCH 07 JULY Ii NOVEMBER 04 APRIL 08 AUGUST 12 DECEMBER ]97 1 SECTION I. RESPONDENT'S BACKGROUND NO. I QUESTIONS AND FILTERS | CODING CATEGORIES I SKIP 103 RECORD THE TIME. HOW tong have you been l i v ing continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? YEARS . . . . . . . . . . . . . . . . . . . . ~ I ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . 95 7 VISITOR . . . . . . . . . . . . . . . . . . . . . . . . 96 ~105 I 104 Just before you ~ved here, d id you l i ve in a c i ty , | CITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 in a town, or in the countryside? I TOWN . 2 COUNTRYSIDE . ] I05 In what month and year were you born? USE CODES BELOW FOR MONTHS. IF SHE DOES NOT KNOW, WRITE 'D K' IN BOXES. BENGAL I . . . . . . . . I MONTH * . . . . . . . . . . . I I I I l l YEAR . 1113 ENOLISN . . . . . . . . ~ MONTH** . . . . . . . . . . . YEAR . 1119 HowoLd,,royou I IN COMPLET DYEARS. I COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. 106A I Are you now married, widowed, or divorced? I MARRIED . . . . . . . . . . . . . . . . . . . . . . . . . I I I WIDOWED . . . . . . . . . . . . . . . . . . . . . . . . . 2 D I VORCED/DESERTED . . . . . . . . . . . . . . . 3 107 I Have you ever attended school? I YES . 1 1 NO . 2 ~114 108 What is the highest leveL of school you attended: J PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . 1 I primary, secondary, or higher? I SECONDARY . . . . . . . . . . . . . . . . . . . . . . . 2 I COLLEGE/UNIVERSITY . . . . . . . . . . . . . . 3 0~I ~, h.,0~.~ouc~e0, I ~" . ~ I 114 CHECK 108: I SECONDARY PRIMARY [~] OR COLLEGE ~ ~115 Can you read and wr i te a le t te r in any language eas i ly , with d i f f i cu l ty , or not at a l l ? I EASILY . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | WITH DIFFICULTY . . . . . . . . . . . . . . . . . 2 I NOT AT ALL . 3 ~116 ,1~ I 0oyou u,o,,,y r'a°" new'oa~r °r mao'z~°" ~t'e~'t I YEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~1 once a week? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,,~ I 0o ~ou ° '° ' "~'"~'n ~° ~'e ~°~° ~ ~"~ °°c ' ' - -~t ~o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~' I * BENGALI MONTHS: ** ENGLISH MONTHS: 01BAISHAN 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 09 SEPTEMBER 02 JAISTHA 06 ASHWIN 10 MAGN 02 FEBRUARY 06 JUNE 10 OCTOBER 03 ASHAR 07 KARTIK 11 FALGUN 03 MARCH 07 JULY 11 NOVEMBER 04 SRABAN 08 AGRAHAYAN 12 CNOITRA 04 APRIL 08 AUGUST 12 DECEMBER 198 NO, I QUESTIONS AND FILTERS m 117 I Do you usua l ly watch te lev is ion at least I once a week? I COOING CATEGORIES J SKIP J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO. . . . . , . . . . . . . . . . . . . . , , ooo , , . . .2 118 What is your re l ig ion? I ISLAM . . . . . . . . . . . . . . . . . . . . . . . . . . . I I HINDUISM . . . . . . . . . . . . . . . . . . . . . . . . 2~ BUDDHISM . . . . . . . . . . . . . . . . . . . . . . . . 3~'~119A CHRISTIANITY . . . . . . . . . . . . . . . . . . . . 4 J OTHER 6 - - J (SPECIFY) J I I F~ 119 How many times a day do you usual ly pray? J TIMES . . . . . . . . . . . . . . . . . . . . . . . . I J J I I IF NONE, WRITE '0'. 119A YES NO Do you belong to any of the fo l lowing organizations? Grameen Bank? BRAC? BRDP? Mother's club? Any other organization? GRAMEEN BANK . . . . . . . . . . . . . . . 1 2 BRAC . . . . . . . . . . . . . . . . . . . . . . . 1 2 BRDP . . . . . . . . . . . . . . . . . . . . . . . I 2 MOTHER'S CLUB . . . . . . . . . . . . . . 1 2 OTHER 1 2 (SPECIFY) 121 Now l would Like to ask about the place in which you usually live. Do you usually Live in a city, in a town, or in a village? IF CITY: In which c i ty do you l ive? I DHAKA/CHITTAGONG . . . . . . . . . . . . . . . . 1 I SMALL CITY . . . . . . . . . . . . . . . . . . . . . . 2 TOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . 4 122 In which d iv i s ion is that located? RAJSHAHI . . . . . . . . . . . . . . . . . . . . . . . . 1 DHAKA . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CHITTAGONG . 3 KHULNA . 4 SARISHAL . 5 SYLHET . 6 123 Now I would Like to ask about the househotd in which you usually live. What is the source of water your household uses for dishwashing? PIPED WATER PIPED INSIDE DWELLING . . . . . . . . . 11 PIPED OUTSIDE DWELLING . . . . . . . . 12 WELL WATER TUBEWELL . . . . . . . . . . . . . . . . . . . . . . 21 SURFACE WELL/OTHER WELL . . . . . . . 22 SURFACE WATER POND/TANK/LAKE . . . . . . . . . . . . . . . . 31 RIVER/STREAM . . . . . . . . . . . . . . . . . . 32 RAINWATER . . . . . . . . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) 124 What is the source of dr ink ing water for members of your household? PIPED WATER PIPED INSIDE DWELLING . . . . . . . . . 11 PIPED OUTSIDE DWELLING . . . . . . . . 12 WELL WATER TUBEWELL . . . . . . . . . . . . . . . . . . . . . . 21 SURFACE WELL/OTHER WELL . . . . . . . 22 SURFACE WATER POND/TANK/LAKE . . . . . . . . . . . . . . . . ]1 RIVER/STREAM . . . . . . . . . . . . . . . . . . 32 RAINWATER . . . . . . . . . . . . . . . . . . . . . . . 41 OTHER 96 (SPECIFY) 199 3 NO, QUESTIONS AND FILTERS 125 What kind of toilet facility does your household have? CODING CATEGORIES SEPTIC TANK/MODERN TOILET . . . . . . . 11 PIT TOILET/LATRINE WATER SEALED/SLAB LATRINE . . . . . 21 PIT LATRINE . . . . . . . . . . . . . . . . . . . 22 OPEN LATRINE . . . . . . . . . . . . . . . . . . 23 HANGING LATRINE . . . . . . . . . . . . . . . 24 NO FACILITY/BUSH/FIELD . . . . . . . . . . 31 OTHER 96 (SPECIFY) SKIP 126 Where do adu l t women in your household usua l ly defecate? SEPTIC TANK/MODERN TOILET . . . . . . . 11 PIT TOILET/LATRINE WATER SEALED/SLAB LATRINE . . . . . 21 PIT LATRINE . . . . . . . . . . . . . . . . . . . 22 OPEN LATRINE . . . . . . . . . . . . . . . . . . 23 HANGING LATRINE . . . . . . . . . . . . . . . 24 NO FACILITY/BUSH/FIELD . . . . . . . . . . 31 OTHER 96 (SPECIFY) 127 Where do children in your household usua l ly defecate? SEPTIC TANK/MODERN TOILET . . . . . . . 11 PIT TOILET/LATRINE WATER SEALED/SLAB LATRINE . . . . . 21 PIT LATRINE . . . . . . . . . . . . . . . . . . . 22 OPEN LATRINE . . . . . . . . . . . . . . . . . . 23 HANGING LATRINE . . . . . . . . . . . . . . . 24 NO FACILITY/BUSH/FIELD . . . . . . . . . . 31 OTHER 96 (SPECIFY) NO CHILDREN . . . . . . . . . . . . . . . . . . . . . 97 ~I 0o,,~our~oo,o,o,d,avee,,,~ I ,~No . . ~ I 129 YES NO Does your household have: A lmi rah (wardrobe)? A tab le , cha i r or bench? A watch or c lock? A cot or bed? A rad io that is working? A te lev i s ion that is working? A b icyc le? ALMIRAH . . . . . . . . . . . . . . . . . . . . I 2 TABLE/CHAIR/BENCH . . . . . . . . . . I 2 WATCH/CLOCK . . . . . . . . . . . . . . . . I 2 COT/BED . I 2 RADIO . I 2 TELEVISION . I 2 BICYCLE . I 2 13o I °°e''nY m°Oer °' Y°ur'°u'eh°'d °wn"r'cuLtura' '~ I YEs NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 11 131 What is the mater ia l of the roof of your house? NATURAL RCX3F KATCHA (BAMB(]O/THATCH) . . . . . . . . 11 RUDIMENTARY R(X3F TIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 FINISHED ROOF CEMENT/CONCRETE . . . . . . . . . . . . . . . 31 OTHER 96 (SPECIFY) 132 What is the mater ia l of the wa l l s of your house? NATURAL WALLS JUTE/BAMBOO/MUD (KATCHA) . . . . . . 11 RUDIMENTARY WALLS WOOD . . . . . . . . . . . . . . . . . . . . . . . . . . 21 FINISHED WALLS BRICK/CEMENT . . . . . . . . . . . . . . . . . . 31 TIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 OTHER 96 (SPECIFY) 133 What is the material of the floor of your house? NATURAL FLOOR I EARTH/BAMBOO (KATCHA) . . . . . . . . . 11 I FINISHED FLOOR (PUKKA) CEMENT/CONCRETE . . . . . . . . . . . . . . . 31 J OTHER 96 200 a NO I 201 I SECTION 2. REPRODUCTION QUESTIONS AND FILTERS Now I would like to ask about all the births you have had during your Life. Have you ever given birth? I CODING CATEGORIES I SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . 2 .206 I 202 Do you have any sons or daughters to whom you have given birth who are now living with you? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~204 I 203 HOW many sons live with you? And how many daughters live with you? IF NONE RECORD iO0'. 204 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~206 I 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE RECORD 'OD'. 206 I Have you ever given birth to a boy or s girl who was | I born alive but later died? IF NO, PROBE: Any I baby who cried or showed any sign of l i fe but only survived a few hours or days? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~208 I 207 I In al l , how many boys have died? And how many girls have died? IF NONE RECORD ~OD,. I SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE RECORD log'. 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL births during your l i fe. Is that correct? PROBE AND YES ~ NO [-'7 • CORRECT 201-208 AS NECESSARY `e ? • 1 NO BIRTHS [~ 1227 201 211 Now I would Like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES, 212 What name was given to your (first/ next) baby? (NAME) % o, I 2,, 12, ,121, 1218 12,, IF ALIVE: IF ALIVE IF DEAD: In what month and year was (NAME) born? WRITE IN EITHER BENGALI OR ENGLISH DATES, BUT NOT BOTH. USE CODES AT BOTTOM OF PAGE FOR MONTHS. BENGALI I ENGLISH How old Is HOW oLd was was (NAME) (NAME) when (NAME) at Living he/she died? his/her with Last you? birthday? RECORD AGE IN COMPLETED YEARS. 220 FROM YEAR OF BIRTH OF (NAME) SUBTRACT IF tOME YEAR'~ YEAR OF ASK: PREVIOUS How many months BIRTH. old was (NAME)? RECORD DAYS IF IS THE UNDER 1 MONTH; DIFFER- MONTHS IF LESS ENCE THAN 2 YEARS; 4 OR OR YEARS, MORE? BOY.1 GIRL,2 MONTH I M O R ~ YES.I yA~AER~N YR~YR Ho! I--I--1 11191 I I 219 YES.1 NO.2] (NEXT 4J BIRTH) DAYS,,.I MONTHS.2 YEARS.3 BOY.1 M O N ~ BIRL2 YR 1 I I I I I M O N ~ YES.1 A~AER~N YES.1 NO.2] (GO TO~ J 220) DAYS. . . I~ MONTHS.2 YEARS--3~ I BOY.1 MONTHr~F~ ~ M O H ~ YES.1 YEARsAGE IN GIRL.2 YR I 11 1 I I YRI 11 9~ I I NO.! 219 ~ YES---11 2201 DAYS. I YES.1 NO. . . .2 (NEXT, ] BIRTH) YES.1 NO.2 (HEXT4J BIRTH) BOY.1 GIRL.2 MOH,,~ YR 1 I I I I I YRIII~Ii H0.!219 YES.1 NO.2] (GO TO4 J 220) DAYS. . . I l I I YES.1 MOHTHS.2~ NO., .2 YEARS"31 I I I BIRTH)(NEXT'J BOY.1 GIRL.2 yRMONTH~ MOHT.yR HoYEB' ~'~:R~" 21, r~ YES.1 NO.2] (GO TO< 220) DAYS. . . I I~ YES.1 MONTHS.2~ NO.2 YEARS.,3 (NEXTJ BIRTH) YR, 1,,,, i,o. ! t No.! Ill ~ l I H°""ll MOHTHS'~ 219 t 22o) I YES.1 NO.2 YES.1 NO.2 YES.1 NO.2 YES.1 NO.2 YES.1 I NO.2 YES.1 202 6 What name Were was given any of to your these next baby? b i r ths twins? Io,,o, .oN YRIll I I I MOM YRI '1 ~1 I YES.1 AGE IN YEARS No! 219 YES.1] 2:J 2201 DAYS, , , I~ YES.1 MONTHS.2~_~ NO. . .2 YEARS.,3 (NEXTJ BIRTH) YES.1 NO.2 I 2 HOMTH MONTH YES.1 AGE IN YEARS NO.! 219 YES.1] No211 DAYS. . . I~ MOMTHS.2~ YEARS. .3 J J I YES.1 NO,. . .2 (NEXT,J BIRTH) YES,,1 NO,,.2 ,o I 222 J FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE? AGE IN YEARS 220) DAYS. . . I~ YES.1 MONTHS.2~ NO. . ,2 YEARS. .3 [~J (NEXT, J BIRTH) YES . . . . . . . 1 ~GO TO 223 NO . . . . . . . . 2 =GO TO 224 Have you had any Live b i r ths since the b i r th of (NAME OF LAST BIRTH)? YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS ~ NUMBERS ARE ARE SAME ~ DIFFERENT I I . (PROBE AND RECONCILE) CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED, FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR I YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. J CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE BAISHAK 1398 OR APRIL 1991 IF NONE, RECORD '0 ' . F] FOR EACH BIRTH SINCE BAISHAK 1398 (APRIL 1901) ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN I OF THE CALENDAR AND 'P' IN EACH OF THE 8 PRECEDING MONTHS. WRITE NAME TO THE LEFT OF THE 'B' CODE. * BENGALI MONTHS: ** ENGLISH MONTHS: 01 BAISHAK 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 09 SEPTEMBER 02 JAISTHA 06 ASHWIN 10 MAGH 02 FEBRUARY 06 JUNE 10 OCTOBER 03 ASHAR 07 KARTIK 11FALGUN 03 MARCH 07 JULY 11 NOVEMBER 04 SRABAN 08 AGRAHAYAN 12 CHOITRA 04 APRIL 08 AUGUST 12 DECEMBER 203 7 NO. I QUESTIONS AND FILTERS 227 Are you pregnant now? CODING CATEGORIES I SKIP YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - -7 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ~230 228 How many months pregnant are you? MONTHS . . . . . . . . . . . . . . . . . . . . . I I I RECORD NUMBER OF COMPLETED MONTHS. ENTER "P" IN COLUMN 1 OF CALENDAR IN MONTH OF INTERVIEW AND IN EAGH PRECEDING MONTH PREGNANT. 229 At the t ime you became pregnant , d id you want to become I THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 pregnant then, did you want to wait until later, I LATER . 2 or did you not want to become pregnant at all? NOT AT ALL . 3 I Have you ever had a pregnancy that miscarried, I YES . I I 230 I was aborted, or ended in a stillbirth? | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~236 231 When did the last such pregnancy end? USE CODES BELOW FOR MONTHS. | | 232A I Was that a s t i l l b i r th , a miscar r iage , a menstrual I I regu la t ion , or an abor t ion? I BENGALI o ; ;:1 . . . . . . . . . YEAR . . . . . . . 111111 ENGLISH . . . . . . . . 2 LAST PREGNANCY ENDED BEFORE~ BAISHAK 1398 OR APRIL 1991 I I STILLBIRTH . . . . . . . . . . . . . . . . . . . . . . 1 MISCARRIAGE . . . . . . . . . . . . . . . . . . . . . 2 MENSTRUAL REGULATION . . . . . . . . . . . . 5 ABORTION . . . . . . . . . . . . . . . . . . . . . . . . 4 ~236 I 233 How many months pregnant were you when the pregnancy ended? ENTER THE APPROPRIATE CODE IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED, AND "P'= IN EACH PRECEDING MONTH PREGNANT. MONTHS . . . . . . . . . . . . . . . . . . . . . 234 I D id you ever have any o ther such pregnancies? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~236 ASK FOR DATES AND DURATIONS OF ANY OTHER PREGNANCIES BACK TO BAISHAK 1398 (APRIL 1991). ENTER THE APPROPRIATE CODE IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT. 236 When d id your Last menstrua l per iod s tar t? DAYS AGO . . . . . . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . . . . . . 3 YEARS AGO . . . . . . . . . . . . . . . . 4 IN MENOPAUSE . . . . . . . . . . . . . . . . . . 994 BEFORE LAST BIRTH . . . . . . . . . . . . . 995 NEVER MENSTRUATED . . . . . . . . . . . . . 996 * BENGALI MONTHS: ** ENGLISH MONTHS: 01 BAISHAK 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 09 SEPTEMBER 02 JAISTHA 06 ASNWIN 10 MAGH 02 FEBRUARY 06 JUNE 10 OCTOBER 03 ASHAR 07 KARTIK 11 FALGUN 03 MARCH 07 JULY 11 NOVEMBER 04 SRABAN 08 AGRAHAYAN 12 CHOITRA 04 APRIL 08 AUGUST 12 DECEMBER 204 8 SECTION 3. CONTRACEPTION I ow I wou ld L ike to ta lk about fami ly p lann ing - the var ious ways or methods that a coup le can use to de lay or avo id a pregnancy• CIRCLE CODE 1 IN 301 FOR EACN METNO0 MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACN METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METNOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED, THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303. 301 Which ways or methods have you heard ab°Ut?PONTANEOUSS 302 Rave you ever(METHOD)? 303 Have you ever heard of used (METHOD)? PROBED YES YES NO 11 PILL, MAYA Women can take a p i l l every day. 211UD Women can have a loop or coil placed inside them by a doctor or a nurse. O~ INJECTIONS Women can have an injection by a doctor or nurse which stops them fr= becoming pregnant For several months. O~ IMPLANT, NORPLANT Women can have several small rods piaced in their upper arm by a doctor or nurse which can prevent pregnancy for several years. DS~ CONDOM, RAJA Men can put a rubber sheath on their penis during sexual intercourse. 06~ FEMALE STERILIZATION, TUBAL LIGATION, TL Women can have an operat ion to avo id hav ing any more ch i ld ren . 71 MALE STERILIZATION, VASECTOMY Men can have an operat ion to avo id hav ing any more ch i ld ren . 08~ MENSTRUAL REGULATION, MR When a woman's menst rua l period does not come on time, she can go to a health centre or to the FWV and have a tube put in her for a short while to bring her period. 09~ SAFE PERIOD, COUNTING DAYS, CALENDAR RHYTHM METNOD Couples can avoid having sexual intercourse on certain days of the month when the woman is more L ike ly to get pregnant . I0~ WITHDRAWAL Men can be carefu l and pul l out be fore c l imax. 11• Nave you heard of any o ther ways or methods that women or men can use to avo id pregnancy? I 2 I 2 I 2 I 2 I 2 I 2 I 2 I 2 I 2 I 2 (SPECIFY) (SPECIFY) 37 37 37 3 7 37 37 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . •••• . . . . . • . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . , . •• . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO. . .•• . . . . . . . . . . . . . . • ,•2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . • . * . . . . . . . . . . . •2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 Have you ever had an operat ion to avo id hav ing any more ch i ld ren? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . ••••• . . . . . . . 2 Has your husband ever had an operat ion to avo id hav ing more ch i ld ren? YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . •• , . . . . . . . . . . . .2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . I NO. . . . . .• . . . . . . . . . ••• , , .2 YES• . . . . . . . . . . . . •, . . . . . . 1 NO., . . . . . . . . . . ••• . 2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO••• . . . . . . . . , •••• . . . . . . 2 LEAST ONE "YES" VER USED) 205 mSKIP TO 308 9 NO. I QUESTIONS AND FILTERS m I Have you ever used anything or t r ied in any way 3O5 to I delay or avoid get t ing pregnant? COOING CATEGORIES I SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 p307 = NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z 308 ENTER "O" IN COLUMN 1 OF CALENDAR IN EACH BLANK HONTH. What have you used or done? I I CORRECT 303 AND 304 (AND 3OZ IF NECESSARY). I p3301 309 Now I would Like to ask you about the f i r s t time that you d id something or used a method to avoid get t ing pregnant. What was the f i r s t method that you ever used? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 04 CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . 05 FEMALE STERILIZATION . . . . . . . . . . . 06 HALE STERILIZATION . . . . . . . . . . . . . 07 MENSTRUAL REGULATION . . . . . . . . . . . 08 SAFE PERIOD, COUNTING DAYS . . . . . 09 WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . 10 OTHER 96 (SPECIFY) IF NONE, RECORD '00'. How many ch i ldren did you have at that time, i f any? 307 WOMAN STERILIZED WIDOWED/ DIVORCED [~ I NUHBER OF CHILDREN . . . . . . . . . ~-~ 312 I CHECK 227: oRNOT UNSuREPREGNANT ~ PREGNANT r~ 313 I Are you cur rent ly doing soo~thing or using any method I to delay or avoid get t ing pregnant? =314A I ~325 I ,-325 I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ] NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 =325 314 314A Which method are you using? CIRCLE '06' FOR FEMALE STERILIZATION. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 | IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 =317A INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 r317B IHPLANTS . . . . . . . . . . . . . . . . . . . . . . . 04 ~317A CONDON . . . . . . . . . . . . . . . . . . . . . . . . . 05 L317C FEMALE STERILIZATION . . . . . . . . . . . 06 HALE STERILIZATION . . . . . . . . . . . . . 07 1=318 MENSTRUAL REGULATION . . . . . . . . . . . 08 =325 SAFE PERIO0, COUNTING DAYS . . . . . 09 ~323 WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . 10 7 OTHER 96 ~324 (SPECIFY) I 3}5 May I see the package of p i l l s you are using now? RECORD NAME OF BRAND IF PACKAGE IS SEEN. I PACKAGE SEEN . . . . . . . . . . . . . . . . . . . . 1 BRAND N A M E _ -- | I PACIOXGE NOT SEEN . . . . . . . . . . . . . . . . 2 10 206 NO. J QUESTIONS AND FILTERS i 316 I SHOW BRAND CHART Fog PILLS: I I Please te l l me which of these is the brand of p i l l s that you are now using. CODING CATEGORIES BRAND NAME DOES ROT KNOW . . . . . . . . . . . . . . . . . . 98 I SKIP 316A Why don't you have a package of p i l l s avai lable? CIRCLE ALL MENTIONED. RAN OUT . . . . . . . . . . . . . . . . . . . . . . . . . A COST TOO MUCH . . . . . . . . . . . . . . . . . . . B HUSBAND AWAY . . . . . . . . . . . . . . . . . . . . C HAS MENSTRUAL PERIOD . . . . . . . . . . . . D NOT AVAILABLE AT HER SOURCE . . . . . E FWA HAS NOT BROUGHT RESUPPLY . . . . F OTHER X (SPECIFY) 317 I How much does one (packet/cycle) of p i l l s cost you? COST . . . . . . . . . . . . . . . . . . . . . . . ~ I FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 ~-~324 DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 317A I How much did i t cost you to have the device put in? FOR IUD USERS AND IMPLANT USERS COST . . . . . . . . . . . . . . . . . . . . ~ 317B I How much does i t cost you to get one in ject ion? COST . F-- q ::::::::::::::::::::::::::::::::::::::: 317C I May I see the package of condoms that you are using? RECORD NAME OF BRAND. I PACKAGE SEEN . . . . . . . . . . . . . . . . . . . . 1 BRAND N A M E F -~I~324 I PACKAGE NOT SEEN . . . . . . . . . . . . . . . . 2 I 31oj Why can' t you show me the package of condoms that you are using? HUSBAND KEEPS . . . . . . . . . . . . . . . . . . . 1 RAN OUT . . . . . . . . . . . . . . . . . . . . . . . . . 2 OTHER 3 (SPECIFY) I 317E| SHOW BRAND CHART FOR CONDOMS: I Please te l l me which of these is the brand of condoms that you are using. 318 Where d id the s ter i l i za t ion take place? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . 12 THANA HEALTH COMPLEX . . . . . . . . . 13 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . 22 NGO CLINIC . . . . . . . . . . . . . . . . . . . . . 42 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . 98 (NAME OF PLACE) 319 J Do you regret that (you/your husband) had the operation I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J I not to have any more chi ldren? J NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~321 320 I Why do you regret i t? RESPONDENT WANTS ANOTHER CHILD.1 | PARTNER WANTS ANOTHER CHILD . . . . . 2 I SIDE EFFECTS . . . . . . . . . . . . . . . . . . . . 3 CHILD DIED . . . . . . . . . . . . . . . . . . . . . . 4 OTHER REASON 6 11 207 NO. QUESTIONS AND FILTERS 321 In what month and year was the s ter i l i za t ion operation performed? USE CODES BELOW FOR MONTHS. CODING CATEGORIES BENGAL I . . . . . . . . I MONTH * . . . . . . . . . . . I l l IJl YEAR . . . . . . . Ill ENGLISH . . . . . . . . 2 MONTH** . . . . . ~ SKIP 321A 322 323 How much did the operation cost you? CHECK 321: STERILIZED BEFORE BAISHAK 1398 I ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN I OF THE CALENDAR AND EACH MONTH BACK TO BAIBHAK 1398 (APRIL 1991) COST . . . . . . . . . . . . . . . . . . . . F R E E . . . . . . . . . . . . . . . . . . . . . . . . . . 996 DOES NOT KNOW . . . . . . . . . . . . . . . . . 998 STERILIZED AFTER BAIBNAK 1398 I ENTER CODE FOR STERILIZATION IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION• THEN SKIP TO r329A THEN SKIP TO r325 You to ld me that you use the safe period (calendar, rhythm) method. Please te l l me which days of your monthly cycle are not safe. DURING HER PERIOD . . . . . . . . . . . . . . . 1 NIGHT AFTER HER PERIOD ENDS . . . . . 2 IN THE MIDDLE OF HER CYCLE . . . . . . 3 JUST BEFORE HER PERIOD BEGINS.4 OTHER 6 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 324 ENTER METHOD CODE FROM 314 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WREN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE. ILLUSTRATIVE QUESTIONS: • When did you s tar t using continuously? • How tong have you been using th is method continuously? 325 I would l i ke to ask you some questions about the times you or your husband may have used a method to avoid gett ing pregnant during the Last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO BAIBHAK 1398 (APRIL 1991). USE NAMES OF CHILDREN, DATES OF gIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN COLUMN 1, ENTER CODE IN EACH MONTH OF METHOD USE OR '0' FOR NONUBE. ILLUSTRATIVE QUESTIONS: COLUMN 1: . When was the Last time you used a method? Which method was that? • When did you s tar t using that method? How Long af ter the b i r th of (NAME)? • How tong d id you use the method then? IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COL.2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1. ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE DECAHE PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT• ILLUSTRATIVE QUESTIONS: COLUMN 2: - Why d id you stop using the (METHOD)? • Did you become pregnant while using (METHOD), or d id you stop to get pregnant, or d id you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: • Now many months did i t take you to get pregnant a f ter you stopped using (METHOD)? AND ENTER '0 ~ IN EACH SUCH MONTH IN COLUMN 1. * BENGALI MONTHS: ** ENGLISH MONTHS: 01 BAISHAK 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 09 SEPTEMBER 02 JAISTHA 06 ASHWIN 10 MAGH 02 FEBRUARY 06 JUNE 10 OCTOBER 03 ASHAR 07 KART IK 11FALGUN 03 MARCH 07 JULY 11 NOVEMBER 04 SRABAN 08 AGRAHAYAN 12 CHOITRA 04 APRIL 08 AUGUST 12 DECEMBER 208 12 NO, I QUESTIONS AND FILTERS 327 CHECK 314: CIRCLE METHOD CODE: COOING CATEGORIES I SKIP NOT ASKED . . . . . . . . . . . . . . . . . . . . . . OO - ~330F PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 m IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 I INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 04 CONDOM . 05 FEMALE STERILIZATION . 06 MALE STERILIZATION . 07 - [ ~329A MENSTRUAL REGULATION . 08 - =330F SAFE PERIOO/RHYTHM . 09 "7 WITHDRAWAL . 10 ~--~1332 OTHER METHOD . 96 328 3281 Where did you obtain (METHOD) the Last time? IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PRO8E TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE, (NAME OF PLACE) (NAME OF PLACE) USING ANOTHER METHO0 Who obtained the (pi l ls/condoms) the Last time you got them? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . 12 THANA HEALTH COMPLEX . . . . . . . . . 13 SATELLITE/EPI CLINIC . . . . . . . . . 14 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . 22 PHARMACY . 23 OTHER PRIVATE SECTOR SHOP . 31 FRIENDS/RELATIVES . 32 FIELDWORKER, FWA . 41 - NGO CLINIC . 42 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . 98 F-7 =328E I I ~328C RESPONDENT . . . . . . . . . . . . . . . . . . . . . . 1 I HUSBAND . . . . . . . . . . . . . . . . . . . . . . . . . 2 SON/DAUGHTER . . . . . . . . . . . . . . . . . . . . 3 ~329 OTHER RELATIVE . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) | 328c I At the place where you got your method the Last time, did anyone there ever tell you about side effects or other problems you might have using this method? I YES . I | RO . . . . . . . . . , ° .o . . . . . . . . . . . , . . . . . 2 I CANNOT REMEMBER . 8 3201 Did anyone there ever teLL you about other methods that you might use? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 / NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~1p329 CANNOT REMEMBER . . . . . . . . . . . . . . . . . 8 / I 328E Did the fami ly planning f ie ldworker ever teLL you about side ef fects or problems you might have with th is (CURRENT METHOD)? I YES . I | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I CANNOT REMEMBER . . . . . . . . . . . . . . . . . 8 328F I Did the fami ly planning f ie ldworker ever te l l you about other methods that you might use? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I CANNOT REMEMBER . . . . . . . . . . . . . . . . . 8 329 I 329A Do you know another place where you could have obtained (CURRENT METHOD) the Last time? At the time of the s ter i l i za t ion operation, d id you know another place where you could have received the operation? YES, . . . . . . . . ° ° . . . . . . . . . , , . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I ~330A I 209 13 NO. 330 OUESTIONS AND FILTERS People seLect the pLace where they get Fami ly p lann ing serv ices fo r var ious reasons, What was the main reason you went to (NAME OF PLACE IN Q.328 OR 0.318) ins tead of the o ther p lace you know about? RECORD RESPONSE AND CIRCLE CODE. CODING CATEGORIES ACCESS-RELATED REASONS CLOSER TO HOME . . . . . . . . . . . . . . . 11 CLOSER TO MARKET/WORK . . . . . . . . 12 AVAILABILITY OF TRANSPORT . . . . 13 SERVICE-RELATED REASONS STAFF MORE COMPETENT/ FRIENDLY . . . . . . . . . . . . . . . . . . . 21 CLEANER FACILITY . . . . . . . . . . . . . 22 OFFERS MORE PRIVACY . . . . . . . . . . 23 SHORTER WAITING TIME . . . . . . . . . 24 LONGER HRS. OF OPERATION . . . . . 25 USE OTHER SERVICES AT THE FACILITY . . . . . . . . . . . . 26 LOWER COST/CHEAPER . . . . . . . . . . . . . 31 WANTED ANONYMITY . . . . . . . . . . . . . . . 41 WORKER SUPPLIED AT HOME . . . . . . . . 51 METHOD NOT AVAILABLE ELSEWHERE.61 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 SKIP 330A What is the reason you decided to use (CURRENT METHOD) ra ther than some other method of famiLy p lann ing? Any o ther reason? CIRCLE ALL MENTIONED. FAMILY PLAN. WORKER RECOMMENDED.A FRIEND/RELATIVE RECOMMENDED . . . . . B SIDE EFFECTS Of OTHER METNODS.C METHOD EASY TO USE . . . . . . . . . . . . . . D ACCESS/AVAILABILITY . . . . . . . . . . . . . E COST . . . . . . . . . . . . . . . . . . . . . . . . . . . . F WANTED PERMANENT METHOD . . . . . . . . . G HUSBAND PREFERRED . . . . . . . . . . . . . . . H WANTED MORE EFFECTIVE METHOD . . . . I FIELDWORKER CAME TO HOUSE . . . . . . . J OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z 330B I Are you having any problems in using (CURRENT METHOD)? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~334 330C What problems are you having w i th us ing (METHOD)? PROBE: Any o ther problems? CIRCLE ALL MENTIONED. WEIGHT GAIN . . . . . . . . . . . . . . . . . . . . . A WEIGHT LOSS . . . . . . . . . . . . . . . . . . . . . B TOO MUCH BLEEDING . . . . . . . . . . . . . . . C HYPERTENSION . . . . . . . . . . . . . . . . . . . . D HEADACHE . . . . . . . . . . . . . . . . . . . . . . . . E NAUSEA . . . . . . . . . . . . . . . . . . . . . . . . . . F NO MENSTRUATION . . . . . . . . . . . . . . . . . G WEAN/TIRED . . . . . . . . . . . . . . . . . . . . . . H DIZZINESS . . . . . . . . . . . . . . . . . . . . . . . I HUSBAND DISAPPROVES . . . . . . . . . . . . . J OTHER RELATIVE DISAPPROVES . . . . . . K RELIGION DISAPPROVES . . . . . . . . . . . . L ACCESS/AVAILABILITY . . . . . . . . . . . . . M COSTS TOO MUCH . . . . . . . . . . . . . . . . . . N INCONVENIENT TO USE . . . . . . . . . . . . . 0 STERILIZED, WANTS CHILDREN . . . . . . P ABDOMINAL PAIN . . . . . . . . . . . . . . . . . . Q OTHER X (SPECIFY) DOES NOT KNOt/ . . . . . . . . . . . . . . . . . . Z 330DI When you F i r s t s ta r ted having these probtems, d id I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I you ta lk to anyone about these problems? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~334 Who d id you ta lk to about these problems? 33o I I FIELDWORNER, FWA . . . . . . . . . . . . . . . . 1~ STAFF AT SATELLITE CLINIC . . . . . . . 2 ~ STAFF AT FAMILY WELFARE CL IN IC . .3Fw334 RELATIVE, FRIEND . . . . . . . . . . . . . . . . 4 1 OTHER 6 1 (SPECIFY) i 210 14 331 What is the main reason you are not using a method of contracept ion to avoid pregnancy? FERTILITY-RELATED REASONS HOT HAVING SEX . . . . . . . . . . . . . . . 21 INFREQUENT SEX . . . . . . . . . . . . . . . 22 MENOPAUSAL/HYSTERECTOMY . . . . . . 23 SUBFECUMD/INFECUHD . . . . . . . . . . . 24 POSTPARTUM/BREAST FEED I NG . . . . . 25 WANTS (MORE) CHILDREN . . . . . . . . 26 PREGNANT . . . . . . . . . . . . . . . . . . . . . 27 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . . . . . 31 HUSBAND OPPOSED . . . . . . . . . . . . . . 32 OTHERS OPPOSED . . . . . . . . . . . . . . . 33 RELIGIOUS PROHIBITION . . . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . . . . ,41 KNOWS NO SOURCE . . . . . . . . . . . . . . 42 METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . . . . 52 LACK OF ACCESS/TO0 FAR . . . . . . . 53 COST TOO MUCH . . . . . . . . . . . . . . . . 54 INCONVENIENT TO USE . . . . . . . . . . 55 INTERFERES WITH BODYIS NORMAL PROCESSES . . . . . . . . . . . 56 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 332 J DOfamilyyOU knOWplanning?Where you can obtain a method of J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 J =334 333 Where is that? J 334 335 (NAME OF PLACE) IF WOMAN SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE SHE WOULD MOST LIKELY USE. CHECK 328 AND 333: TIE LI'TTEEHO I , IONED CLiNIcSATEL' 'TE/EPIMEMTIONED IninDurin~partth~ss~me~ftheVi~age/~1~hal~a?aplaces~daypastin3theres~me~ne'sm~nths~is awashOuseCliniCthermOrSetanyinUPasuchSChool.for c l in i c a day or J PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . . 12 THANA HEALTH COMPLEX . . . . . . . . . . 13 SATELLITE/EPI CLINIC . . . . . . . . . . 14 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . . 23 OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . 31 FRIENDS/RELATIVES . . . . . . . . . . . . . 32 F IELDWOMKER, FWA . . . . . . . . . . . . . . . . 41 HGO CLINIC . . . . . . . . . . . . . . . . . . . . . .42 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 ,336 I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 =339 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 =339 I '3010'Oy°ueverv'"t'uc''temp°rar hea'th "°'c INO,. . . . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z'''" 211 is NO. I QUESTIONS AND FILTERS 337 What services did they provide? CIRCLE ALL MENTIONED. CODING CATEGORIES FAMILY PLANNING METHODS . . . . . . . . . A IMMUNIZATION . . . . . . . . . . . . . . . . . . . . B CHILD GROWTH MONITORING . . . . . . . . . C T.T. FOR PREGNANT WOMEN . . . . . . . . . D ANTENATAL CARE . . . . . . . . . . . . . . . . . . E OTHER X J SKIP DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z 339 I During the last six months has anyone visited you in l YES . I l I your house to talk to you about family planning or I NO . 2 ~342 to give you any family planning method? DOES NOT KNOW . 8 ~342 °IH°wmn ° m nnnw°rerv ° u o I . . . . . . . . . . . . . . . . . . . . . . o . . . . . . . . . . . . . . . . . . IF LESS THAN ONE MONTH AGO, WRITE 'DO j. DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 342 I During the Last six m°nths have Y°U had any c°ntact I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I with a f ie ldworker about fami ly p lann ing? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~344 DOES NOT KNOW . 8 ~344 I 343 I When was the last time you had contact with the I fietdworker about family planning? IF LESS THAN ONE MONTH AGO, WRITE ,DO J, "NO" IN BOTH NO VISITS OR CON -~ TACT WITH FIELDWORKER 345 I Did you receive any family planning supplies from the I fieldworker during the last visit/contact? I MONTHSAO0 . I--il DOES NOT KNOt4 . . . . . . . . . . . . . . . . . . . 8 ~351B I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~348 346 I What supp l ies d id you receive? I PILLS . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I CONDOMS . . . . . . . . . . . . . . . . . . . . . . . . . 2 INJECTION . 3 ~348 OTHER 6 ~348 347 I HOW many cycles/condoms? I CYCLES/CONDOHS . . . . . . . . . . . . . ~ ] 348 Thinking back to all the contacts you have ever had from family planning workers, which methods of avoiding pregnancy did they discuss with you? CIRCLE ALL MENTIONED. PILLS . . . . . . . . . . . . . . . . . . . . . . . . . . . A IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B INJECTION . . . . . . . . . . . . . . . . . . . . . . . C IMPLANT/NORPLANT . . . . . . . . . . . . . . . . D CONDOMS . . . . . . . . . . . . . . . . . . . . . . . . . E FEMALE STERILIZATION . . . . . . . . . . . . F MALE STERILIZATION . . . . . . . . . . . . . . G NEVER DISCUSSED . . . . . . . . . . . . . . . . . Y 349 I Did the family planning fieldworker ever refer you to I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I I a c l in i c fo r any reason? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 r 351 350 Why did she refer you to a clinic? FOR STERILIZATION . . . . . . . . . . . . . . 11 TO GET AN IUD INSERTED . . . . . . . . . 12 TO GET INJECTION . . . . . . . . . . . . . . . 13 TO GET OTHER FP METHOOS . . . . . . . . 14 FOR TREATMENT OF SIDE EFFECTS.15 FOR OTHER HEALTH REASONS . . . . . . . 16 FOR ANTENATAL CARE . . . . . . . . . . . . . 17 OTHER 96 351 1 Have you ever recof~11endc~:J family planning to a frier~d, I YES . 1 1 relative, or anyone else? NO . 2 352 | Do you think that women should have a medica[ check up I YES . I | I when they are pregnant, even if they are not sick? I NO . 2 I DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 212 16 SECTION 4A. PREGNANCY AND BREASTFEEDING 402 403 404 405 CHECK 215: ONE OR MORE BIRTHS SINCE [ BAISHAK 1398 (APRIL 1991) NO BIRTHS SINCE BAISHAK 1398 I I ~ (SKIP TO 501) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE BAISHAK 1398 (APRIL 1991) IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS), Now I would l i ke to a~k you some more quest ions about the hea l th of a l l your ch i ld ren born in the past 5 years. (We w i l l ta lk about one ch i ld at a t ime. ) LINE NUMBER FROM Q. 212 FROM Q. 212 AND O. 216 At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until tater or did you want no imore) ch i ld ren at a l l ? LAST BIRTH LINE . . . . . NAME ALIVE [~ DEAD [~ v l l l~mln v THEN . . . . . . . . . . . . . . . . . . . . . 1 LATER . . . . . . . . . . . . . . . . . . . . 2 NO MORE . . . . . . . . . . . . . . . . . . 3 NEXT-TO-LAST BIRTH LINE . . . . . NAME ALIVE [~ DEAD v ~ v THEN . I LATER . . . . . . . . . . . . . . . . . . . . 2 NO MORE . 3 SECOND-FROM-LAST BIRTH LINE . . . . . ~-~ NAME ALIVE [~ v ~11~1 DEAD ~v g n THEN . . . . . . . . . . . . . . . . . . . . . 1 LATER . . . . . . . . . . . . . . . . . . . . 2 NO MORE . . . . . . . . . . . . . . . . . . 3 407 When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES, Whom d id you see? Anyone else? RECORD ALL PERSONS SEEN. HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . B FAMILY WELFARE VISITOR.C OTHER PERSON TRAINED TRADITIONAL BIRTH ATTENDANT (DAI).D UNTRAINED TBA (DAI) . . . . . E OTHER X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . Y ] (SKIP TO 410)4 / HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . B FAMILY WELFARE VISITOR.C OTHER PERSON TRAINED TRADITIONAL BIRTH ATTENDANT (DAI) . .D UNTRAINED TBA (DAI) . . . . . E OTHER X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . Y- (SKIP TO 410)~ HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . B FAMILY WELFARE VISITOR.C OTHER PERSON TRAINED TRADITIONAL BIRTH ATTENDANT (DAI ) . .D UNTRAINED TBA (OAT) . . . . . E OTHER X (SPECIFY) NO ONE . (SKIP TO 410)4 408 I Now many months pregnant were you when you first MONTHS . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . 98 409 n How many times did you receive antenataI care during this pregnancy? NO. OF TIMES . . . . . . . . I I I DOES NOT KNOW . . . . . . . . . . . 98 NO. OF TIMES . . . . . . . . I t l DOES NOT KNOW . . . . . . . . . . . 98 F ~ NO. OF TIMES . . . . . . . . I I1~ DOES NOT KNOW . 98 | 410 I When you were pregnant w i th (NAME) were you g iven an in jec t ion in the arm I to prevent the baby from | get t ing te tanus , that i s , | convu ls ions a f te r b i r th? I YES No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' I ] 2] YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 NO . 2 (SKIP TO 411A)4 |I (SKIP TO 411A)4 ~ (SKIP TO 411A)~ gOES NOT KNOW . 8J l DOES NOT KNOW . 8JJ gOES NOT KNOW . . . . . . . . .U J l I 411 | During this pregnancy how many times did you get I this injection? I 411A| When you were pregnant I with (NAME), did anyone take your blood pressure (put a cuff on your arm and pump air | ~nto it)? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOU . . . . . . . . . . . . B YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNDW . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 213 17 I 411B| When you were pregnant I with (NAME), d id anyone take your urine for tes t ing? LAST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . B NEXT-TO-LAST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . B SECOND-FROM-LAST BIRTH I NAME YES . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . 2 I DOES NOT KNOW . . . . . . . . . . . . B 412 Where d id you g ive b i r th to (NAME)? HOME YOUR HOME . . . . . . . . . . . . . . 11 OTHER HOME . . . . . . . . . . . . . 12 PUBLIC SECTOR GVT, HOSPITAL . . . . . . . . . . 21 THANA HEALTH COMPLEX. .22 PRIVATE SECTOR PVT. HOSP ITAL /CL IN IC . . .31 OTHER 96 (SPECIFY) HOME YOUR HOME . . . . . . . . . . . . . . 11 OTHER HOME . . . . . . . . . . . . . 12 PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . 21 THANA HEALTH COMPLEX,, .22 PRIVATE SECTOR PVT. HOSP ITAL /CL IN IC . . .31 OTHER 96 (SPECIFY) HOME YOUR HOME . 11 OTHER HOME . 12 PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . 21 THANA HEALTH COMPLEX. . . /2 PRIVATE SECTOR PVT. HOSP ITAL /CL IN IC . . .31 OTHER 96 (SPECIFY) 413 Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . B FAMILY WELFARE V IS ITOR. .C OTHER PERSON TRAINED TBA . . . . . . . . . . . . . D TBA . . . . . . . . . . . . . . . . . . . . . E RELATIVE . . . . . . . . . . . . . . . . F OTHER X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . Y HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . B FAMILY WELFARE VISITOR.C OTHER PERSON TRAINED TBA . . . . . . . . . . . . . D TBA . . . . . . . . . . . . . . . . . . . . . E RELATIVE . . . . . . . . . . . . . . . . F OTHER X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . y HEALTH PROFESSIONAL DOCTOR . . . . . . . . . . . . . . . . . . A NURSE/MIDWIFE . . . . . . . . . . . g FAMILY WELFARE V IS ITOR. .C OTHER PERSON TRAINED TDA . . . . . . . . . . . . . D TBA . . . . . . . . . . . . . . . . . . . . . E RELATIVE . . . . . . . . . . . . . . . . F OTHER X (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . Y 414 Around the time of the birth of (NAME), did you have any of the following problems: Long Labor, that is, did your regular contractions l as t more more than 12 hours? Excess ive b leed ing that was so much that you feared i t was l i fe th reaten ing? A high fever with bad smelling vaginal discharge? YES NO LABOR MORE THAN 12 HOURS.1 2 EXCESSIVE BLEEDING . . . . . . . . . . . . 1 2 FEVER/BAD SMELLING VAG. DISCHARGE . . . . . . 1 2 YES NO LABOR MORE THAN 12 HOURS.1 2 EXCESSIVE BLEEDING . . . . . . . . . . . . 1 2 FEVER/BAD SMELLING VAG. DISCHARGE . . . . . . I 2 YES NO LABOR MORE THAN 12 HOURS.1 2 EXCESSIVE BLEEDING . . . . . . . . . . . . 1 2 FEVER/BAD SMELLING VAG. DISCHARGE . . . . . . 1 2 Convu ls ions not caused by CONVULSIONS . . . . . . . . . . 1 2 CONVULSIONS . . . . . . . . . . 1 2 CONVULSIONS . . . . . . . . . . 1 2 fever? 419 I Has your period returned YES . I i~ i i i i~ i i i i i : ! i i~)~)~)~ ~ : : ~ ) ~ ) ~ : ~ : ~ l I NO . . . . . . . . . • . . . . . . . . . . . Z iEi i i{F:?:::=:::: : : : : : : : :=:::=:::: : , hii i i:: i i i i i i i i i i i i~iilHi;~H~H Hi i l iEF~E:~=m:~ffi i~ffi~ii i i i i i i i i i i f iHi~ffff~iff;ff;~ffffEff~H~;;~ (SKIP TO 422)~ ] !illlliffff~ffffff~iH!Hi!HHHff!H~B~!~!!!ff!H!!!H!~Hffli~Hffff~ 420 D id your per iod re turn between iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiill YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1] j I the b i r th o f (NAME) and your iiiiiiiilmiiiiiiilmiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii next pregnancy? ~ i~ i~ i i i i i i i i~ i i~ i !~ i~!~i~!~ NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . 2 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ] . . . . . . . . . . . . iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii (SKIP TO 424) . (SK IP TO 424) , 421 For how many months a f te r the b i r th o f (NAME) d id you not have a period? 422 CHECK 227: 423 RESPONDENT PREGNANT? Have you resumed sexua l relations since the birth of (NAME)? MONTHS . . . . DOES NOT KNOW . . . . . . . . . . . 98 NOT PREGNANT YES . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . 2 l (SKIP TO 425) , ~F- -~ MONTHS . . . . . . . . . . . . . . ~ MONTHS . . . . . . . [ ~ DOES NOT KNOW . . . . . . . . . . . 98 DOES NOT KNOW . . . . . . . . . . . 98 PREGNANT I ~i~]~11ffiffff~ffff!illiffiiffiiiffiffiillliiillliHiliHHH!HHff{ffffff~ I OR [~ : i mtmm~lml:::m::mmmm'mmmmm:mrm:mr r . UNSURE ::::: ::::::::=::m=======:=== ==== ==== =: I i1 : ~1~ i ~l tffIff t I ffff~ ~] ]iiiiiiiiiiff iffff fit lit iitittt titlt ttitE ttLff,ffffl • 111111 ffffff~ff~Hii]HH~i!~i!H~Hff~!iiiiiiiiiiiiiiiiiiiiiiiliiiiffiiiffHiHlffl ~!ffEiffffff illli~i • I ::w :lIlll~l:mml::mmmmmmmmmmmmmm:::: I :: : : . ~!!!:h! . '.'=' . = . t :::::::::::::::::::::m:::::m::im: nnh~hnnlllllllll,I,L:l,,lfftiHffff fflili.BAilll iiiiiiiiffill ,B i (gKI P TO 424 ) ffff ff+ff"+::hi'+t'ti'l thtl'"~j':lllt I.1111.I,.I,.11L.J.J.JIL.L ffffJffffALILttiiiiiitiittiffL+LLffi,!ff.,L.L.fft+ff_L+ff.L++L • ~ff!HH!iHff~H!iHffffH~HffHE!Hffl!tltilHllltlllllllllffllffffffffffff ffffffff!ff~HllffEHiiHIH~!lttffff~ffffff~fffffffft!ffffffffffffff!ffffff ~Hff~H~iHffHiliffilliHiffiliffllliHiifflllifi~ili ff]H~H.HHHHfffl ffffffff~ff~ff~iiiiiiiiiiilHiiffffffffffliBff~ffi~illlllifflillllllllliiffll ::::::~mmmmmmm::m:mm:mlr:. =. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . i. i.,L.,.i . :::::::::::mmmmmm:m:m:m::m::=:mz:ctmm~m=:=:=m ~iiiiii~iii~iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii}}iliiiii!i ~i~iiiiiiiiii~iiii~i~iiiii*~iiiiiiii~iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ff~!ffHHHHHHH~HHHE~HHHHHHffffHH!!HHH~HH~ffff~ 214 18 424 I I For how many months after the birth of (NAME) did you not have sexual relations? LAST BIRTH NAME MONTHS . . . . . . . . . . . . . . ~ DOES NOT KNOW . . . . . . . . . . . 98 NEXT-TO-LAST BIRTH NAME MOHTHB . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . 98 SECOND-FROM'LAST BIRTH I NAME 425 I B id you ever bress t feed (NAME)? YES . . . . . . . . . . . . . . . . . . . . . . ~I YES . . . . . . . . . . . . . . . . . . . . . . ~I YEB . . . . . . . . . . . . . . . . . . . . . . 1 I I No . . . . . . . . . . . . . . . . . . . . . . . 21 ' NO . . . . . . . . . . . . . . . . . . . . . . . 2TI NO . . . . . . . . . . . . . . . . . . . . . . . 21 ' I (SKIP TO 431), (SKIP TO 431)~ I I (SKIP TO 431)4 'I 426 How Long after birth did you first put (NAME) to the breast? IF LESS THAN 1 NO/JR, RECORD '00 ' HOURS• IF LESS THAN 24 HOURS, BECORD HOURS. OTHERWISE, RECORD DAYS. IMMEDIATELY . . . . . . . . . . . . 000 HOURS . . . . . . . . . . . . . . 1 ~ DAYS . . . . . . . . . . . . . . . 2L_L . ] I I I I I ! I ! I I I i I ! I I I I I I I I I I I I I I I I I I I I I I I I lE I IE ! ! I I I I I I ! I I I I I I I I I I I I I I I I I I I I I I I I I!~!~ililIIEIIIIIIIIlIIIlIIIIIIilIilI!I!IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIlIIIIElll!lll!ll~!II!!!IIIIIIIIIIIIIIIIIIIIIIIIIII!II!I~I!IlIIIIIIIIIIII Hiiii[iiiii]i i !~ ~mmmmliiiiiHiiiiiiiiii[i m; ml mmmHii iiiiiiiiiiiiil[!mmmmmim~i[iiiiiii~ii!iliHmmmmHiliiiii , = = = = mliiiiiiiiii i ;Lmmmmmi~iiiiiiiii: i .Lmm.zz~m zz~i~i i i i i i i i ! i~iEI! i l i ! i l ] i i i l ] ] i i i i i i l l i i l t i i i ! i l l i i i i ! t i i i i i i i i i i i i i i i i i i i i i i i i~i!!! I I 1111!II]]IIIIEIEhIEE • . .~: : : :~: : . : , r . . . .mmmmm m:m i i]ii!!i! ; t t I t I I I I ! I I I I I I I I ! I I I I I I I I ! I IE I ! : , , I I I I I I I I I I I I I I ! I I I I I I I I I I i liililil iiiliiiiiiiiill i IIIIIIIIIEI!!! i I!!IEIIIIIIIIIIIII!IIIIIIII~III! !I!iiiliiiiii!iili!ii . L.hh~h•••~.•~.L.:Il l lh.l . mmmmm *m:~:~.mmmm m::.~::: i i i i i i i i i i i l l i i i iLi~!!~iR~i~ii~E~iiii~ii~i~ L , J I L I I I I I I I I I I I I I E I : . : :.::::1=:==1111 . h=.= . . . . . . . . . . . . . . . . . . . . . . . ~.tLt=.t.=.= . . . . . M !il i . . i~ i t l l ; ;~ i ! i~ i ! i l l i l l l l l I I I I I I I I I I I I ! I !~!! I ! ! ! I ! I ! I I I I I I I I I I I I IR I IE !t l l i i i i i i i i i i i i i i i i i i i ! i i i i i i i i ! iii i~mmmm~iii~i~iiiiil~ Emmm~iiiiiiiiiiiiiiii!!!!! . . . . t t**~ . . . . . . d.*~ . = iii . . ~ I, Lr .m~iiiiiiii i . t Lml.i~i:!:i!ii:.!:~!:: ! : , i l l l l l i i i i i i i i i i i i i i i l I i t t th m ::::: l i i i i i i i i i i i i i i! i i=~t=m m m~::::: : i l l i t i tt!tt~1111111111 i i i i~i! i i! i i i i i l l l l l ] i i i i i i i l ; i i ! IIIIIIIIIIIIIIIIIIIIIIIIIIIIE !i iiii1111~iiiii~i!iI~ iii I iiiiiiiiiiiiiii I iiiiiiiiiiiiiiiiiililiil ,!IIilIIIIIIL EIIIIIIIIIIIII!I J I~LII LIilIIIIIIIIII J,i!i.ilhli.iliI. i l l i !!i!!iiii~i i l i i f i i i l [ i [ i l t [~tttt t!ti tt tt ~ii i i i i i i i i i i i i i i l i l i i i i i l i ! I l! i i i i i i i i i i i i i i i i!!!!t!titt l i~ttl l iii i !!ilUIIIIIII~IIIIIIII i II!IIIIRII~I~IIIIIII!IIIIIlll . . . . : m::,u I t~ili~ili i i i i[i i i i i i l l l l l I I l i l i l l i l l i ! i i ! l i i i i t~ Ittt l tt l t l I~lt i l i i I l l i i l l l l l l t t l I I I ! i ! i i i i i l ! i i t t l l i l i i i l l l l l l l l l l ! l i i i i ! i l I i ! I t i i i lli~ il IIIilIIIUIIIII I • • !li~]]iiiiiiill lll!II!i!!!l!iii!!i!i IiiIIiiiiJi ii ! ! I I IE! I I I I I I I ! I I I I ! I I ! I ! ! ! I I i I i! i i i i! l i! l i i! i i i i! l! l !! I I I I I ! I I !EI I I I I I ! I I I ! I ! I ! ! !! I tt! i i i i i !t i!! i i l l l l l ii I I i ! I t t it! i I i i i i i i i i i i i ln! i ( f i rst milk f rom the breast) I I i i i l t t t ~ iIi i i i i i i i~ l i t I t I I t t l I I I I I I I I I t l L t t t t t t l t I I l . i l i . . i i i i i l i i i . . i i . t l t l " l J t t ~ t ' i i i i i i i i i i i i i i i t I t i t i l i t i t i l t tL l l i i l l l l i . t l l l i i i i i i i i i i i i i i i i i i i i i to d r ink? NO . . . . . . . . . . . . . . . . . 2 mz mmmmmmmm ~ ~ • ' ' ' ' ' !! i l l l ! l l ! i ! i ! l l l l !! l i ! ! i t i l i ! i l l i i i l i i i ! ! i ! i l t l l t I I ! l l l l ! l ! l l i i i l l l I 426B I Was (NAME) g iven water or any YEB . . . . . . . . . . . . . . . . . . . . . . 1 I other l iqu id to dr ink soon after birth? NO . 2 CHILD ALIVE? • (GO TO 429) YES . 1] (SKIP TO 432) 4 NO. . . . . . • . . . , , , , , , . . . . . . . ~; 428 I Are you s t i LL breast feed ing I (NAME)? III!!!III!IIIIIIIIIIIIIIE E~IIIIIIIIIEI!IEIIIIIIII!I!!!!IIIIIIIIIIIIIIIIIII I!iiiiiiii!iiii i I IiiiIiiIiiiiiiIiiI II Ii I iiiiiiiiiiii]!!]il]I!III i I i!iiii!IiiliJiii!IIi!IiI i iifiiiiiiiiliii ill III.iIiili.IIIILIII~IIIIIIIIII IIIIII LIIIIIIIIIII t i l i l i ! i i i i i i l l !111 I lnt l i t ! l i l l l l l l i ! l I t t ttt l i i i t l i t i i i i!t i i i it! l l i i i i i i i i i i i i i i i i i i i i i i i i l i i i l l i l i t i i i l l l i i i i ! i i i i i i i i i i i i i i i i i ! i i i i i i i i i i i i i i i i i i i i i i i ni i i lEi i i i i ! i i!!! i! i i i l l ! i l i ! i i i i i i i i i i i i i i i i i i i i i i i i l i i !!!! i i!!! i i l ! i i l l ALIVE? OEAO@, (GO TO 429) YES . 1. (SKIP TO 432) • NO . . . . . . . . , , , , . . . . . . . . . . ,2 you breast feed (NAME)? 430 Why d id you s top breast feed inR (NAME)? I i! 31 tilE!i! I i!!!lii]]]i]i~]il J~133 i~t i ' i ! l ] i ]!t i i i i i i3131tlt]l]il lnE J t l~ t l t i ! l l ! i l i i iHl I t t t t l t l t E IIHiHE~iIIIII~ tt i ill I I t IIIlllli!iiliiill ~ II!!IiIi!iiiiiiilillii!iilll ill IIIIIIIFIIIIIIIIIIIIIIIIIIII ~iiiiiiiiiiiiiiiiiiIIi]iiiiIii! IIIIIII~I~!EII]!i !Eli ]]i]iii!!!ii!il ! m = ,:,~mm:=::: = .:,:mmmm=:~:=~ . . . . . . . . . . t.,EE . . . . . . . . . . . . . . . I., tt ALIVE ? DEAO @, (GO TO 429) YES . . . . . . . . . . . . . . . . . . . . . . 11 (SKIP TO 432) • 2 J NO . . . . . . . • . . . . . . . . , , . . . . . 4291F°rh°wmanym°nthsdid FT] MONTHS . . . . . . . . . . MONTHS . . . . . . . . . . . . . . MONTHS . . . . . . . . . . DOES NOT KNOW. DOES NOT KNOW . . . . . . . . . . . 98 DOES NOT KNOW. MOTHER ILL/WEAK . . . . . . . . . 01 CHILD ILL/WEAK . . . . . . . . . . 02 CHILD DIED . . . . . . . . . . . . . . 03 NIPPLE/BREAST PROBLEM.04 INSUFFICIENT MILK . . . . . . . 05 MOTHER WORKING . . . . . . . . . . 06 CHILD REFUSED . . . . . . . . . . . 07 WEANING AGE . . . . . . . . . . . . . OS BECAME PREGNANT . . . . . . . . . 09 STARTED USING COWTBACEPTION . . . . . . . . . . 10 OTHER 96 (SPECIFY) MOTHER ILL/WEAK . . . . . . . . . 01 CHILD ILL/WEAK . . . . . . . . . . 02 CHILD DIED . . . . . . . . . . . . . . 03 NIPPLE/BREAST PROBLEM.O4 INSUFFICIENT MILK . . . . . . . 05 MOTHER WORKING . . . . . . . . . . 06 CHILD REFUSED . . . . . . . . . . . 07 WEANING AGE . . . . . . . . . . . . . 08 BECAME PREGNANT . . . . . . . . . 09 STARTED USING CONTRACEPTION . . . . . . . . . . 10 OTHER 96 (SPECIFY) MOTHER ILL/WEAK . . . . . . . . . 01 CHILD ILL/WEAK . . . . . . . . . . 02 CHILD DIED . . . . . . . . . . . . . . 03 NIPPLE/BREAST PROBLEM.O4 INSUFFICIENT MILK . . . . . . . 05 MOTHER WORKING . . . . . . . . . . 06 CHILD REFUSED . . . . . . . . . . . 07 WEANING AGE . . . . . . . . . . . . . O8 BECAME PREGNANT . . . . . . . . . 09 STARTED USING CONTRACEPTION . . . . . . . . . . 10 OTHER 96 (SPECIFY) 431 432 CHECK 404: CHILD ALIVE? How many times did you breastfeed last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER ALIVE [~ DEAD [~ (GO TO 435) (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440) NUMBER OF ~ NUMBER OF NIGHTTIME I I I NIGHTTIME FEEDINGS FEEDINGS ALIVE @ DEAD @ (GO TO 435) (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIBTHS, GO TO 440) ALIVE E~ DEAD E~ (GO TO 435) (GO BACK TO 4D5 IN NEXT DOLUMN OR, IF NO MORE BIRTHS, GO TO 440) NUMBER OF [ ~ NIGHTTIME FEEDINGS 215 ~9 433 I I Now many times did you breastfeed yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER LAST BIRTH NAME NUMBER OF DAYLIGHT FEEDINGS NEXT-TO'LAST BIRTH NAME NUMBER OF DAYLIGHT FEEDINGS SECOND-FROM-LAST BIRTH NAME NUMBER OF DAYLIGHT FEEDINGS 435 At any time yesterday or last night was (NAME) given any of the following?: P la in water? Sugar water or honey? Ju ice? Tea? Baby formula? Cow's mitk? Other liquids? Meat? YES PLAIN WATER . . . . . . . 1 SUGAR WATER, HONEY.1 JUICE . . . . . . . . . . . . . . 1 TEA . I BABY FORMULA . I COW'S MILK . . . . . . . . . I OTHER LIQUIDS . . . . . . I MEAT . . . . . . . . . . . . . . . I NO YES NO 2 PLAIN WATER . . . . . . . 1 2 2 SUGAR WATER, HONEY.I 2 2 JUICE . . . . . . . . . . . . . . 1 2 2 TEA . . . . . . . . . . . . . . . . 1 2 2 BABY FORMULA . . . . . . . 1 2 2 COW'S MILK . I 2 2 OTHER LIQUIDS . . . . . . 1 2 2 MEAT . I 2 YES NO PLAIN WATER . . . . . . . 1 2 SUGAR WATER, HONEY.1 2 JUICE . . . . . . . . . . . . . . 1 2 TEA . . . . . . . . . . . . . . . . 1 2 BABY FORMULA . . . . . . . 1 2 COW'S MILK . . . . . . . . . 1 2 OTHER LIQUIDS . . . . . . 1 2 MEAT . . . . . . . . . . . . . . . 1 2 216 20 SECTION 4B. IMMUNIZATION AND HEALTH ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE BAISHAK 1398 (APRIL 1991) IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. ( IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS). LINE NUMBER FROM Q. 212 LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH 442 m 443 FROW Q. 212 AND Q. 216 Do you have a card where (NAME'S) vaccinations are written down? NAME ALIVE I DEAD@ (GO TO 442 v IN NEXT COLUMN; IF NO MORE BIRTHS GO TO 501) ~ I B v NAME ALIVE I DEAD @ (GO TO 442 v IN NEXT COLUMN; IF NO MORE BIRTHS GO TO 501) V YES, SEEN . . . . . . . . . . . . . . . . l l J YES, SEEN . . . . . . . . . . . . . . . . l l J (SKIP TO 445)~ / I (SKIP TO 445), / I YES, NOT SEEN . 2 (SKIP TO 447)• l (SKIP TO 447)q ] YES, NOT BEEN . 211 NO CARD . 3 NO CARD . 3 NAME ALIVE DEAD [~ (GO TO 442 v IN NEXT COLUMN; IF NO MORE BIRTH! GO TO 501) YES, EEN . . . . . . . . . . . . . . . . 1 SKIP TO 445)~ ] YES, NOT SEEN . . . . . . . . . . . . 21 (SKIP TO 447)~ I NO CARD . . . . . . . . . . . . . . . . . . 3 IF YES: May I see i t , please? 444 I Did you ever have a YES . . . . . . . . . . . . . . . . . . . . . . I l l YES . . . . . . . . . . . . . . . . . . . . . . I] YES . . . . . . . . . . . . . . . . . . . . . . I] J I vaccination card for (SKIP TO 447)~ j (SKIP TO 456), / I (SKIP TO 456) . - - -~ I (NAME)? NO . . . . . . . . . . . . . . . . . . . . . . . Z ~ NO . . . . . . . . . . . . . . . . . . . . . . . 2J I NO . . . . . . . . . . . . . . . . . . . . . . . 2J m 445 (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD (2) WRITE '44' IN 'DAY' COLUMN IF CARD SNOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE WAS RECORDED. DAY MO YR DAY MO YR DAY BCG BCG B C G ' ~ BCG DPT I DI DI i DI DPT 2 D2 D2 I D2 L DPT 3 D3 D5 D3 POLIO 1 P1 P1 P1 POLIO 2 P2 i P2 P2 POLIO 3 P3 P3 P3 i MEASLES MEA j MEA MEA VITAMIN A V A J V A V A MO YR ! i I i . 446 Has (NAME) received any vaccinations that are not recorded on this card? RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT I-3, POLIO 0-3 AND/OR MEASLES VACCINE(S). YES . . . . . . . . . . . . . . . . . . . . . . I- (PROBE FOR VACCINATIONS AND WRITE '66 ~ IN THE CORRESPONDING DAY ~-- COLUMN IN 445) NO. . . , , , , . , . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . 8 (SKIP TO 449) YES . I 1 (PROBE FOR VACCINATIONS I AND WRITE '66 ~ IN THE CORRESPONDING DAY 4-J COLUMN IN 445) NO . . . . . . . . . . . . . . . . . . . . . . . .~ DOES NOT KNOW . . . . . . . . . . . . (SKIP TO 449) • YES . . . . . . . . . . . . . . . . . . . . . . 1 ] (PROBE FOR VACCINATIONS / AND WRITE ~66' IN THE | CORRESPONDING DAY ,~ COLUMN IN 445) NO . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW . . . . . . . . . . . . (SKIP TO 449) YES . I J 447 Did (NAME) ever receive YES . I J YES . I NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . 2 L 1 any vaccinations to NO . 2]J ] I prevent him/her from (SKIP TO 449)4 _[I (SKIP TO 449), J (SKIP TO 449), _I getting diseases? DOES NOT KNOW . . . . . . . . . . . . ~ I DOES NOT KNOW . . . . . . . . . . . . 8JJ DOES NOT KNOW . . . . . . . . . . . . 217 21 448 448A 448B 448C 448D 448E 448F 448G Has (NAME) received any of the fo l low ing vacc inat ions : A BCG vacc inat ion agaLnst tubercu los i s , that i s , an in jec t ion in the Left shou lder that caused a scar? Po l io vacc ine, that i s , drops in the mouth? IF YES: How many times? When was the first po l io vaccine given, just after birth or Later? DPT vacc inat ion , that i s , an in jec t ion usua l ly g iven at the same t ime as po l io drops? IF YES: How many t imes? An injection to prevent measles? LAST BIRTH NAME YES . . . . . . , , , , , , . . . . . . . . . . I NO . . . . . . . , , , , , , °oooo° . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 YES . . . . . . * *° , ° . , , . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 NUMBER OF TIMES . . . . . . . . JUST AFTER BIRTH . . . . . . . . . I LATER . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . , , . , , , , , , , o° . . . . . 1 NO . . . . . . , , , , , , , , , , . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 NUMBER OF TIMES . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 NEXT-TOLAST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . . 1 NO. , . . , , , ° ° . . . . . . . . . . oo , ,2 DOES NOT KNOW . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 NUMBER OF TIMES . . . . . . . . JUST AFTER BIRTH . . . . . . . . . I LATER . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO, . . , . ° , , , , , . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 NUMBER OF TIMES . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 SECOND-FROM-LAST BIRTH NAME YES, . . . . . . . . . . . . . , , . , , , , ,1 NO, , , , ° . . . . . . . . . . . . , , , ° , °2 DOES NOT KNOW . . . . . . . . . . . . 8 YES. . , . . . . . . . . . . . . . . . , , , , I NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 NUMBER OF TIMES . . . . . . . . JUST AFTER BIRTH . . . . . . . . . I LATER . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . °oo , , , , , , , . . . . . 1 NO . . . . . . . . . . ° , , , , , , , , , , . ,2 DOES NOT KNOW . . . . . . . . . . . . 8 NUMBER OF TIMES . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . ° , °2 DOES NOT KNOW . . . . . . . . . . . . 8 449 I Has (NAME) been i l l w i th s fever at any t ime in the las t 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . , , , ° °° . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 YES . . . . . . . . , , , , . , . . . . . . . . I NO . . . . . . . . . , , , ° , , , . , . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 I YES . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . 2 I DOES NOT KNOW . . . . . . . . . . . . 8 450 J Has (NAME) been i t t w i th a cough at any t ime in the las t 2 weeks? YES . . . . . . . . . , , , , , , , , . , , , . I NO . . . . . . . . . . . . . . . . . . . . . . . 2 l (SKIP TO 454) , I DOES NOT KNOW . . . . . . . . . . . . . RJ YES . . . . . . . . . . . . . . . . . . . . . . 1 NO, , , , , , , . . . . . . . . . . . . . . . . 2 ¢-1 (SKIP TO 454)~ DOES NOT KNOW . 8J I YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 454)4 DOES NOT KNOW . 8 J 451 I When (NAME) had the i l l ness with a cough, d id he/she breathe faster than usual with short, rapid breaths? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . B YES . I No . 2 DOES NOT KNOW . 8 452 I Did you seek advice or treatment for the cough? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2] (SKIP TO 454)4- - YES . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 454)~ YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2] (SKIP TO 454)4 - - 453 Where d id you seek advice or t reatment? Anywhere else? RECORD ALL MENTIONED. PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . . A FAMILY WELFARE CENTER.B THANA HEALTH COMPLEX.C SATELLITE CLINIC . . . . . . . . D EPI CLINIC . . . . . . . . . . . . . . E SATELLITE/EPI CLINIC . . . . F FWV/FIELDWORKER . . . . . . . . . G MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . . . . H PHARMACY . . . . . . . . . . . . . . . . I PRIVATE DOCTOR . . . . . . . . . . J OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . K TRADITIONAL DOCTOR . . . . . . L NGO CLINIC . . . . . . . . . . . . . . M HOMEOPATHIC DOCTOR . . . . . . N OTHER X (SPECIFY) PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . . A FAMILY WELFARE CENTER.B THANA HEALTH COMPLEX . . . . C SATELLITE CLINIC . . . . . . . . O EPI CLINIC . . . . . . . . . . . . . . E SATELLITE/EPI CLINIC . . . . F FWV/FIELDWORKER . . . . . . . . . G MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . . . . H PHARMACY . . . . . . . . . . . . . . . . I PRIVATE DOCTOR . . . . . . . . . . J OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . K TRADITIONAL DOCTOR . . . . . . L NGO CLINIC . . . . . . . . . . . . . . M HOMEOPATHIC DOCTOR . . . . . . N OTHER X (SPECIFY) PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . . A FAMILY WELFARE CENTER.B THANA HEALTH COMPLEX.C SATELLITE CLINIC . . . . . . . . D EPI CLINIC . . . . . . . . . . . . . . E SATELLITE/EPI CLINIC . . . . F FWV/FIELDWORKER . . . . . . . . . G MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . . . . H PHARMACY . . . . . . . . . . . . . . . . I PRIVATE DOCTOR . . . . . . . . . . J OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . K TRADITIONAL DOCTOR . . . . . . L NGO CLINIC . . . . . . . . . . . . . . M HOMEOPATHIC DOCTOR . . . . . . N OTHER X (SPECIFY) 218 2e 454 Has (NAME) had d~arrhea in the las t two weeks? LAST BIRTH NAME YES . . . . . . . . . . °o° . . . ° °°oo°1 NDooooo , , . . . ° °°° . . . . . . . . . 2 (SKIP TO 464)~ _ l DOES NOT KNOt# . . . . . . . . . . . . 8 J NEXT-TO-LAST BIRTH N/~4E YES . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . 2] J (SKIP TO 464) , _jj DOES NOT KNOW . . . . . . . . . . . . 8JJ SECOND-FROM-LAST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 r. 1 (SKIP TO 464)q _I DOES NOT KNOW . . . . . . . . . . . . 8J 455 I Was there any b lood YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 I I i n the s too ls? NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 I DOES NOT KNOW . . . . . . . . . . . . 8 DOES NOT KNOW . . . . . . . . . . . . 8 DOES NOT KNOW . . . . . . . . . . . . 8 457 J Was he /she g iven the same SAME . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . 1 I I amount to drink as before MORE . 2 MORE . 2 MORE . 2 I I the d ia r rhea , or more, or LESS . . . . . . . . . . . . . . . . . . . . . ] LESS . . . . . . . . . . . . . . . . . . . . . 3 LESS . . . . . . . . . . . . . . . . . . . . . 3 Less? DOES NOT KNOW . . . . . . . . . . . . B DOES NOT KNOW . . . . . . . . . . . . 8 DOES NOT KNOW . . . . . . . . . . . . 8 459 When (NAME) had d ia r rhea , was he /she g iven any o f the fo l low ing to dr ink : A f lu id made f rom a spec ia l sa l ine packet? Home-made sugar -sa l t -water so lu t ion (Laban Bur )? Water? Any o ther t iqu~ds? YES NO DK FLUID FROM PACKET.1 2 8 LABAN GUN . . . . . . . . . . 1 2 8 WATER . . . . . . . . . . . . . . 1 2 8 OTHER LIQUID . . . . . . . 1 2 8 YES NO DK FLUID FROM PACKET.1 2 8 LABAN GUR . . . . . . . . . . 1 2 8 WATER . . . . . . . . . . . . . . 1 2 8 OTHER LIQUID . . . . . . . 1 2 8 YES NO DK FLUID FROM PACKET.°1 2 8 LABAN GUR . . . . . . . . . . 1 2 8 WATER . . . . . . . . . . . . . . 1 2 B OTHER LIQUID . . . . . . . 1 2 8 460 J Was anyth ing (e l se ) g iven to t reat The d~arrhea? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 21 (SKIP TO 462) , [ DOES NOT KNOW . . . . . . . . . . . . 8J YES . . . . . . °o=o°o°°°o ,o°°°° NO . . . . ° °°°°°°°°°°°°°°°°o° (SKIP TO 462)q DOES NOT KNOW . . . . . . . . . . . . & I YES . . . . . . . . . . . . . . . . . . . . . . 1 | NO . . . . . . . . . . . . . . . . . . . . . . . 21 z I (SKIP TO 462)~ / I DOES NOT KNOW . . . . . . . . . . . . 8 J J 461 I What was given to treat the diarrhea? Anything else? RECORD ALL MENTIONED. PILL OR SYRUP . . . . . . . . . . . . A INJECTION . . . . . . . . . . . . . . . . B ( I .V° ) INTRAVENOUS . . . . . . . C HOME REMEDIES/HERBS . . . . . . D OTHER X PILL OR SYRUP . . . . . . . . . . . . A INJECTION . . . . . . . . . . . . . . . . B ( I .V . ) INTRAVENOUS . . . . . . . C HOME REMEDIES/HERBS . . . . . . O OTHER X PILL OR SYRUP . . . . . . . . . . . . A INJECTION . . . . . . . . . . . . . . . . S ( I .V . ) INTRAVENDUB . . . . . . . C HOME REMEDIES/HERBS . . . . . . D OTHER X (SPECIFY) (SPECIFY) (SPECIFY) 462 D id you seek adv ice or YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 t reatment For the d ia r rhea? NO . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 464)4 2] NO . . . . . . . . . . . . . . . . . . (SKIP TO 464)4 NO . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 464)4 2] 463 Where did you seek advice or treatment? Anywhere etse? RECORD ALL MENTIONED. PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . . A FAMILY WELFARE CENTER.B THANA HEALTH COMPLEX.C SATELLITE CLINIC . . . . . . . . D EPI CLINIC . . . . . . . . . . . . . . E SATELLITE/EPI CLINIC . . . . F FWV/FIELDWDRKER . . . . . . . . . G MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CL IN IC . . . .H PHARMACY . . . . . . . . . . . . . . . . I PRIVATE DOCTOR . . . . . . . . . . J OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . K TRADITIONAL DOCTOR . . . . . . L NGO CLINIC . . . . . . . . . . . . . . M HOMEOPATHIC DOCTOR . . . . . . N OTHER X (SPECIFY) PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . . A FAMILY WELFARE CENTER°.*B THANA HEALTH COMPLEX . . . . C SATELLITE CLINIC . . . . . . . . D EPI CLINIC . . . . . . . . . . . . . . E SATELLITE/EPI CLINIC . . . . F FWV/FIELDWORKER . . . . . . . . . G MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . . . . H PHARMACY . . . . . . . . . . . . . . . . [ PRIVATE DOCTOR . . . . . . . . . . J OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . K TRADITIONAL DOCTOR . . . . . . L NGO CLINIC . . . . . . . . . . . . . . N HOMEOPATHIC DOCTOR . . . . . . N OTHER X (SPECIFY) PUBLIC SECTOR GVT. HOSPITAL . . . . . . . . . . . A FAMILY WELFARE CENTER.B THANA HEALTH CDMPLEX.C SATELLITE CLINIC . . . . . . . . D EPI CLINIC . . . . . . . . . . . . . . E BATELLITE/EPI CLINIC . . . . F FWV/FIELDWDRKER . . . . . . . . . G MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . . . . H PHARMACY . . . . . . . . . . . . . . . . I PRIVATE DOCTOR . . . . . . . . . . J OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . K TRADITIONAL DOCTOR . L NGO CLINIC . . . . . . . . . . . . . . M HOMEOPATHIC DOCTOR . . . . . . N OTHER X (SPECIFY) I 464 I In the past 6 months , has I (NAME) taken a V i tamin A capsu le? SHOW CAPSULE. 465 J YES . . . . . . . ° ,o , , , , , , . . . . . 1 NO . . . . . . . . ° °°°°° . . . . . . . . 2 NOT SURE/DOES NOT KNOW.8 YES, , . . . . . . . . . . . . . o .oo° .1 NO. , , , . . . . . . . . . . . ooo°o° ,2 NOT SURE/DOES NOT KNG~.8 GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 501 219 YES . . . . . . . . . . . . . . . . . . . . . 1 NO. . . , . , , , . . . . . . . . . . . . . .2 NOT SURE/DOES NOT KNOW.8 23 NO. I 501 I SECTION 5. QUESTIONS AND FILTERS Have you been married only once or more than once? MARRIAGE SKIP I CODING CATEGORIES I TO IONCE . 1 I MORE THAN ONCE . . . . . . . . . . . . . . . . . . 2 502 In what month and year did you get married ( for the f i r s t time? BENGALI . . . . . . . . . . . . . ; .1 I I ~ , I MONTH . . . . . . . . . . . YEAR I l l ,504 ENGLISH . . . . . . . . 2 I MONTH** . . . . . . . . . . . . . . . . . . I I F -~ I YEAR 1 ' .504 I 503 504 505 508 HOW old were you when you got married? AGE . . . . . . . . . . . . . . . . . . . . . . . . DOES NOT KNOW AGE . . . . . . . . . . . . . . 98 DETERMINE MONTHS MARRIED SINCE BAISHAK 1398. ENTER "X" IN COLUMN 3 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER "O" FOR EACH MONTH NOT MARRIED, SINCE BAISHAK 1398. FOR WOMEN WITH MORE THAN ONE MARRIAGE: PROBE FOR DATE WHEN CURRENT MARRIAGE STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS MARRIAGE. FOR WOMEN NOT CURRENTLY MARRIED: PROBE FOR DATE WHEN LAST MARRIAGE STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS MARRIAGES. How tong af ter you were married did you star t Living with your husband? IF IMMEDIATELY AFTER MARRIAGE, WRITE 'GO DAYS' DAYS . . . . . . . . . . . . . . . . . . . 1 MONTHS . . . . . . . . . . . . . . . . . 2 F - ~ WIDOWED, DIVORCED Is your husband Living with you now or is he staying elsewhere? F-] LIVING WITH HER . . . . . . . . . . . . . . . . . 1 STAYING ELSEWHERE . . . . . . . . . . . . . . . 2 ,509 1 [ I 508A| INTERVIEWER: WRITE LINE NUMBER OF HUSBAND FROM THE I HOUSEHOLD QUESTIONNAIRE. IF HUSBAND IS NOT LISTED, WRITE ~OO'. 509 I PRESENCE OF OTHERS AT THIS POINT. I LINE NUMBER OF HUSgAND . I YES NO I CHILDREN UNDER 10 . . . . . . . . . . 1 2 HUSBAND . . . . . . . . . . . . . . . . . . . . 1 2 OTHER HALES . . . . . . . . . . . . . . . . 1 2 OTHER FEMALES . . . . . . . . . . . . . . 1 2 * BENGALI MONTHS: ** ENGLISH MONTHS: 01 BAISHAK 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 09 SEPTEMBER 02 JAISTHA 06 ASHWIN 10 MAGN 02 FEBRUARY 06 JUNE 10 OCTOBER 03 ASHAR 07 IC~RTIK 11 FALGUN O] MARCH 07 JULY 11 NOVEMBER 04 SRABAN 08 AGRAHAYAN 12 CHOITRA 04 APRIL 08 AUGUST 12 DECEMBER 220 24 NO. 602 SECTION 6, FERTILITY PREFERENCES QUESTIONS AND FILTERS CODING CATEGORIES CHECK 106A: CURRENTLY MARRIED NOT CURRENTLY~ MARRIED i i CHECK 314: NEITHER mSTERILIZED 9• CHECK 227: SHE OR HE STERILIZED NOT PREGNANT OR UNSURE [~ I Now I have some quest ions about the fu ture . Would you l i ke to have (a /another ) ch i ld or would you pre fer not to have any (more) ch i ld ren? PREGNANT 9 I Now I have some quest ions about the fu ture . After the ch i ld you are expecting, would you like to have another child or would you prefer not to have any more children? HAVE A (ANOTHER) CHILD . . . . . . . . . . 1 NO MORE/NONE . . . . . . . . . . . . . . . . . . . . 2 SAYS SHE CAN'T GET PREGNANT . . . . . 3 UNDECIDED OR DOES NOT KNOW . . . . . . 8 I ~, 629 I ~614 ~604 603 605 607 CHECK 227: NOT PREGNANT OR UNSURE [ ] I r How Long would you Like to wait from now before the birth of (e/another) child? PREGNANT 9 P How tong would you like to wait after the birth of the child you are expecting before the birth of another ch i ld? PREGNANT I~ If you became pregnant in the next few weeks, would you be happy, unhappy, or woutd it not matter very much? F-~ MONTHS . . . . . . . . . . . . . . . . . . . 1 I l l YEARS . . . . . . . . . . . . . . . . . . . . 2 SOON/HOW . . . . . . . . . . . . . . . . . . . . . . 994 SAYS SHE CAN'T GET PREGNANT.995 OTHER 996 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . 998 HAPPY . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 UNHAPPY . . . . . . . . . . . . . . . . . . . . . . . . . 2 WOULD NOT MATTER . . . . . . . . . . . . . . . . 3 NTLY [~ CURRENTLY USING By I Do you th ink you w i l l use a method to de lay or avoid I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 pregnancy w i th in the next 12 months? J NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 ~607 1 I 1~614 I ~609 I 608 I Do you think you will use a method at any time in I YES . I | the future? NO . 2 ~611 DOES NOT KNOW . 8 u611 609 When you use a method, which method would you prefer to use? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 IMPLANT . . . . . . . . . . . . . . . . . . . . . . . . 04 CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . 05 FEMALE STERILIZATION . . . . . . . . . . . 06 MALE STERILIZATION . . . . . . . . . . . . . 07 MENSTRUAL REGULATION . . . . . . . . . . . 08 CALENDAR, COUNTING DAYS . . . . . . . . 09 WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . 10 OTHER 96 (SPECIFY) UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . 98 ~ 614 221 25 NO. J QUESTIONS AND FILTERS 609A Where can you get (METHOD MENTIONED IN 609)? (NAME OF PLACE) CODING CATEGORIES PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . 12 THANA HEALTH COMPLEX . . . . . . . . . 13 SATELLITE CLINIC/EPI . . . . . . . . . 14 MEDICAL PRIVATE SECTOR TRADITIONAL DOCTOR . . . . . . . . . . . 21 QUALIFIED DOCTOR . . . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . 2] OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . 51 FRIENDS/RELATIVES . . . . . . . . . . . . 32 FIELDWORKER, FWA . . . . . . . . . . . . . . . 41 NGO CLINIC . . . . . . . . . . . . . . . . . . . . . 42 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . 98 J SKIP ,614 611 What is the main reason you do not intend to use a method? FERTILITY-RELATED REASONS INFREQUENT SEX . . . . . . . . . . . . . . . 22 MENOPAUSAL/HYSTERECTOMY . . . . . . 23 SUBFECURD/INFECUHD . . . . . . . . . . . 24 WANTS MORE CHILDREN . . . . . . . . . . 26 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . . . . . ]1 HUSBAND OPPOSED . . . . . . . . . . . . . . ]2 OTHERS OPPOSED . . . . . . . . . . . . . . . 3 ] RELIGIOUS PROHIBITION . . . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . . . . . 41 KNOWS NO SOURCE . . . . . . . . . . . . . . 42 METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . . . . 52 LACK OF ACCESS/TO0 FAR . . . . . . . 53 COST TOO MUCH . . . . . . . . . . . . . . . . 54 INCONVENIENT TO USE . 55 iNTERFERES WITH BODY'S NORMAL PROCESSES . 56 OTHER 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 98 '41 w°°l° Y°u"Y'"' Y°u' r°v" °r °' I App.°rE . ' 1 couples using a method to avoid get t ing pregnant? DISAPPROVE . . . . . . . . . . . . . . . . . . . . . . 2 NO OPINION . . . . . . . . . . . . . . . . . . . . . . 3 616 I In the Last month, have you heard or seen a message I I about fami ly p lanning on: J YES NO the radio? RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 teLevis ion? TELEVISION . . . . . . . . . . . . . . . . . 1 2 newspaper or magazine? NEWSPAPER/MAGAZINE . . . . . . . . . I 2 a paster or biLLboard? POSTER/BILLBOARD . . . . . . . . . . . 1 2 RESPONDENT [~ STERILIZED [--7 How of ten have you ta lked to your husband about fami ly p lanning in the las t three months? 618j J NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J ONCE OR TWICE . . . . . . . . . . . . . . . . . . . 2 MORE OFTEN . . . . . . . . . . . . . . . . . . . . . . 3 ~620 I 619 I Do you th ink your husband wants the same number J SAME NUMBER . . . . . . . . . . . . . . . . . . . . . 1 I of ch i ld ren that you want, or does he want more J MORE CHILDREN . . . . . . . . . . . . . . . . . . . 2 I or fewer than you want? FEWER CHILDREN . . . . . . . . . . . . . . . . . . 3 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 620 I S u'e"'r'ner'd°n°t"w Y' gree°neveryth ng" I I Now I want to ask you about your husband's APPROVES . . . . . . . . . . . . . . . . . . . . . . . . 1 views on fami ly p lann ing . DISAPPROVES . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 Do you th ink that your husband approves or disapproves of couples us ing a method to avoid pregnancy? 222 26 NO. I QUESTIONS AND FILTERS 621 I In the Last three months, have you discussed fami ly I planning with your f r iends, neighbors, or re lat ives? I COOING CATEGORIES I SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~624 622 With whom? Anyone else? RECORD ALL MENTIONED. HUSBAND/PARTNER . . . . . . . . . . . . . . . . . A MOTHER . . . . . . . . . . . . . . . . . . . . . . . . . . B FATHER . . . . . . . . . . . . . . . . . . . . . . . . . . C SISTER(S)/SISTERS-IH-LAW . . . . . . . . D BROTRER(S)/BROTHERS-IN-LAW . . . . . . E DAUGHTER . . . . . . . . . . . . . . . . . . . . . . . . F MOTHER-IN-LAW . . . . . . . . . . . . . . . . . . . G FATHER-IN-LAW . . . . . . . . . . . . . . . . . . . H FRIENDS/NEIGHBORS . . . . . . . . . . . . . . . I OTHER X 624 I Since you have been married, how frequently do you I ONCE A MONTH OR MORE . . . . . . . . . . . . 1 I I go shopping/marketing? J SEVERAL TIMES A YEAR . . . . . . . . . . . . 2 I ONCE A YEAR OR LESS . . . . . . . . . . . . . 3 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 u626 or your husband or other re la t ives? WITH CHILDREN . . . . . . . . . . . . . . . . . . . 2 WITH HUSBAND . . . . . . . . . . . . . . . . . . . . 3 WITH OTHER RELATIVES OR FRIENDS.4 626 l Do you go outside the v i l l age / town/c i ty alone (or I YES, ALONE . . . . . . . . . . . . . . . . . . . . . . 1 ~627 I with your young chi ldren)? J YES, WITH CHILDREN . . . . . . . . . . . . . . 2 ~627 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 I OTHER 6 ~627 (SPECIFY) 1 626A I Can you go outside the v i l l age / town/c i ty alone (or with your young chi ldren)? I YES, ALONE . . . . . . . . . . . . . . . . . . . . . . 1 I YES, WITH CHILDREN . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ~628 OTHER 6 I 627 Now frequent ly do you go outside th is I ONCE A MONTH OR MORE . . . . . . . . . . . . 1 I v i l l age / town/c i ty? I SEVERAL TIMES A YEAR . . . . . . . . . . . . 2 I LESS THAN ONCE A YEAR . . . . . . . . . . . 3 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 628 Do you go to a health center or hospital alone (or with your young chi ldren)? I YES, ALONE . . . . . . . . . . . . . . . . . . . . . . 1 ~629 YES, WITH CHILDREN . . . . . . . . . . . . . . 2 ~629 YES, WITH HUSBAND . . . . . . . . . . . . . . . 3 ~629 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 J OTHER 6 ~629 (SPECIFY) I 628A I Can you go to a health center or hospita l alone (or with your young chi ldren)? I YES, ALONE . . . . . . . . . . . . . . . . . . . . . . 1 I YES, WITH CHILDREN . . . . . . . . . . . . . . 2 YES, WITH HUSBAND . . . . . . . . . . . . . . . 3 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER 6 629 CHECK 216: HAS LIVING CNILD(REN) [ ] ! I I f you could go back to the time you did not have any chi ldren and could choose exact ly the nun~er of chi ldren to have in your whole l i fe , how many would that be? NO LIVING CHILD(REN)~ I I f you COUld choose exact ly the number of chi ldren to have in your whole l i fe , how many would that be? RECORD SINGLE NUMBER OR OTHER ANSWER. HUMBER . . . . . . . . . . . . . . . . . . . . . OTHER ANSWER 96 (SPECIFY) 630 Now many of these would you Like to be boys and how many would you Like to be g i r l s? BOYS . . . . . . . . . . . . . . . . . . . . . . . GIRLS . . . . . . . . . . . . . . . . . . . . . . EITHER . . . . . . . . . . . . . . . . . . . . . UP TO GOD . . . . . . . . . . . . . . . . . . . . . . 95 OTHER 96 223 27 NO. CHECK 106A: CURRENTLY MARRIED SECTION 7. QUESTIONS AND FILTERS WIDOWED/ DIVORCED/ L--J SEPARATED HUSBAND'S BACKGROUND, RESIDENCE AND WOMAN'S WORK J COOING CATEGORIES J SKIP 1 703 I AGE . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 =706 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . B ~706 704 J What was the highest level °f sch°°l he atte~ed: J PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . 1 I primary, seco~ary, or higher? SECONDARY . . . . . . . . . . . . . . . . . . . . . . . 2 HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DOES NOT KNOW . 8 ~706 706 What kind of work does (did) your J F 708 (Does/did) your husband work mainly on his own land or family Land, or (does/did) he rent land, or (does/did) he work on someone else's land? I HIS/FAMILY LAND . . . . . . . . . . . . . . . . . I | RENTED LAND . . . . . . . . . . . . . . . . . . . . . 2 I SOMEONE ELSE'S LAND . 3 709 J your are you currently | I Aside from own housework, working? I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 =712 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 J 710 As you know, some women take up jobs for which they are paid in cash or in kind. Others sel l things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work? Are you currentty doing any of these things or any other work? YES . I NO . 2 I ~801 I 712 What is your occupation, that is, what kind of work do you mainly do? [~ DOES NOT WORK IN AGRICULTURE 224 28 NO. QUESTIONS AND FILTERS 714 Do you work mainly on your own Lend or fami ly Land, or do you rent Land, or work on someone etse's Land? I COOING CATEGORIES I SKIP I OWN/FAMILY LAND . . . . . . . . . . . . . . . . . 1 I RENTED LAND . . . . . . . . . . . . . . . . . . . . . 2 SOMEONE ELSE'S LAND . . . . . . . . . . . . . 3 I 'nyourcurre 'w°r" d°Y°uw°rk'°r'°eOr°'Y° r I . '1 fami ly , for someone else, or are you self-envptoyed? FOR SOMEONE ELSE . . . . . . . . . . . . . . . . 2 SELF-EMPLOYED . . . . . . . . . . . . . . . . . . . 3 work seasonaLLy, or onLy once in a while? ONLY SOME TIMES (SEASONAL) . . . . . . 2 ONCE IN A WHILE . . . . . . . . . . . . . . . . . 3 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~723 PROBE: DO you make money for working? I 722 Most of the time when you work for cash, do you decide I RESPONDENT DECIDES . . . . . . . . . . . . . . I J how the money you earn wiLL be used, or does someone I SOMEONE ELSE DECIDES . . . . . . . . . . . . 2 I else decide how your earnings are used? JOINTLY . . . . . . . . . . . . . . . . . . . . . . . . . 3 723 Do you work at home or away from home? 725 CHECK 217 AND 218: HAS CHILD BORN SINCE BAISNAK 1398 AND LIVING AT HOME? YES Who usuaLLy takes care of (NAME OF YOUNGEST CHILD AT HOME) white you are working? HOME . . . . . . . . . . . . . . . . . . . . . . . . . . . . I AWAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO RESPONDENT . . . . . . . . . . . . . . . . . . . . . 01 HUSBAND/PARTNER . . . . . . . . . . . . . . . . 02 OLDER CHILD(REN) . . . . . . . . . . . . . . . 03 OTHER RELATIVES . . . . . . . . . . . . . . . . 04 NEIGHBORS . . . . . . . . . . . . . . . . . . . . . . 05 FRIENDS . . . . . . . . . . . . . . . . . . . . . . . . D6 SERVANTS/HIRED HELP . . . . . . . . . . . . 07 CHILD IS IN SCHOOL . . . . . . . . . . . . . 08 INSTITUTIONAL CHILOCARE . . . . . . . . 09 OTHER 96 (SPECIFY) I ,8011 29 225 SECTION 8. AIDS . o I QUESTIONS AND FILTERS I 801 J Have you ever heard of an i l l ness ca l led AIDS? I I COOING CATEGORIES I SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~809 802 From which sources of in fo rn la t ion have you learned most about AIDS? Any o ther sources? RECORD ALL MENTIONED. RADIO . . . . . . . . . . . . . . . . . . . . . . . . . . . A TV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B NEWSPAPERS/MAGAZINES . . . . . . . . . . . . C PAMPHLETS/POSTERS . . . . . . . . . . . . . . . D HEALTH WORKERS . . . . . . . . . . . . . . . . . . E MOSQUES/CHURCHES . . . . . . . . . . . . . . . . F SCHOOLS/TEACHERS . . . . . . . . . . . . . . . . G COMMUNITY MEETINGS . . . . . . . . . . . . . . H FRIENDS/RELATIVES . . . . . . . . . . . . . . . I WORN PLACE . . . . . . . . . . . . . . . . . . . . . . J OTHER X (SPECIFY) 803 [ Is there anyth ing a person can do to avoid [ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ,7 Ret t ing AIDS or the v i rus that causes AIDS? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON~T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 / rED7 804 606 What can a person do? Any o ther ways? RECORD ALL MENTIONED. 9 What does '=safe sex" mean to you? SAFE SEX . . . . . . . . . . . . . . . . . . . . . . . . A ABSTAIN FROM SEX . . . . . . . . . . . . . . . . B USE CONDO~4S . . . . . . . . . . . . . . . . . . . . . C HAVE ONLY ONE SEX PARTNER . . . . . . . D AVOID SEX WITH PROSTITUTES . . . . . . E USE STERILE SYRINGES/BUY SYRNGS.F AVOID BLOOD TRANSFUSIONS . . . . . . . . G AVOID KISSING . . . . . . . . . . . . . . . . . . . H AVOID MOSQUITO BITES . . . . . . . . . . . . I AVOID TRADITIONAL DOCTORS . . . . . . . J OTHER W (SPECIFY) OTHER X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . Z DID NOT I MENTION SAFE SEX [--~ ~BO7 I ABSTAIN FROM SEX . . . . . . . . . . . . . . . . B USE CONDO~tS . . . . . . . . . . . . . . . . . . . . . C HAVE ONLY ONE SEX PARTNER . . . . . . . D AVOID SEX WITH PROSTITUTES . . . . . . E AVOID SEX WITH H~OSEXUALS . . . . . . F OTHER X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . Z 807 | Is i t poss ib le fo r a hea l thy - look ing person J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I to have the AIDS v i rus? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 808 J Do you th ink that persons w i th AIDS almost never d ie f rom the disease, sometimes d ie , or a lmost always d ie f rom the disease? m RECORD THE TIME. ALMOST NEVER . . . . . . . . . . . . . . . . . . . . 1 | SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . 2 I ALMOST ALWAYS . . . . . . . . . . . . . . . . . . . 3 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 226 30 SECTION 9, HEIGHT AND WEIGHT CHECK 215: ONE OR MORE BIRTHS BAISHAK 1398 (APRIL 1991) NO BIRTHS SINCE BAISHAK 1398 (APRIL 1991) F~ D END 902 IN 902 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE BAISHAK 1398 AND STILL ALIVE. IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE BAISHAK 1398. IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE BAISHAK 1398 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE BAISHAK 1398, USE ADDITIONAL QUESTIONNAIRES). I LINE NO. FROM Q.212 I I l l RESPONDENT R Y N° ST I NEXT-TO L SECONO-TO I LIVING CHILD YOUNGEST yOUNGEST LIVING CHILD LIVING CHILD 9031NA'E I C AME K I I "AME FROM Q.212 FOR CHILDREN 9°4 IDATE OF SIRTN DAY . . . . . . DAY . . . . . . DAY . . . . . . FROM Q.215, AND I ASK FOR DAY OF BIRTH MONTH . . MONTH . . MONTH . . . YEAR . . . . . YEAR . . . . . YEAR . . . . . OF LEFT SHOULDER** SCAR SEEN . . . . . . 1 SCAR SEEN . . . . . . 1 SCAR SEEN . . . . . . 1 NO SCAR . . . . . . . . 2 NO SCAR . . . . . . . . 2 NO SCAR . . . . . . . . 2 U I .DI I CHILD MEASURED LYING DOWN LYING . . . . . . . . . . I LYING . . . . . . . . . . I LYING . . . . . . . . . . I OR STANDING UP? STANDING . . . . . . . 2 STANDING . . . . . . . 2 STANDING . . . . . . . 2 908 I WEIGheR kilograms) I ~ - ~ . ~ I ~ . ~ I ~ - - ~ . ~ I ~ - ~ . ~ 909 I DATE WEIGHED DAY . . . . . . DAY . . . . . . DAY . . . . . . DAY . . . . . . AND MEASURED MONTH . . MONTH . . MONTH . . MONTH . . . YEAR . . . . . YEAR . . . . . YEAR . . . . . YEAR . . . . . 910 RESULT MEASURED . . . . . . . 1 NOT PRESENT . . . . 3 REFUSED . . . . . . . . 4 OTHER . . . . . . . . . . 6 (SPECIFY) CHILD MEASURED.I CHILD SICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED.4 MOTHER REFUSED.5 OTHER . . . . . . . . . . 6 (SPECIFY) CHILD MEASURED.I CHILD SICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED.4 MOTHER REFUSED.5 OTHER . . . . . . . . . . 6 (SPECIFY) CHILD MEASURED.I CHILD SICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED.4 MOTHER REFUSED.5 OTHER . . . . . . . . . . 6 (SPECIFY) 911 I NAME OF MEASURER: ~ - ~ NAME OF ASSISTANT: | 227 31 Comments About Respondent: INTERVIEWER'S OBSERVATIONS (To be f i l led in after complet ing interview) Comments on Speci f ic Questions: Any Other Comments: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS 32 228 INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1, 3, AND 4, ALL MONTHS SHOULD BE FILLED IN. INFORMATION TO BE COOED FOR EACH COLUMN COL.I: Births, Pregnancies, Contraceptive Use B BIRTHS P PREGNANCIES S STILLBIRTHS M MISCARRIAGES R MENSTRUAL REGULATION A ABORTION O NO METHOD I PILL 2 IUD 3 INJECTIONS 4 IMPLANTS 5 CONDOM 6 FEMALE STERILIZATION 7 MALE STERILIZATION 9 PERIOOIC ABSTINENCE/RHYTHM W WITHDRAWAL X OTHER (SPECIFY) COL.2: Discontinuation of Contraceptive Use O INFREQUENT SEX/HUSBAND AWAY I BECAME PREGNANT WHILE USING 2 WANTED TO BECOME PREGNANT 3 HUSBAND DISAPPROVED 4 WANTED MORE EFFECTIVE METHOD 5 HEALTH CONCERNS 6 SIDE EFFECTS 7 LACK OF ACCESS/TO0 FAR 8 COST TOO MUCK 9 INCONVENIENT TO USE F FATALISTIC A DIFFICULT TO GET PREGNANT/MENOPAUSE D MARITAL DISSOLUTION/SEPARATION X OTHER (SPECIFY) Z DON=T KNOW COL.3: Marriage/Union X IN UNION (MARRIED OR LIVING TOGETHER) 0 NOT IN UNION I 2 12 CHOITRA 01 11 FALGUN 02 10 MAGH 03 09 POUBH 04 08 AGRANAYAN 05 07 KARTIK 06 06 ASHWIN 07 05 BADHRA 08 04 SRABAN 09 03 ASHAR 10 02 JAISTHA 11 01 BAI SHAK 12 12 CHOITRA 13 11 FALGUN 14 10 MAGH 15 09 POUSH 16 08 AGRAHAYAN 17 07 KARTIK 18 06 ASHWIN 19 05 BADHRA 20 04 SRABAH 21 03 ASHAR 22 02 JAIBTHA 23 01BAISHAK 24 12 CHOITRA 25 11FALGUN 26 10 MAGH 27 09 pOUSN 28 08 AGRAHAYAN 29 07 KARTIK 30 06 ASHWIN 31 05 BADHRA 32 04 BRABAN 33 03 ASHAR 34 02 JAIBTHA 35 01BAISHAK 36 12 CNOITRA 37 11 FALGUN 38 10 MAGH 39 09 POUSH 40 08 AGRAHAYAN 41 07 KARTIK 42 06 ASHWIN 43 05 BADHRA 44 04 SRABAH 45 03 ASHAR 46 02 JAISTHA 47 01BAISHAK 48 12 CHOITRA 49 11 FALGUN 50 10 MAGH 51 09 pOUSH 52 08 AGRAHAYAN 53 07 KARTIK 54 06 ASHWIN 55 05 BADHRA 56 04 SRABAN 57 03 ASHAR 58 02 JAIBTHA 59 01BAIBHAK 60 12 CHOITRA 61 11 FALGUN 62 10 MAGH 63 09 POUSH 64 08 AGRAHAYAN 65 I 07 KARTIK 66 3 06 ASHWIN 67 9 05 BADHRA 68 8 04 SRABAN 69 03 ASHAR 70 02 JAIBTHA 71 01BAIBHAK 72 229 3 03 02 01 12 11 10 09 08 07 06 05 04 03 02 01 12 11 10 09 08 07 06 05 04 03 O2 01 12 11 10 09 08 07 06 05 04 03 O2 01 12 11 10 09 08 07 06 05 04 03 O2 01 12 11 10 09 08 07 06 05 04 03 02 01 12 11 I0 O9 08 07 06 05 04 MAR FEB JAN DEC NOV OCT SEP AUG JUL dUN 1 MAY 9 APR 9 6 MAR FEB JAN DEC NOV OCT SEP AUG JUL JUN 1 MAY 9 APR 9 5 MAR FEB JAN DEC NOV OCT SEP AUG JUL JUN I MAY 9 APR 9 4 MAR FEB JAN DEC NOV OCT SEP AUG JUL JUN 1 MAY 9 APR 9 3 MAR FEB JAN DEC NOV OCT SEP AUG JUL JUN 1 MAY 9 APR 9 2 MAR FEB JAN DEC NOV OCT SEP AUG I JUL 9 JUN 9 MAY I APR 33 230 4 Feb/97 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 1996-97 MEN'S QUEST IONNAIRE (FOR CURRENTLY MARRIED MEN 15-59) DIV IS ION D ISTR ICT UPAZILA/THANA UNION V ILLAGE/MOHALLA/BLOCK CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . DHAKA/CHITTAGONG=I , SMALL CITY=2, NAME OF HOUSEHOLD HEAD NAME AND L INE NUMBER OF MAN TOWN=3, V ILLAGE=4 . INTERVIEWER V IS ITS 2 DATE INTERVIEWER'S NAME RESULT * NEXT V IS IT : DATE T IME amommooowwwowwww.g |mgwmwwnwwn, , , , , , , mml l i iw l ,gwa, , , , , , mmmlgg lgwmgg, ,nmmm F INAL V IS IT DAY MONTH** YR 1 9 9 CODE RESULT OF V IS ITS ***RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER NAME DATE F IELD EDITED BY OFF ICE EDITED BY (SPECIFY) KEYED BY KEYED BY ** MONTH: 01 JANUARY 02 FEBRUARY 03 MARCH 04 APRIL 05 MAY 06 JUNE 07 JULY 08 AUGUST 231 09 SEPTEMBER I0 OCTOBER Ii NOVEMBER 12 DECEMBER SECTION 1. RESPONDENT'S BACKGROUND NO. I QUESTIONS AND FILTERS I COOING CATEGORIES I SKIP RECORD THE TIME. 103 I HOW tong have you been L iv ing cont inuous ly in I YEARS . . . . . . . . . . . . . . . . . . . . ~ I (NAME OF CURRENT PLACE OF RESIDENCE)? ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . 95 I VISITOR . . . . . . . . . . . . . . . . . . . . . . . . 96 1.105 olute°rey°u°veOheredOy°uvenactY I cxTY . I in a town, or in the countryside? TOWN . 2 COUNTRYS I DE . . . . . . . . . . . . . . . . . . . . . 3 105 In what month and year were you born? USE COOES BELOW FOR MONTHS. IF HE DOES NOT KNOW, WRITE 'D K' IN BOXES. BENGAL I . . . . . . ~. 1 MONTH . . . . . . . . . . . . I l l YEAH . I '1' ENGL l SHMoNTH;,; : 2 " . . . . . . . . . . YEAR . i , t91 I ] I r ~ 106 J How old are you? AGE IN COMPLETED YEARS. . . I I I I COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. J NEVER MARRIED . . . . . . . . . . . . . . . . . . . 1 ~END 106A Are you now marr ied, widowed, or divorced? MARRIED . . . . . . . . . . . . . . . . . . . . . . . . . 2 I WIDOWED . . . . . . . . . . . . . . . . . . . . . . . . . 3 ~END DIVORCED/DESERTED . . . . . . . . . . . . . . . 4 ~END NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~114 108 I What is the h ighest leve( of schoot you attended: PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . 1 I pr imary, secondary, or higher? SECONDARY . . . . . . . . . . . . . . . . . . . . . . . 2 COLLEGE/UNIVERSITY . . . . . . . . . . . . . . 3 109 What is the h ighest c lass you completed? CLASS . . . . . . . . . . . . . . . . . . . . 114 SECONDARY OR COLLEGE [~ Can you read and wr i te a le t te r in any Language eas i ly , w i th d i f f i cu l ty , or not at a l l ? I 1.1,, I I EASILY . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | WITH DIFFICULTY . . . . . . . . . . . . . . . . . 2 I NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3 ~116 115 Do you usua l ly read a newspaper or magazine at Least YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 once a week? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 "6 I B° Y°° °s°°LLy ~ist°n t° the radi° at least °nce ° week?l YESNo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o . o . . . . . . . . . . . . . . . 2' I * BENGALI MONTHS: ** ENGLISH MONTHS: 01BAISHAK 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 09 SEPTEMBER 02 JAISTHA 06 ASHWIN 10 MAGH 02 FEBRUARY 06 JUNE 10 OCTOBER 03 ASHAR 07 KARTIK 11FALGUN 03 MARCH 07 JULY 11 NOVEMBER 04 SRABAN 08 AGRAHAYAN 12 CHOITRA 04 APRIL 08 AUGUST 12 DECEMBER 232 M-2 NO. I QUESTIONS AND FILTERS 1 m 117 J Do you usua l ly watch te lev is ion at Least I once a week? I COOING CATEGORIES I SKIP I . '1 NO . . . . . . . . . . . , , , , , , . . . . . . . . . . . . °~ 118 What is your re l ig ion? ISLAH . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HINDUISM . . . . . . . . . . . . . . . . . . . . . . . . 2 BUOOHISH . . . . . . . . . . . . . . . . . . . . . . . . 3 CHRISTIANITY . . . . . . . . . . . . . . . . . . . . 4 OTHER S (SPECIFY) 119 J Are you cur rent ly working? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO, . . . . . . . . . . . . . , , , , ° ° , , . . . . . . . . 120 What is your occupation, that is , what kind of work do you mainly do? I l l DOES NOT ~ORK IN AGRICULTURE [~ UNENPLOYED V ~123 I I 1201 I I 122 | DO you work mainLy on your own Land or fami ly Land, or | Ot4N/FAMILY LAND . . . . . . . . . . . . . . . . . 1 I do you rent Land, or work on someone elsems land? I RENTED LAND . . . . . . . . . . . . . . . . . . . . . 2 SOMEONE ELSE'S LAND . . . . . . . . . . . . . 3 123 J Do you do th i s woPk for a member of your fami ly , J FOR FAN1LY HEHBER . . . . . . . . . . . . . . . 1 I for someone else, or are you self-employed? J FOR SOMEONE ELSE . . . . . . . . . . . . . . . . 2 SELF-EHPLOYED . . . . . . . . . . . . . . . . . . . 3 work seasonally, or only once in a while? ONLY SONS TIMES (SEASONAL) . . . . . . 2 ONCE IN A WHILE . . . . . . . . . . . . . . . . . 3 125 J Do you earn cash for th i s work? J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NOo,o .o . . . . . . . . . . . . . . . , , o ,o ,o° , ,2 PROSE: Do you make money for working? 233 M-3 SECTION 2. REPRODUCTION NO. I QUESTIONS AND FILTERS I 201 I Now I wouLd Like to ask about your chitdern. 1 am I I in terested only in the chi ldren that are b io log ica l ly I yours. Have you ever had chi ldren? CODING CATEGORIES I SKIP m YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~206 I I I I 202 I 0o you have any sons or daughters who are now Living I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I I with you? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~204 And how many daughters Live with you? DAUGHTERS AT HIIME . IF NONE ENTER '00'. 204 I Do you have any sons or daughters who do not Live I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I with you? I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~206 And how many daughters are a l i ve but do not l i ve with you? DAUGHTERS ELSEWHERE . . . . . . . . IF NONE, ENTER ' 00 ' , 206 I Have you ever had a son or daughter who was born a l i ve YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I but Later died? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~208 I ,oo,. I . 209 CHECK 207: Just to make sure that I have th is r ight : you have TOTAL chi ldren burn a l i ve during your L i fe . Is that correct? PROBE AND YES ~ NO r -~ ~ CORRECT 201-208 AS NECESSARY I • CHILDREN (NONE) 210A In what month and year was your Last ch i ld born? [~ ~301B 211 BENGAL I ~I(~I~.H.I ~EAR.IIIIII "i" ":~ ENGLXS%~÷~:::2. . ~ ,EAN . I , l~ l I I BORN BEFORE BAISHAK 1398r- - ] (APRIL 1991) I i I When you were expecting your tastborn ch i ld , did you | want to have the ch i ld then, did you want to wait unt i l I l a ter , or did you not want to have any (more) chi ldren at a l l ? I THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | LATER . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3 • 3011 234 M-4 NO. QUESTIONS AND FILTERS 212 When one of your chiLdren is sick with diarrhea, what signs of iLLness would te l l you that he or she should be taken to a health fac i l i ty or health worker? CIRCLE ALL MENTIONED. COOING CATEGORIES REPEATED WATERY STOOLS . . . . . . . . . . A ANY WATERY STOOLS . . . . . . . . . . . . . . . B REPEATED VOMITING . . . . . . . . . . . . . . . C ANY VOMITING . . . . . . . . . . . . . . . . . . . . D BLOOD IN STOOLS . . . . . . . . . . . . . . . . . E FEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . F MARKED THIRST . . . . . . . . . . . . . . . . . . . G NOT EATING/DRINKING WELL . . . . . . . . N GETTING SICKER/VERY SICK . . . . . . . . I NOT GETTING BETTER . . . . . . . . . . . . . . J OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z SKIP 213 When one of your ch i ldren is sick with a cough, what signs of i l l ness would te l l you that he or she should be taken to a health fac i l i ty or health worker? CIRCLE ALL MENTIONED. RAPID BREATHING . . . . . . . . . . . . . . . . . A DIFFICULT BREATHING . . . . . . . . . . . . . B NOISY BREATHING . . . . . . . . . . . . . . . . . C FEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . D UNABLE TO DRINK . . . . . . . . . . . . . . . . . E NOT EATING/DRINKING WELL . . . . . . . . F GETTING SICKER/VERY SICK . . . . . . . . G NOT GETTING BETTER . . . . . . . . . . . . . . H OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z 214AJ DO you have any ch i ld born since Baishak 1398 J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I (April 1991) who is still alive? NO . 2 =301 I 214BJ What is the name of your ch i ld under age 5? J J I I I (NAME) 215A I Has (NAME) ever been sick? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~301 215BJ Nave your or your wife ever taken (NAME) J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I to a health fac i l i ty or health worker or any other NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~218 place/person for treatment, when he/she was sick? DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 ~218 216 The last time (NAME) was taken for treatment, what was h is /her i l lness? DIARRHEA . . . . . . . . . . . . . . . . . . . . . . . . A FEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . B COUGH . . . . . . . . . . . . . . . . . . . . . . . . . . . E SKIN DISEASE . . . . . . . . . . . . . . . . . . . . D LOSS OF APPETITE . . . . . . . . . . . . . . . . E OTHER X (SPECIFY) CANNOT RECALL . . . . . . . . . . . . . . . . . . . Z 217 J Who took (NAME) for treatment the last time, yourself or your wife or socnebody else? I HIMSELF . . . . . . . . . . . . . . . . . . . . . . . . . 1 HIS WIFE . . . . . . . . . . . . . . . . . . . . . . . . 2 BOTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER PERSON 6 (SPECIFY) CANNOT RECALL . . . . . . . . . . . . . . . . . . . B 21 lo'dyouever°r'ng''°'any'O'"n''°r NAME'? IYES . ' l NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~301 Who bought/brought the medicine? 219J HIMSELF . I HIS WIFE . 2 BOTH . 3 OTHER PERSON 6 (SPECIFY) CANNOT RECALL . . . . . . . . . . . . . . . . . . . 8 235 M-5 NO. 220 QUESTIONS AND FILTERS Who gave the med ic ine to the ch i td , yourse l f or your w i fe? CODING CATEGORIES HIMSELF . . . . . . . . . . . . . . . . . . . . . . . . . 1 HIS WIFE . . . . . . . . . . . . . . . . . . . . . . . . 2 BOTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER PERSON 6 (SPECIFY) CANNOT RECALL . . . . . . . . . . . . . . . . . . . 8 SKIP 221 Where d id you get the med ic ine? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . . . 12 THANA HEALTH COMPLEX . . . . . . . . . . . 13 I MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . . . 21 TRADITIONAL DOCTOR . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . . . 23 OTHER 96 (SPECIFY) DOES NOT KNOW . 98 236 M-6 301 SECTION 3. CONTRACEPTION I ow I would Like to ta lk about fami ly ptanning - the var ious ways or methods that a couple can use to de lay or avoid a pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE N/U4E AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE COUE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED, THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303, YES ever(METHOO)? Which ways or methods have you heard about? 302 Have you 303 Have you ever heard of used (METHOD)? SPONTANEOUS PROBED YES NO 1J PILL, MAYA Women can take a p i t t every day. 211UD Women can have a Loop or co i l placed ins ide them by a doctor or a nurse. 31 INJECTIONS Women can have an in jec t ion by a doctor or nurse which stops them from becoming pregnant for several months. IMPLANT, NORPLANT Women can have several small rods placed in the i r upper arm by a doctor or nurse which can prevent pregnancy for several years. 51 CONDOM, RAJA Men can put a rubber sheath on the i r penis dur ing sexual in tercourse . •J FEMALE STERILIZATION, TUBAL LIGATION, TL Women can have an operat ion to avoid having any more ch i ld ren . 71 MALE STERILIZATION, VASECTOMY Men can have an operat ion to avoid having any more ch i ld ren . 0 8 • MENSTRUAL REGULATION, MR When a woman's menstrual per iod does not come on t ime, she can go to a hea l th centre or to the FWV and have a tube put in her for a short whi te to br ing her per iod. O• SAFE PERlO0, COUNTING DAYS, CALENDAR RHYTHM METHOD Couples can avoid having sexual in tercourse on cer ta in days of the month when the woman is more l i ke ly to get pregnant. •J WITHDRAWAL Men can be care fu l and putt out before c l imax. Have you heard of any other ways or methocls that women or men can use to avoid pregnancy? 1 2 37 1 2 37 1 2 3- 7 I 2 I 2 3-~ 1 2 3 7 1 2 7 1 2 31 1 2 3 7 1 2 3- 7 1 3 (SPECIFY) (SPECIFY) YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . .= . , , . . .2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO, , , , , , . . . . . . . . . . . . . . . ,2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . , . , , o . , . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO. . , , . , , , . . . . . . . . . . . . oo2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO, , , , . . , . . . . . . . . . . . . . . . 2 Has your wife had an operat ion to avoid having any more ch i ld ren? YES . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . , , , , , , , , . , . . . . . . 2 Have you ever had an operat ion to avoid having any more ch i ld ren? YES . . . . . . . . . . . . . . . . . . . . . 1 NO, , . . . . . . . . . . . . . . . . . . , ,2 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . , o . . , , .2 YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . , . . . . . I NO. , . . . . . . . . . . . . . . . . . .2 YES . . . . . . . . . . . . . . , . . , . . .1 NO. , , , , . . . . . . . . . . . . . . . . .2 LEAST ONE "YES" [ -7 VER USED) 237 tSKIP TO 308 M-7 NO. J 3051 QUESTIONS AND FILTERS Have you or your wi fe ever used anyth ing or t r ied in any way to de lay or avoid get t ing pregnant? l COOING CATEGORIES I SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~331 I I I 307 I What have you used or done? I I I CORRECT 303-305 (AND 302 IF NECESSARY). 3O8 Now I would Like to ask you about the f i r s t t ime that you d id something or used a method to avoid get t ing pregnant• What was the f i r s t method that you ever used? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 IMPLANTS . . . . . . . . . . . . . . . . . . . CONDOM . . . . . . . . . . . . . . . . . . . . . FEMALE STERILIZATION . . . . . . . MALE STERILIZATION . . . . . . . . . MENSTRUAL REGULATION . . . . . . . SAFE PERIOD, COUNTING DAYS• WITHDRAWAL . . . . . . . . . . . . . . . . . OTHER • .04 • .05 • .06 • .07 • .08 • .09 .10 96 (SPECIFY) 309 313 Are you or your wi fe cur rent ly doing something or using any method to de lay or avoid get t ing pregnant? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~331 314 314A Which method are you using? CIRCLE '07 ' FOR MALE STERILIZATION• PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01---- 7 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02/328 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 IMPLANTS . . . . . . . . . . . . . . . . . . . . . . . 04 CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . 05 FEMALE STERILIZATION . . . . . . . . . . . 06 ~318 MALE STERILIZATION . . . . . . . . . . . . . 07 ~318 MENSTRUAL REGULATION . . . . . . . . . . . 08 ~328 SAFE PERIOD, COUNTING DAYS . . . . . 09~ WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . 10~, ,330A OTHER 96 ~ (SPECIFY) I 317c I PLease show me the package of condoms that you are us ing. PACKAGE SEEN . . . . . . . . . . . . . . . I I I /~317F BRAND NAME I I I I PACKAGE NOT S -E - '~ .~ . . . . . 2 I 3oJ Why can ' t you show me the package of condoms that you are using? I WIFE KEEPS . . . . . . . . . . . . . . . . . . . . . . 1 l NAN OUT . . . . . . . . . . . . . . . . . . . . . . . . . 2 I OTHER 6 (SPECIFY) 317E I s o ANo cHA T CONOOMS: I PLease teLL me which of these is the brand of condoms BRAND NAME that you are us ing. DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 238 M-8 NO. 317F QUESTIONS AND FILTERS HOW much d id the condom you Last used cost? I COOING CATEGORIES I SKIP I . PARTNER OBTAINED . . . . . . . . . . . . . . . . 95 FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 98 37ol O°y°uu''c°nd°''vervt me " Y°° 'v ' - - I vE YT'M . I in tercourse or on ly sometimes? ONLY SOMETIMES . . . . . . . . . . . . . . . . . . 2 317H How many times have you used condoms dur ing the Last NUMBER OF TIMES . . . . . . . . . . . . ~328 one month? | 318 Where d id the s ter i l i za t ion take place? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . 12 THAHA HEALTH COHPLEX . . . . . . . . . 13 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . 22 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . 98 (NAME OF PLACE) 319 J DO you regret that (you/your wi fe) had the oJ:.~ration I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I not to have any more ch i ld ren? | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~321 PARTNER WANTS ANOTHER CHILD . . . . 02 SIDE EFFECTS . . . . . . . . . . . . . . . . . . . 03 CHILD DIED . . . . . . . . . . . . . . . . . . . . . 04 OTHER REASON 96 321 In what month and year was the s ter i l i za t ion operat ion performed? USE COOES BELOW FOR HONTHS. BENGAL I i ' l r l l MONTH * . . . . . . . . . . 1 I I I I I I YEAR . . . . . . . r ' l ENGLISH r - - - -T - -~ MONTH** . . . . . . . . . . 2 I I ] I l l YEAR . . . . . . . I,I, 321A I How much d id the operat ion cost you? I I COST . . . . . . . . . . . . . . . . . ~ 3 2 9 A 328 Where d id you obta in (METHOD) the Last time? IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . 12 THAHA HEALTH COHPLEX . . . . . . . . . 13 SATELLITE CLINIC . . . . . . . . . . . . . 14 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . 23 OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . 31 FRIENDS/RELATIVES . . . . . . . . . . . . 32 FIELD~K)RNER, FWA . . . . . . . . . . . . . . . 41 NGO CLINIC . . . . . . . . . . . . . . . . . . . . . 42 OTHER 96 DOES NOT KNOW . . . . . . . . . . . . . . . . . 98 1-329 I * BENGALI MONTHS: ** ENGLISH MONTHS: 01BAISHAK 05 BADHRA 09 POUSH 01 JANUARY 05 MAY 02 JAISTHA 06 ASHWIN 10 MAGH 02 FEBRUARY 06 JUNE 03 ASHAR 07 MARTIN 11FALGUN 03 MARCH 07 JULY 04 SRABAN 08 AGRAHAYAN 12 CHOITRA 04 APRIL 08 AUGUST 239 09 SEPTEMBER 10 OCTOBER 11 NOVEMBER 12 DECEMBER H-9 328s I Who obtained the (p i l l s /condoms) the Last time you got them? I RESPONDENT . . . . . . . . . . . . . . . . . . . . . . 1 I I WIFE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SON/DAUGHTER . . . . . . . . . . . . . . . . . . . . 3 329 OTHER RELATIVE . . . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) I 32sc I I At the place where you got your methed the las t t ime, l d id anyone there ever te t t you about side e f fects or I other problems you might have using th i s method? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I CANNOT REMEMBER . . . . . . . . . . . . . . . . . 8 32° I Did anyone there ever te l l you about other methods that you might use? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I CANNOT REMEMBER . . . . . . . . . . . . . . . . . 8 32°[ 329A I Do you know another p lace where you could have obtained (CURRENT METHOD) the las t time? At the t ime of the s ter i l i za t ion operat ion, d id you know another p lace where you could have received the operat ion? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,330A 330 People se lect the place where they get fami ly p lanning serv ices for var ious reasons. What was the main reason you went to (NAME OF PLACE IN 0.328 OR 0.318) instead of the other place you know about? RECORD RESPONSE AND CIRCLE CODE. ACCESS-RELATED REASONS CLOSER TO HOME . . . . . . . . . . . . . . . 11 CLOSER TO MARKET/~RK . . . . . . . . 12 AVAILABILITY OF TRANSPORT . . . . 13 SERVICE-RELATED REASONS STAFF MORE COMPETENT/ FRIENDLY . . . . . . . . . . . . . . . . . . . 21 CLEANER FACILITY . . . . . . . . . . . . . 22 OFFERS MORE PRIVACY . . . . . . . . . . 23 SHORTER WAITING TIME . . . . . . . . . 24 LONGER HRS. OF OPERATION . . . . . 25 USE OTHER SERVICES AT THE FACILITY . . . . . . . . . . . . 26 LOWER COST/CHEAPER . . . . . . . . . . . . . 31 WANTED ANONYMITY . . . . . . . . . . . . . . . 41 WORKER SUPPLIED AT HOME . . . . . . . . 51 METHOD NOT AVAILABLE ELSEWHERE.61 OTHER 96 (SPECIFY) DOES MOT KNOW . . . . . . . . . . . . . . . . . . 98 330A What is the reason you decided to use (CURRENT METHOD) ra ther than some other method of fami ly planning? Any other reason? CIRCLE ALL MENTIONED. FAMILY PLAN. WORKER RECOMMENDED.A FRIEND/RELATIVE RECOMMENDED . . . . . B SIDE EFFECTS OF OTHER METHODS.C METHOD EASY TO USE . . . . . . . . . . . . . . D ACCESS/AVAILABILITY . . . . . . . . . . . . . E COST . . . . . . . . . . . . . . . . . . . . . . . . . . . . F WANTED PERMANENT METHOD . . . . . . . . . G HUSBAND PREFERRED . . . . . . . . . . . . . . . H WANTED MORE EFFECTIVE METHOD . . . . I FIELDWORKER CAME TO HOUSE . . . . . . . J OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z I I 330BI When a couple is making a dec is ion, sometimes the husb* I I and has more in f luence , s~ow~tin~s the wi fe has more | in f luence and sometimes other people have mere in f luence | In your fami ly , who had the most in f luence in dec id ing | to use fami ly p lanning the f i r s t t ime you used s method?l I RESPONDENT HAD MORE INFLUENCE. . .1 - 1 WIFE HAD MORE INFLUENCE . . . . . . . . . 2 | BOTH, HUSBAND AND WIFE EQUAL.3 r334 OTHER RELATIVE . . . . . . . . . . . . . . . . . . 4 OTHER 6 240 M-lO NO. I QUESTIONS AND FILTERS 331 What is the main reason you are not us ing a method of cont racept ion to avoid pregnancy? I I SKIP COOING CATEGORIES FERTILITY-RELATED REASONS NOT HAVING SEX . . . . . . . . . . . . . . . 21 INFREQUENT SEX . . . . . . . . . . . . . . . 22 MENOPAUSAL/HYSTERECTOHY . . . . . . 23 SUBFECUND/INFECUND . . . . . . . . . . . 24 POSTPARTUM/BREASTFEEDING . . . . . 25 WANTS (MORE) CHILDREN . . . . . . . . 26 PREGNANT . . . . . . . . . . . . . . . . . . . . . 27 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . . . . . 31 WIFE OPPOSED . . . . . . . . . . . . . . . . . 32 OTHERS OPPOSED . . . . . . . . . . . . . . . 33 RELIGIOUS PROHIBITION . . . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOD . . . . . . . . . . . . . . 41 KNOWS NO SOURCE . . . . . . . . . . . . . . 42 HETHOO-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . . . . 52 LACK OF ACCESS/T(X) FAR . . . . . . . 53 COST TOO MUCH . . . . . . . . . . . . . . . . 54 INCONVENIENT TO USE . . . . . . . . . . 55 iNTERFERES WITH BODYIS NORMAL PROCESSES . . . . . . . . . . . 56 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 I I I 332 | Do you know where you can obta in a method of | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | I fami ly p lann ing? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~334 333 Where is that? 335 (NAME OF PLACE) IF HE SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE HE gOULD MOST LIKELY USE. SATELLITE/EPI CLINIC MENTIONED ~ I n some p laces , there is a c l in i c set up fo r a day or par t of a day in someone's house or in a school . Dur ing the past 3 months, was there any such c l in i c in th i s v i lLage/mohaLta? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . . 12 TRANA HEALTH COMPLEX . . . . . . . . . . 13 SATELLITE/EPI CLINIC . . . . . . . . . . 14 HEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . . 23 OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . 31 FRIENDS/RELATIVES . . . . . . . . . . . . . 32 FIELDWORKER, FWA . . . . . . . . . . . . . . . . 41 NGO CLINIC . . . . . . . . . . . . . . . . . . . . . . 42 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 ~336 I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~338 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 ~338 I 336 I D id you ever v i s i t such a temporary hea l th c l in i c? | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,338 337 What serv ices d id they provide? CIRCLE ALL MENTIONED. FAMILY PLANNING HETHODS . . . . . . . . . A IMMUNIZATION . . . . . . . . . . . . . . . . . . . . B CHILD GROWTH HONITORING . . . . . . . . . C T.T. FOR PREGNANT WOMEN . . . . . . . . . D ANTENATAL CARE . . . . . . . . . . . . . . . . . . E OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z 338 I Have you ever v i s i ted a hea l th fac i l i ty /cent re w i th I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I your w i fe or your ch i ld ren? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~551 241 M-lq NO. QUESTIONS AND FILTERS 339 For what services did you go there? CIRCLE ALL MENTIONED. CODING CATEGORIES FAMILY PLANNING METHODS . . . . . . . . . A IMMUNIZATION . . . . . . . . . . . . . . . . . . . . B CHILD GROWTH MONITORING . . . . . . . . . C T.T. FOR PREGNANT WOHEN . . . . . . . . . D ANTENATAL CARE . . . . . . . . . . . . . . . . . . E OTHER X (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . . Z SKIP 351 I Have you ever recommended fami ly planning to a Friend, I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 m I re la t ive , or anyone else? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I I °° u° I . ' 1 when they are pregnant, even i f they are not sick? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNC~ . . . . . . . . . . . . . . . . . . . 8 354A CHECK 302 AND 303: HEARD ABOUT MALE STER.~ OTHER BUT DID NOT USE ~ From where did you hear about male s ter i l i za t ion? PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . . 11 FAMILY WELFARE CENTRE . . . . . . . . . 12 THANA HEALTH CONPLEX . . . . . . . . . . 13 SATELLITE/EPI CLINIC . . . . . . . . . . 14 MEDICAL PRIVATE SECTOR PRIVATE CLINIC/DOCTOR . . . . . . . . . 21 TRADITIONAL DOCTOR . . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . . 23 OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . 31 FRIENDS/RELATIVES . . . . . . . . . . . . . 32 FIELDWORKER, FWA . . . . . . . . . . . . . . . . 41 NGO CLINIC . . . . . . . . . . . . . . . . . . . . . . 42 OTHER 96 (SPECIFY) DOES NOT KNOW . . . . . . . . . . . . . . . . . . 98 I ~357 354B I Do you know of a place where you can obtain male IYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I s ter i l i za t ion? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3" I NaB anv fietd'er~ar ever ~is°u"ed ~ith Y°u °bo°t mal° I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '1 s ter i l i za t ion? HO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 356 I some people say that vaaecto~ ~kes a man weak, white I MAKES HIM WEAK . . . . . . . . . . . . . . . . . . 1 I I others say that i t has no ef fect . What do you think? I NO EFFECT . . . . . . . . . . . . . . . . . . . . . . . 2 I DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 358 CHECK 208: HAS LIVING HAS NO LIVING CHILD(REN)[~ J When a couple is making a decision, sometimes the husb- and has more inf luence, sometimes the wife has more inf luence and sometimes other people have more influence In your fami ly , who has the most influence in deciding about the health care of chi ldren? RESPONDENT HAD MORE INFLUENCE.1 WIFE HAD MORE INFLUENCE . . . . . . . . . 2 BOTH, HUSBAND AND WIFE EQUAL.3 OTHER RELATIVE . . . . . . . . . . . . . . . . . . 4 OTHER 6 I ~401 242 M-lZ SECTION 4. MARRIAGE 401A I Have you been married only once or more than once? I ONCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I MORE THAN ONCE . . . . . . . . . . . . . . . . . . 2 402 %n what month and year did you star t l i v ing with your ( f i r s t ) wife? BENGAL I . . . . . . . . 1 ~ I MONTH w . . . . . . . . . . . . I I I YEAR . I '1'1111,'0' ENGLISH . . . . . . . . 2 I I I I I ~ I MONTH*'* . . . . . . . . . . . . YEAR . . . . . . . I 11 9 I [ I ~501 1 1 1 1 1 I 403 How old were you when you started l i v ing with her? IAOB . --lt DOES NOT KNOW AGE . . . . . . . . . . . . . . 98 * BENGALI MONTHS: 01BAISHAK 05 BADHRA 09 POUSH 02 JAISTHA 06 ASHWIN 10 MAGH 03 ASHAR 07 KARTIN 11FALGUN 04 SRABAN 08 AGRAHAYAN 12 CHOITRA ** ENGLISH NORTHS: 01 JANUARY 05 MAY 09 SEPTEMBER 02 FEBRUARY 06 JUNE 10 OCTOBER 03 MARCH 07 JULY 11 NOVEMBER 04 APRIL 08 AUGUST 12 DECEMBER M-13 243 NO. 502 SECTION 5. FERTILITY PREFERENCES QUESTIONS AND FILTERS | CHECK 314: NEITHER SHE OR HE STERILIZED 9 ~ S T E R I L I Z E D F~ Now I have some questions about the future. Would you Like to have a (another) child or woutd you prefer not to have any more children? COOING CATEGORIES HAVE A (ANOTHER) CHILD . . . . . . . . . . 1 NO MORE/NONE . . . . . . . . . . . . . . . . . . . . 2 SAYS WIFE CAN=T GET PREGNANT . . . . 3 UNDECIDED OR DK . . . . . . . . . . . . . . . . . 8 i ~514 I l SO6 I 503 How long would you Hke to wait from now before the birth of a (another) child? MONTHS . I I I I YEARS . 2 SOON/NOW . 995 OTHER 996 (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998 507 Do you think you will use a method to delay or avoid YES . I pregnancy within the next 12 months? NO . 2 DX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 508 Do you intend to use a method at any time in I YES . I I the future? I NO . 2 ~511 DK . 8 ~511 509 When you use a method, which method would you prefer to use? I ~509 I PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 IMPLANT . . . . . . . . . . . . . . . . . . . . . . . . 04 CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . 05 FEMALE STERILIZATION . . . . . . . . . . . 06 MALE STERILIZATION . . . . . . . . . . . . . 07 MENSTRUAL REGULATION . . . . . . . . . . . 08 CALENDAR, COUNTING DAYS . . . . . . . . 09 WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . 10 OTHER 96 (SPECIFY) UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . 98 ~ 514 509A Where can you get (METHOD MENTIONED IN 509)? (NAME OF PLACE) PUBLIC SECTOR HOSPITAL/MEDICAL COLLEGE . . . . . I t - - FAMILY WELFARE CENTRE . . . . . . . . 12 TBAMA HEALTH COMPLEX . . . . . . . . . 13 SATELLITE CLINIC . . . . . . . . . . . . . 14 MEDICAL PRIVATE SECTOR TRADITIONAL DOCTOR . . . . . . . . . . . 21 QUALIFIED DOCTOR . . . . . . . . . . . . . 22 PHARMACY . . . . . . . . . . . . . . . . . . . . . 23 OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . 31 FRIENDS/RELATIVES . . . . . . . . . . . . 32 FIELDWORKER, FWA . . . . . . . . . . . . . . . 41 NGO CLINIC . . . . . . . . . . . . . . . . . . . . . 42 OTHER 96 (SPECIFY) DOES ROT KNOW . . . . . . . . . . . . . . . . . 98 ~514 244 M-14 NO. QUESTIONS AND FILTERS 511 What is the main reason you do not intend to use a method? COOING CATEGORIES FERTI LITY-RELATED REASONS INFREQUENT SEX . . . . . . . . . . . . . . . 22 MENOPAUSAL/HYSTERECTOMY . . . . . . 23 SUBFECUND/I NFECUND . . . . . . . . . . . 24 WANTS MORE CHILDREN . . . . . . . . . . 26 OPPOSITION TO USE RESPONDENT OPPOSED . . . . . . . . . . . 31 WIFE OPPOSED . . . . . . . . . . . . . . . . . 32 OTHERS OPPOSED . . . . . . . . . . . . . . . 33 RELIGIOUS PROHIBITION . . . . . . . . 34 LACK OF KNOWLEDGE KNOWS NO METHOO . . . . . . . . . . . . . . 41 KNOWS NO SOURCE . . . . . . . . . . . . . . 42 METHOD-RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . . 51 FEAR OF SIDE EFFECTS . . . . . . . . . 52 LACK OF ACCESS/TO0 FAR . . . . . . . 53 COST TO() MUCH . . . . . . . . . . . . . . . . 54 INCONVENIENT TO USE . . . . . . . . . . 55 INTERFERES WITH BODY'S NORMAL PROCESSES . . . . . . . . . . . 56 OTHER 96 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 98 SKIP 514 I c°upLeW s°Utd Y°uUsinS gay athamtethY°d°U ta°ppr°Va ev°id°gettind giSappr°Vep °fregnant? I NDoISAPPROVE'''A "PPROVE' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' "O 1 p I N I O N . . . . . . . . . . . . . . . . . . . . . . "" 3" ' ' ' ' ' ' ' ' ' ' ' ' ' "2 I 516 YES NO In the fast month, have you heard or seen a message about famity ptanning on: the radio? tetevisior? newspaper or magazine? a poster or bilLboard? RADIO . . . . . . . . . . . . . . . . . . . . . . 1 Z TELEVISION . . . . . . . . . . . . . . . . . 1 2 NEWSPAPER/MAGAZINE . . . . . . . . . 1 2 POSTER/BILLBOARD . . . . . . . . . . . 1 2 518 I Ip~anning w i t thhe last fe;oum~nths ha l Verier~ds, Y°neUighborsdiScuSSeodr familr Yetatives? I YES ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' . - - - ' ' - ' 'N " 0 . . . . . . . . . . . . . . . . . . . . . . . . . . ".i''1.2 11,521 519 With whom? Anyone else? RECORD ALL MENTIONED. WIFE . . . . . . . . . . . . . . . . . . . . . . . . . . . . A MOTHER . . . . . . . . . . . . . . . . . . . . . . . . . . B FATHER . . . . . . . . . . . . . . . . . . . . . . . . . . C SI STERCS)/SI STERS- I N- LAW . . . . . . . . D BROTHER(S)/BROTNERS- I N-LAW . . . . . . E DAUGHTER . . . . . . . . . . . . . . . . . . . . . . . . F MOTHER-IN-LAW . . . . . . . . . . . . . . . . . . . G FATHER-IN-LAW . . . . . . . . . . . . . . . . . . . H FRIENDS/NEIGHBORS . . . . . . . . . . . . . . . I OTHER X (SPECIFY) 521 Spouses/partners do not aLways agree on everything. Now I want to ask you about your wife's views on family planning. Do you think that your wife approves or disapproves APPROVES . . . . . . . . . . . . . . . . . . . . . . . . 1 of couptes using a method to avoid pregnancy? DISAPPROVES . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 522 I familH Y°W °ftepnlanninh gave y°iun tht eatkepdastt°yearY ?°ur wife about I SOMETIMES.----.,.-.*----.--M 4 0 R O ENcN EEVER''"O "FTEN' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 'O 3 R TWICE ' ' ' ' ' ° ' ' ' ' ' ' ' ' ' ' ' ' ' " 2" ' °° ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 1 245 M-15 NO. I 523 I QUESTIONS AND FILTERS Do you think your wife wants the same number of children that you want, or does she want mere or fewer than you want? CODING CATEGORIES SAME NUMBER . . . . . . . . . . . . . . . . . . . . . 1 MORE CHILDREN . . . . . . . . . . . . . . . . . . . 2 FEWER CHILDREN . . . . . . . . . . . . . . . . . . 3 DONIT KNOW . . . . . . . . . . . . . . . . . . . . . . 8 SKIP 529 CHECK 216: HAS LIVING CHILD(REN) [ ] / I V I f you could go back to the time you did not have any ch i ldren and could choose exact ly the number of ch i ldren to have in your whole Life, how many would that be? NO LIVING CHILD(REN) 9 r v If you could choose exactly the number of ch i ldren to have in your whole Life, how many would that be? RECORD SINGLE NUMBER OR OTHER ANSWER. NUMBER . . . . . . . . . . . . . . . . . . . . . ~- -~ OTHER ANSWER 96 (SPECIFY) 530 How many of these would you Like to be boys and how many would you Like to be girls? BOYS . . . . . . . . . . . . . . . . . . . . . . . GIRLS. EITHER . . . . . . . . . . . . . . . . . . . . . UP TO GOD . 95 OTHER 96 (SPECIFY) 246 M-16 NO I 601 SECTION 6. AIDS QUESTIONS AND FILTERS I Have you ever heard of an i l l ness catted AIDS? J COOING CATEGORIES J SKIP I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 =609 602 From which sources of i n fo rmat ion have you i (earned most about AIDS? I Any other sources? RECORD ALL MENTIONED. RADIO . . . . . . . . . . . . . . . . . . . . . . . . . . . A TV . . . . . . . . . ,ooo . . . . . . . . . . . . . , ° . .H NEWSPAPERS/MAGAZINES . . . . . . . . . . . . C PAMPHLETS/POSTERS . . . . . . . . . . . . . . . D HEALTH WORKERS . . . . . . . . . . . . . . . . . . E MOSQUES/CHURCHES . . . . . . . . . . . . . . . . F SCHOOLS/TEACHERS . . . . . . . . . . . . . . . . COMMUNITY MEETINGS . . . . . . . . . . . . . . H FRIENDS/RELATIVES . . . . . . . . . . . . . . . I WORK PLACE . . . . . . . . . . . . . . . . . . . . . . J OTHER X (SPECIFY) 603 J Is there anything a person can do to avoid [ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 17 get t ing AIDS or the v i rus that causes AIDS? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON=T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 1 =607 6O4 606 What can a person do? Any other ways? RECORD ALL MENTIONED. 9 What does "safe sex" mean to you?* SAFE SEX . . . . . . . . . . . . . . . . . . . . . . . . A ABSTAIN FROM SEX . . . . . . . . . . . . . . . . B USE COND(~4S . . . . . . . . . . . . . . . . . . . . . C NAVE ONLY ONE SEX PARTNER . . . . . . . b AVOID SEX WITH PROSTITUTES . . . . . . E USE STERILE SYRINGES/BUY SYRNGS.F AVOID BLOOD TRANSFUSIONS . . . . . . . . D AVOID KISSING . . . . . . . . . . . . . . . . . . . H AVOID MOSQUITO BITES . . . . . . . . . . . . l AVOID TRADITIONAL DOCTORS . . . . . . . J OTHER W (SPECIFY) OTHER X (SPECIFY) DONaT KNOW . . . . . . . . . . . . . . . . . . . . . . Z DID NOT I MENTION SAFE SEX ['--1 ~607 I ABSTAIN FRO~4 SEX . B USE CONDOMS . . . . . . . . . . . . . . . . . . . . . C HAVE ONLY ONE SEX PARTNER . . . . . . . D AVOID SEX WITH PROSTITUTES . . . . . . E AVOID SEX WITH HOMOSEXUALS . . . . . . F OTHER X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . Z 607 I is it possible f°r a he°Lthy-l°°ki°s P°rs°° IYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 to have the AIDS virus? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 608 Do you th ink that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease? RECORD THE TIME. I ALMOST NEVER . . . . . . . . . . . . . . . . . . . . 1 I SOMETIMES . . . . . . . . . . . . . . . . . . . . . . . 2 ALMOST ALWAYS . . . . . . . . . . . . . . . . . . . 3 DON'T KNOt/ . . . . . . . . . . . . . . . . . . . . . . 8 F ~ HOUR, . . . . . . . . °°°o,. . . . . . . . . I ~ I f ~ MINUTES . . . . . . . . . . . . . . . . . . . . 247 M17 Comments About Respondent: INTERVIEWER'S OBSERVATIONS (To be f i l led in after complet ing interview) Comments on Speci f ic Questions: Any Other Comments: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS 248 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 1996-97 21 /11 /96 COMMUNITY QUEST IONNAIRE D IV IS ION D ISTR ICT UPAZILA/THANA UNION VILLAGE/MOHALLA/BLOCK CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . DHAKA/CHITTAGONG=I , SMALL CITY=2, TOWN=3, V ILLAGE=4. . INTERVIEWER NAME DATE QUEST IONNAIRE IS COMPLETED. INFORMANTS WHO PROVIDED INFORMATION: (WRITE POSIT ION, E.G., V ILLAGE LEADER, . . . . . . . . . . . DAY MONTH** YEAR~ FWA) 1. 2. 3. 4. 5. F IELD EDITED BY | |OFF ICE EDITED BY KEYED BY NAME DATE KEYED BY ** MONTH: 01 JANUARY 05 MAY 09 SEPTEMBER 02 FEBRUARY 06 JUNE i0 OCTOBER 03 MARCH 07 JULY ii NOVEMBER 04 APRIL 08 AUGUST 12 DECEMBER 249 I0. 4 5 6 7 8 9 I. GENERAL DESCRIPTION OUESTIONS How far is i t from here to the thane headquarters in miles? IF LESS THAN 1 MILE, WRITE 'OO'. IF 97 MILES OR MORE, WRITE 97 IF UNKNOWN RECORD '9Be(BUT TRY TO GET AN ESTIMATE). HOW far is i t from here to the d i s t r i c t headquarters in miles IF LESS THAN 1 MILE, WRITE 'O0~.IF 97 MILES OR NORE, WRITE 97 IF UNKNOWN RECORD '98'(BUT TRY TO GET AN ESTIMATE). In th i s v i l l age /mohaILa , are there any mother's c lubs or lad ies associat ions? In th i s v i l l age /moha I ta , is there a Grameen Bank? COOING CATEGORIES MILES. MILES. Y E S . . . . . . . . . . . . . ° ° . . . . . . . . oo . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . , . . . . . . . . . . o . . . . . . . . . °o . . . . . In th i s v i t tage /mohat la , are there any cottage indust r ies YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 of BSIC? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 In th i s v i l lage/mohaLta , is there any cooperat ive society? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In th i s v i t tage /moha l la , are there any NGOs having income- YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I generat ing ac t iv i t ies? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z In th i s v i t lage/mohaLLa, is there a te lev i s ion for the YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 co~nunity? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 MILES Please te l l me i f the fo l low ing th ings are in th i s v i l l age / mohatta. %s there a Madrasha here? IF YES, WRITE "DO". IF NO, ASK: How far is i t to the nearest Hadrasha? IF DON'T KNOW, PUT 98. Is there a pr imary schooL here in the v i t tage/mohal la? Is there a high school here? Is there a post o f f i ce here? Is there a da i ly market here? Is there a weekly market here? Is there a cinema here? Is there a rura l d ispensary (RD) here? Is there a pharmacy here? Is there a government or NGO hea l th c l in i c here? NOTE: FOR EACH, IF IN VILLAGE/HOHALLA, WRITE "OO". IF NOT IN VILLAGE/MOHALLA, ASK HOW FAR. WRITE IN MILES. IF DO NOT KNOW, WRITE "98". IF MORE THAN 97, WRITE "97" 2 of 4 25O MADRASHA SCHOOL . . . . . . . . . . PRIHARY SCHOOL . . . . . . . . . . . HIGH SCHOOL . . . . . . . . . . . . . . POST OFFICE . . . . . . . . . . . . . . DAILY NARKET . . . . . . . . . . . . . WEEKLY MARKET . . . . . . . . . . . . ~ - ~ CINENA . . . . . . . . . . . . . . . . . . . RD . . . . . , . . . . . . . . , . . . . . . . . PHARNACY . . . . . . . . . . . . . . . . . HEALTH CLINIC . . . . . . . . . . . . ~ - ~ SKIP TO I f . COMHUNITY'BASED SERVICES QUESTIONS COOING CATEGORIES SKIP TO (s there s fami ly planning fieLdworker who v i s i t s th is YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 v i l lage/mohairs? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -- ~ 16 PROBE: Does a woman come to v i s i t houses here to ta lk about DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 -- ~ 16 fami ly planning? What is the name of the fami ly planning fietdworker? ~0. 10 11 12 13 16 Is there another fami ly planning f ie ldworker who v i s i t s th is viLlage/mohatIa? What is her name? Is there any health worker working in th is v i l lage/mohal ls? Is there any fami ly planning worker who l ives in th is vi l lage/mohairs? (NANE OF CBD WORKER) YES. , . ° °°°° . . . . . . ooooo°° . . . . . . . °1 NO, , °°°°°°°°° . . ° . °°°°° , ° , . . . . . ° .2 - - DOES HOT KNOW . . . . . . . . . . . . . . . . . . . 8 - - (NAME OF CBD WORKER) YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HO. . . . °ooo ,° . . . .o°°°° , ° , , . . ° °°oo 2 - - DOES HOT KNOW . . . . . . . . . . . . . . . . . . . 8 -- 14 14 18 18 YES . . . . , . , , , , , . . . . . . , oo . . . . ° . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 Is there anyone in th is v i l tsge/mohat la who se l l s fami ly YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 planning methods from his or hen house? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 v 19A DOES NOT KNOW . . . . . . . . . . . . . . . . . . . 8 ~ 19A Which methods does he/she se l l? 18 19 19A 19 20 21 PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . A CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . B IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C OTHER D CIRCLE ALL HENTIOHED. (SPECIFY) Is there any shop in th is viLLage/mohatta which se l l s fami ly YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 planning methods? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - ~ 20 DOES NOT KNOg . . . . . . . . . . . . . . . . . . . 8 . . . . . . . ~ 20 Which methods does the shop se l l? CIRCLE ALL HENTIONED, In some places, there is a c l in i c which is set up temporari ly in someone,s house or a school on certain days to provide health and fami ly planning services to mothers and ch i ldren. Is there a c l in i c Like th is held in th is v i l lage/mohairs in the Last 6 months? is there a c l in i c l i ke th is held nearby to th is v i l l age / mohalla in the Last 6 months? IF YES: How far away is the place where they have the c l in i c? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . . A CONDOR . . . . . . . . . . . . . . . . . . . . . . . . . . B IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C OTHER O (SPECIFY) YES . . . . , , , . . . . . . . . , ,o . . . . . . . , , , ,1 ~ . HOo,ooo . . . . °ooo . . . . . . , °oo , . . . . . . 2 DOES NOT KHC~J . . . . . . . . . . . . . . . . . . . 8 ,- 22 YES, . , , , , , . . . . . . , , , . . . . . . . , , , . . .1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- ~ 24 DOES NOT KNOt4 . . . . . . . . . . . . . . . . . . . 8 - ~ 24 HILES . . . . . . . . . . . . . . . . . . . . [ ~ 3of4 25! NO. 22 23 24 25 QUESTIONS COOING CATEGORIES SKIP TO What services are available from this temporary cLinic? CIRCLE ALL MENTIONED. FAMILY PLANNING PILL . . . . . . . . . . . . A CONDOM . . . . . . . . . . . . . . . . . . . . . . . . . . B IUD INSERTIONS . . . . . . . . . . . . . . . . . . C FAMILY PLANNING INJECTIONS . . . . . . D IMMUNIZATIONS . . . . . . . . . . . . . . . . . . . E ORAL REHYDRATION PACKETS . . . . . . . . F VITAMIN A CAPSULES . . . . . . . . . . . . . . G WEIGHING CHILDREN . . . . . . . . . . . . . . . N CHECKING PREGNANT WOMEN . . . . . . . . . I TETANUS INJECTIONS . . . . . . . . . . . . . . J OTHER K (SPECIFY) NO. OF TIMES How frequently are these temporary c l in ics held? PER MONTH . . . . . . . . . . . . . I PER YEAR . . . . . . . . . . . . . . Z How far away is the nearest Family WeLfare Center? MILES . . . . . . . . . . . . . . . . . . How fBr away is the nearest hospital or thana health comptex? MILES . . . . . . . . . . . . . . . . . . 4of4 252 Front Matter World Summit for Children Indicators: Bangladesh 1997-97 Title Page Citation Page Table of Contents List of Tables List of Figures Foreword Preface Summary of Findings Map of Bangladesh Chapter 01 - Introduction Chapter 02 - Characteristics of Households and Respondents Chapter 03 - Fertility Chapter 04 - Fertility Regulation Chapter 05 - Other Proximate Determinants of Fertility Chapter 06 - Fertility Preferences Chapter 07 - Infant and Child Mortality Chapter 08 - Maternal and Child Health Chapter 09 - Infant Feeding, Childhood and Maternal Nutrition Chapter 10 - Knowledge of AIDS Chapter 11 - Availability of Health and Family Planning Services References Appendix A - Survey Implementation Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tables Appendix D - Persons Involved int he 1996-97 Bangladesh Demographic and Health Survey Appendix E - Questionnaires Household Questionnaire Woman Questionnaire Men's Questionnaire

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