Bangladesh Demographic and Health Survey 2014

Publication date: 2016

Bangladesh Demographic and Health Survey 2014 B angladesh 2014 D em ographic and H ealth Survey BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 2014 National Institute of Population Research and Training Ministry of Health and Family Welfare Dhaka, Bangladesh Mitra and Associates Dhaka, Bangladesh The DHS Program ICF International Rockville, Maryland, U.S.A. March 2016 Cover motif: Nakshi Katha tapestry by Suraiya The 2014 Bangladesh Demographic and Health Survey (2014 BDHS) was implemented under the authority of the National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare. The survey was conducted by Mitra and Associates from June to November 2014. Funding was provided by the United States Agency for International Development (USAID)/Bangladesh. ICF International provided technical assistance through The DHS Program, a USAID-funded project. Information about the BDHS may be obtained from the National Institute of Population Research and Training (NIPORT), Azimpur, Dhaka, Bangladesh (Telephone: 5861-1206; Internet: http://www.niport.gov.bd) or from Mitra and Associates, 2/17 Iqbal Road, Mohammadpur, Dhaka, Bangladesh; Telephone: 911-5503; Fax: 912-6806; Internet: www.mitra.bd.com. Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: 301-407-6500; Fax: 301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Suggested citation: National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. 2016. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . vii FOREWORD . xiii PREFACE . xv CONTRIBUTORS TO THE REPORT . xvii ABBREVIATIONS . xix MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxiii MAP OF BANGLADESH . xxiv 1 INTRODUCTION . 1 1.1 Geography and Economy . 1 1.2 Population . 2 1.3 Population, Family Planning, and Maternal and Child Health Policies and Programs. 2 1.4 Organization of the 2014 Bangladesh Demographic and Health Survey . 4 1.4.1 Survey Objectives and Implementing Organizations . 4 1.4.2 Sample Design . 5 1.4.3 Questionnaires . 5 1.4.4 Training and Fieldwork . 6 1.4.5 Data Processing . 7 1.4.6 Coverage of the Sample . 7 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 2.1 Household Characteristics . 10 2.1.1 Water and Sanitation . 10 2.1.2 Housing Characteristics . 13 2.1.3 Household Possessions . 15 2.2 Socioeconomic Status Index . 16 2.3 Household Population by Age and Sex . 17 2.4 Household Composition . 19 2.5 Birth Registration . 19 2.6 School Attendance . 20 2.7 Education of Household Population . 21 2.7.1 Educational Attainment of the Household Population . 21 2.7.2 School Attendance Ratios . 24 2.8 Employment . 26 2.9 Ownership of Mobile Phones . 27 3 CHARACTERISTICS OF RESPONDENTS . 29 3.1 Characteristics of Survey Respondents . 29 3.2 Educational Attainment . 30 3.3 Literacy . 31 3.4 Access to Mass Media . 32 3.5 Employment . 34 3.6 Occupation . 35 3.7 Earnings, Employers, and Continuity of Employment . 37 4 MARRIAGE AND SEXUAL ACTIVITY . 39 4.1 Introduction . 39 4.2 Current Marital Status . 40 iv • Contents 4.3 Age at First Marriage . 41 4.4 Age at First Sexual Intercourse . 43 4.5 Recent Sexual Activity . 44 4.7 Spousal Separation . 45 4.8 Perception Toward Age at First Marriage . 47 5 FERTILITY . 49 5.1 Current Fertility . 50 5.2 Fertility Differentials . 51 5.3 Fertility Trends . 52 5.4 Children Ever Born and Living . 55 5.5 Birth Intervals . 56 5.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 58 5.7 Menopause . 60 5.8 Age at First Birth . 61 5.9 Teenage Pregnancy and Motherhood . 62 6 FERTILITY PREFERENCES . 65 6.1 Desire for More Children . 65 6.2 Desire to Limit Childbearing . 66 6.3 Ideal Family Size . 68 6.4 Fertility Planning . 69 6.5 Wanted Fertility Rates . 70 6.6 Spousal Agreement in Desired Number of Children . 72 7 FERTILITY REGULATION . 73 7.1 Current Use of Contraception . 74 7.2 Differentials in Current Use of Family Planning . 74 7.3 Trends in Current Use of Family Planning . 76 7.4 Timing of Sterilization. 79 7.5 Knowledge and Use of Menstrual Regulation . 79 7.6 Knowledge of Fertile Period . 80 7.7 Knowledge and Use of ECP . 81 7.8 Knowledge and Practice of Lactational Amenorrhea Method . 82 7.9 Sources of Family Planning Methods . 82 7.10 Use of Social Marketing Brands . 85 7.11 Contraceptive Discontinuation . 86 7.12 Future Use of Contraception . 89 7.13 Reasons for Not Intending to Use Contraception . 90 7.14 Unmet Need for Family Planning Services . 91 7.15 Exposure to Family Planning Messages . 93 7.16 Fieldworker Visits . 95 7.17 Satellite Clinics . 96 7.18 Community Clinics . 97 8 INFANT AND CHILD MORTALITY . 99 8.1 Assessment of Data Quality . 100 8.2 Levels and Trends in Infant and Child Mortality . 101 8.3 Socioeconomic Differentials in Infant and Child Mortality . 103 8.4 Demographic Differentials in Infant and Child Mortality . 104 8.5 Perinatal Mortality . 106 8.6 High-Risk Fertility Behavior . 108 Contents • v 9 MATERNAL AND NEWBORN HEALTH . 111 9.1 Antenatal Care . 112 9.1.1 Antenatal Care Coverage . 112 9.1.2 Place of Antenatal Care . 114 9.1.3 Number of Antenatal Visits . 116 9.1.4 Components of Antenatal Care . 117 9.2 Delivery Care . 118 9.2.1 Place of Delivery. 118 9.2.2 Caesarean Section . 120 9.2.3 Assistance during Delivery . 122 9.3 Postnatal Care for Mothers and Children . 124 9.3.1 Postnatal Checkup for Mother . 124 9.3.2 Postnatal Checkup for the Newborn . 128 9.4 Newborn Care . 130 9.4.1 Care of the Umbilical Cord . 130 9.4.2 Drying and Bathing the Newborn . 132 9.4.3 Essential Newborn Care . 134 10 CHILD HEALTH . 137 10.1 Child’s Size at Birth . 137 10.2 Vaccination of Children . 138 10.2.1 Vaccination Coverage . 139 10.2.2 Differentials in Vaccination Coverage . 140 10.2.3 Trends in Vaccination Coverage . 141 10.3 Childhood Illness and Treatment . 141 10.3.1 Childhood Diarrhea . 141 10.3.2 Treatment of Childhood Diarrhea . 142 10.3.3 Feeding Practices during Diarrhea . 145 10.3.4 Acute Respiratory Infections . 147 10.4 Fever . 148 11 NUTRITION OF CHILDREN AND WOMEN . 151 11.1 Nutritional Status of Children . 152 11.1.1 Measurement of Nutritional Status among Young Children . 152 11.1.2 Data Collection . 153 11.1.3 Levels of Child Malnutrition . 153 11.1.4 Trends in Children’s Nutritional Status . 156 11.2 Breastfeeding and Complementary Feeding . 157 11.2.1 Initiation of Breastfeeding . 157 11.2.2 Prelacteal Feeding . 157 11.3 Breastfeeding Status by Age . 158 11.4 Duration of Breastfeeding . 162 11.5 Types of Complementary Foods . 162 11.6 Infant and Young Child Feeding Practices . 164 11.7 Micronutrient Intake among Children . 167 11.7.1 Consumption of Micronutrient-rich Foods . 167 11.7.2 Micronutrient Supplementation . 169 11.7.3 Deworming . 169 11.8 Nutritional Status of Women . 169 11.9 Micronutrient Intake among Mothers . 173 vi • Contents 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 175 12.1 Knowledge of HIV/AIDS and Transmission and Prevention Methods . 177 12.1.1 Knowledge of HIV/AIDS . 177 12.1.2 Knowledge of HIV Prevention Methods . 177 12.1.3 Comprehensive Knowledge about AIDS . 178 12.2 Knowledge about Mother-to-Child Transmission of HIV . 180 12.3 Knowledge of Means of Transmission of HIV . 181 12.4 Attitude toward Negotiating Safe Sexual Relations with Husbands . 182 12.5 Self-reported Prevalence of Sexually Transmitted Infections (STIs) and STI Symptoms . 183 13 WOMEN’S EMPOWERMENT AND HEALTH SEEKING BEHAVIOR . 187 13.1 Employment and Form of Earnings . 188 13.2 Women’s Control over their Own Earnings . 189 13.3 Freedom of Movement . 190 13.4 Women’s Empowerment . 191 13.5 Attitudes toward Wife Beating . 194 13.6 Indicators of Women’s Empowerment . 195 13.7 Current Use of Contraception by Women’s Empowerment . 196 13.8 Ideal Family Size and Unmet Need by Women’s Empowerment . 197 13.9 Reproductive Health Care by Women’s Empowerment . 198 13.10 Infant and Child Mortality and Women’s Empowerment . 199 14 COMMUNITY CHARACTERISTICS . 201 REFERENCES . 207 APPENDIX A: SAMPLE DESIGN AND IMPLEMENTATION . 213 A.1 Introduction . 213 A.2 Sampling Frame . 213 A.3 Sample Design . 214 A.4 Sampling Weight . 216 APPENDIX B: ESTIMATES OF SAMPLING ERRORS . 219 APPENDIX C: DATA QUALITY TABLES . 233 APPENDIX D: PERSONS INVOLVED IN THE SURVEY . 235 APPENDIX E: QUESTIONNAIRES . 243 APPENDIX F: SUMMARY INDICATORS . 327 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators . 2 Table 1.2 Results of the household and individual interviews . 7 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 Table 2.1 Household drinking water . 10 Table 2.2 Household sanitation facilities . 11 Table 2.3 Hand washing: availability of cleansing agents . 12 Table 2.4 Hand washing: location . 13 Table 2.5 Housing characteristics . 14 Table 2.6 Cooking amenity . 15 Table 2.7 Household possessions . 15 Table 2.8 Wealth quintiles . 17 Table 2.9 Household population by age, sex, and residence . 17 Table 2.10 Trends in population by age . 19 Table 2.11 Household composition . 19 Table 2.12 Birth registration of children under age 5 . 20 Table 2.13 School attendance . 21 Table 2.14.1 Educational attainment of the male household population . 22 Table 2.14.2 Educational attainment of the female household population . 23 Table 2.15 School attendance ratios . 25 Table 2.16 Employment status . 26 Table 2.17 Availability of mobile phone among household members . 27 Figure 2.1 Availability of electricity by urban-rural residence . 13 Figure 2.2 Population pyramid . 18 Figure 2.3 Household age distribution by sex . 18 Figure 2.4 Trend in completed median of years of schooling of men and women age 6 and over, 1999-2014 . 24 Figure 2.5 Age-specific attendance rates of the de facto population age 5-24 . 26 3 CHARACTERISTICS OF RESPONDENTS . 29 Table 3.1 Background characteristics of respondents . 29 Table 3.2 Educational attainment . 30 Table 3.3 Literacy . 32 Table 3.4 Exposure to mass media . 33 Table 3.5 Employment status . 35 Table 3.6 Occupation . 36 Table 3.7 Type of employment . 37 Figure 3.1 Trends in education of ever-married women, 2007-2014 . 31 Figure 3.2 Trends in exposure to mass media of ever-married women, 2007-2014 . 34 4 MARRIAGE AND SEXUAL ACTIVITY . 39 Table 4.1 Current marital status . 40 Table 4.2 Trends in proportion never married . 40 Table 4.3 Age at first marriage . 41 viii • Tables and Figures Table 4.4 Median age at first marriage by background characteristics . 42 Table 4.5 Age at first sexual intercourse . 43 Table 4.6 Median age at first sexual intercourse by background characteristics . 44 Table 4.7 Recent sexual activity . 45 Table 4.8 Husband’s visit . 46 Table 4.9 Preferred age at first marriage . 47 Figure 4.1 Trends in proportion of women age 20-24 who were first married by age 18 . 42 5 FERTILITY . 49 Table 5.1 Current fertility . 50 Table 5.2 Fertility by background characteristics . 52 Table 5.3.1 Trends in age-specific fertility rates . 53 Table 5.3.2 Trends in current fertility rates. 53 Table 5.4 Children ever born and living . 56 Table 5.5 Birth intervals . 57 Table 5.6 Postpartum amenorrhea, abstinence and insusceptibility . 58 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 60 Table 5.8 Menopause . 60 Table 5.9 Age at first birth . 61 Table 5.10 Median age at first birth . 62 Table 5.11 Teenage pregnancy and motherhood . 63 Figure 5.1 Age-specific fertility rates by urban-rural residence . 51 Figure 5.2 Trends in total fertility rates, 1975-2014 . 54 Figure 5.3 Trends in age-specific fertility rates, 2004-2014 . 54 Figure 5.4 Trends in total fertility by division, 2011 and 2014 . 55 6 FERTILITY PREFERENCES . 65 Table 6.1 Fertility preferences by number of living children . 66 Table 6.2 Desire to limit childbearing . 68 Table 6.3 Ideal number of children by number of living children . 69 Table 6.4 Mean ideal number of children . 69 Table 6.5 Fertility planning status . 70 Table 6.6 Wanted fertility rates . 71 Table 6.7 Comparison in desired number of children . 72 Figure 6.1 Trends in fertility preferences among currently married women age 15-49, 2004-2014 . 66 Figure 6.2 Trends in currently married women with two children who want no more children, 1993-2014 . 67 Figure 6.3 Trends in gap between wanted and unwanted fertility rates, 1993 2014 . 71 7 FERTILITY REGULATION . 73 Table 7.1 Current use of contraception by age . 74 Table 7.2 Current use of contraception by background characteristics . 75 Table 7.3 Trends in current use of contraceptive methods . 77 Table 7.4 Timing of sterilization . 79 Table 7.5 Knowledge and use of menstrual regulation . 80 Table 7.6 Source of service for menstrual regulation in last three years . 80 Table 7.7 Knowledge of fertile period . 81 Tables and Figures • ix Table 7.8 Knowledge and use of ECP by background characteristics by background characteristics . 81 Table 7.9 Knowledge and use of LAM by background characteristics by background characteristics . 82 Table 7.10 Source of modern contraception methods . 83 Table 7.11 Knowledge of source of specific source of family planning method services . 85 Table 7.12 Use of pill brands by residence . 86 Table 7.13 Use of condom brands by residence . 86 Table 7.14 First-year contraceptive discontinuation rates . 87 Table 7.15 Reasons for discontinuation . 88 Table 7.16 Future use of contraception . 89 Table 7.17 Preferred method of contraception for future use . 90 Table 7.18 Reason for not intending to use contraception . 90 Table 7.19 Need and demand for family planning among currently married women . 92 Table 7.20 Exposure to family planning messages . 94 Table 7.21 Contact with family planning fieldworkers: Type of service . 95 Table 7.22 Contact with family planning fieldworkers: Type of fieldworker . 96 Table 7.23 Satellite clinics . 97 Table 7.24 Community clinics . 98 Figure 7.1 Contraceptive use by background characteristics . 76 Figure 7.2 Trends in contraceptive use among currently married women, 1975-2014 . 77 Figure 7.3 Trends in modern method use by age of currently married women, 2011 2014 . 78 Figure 7.4 Trends in use of modern contraceptives by division, 2007-2014. 78 Figure 7.5 Trends in contraceptive method mix among currently married women age 10-49, 1975-2014 . 79 Figure 7.6 Distribution of current users of modern methods by source of supply . 84 Figure 7.7 Trends in source of contraceptive methods, 2004-2014 . 84 Figure 7.8 Trends in all method contraceptive discontinuation rates, 1993/94-2014 . 88 Figure 7.9 Trends in future intention to use contraception by currently married women who are not using a contraceptive method, age 15-49, from 2004-2014 . 89 Figure 7.10 Trends in unmet need for family planning among currently married women age 15-49, 2011 and 2014 BDHS . 93 Figure 7.11 Trends in unmet need for family planning services among currently married women age 15-49, by division, 2011-2014 . 93 8 INFANT AND CHILD MORTALITY . 99 Table 8.1 Early childhood mortality rates . 102 Table 8.2 Trend in early childhood mortality . 102 Table 8.3 Early childhood mortality rates by socioeconomic characteristics . 103 Table 8.4 Early childhood mortality rates by demographic characteristics . 105 Table 8.5 Perinatal mortality . 107 Table 8.6 High-risk fertility behavior . 108 Figure 8.1 Trends in childhood mortality rates, 1989-2014 . 103 Figure 8.2 Under-5 mortality rates by socioeconomic characteristics . 104 Figure 8.3 Under-5 mortality rates by demographic characteristics . 106 9 MATERNAL AND NEWBORN HEALTH . 111 Table 9.1 Antenatal care . 113 Table 9.2 Place of antenatal care . 115 Table 9.3 Number of antenatal care visits . 116 Table 9.4 Components of antenatal care . 118 x • Tables and Figures Table 9.5 Place of delivery . 119 Table 9.6 Length of stay in the health facility after delivery . 121 Table 9.7 Reasons for C-section . 122 Table 9.8 Assistance during delivery . 123 Table 9.9 Postnatal care for mothers and children . 125 Table 9.10 Timing of first postnatal checkup for the mother . 126 Table 9.11 Type of provider of first postnatal checkup for the mother . 127 Table 9.12 Components of postnatal care for the mother . 127 Table 9.13 Timing of first postnatal checkup for the children . 128 Table 9.14 Type of provider of first postnatal checkup for the newborn . 129 Table 9.15 Components of postnatal checkup for the newborn . 129 Table 9.16 Type of instrument used to cut the umbilical cord . 130 Table 9.17 Application of material after the umbilical cord was cut . 132 Table 9.18 Newborn care practices: timing of drying . 133 Table 9.19 Newborn care practices: Timing of first bath . 134 Table 9.20 Essential newborn care . 134 Figure 9.1 Trend in use of antenatal care, 2004-2014 . 114 Figure 9.2 Trend in place of antenatal care, 2011-2014 . 116 Figure 9.3 Trend in number of antenatal care visits, 2004-2014 . 117 Figure 9.4 Trend in facility births, 2004-2014 . 120 Figure 9.5 Health facility delivery by wealth quintile, 2011 and 2014 . 120 Figure 9.6 Trend in births delivered by C-section, 2004-2014 . 121 Figure 9.7 Trend in skilled attendance at deliveries, 2004-2014 . 124 Figure 9.8 Trend in use of postnatal care for women and children from a medically trained provider within two days of delivery, 2004-2014 . 125 Figure 9.9 Trend in use of appropriate cord care, 2007-2014 . 131 Figure 9.10 Trend in use of essential newborn care practices, 2011-2014 . 135 10 CHILD HEALTH . 137 Table 10.1 Child’s size and weight at birth. 138 Table 10.2 Vaccinations by source of information . 139 Table 10.3 Vaccinations by background characteristics . 140 Table 10.4 Prevalence of diarrhea . 142 Table 10.5 Diarrhea treatment . 143 Table 10.6 Diarrhea treatment with ORT and zinc . 145 Table 10.7 Feeding practices during diarrhea . 146 Table 10.8 Prevalence and treatment of symptoms of ARI . 147 Table 10.9 Prevalence and treatment of fever . 149 Table 10.10 First source of treatment of fever . 150 Figure 10.1 Trend in vaccination coverage by age 12 months, 2004-2014 . 141 Figure 10.2 Trend in use of ORT and zinc for treatment of diarrhea in children under age 5, 2007-2014 . 144 11 NUTRITION OF CHILDREN AND WOMEN . 151 Table 11.1 Nutritional status of children . 154 Table 11.2 Initial breastfeeding . 158 Table 11.3 Breastfeeding status by age . 159 Table 11.4 Median duration of breastfeeding . 162 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 163 Table 11.6 Infant and young child feeding (IYCF) practices . 166 Tables and Figures • xi Table 11.7 Micronutrient intake among children . 168 Table 11.8 Nutritional status of ever-married women . 170 Table 11.9 Micronutrient intake among mothers . 173 Figure 11.1 Nutritional status of children by age . 156 Figure 11.2 Trends in nutritional status of children under age 5, 2004-2014 . 156 Figure 11.3 Infant feeding practices by age . 160 Figure 11.4 Trends in exclusive breastfeeding practices among children age 0-5 months, 2004-2014 . 161 Figure 11.5 IYCF indicators on breastfeeding status . 161 Figure 11.6 Trends in complementary feeding for breastfeeding children age 6-9 months . 164 Figure 11.7 Percentage fed according to minimum standard of acceptable feeding practices . 167 Figure 11.8 Percentage of undernourishment (BMI <18.5) among ever-married women age 15-49 years . 171 Figure 11.9 Trends in nutritional status of ever-married women, 2004-2014 . 172 Figure 11.10 Trend in BMI among ever-married women age 15-49, 1996, 2000, 2004, 2007, 2011, and 2014 BDHS . 172 Figure 11.11 Trends in postpartum vitamin A supplementation among mothers, 2004-2014 . 174 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 175 Table 12.1 Knowledge of AIDS . 177 Table 12.2 Knowledge of HIV prevention methods . 178 Table 12.3 Comprehensive knowledge about AIDS . 179 Table 12.4 Knowledge of prevention of mother to child transmission of HIV . 181 Table 12.5 Knowledge of transmission of HIV through unclean needles and unsafe blood transfusions . 182 Table 12.6 Attitudes toward negotiating safer sexual relations with husband . 183 Table 12.7 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 184 Figure 12.1 Comprehensive knowledge about AIDS among ever-married women age 15-49 . 180 Figure 12.2 Care seeking for STIs of women, 2011 and 2014 . 185 13 WOMEN’S EMPOWERMENT AND HEALTH SEEKING BEHAVIOR . 187 Table 13.1 Employment and cash earnings of currently married women . 189 Table 13.2 Control over women’s cash earnings . 190 Table 13.3 Freedom of movement . 191 Table 13.4 Participation in decision-making . 192 Table 13.5 Women’s participation in decision-making by background characteristics . 193 Table 13.6 Women’s attitude toward wife beating . 195 Table 13.7 Indicators of women’s empowerment . 196 Table 13.8 Current use of contraception by women’s empowerment . 197 Table 13.9 Women’s empowerment and ideal number of children and unmet need for family planning . 198 Table 13.10 Reproductive health care by women’s empowerment . 199 Table 13.11 Early childhood mortality rates by women’s empowerment . 200 Figure 13.1 Number of decisions in which currently married women participate, Bangladesh 2014 . 194 xii • Tables and Figures 14 COMMUNITY CHARACTERISTICS . 201 Table 14.1 Distance to the nearest service location . 202 Table 14.2 Distance to the nearest education facility. 202 Table 14.3 Availability of income-generating organizations . 203 Table 14.4 Availability of health facility . 204 Table 14.5 Availability of health and family planning workers . 205 Table 14.6 Availability of family planning and other health services . 205 Table 14.7 Means of transport to upazila headquarters . 205 Table 14.8 Means of transport to district headquarters . 206 APPENDIX A: SAMPLE DESIGN AND IMPLEMENTATION . 213 Table A.1 Percent distribution of households by division and type of residence . 213 Table A.2 Sample allocation of clusters by division and type of residence . 215 Table A.3 Sample allocation of households by division and type of residence . 215 Table A.4 Sample allocation of completed women interviews by division and type of residence . 215 Table A.5 Sample implementation . 216 APPENDIX B: ESTIMATES OF SAMPLING ERRORS . 219 Table B.1 List of selected variables for sampling errors, Bangladesh 2014 . 221 Table B.2 Sampling errors: Total sample, Bangladesh DHS 2014 . 222 Table B.3 Sampling errors: Urban sample, Bangladesh DHS 2014 . 223 Table B.4 Sampling errors: Rural sample, Bangladesh DHS 2014 . 224 Table B.5 Sampling errors: Barisal sample, Bangladesh DHS 2014 . 225 Table B.6 Sampling errors: Chittagong sample, Bangladesh DHS 2014 . 226 Table B.7 Sampling errors: Dhaka sample, Bangladesh DHS 2014 . 227 Table B.8 Sampling errors: Khulna sample, Bangladesh DHS 2014 . 228 Table B.9 Sampling errors: Rajshahi sample, Bangladesh DHS 2014 . 229 Table B.10 Sampling errors: Rangpur sample, Bangladesh DHS 2014 . 230 Table B.11 Sampling errors: Sylhet sample, Bangladesh DHS 2014 . 231 APPENDIX C: DATA QUALITY TABLES . 233 Table C.1 Household age distribution . 233 Table C.2 Age distribution of eligible and interviewed women . 233 Table C.3 Completeness of reporting . 234 Table C.4 Births by calendar years . 234 Table C.5 Reporting of age at death in days . 235 Table C.6 Reporting of age at death in months . 236 Foreword • xiii FOREWORD Secretary Ministry of Health and Family Welfare Government of the People’s Republic of Bangladesh angladesh Demographic and Health Survey (BDHS) 2014 is the seventh national-level demographic and health survey designed to provide information to address the monitoring and evaluation needs of the Health, Population and Nutrition Sector Development Program (HPNSDP) and to provide managers and policy makers involved in this program with the information that they need to effectively plan and implement future interventions. The survey generates evidences on basic national indicators of social progress including fertility, childhood mortality, fertility preferences and fertility regulation, maternal and child health, nutritional status of mothers and children, and awareness and attitude towards HIV/AIDS. In addition to presenting the main findings from BDHS 2014 on fertility, family planning, maternal and child health and nutrition, this report highlights the major changes that have taken place in Bangladesh’s demographic and health situation since 1993-94. Results of BDHS 2014 illustrate that Bangladesh has achieved the Millennium Development Goal (MDG) 4 target ahead of time. There are evidences that Bangladesh is moving ahead in achieving MDG 5. Since BDHS 2004, deliveries attended by skilled providers have increased by 2.6 times and deliveries in health facilities have increased by more than 3 times. Khulna and Rangpur divisions have reached HPNSDP target of total fertility rate 2.0. Rajshahi and Barisal divisions are near to reach the target. Fertility also continues to decline in Chittagong and Sylhet divisions. BDHS data show continuous improvement in nutritional status of children. HPNSDP targets for prevalence of stunting and underweight have already been achieved. The findings of this report and its policy and programmatic implications will be instrumental in monitoring and evaluation of HPNSDP and in designing the next HPN sector program in Bangladesh. The need, however, for further detailed analysis of BDHS data remains. I hope that such analysis will be carried out by the academicians, researchers and program personnel to provide more in-depth knowledge for future direction and effective program implementation in the coming years. The successful completion of BDHS 2014 was made possible by the contributions of a number of organizations and individuals. I would like to thank NIPORT, Mitra & Associates and ICF International for their efforts in conducting BDHS 2014. I deeply appreciate the United States Agency for International Development (USAID), Bangladesh for providing financial assistance that helped ensure the ultimate success of this important national survey. Syed Monjurul Islam B Preface • xv PREFACE Director General National Institute of Population Research and Training Ministry of Health and Family Welfare angladesh Demographic and Health Survey (BDHS) 2014 is the seventh survey of its kind conducted in Bangladesh. This survey was implemented through a collaborative effort of the National Institute of Population Research and Training (NIPORT), ICF International, USA and Mitra & Associates. The financial support for the survey was provided by the United States Agency for International Development (USAID), Bangladesh. The wealth of demographic and health data that BDHS 2014 provides is essential and instrumental in monitoring and evaluating the performance of the Health, Population and Nutrition Sector Development Program (HPNSDP). BDHS presents estimates for 18 indicators of the Results Framework of HPNSDP and considered as a major source of information for program monitoring. We hope the survey data will assist policymakers and program managers in monitoring and designing programs and strategies for improving health, family planning, and nutrition services in the country. Members of the Technical Review Committee (TRC), consisting of experts from government, Non- government and international organizations as well as researchers and professionals working in the Health Nutrition and Population Sectors were involved and gave their expert opinion in various phases of the survey implementation. A Technical Working Group (TWG) was also formed with the representatives from NIPORT, PMMU-MOHFW, University of Dhaka, icddr,b, USAID/Bangladesh, Save the Children, ICF International and Mitra and Associates for designing the survey questionnaires and the implementation of the survey. I would like to put on record my sincere appreciation to TRC and TWG members for their sincere effort in different stages of the survey. I extend sincere thanks to the Bangladesh Bureau of Statistics (BBS) for their support in selecting sample clusters and providing Enumeration Area (EA) maps for the survey. The preliminary results of BDHS 2014, with its key indicators were released through a dissemination seminar in April 2015. This final report brings more comprehensive analysis of the survey results. Along with the key results, detailed findings and possible interpretations are presented in the final report. This report is an outcome of contributions of the professionals of NIPORT, NIPSOM, University of Dhaka, icddr,b, ICF International, MEASURE Evaluation, USAID/Bangladesh, SMC, and Mitra & Associates. I would like to acknowledge everyone for their contributions to BDHS 2014 Final Report. I would like to congratulate all the professionals of Research Unit of NIPORT for the successful completion of the survey. I also extend my thanks to ICF International and Mitra & Associates for completing the task in a professional manner. Finally, USAID/Bangladesh deserves special thanks for providing technical and financial support for the survey. Rownaq Jahan B Contributors to the Report • xvii CONTRIBUTORS TO THE REPORT Mr. Shahidul Islam, Mitra and Associates Mr. Moinuddin Haider, International Center for Diarrheal Disease Research, Bangladesh Mr. Mohammed Ahsanul Alam, National Institute of Population Research and Training Mr. Md. Rabiul Haque, University of Dhaka Ms. Shahin Sultana, National Institute of Population Research and Training Mr. Shamal Chandra Karmaker, University of Dhaka Mr. Md. Moshiur Rahman, Social Marketing Company Mr. Toslim Uddin Khan, Social Marketing Company Ms. Rashida-E-Ijdi, Measure Evaluation Ms. Shumona Sharmin Salam, International Center for Diarrheal Disease Research, Bangladesh Dr. Afsana Bhuiyan, International Center for Diarrheal Disease Research, Bangladesh Dr. Md. Shafiqul Islam, National Institute of Preventative and Social Medicine Dr. Mahamudul Hasan, International Center for Diarrheal Disease Research, Bangladesh Ms. Shusmita Hossain Khan, Measure Evaluation Mr. Subrata K. Bhadra, National Institute of Population Research and Training Dr. Mahmuda Khatun, University of Dhaka Ms. Sri Poedjastoeti, ICF International Dr. Ahmed Al-Sabir, ICF International Prof. Nitai Chakraborty, ICF International Dr. Kanta Jamil, United States Agency for International Development (USAID)/Bangladesh Abbreviations • xix ABBREVIATIONS AIDS acquired immune deficiency syndrome ANC antenatal care ARI acute respiratory infection ASA Association of Social Advancement ASFR age-specific fertility rates BBS Bangladesh Bureau of Statistics BCC behavior change communication BCG Bacille-Calmette-Guerin vaccine against tuberculosis BDHS Bangladesh Demographic and Health Survey BFS Bangladesh Fertility Survey BMI body mass index BMMS Bangladesh Maternal Mortality Survey BRAC Bangladesh Rural Advancement Committee CBR crude birth rate CDC Centers for Disease Control and Prevention CPS Contraceptive Prevalence Survey CSBA community-skilled birth attendant DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DHS Demographic and Health Survey DPT diphtheria, pertussis, and tetanus vaccine EA enumeration area EmOC emergency obstetric care EPI Expanded Program on Immunization FP family planning FWA family welfare assistant FWV family welfare visitor GAR gross attendance ratio GAVI Global Alliance for Vaccination and Immunization GDP gross domestic product GFR general fertility rate GOB Government of Bangladesh GPI gender parity index GPS global positioning system HA health assistant HDI human development index HIV human immunodeficiency virus HMN Health Metrics Network HNPSP Health, Nutrition and Population Sector Program HPI human poverty index xx • Abbreviations HPNSDP Health, Population and Nutrition Sector Development Program HPSP Health and Population Sector Program ICDDR,B International Center for Diarrhoeal Disease Research, Bangladesh ICPD International Conference on Population and Development IDU injection drug user IMCI integrated management of childhood illness IUD intrauterine device IYCF Infant and Young Child Feeding LAPM long-acting and permanent method LDC least developed country LMP last menstrual period LPG liquid petroleum gas MA medical assistant MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MMR maternal mortality ratio MOHFW Ministry of Health and Family Welfare MR menstrual regulation MSM men who have sex with men MTCT mother-to-child transmission NAR net attendance ratio NASP National AIDS/STD Programme NCD noncommunicable diseases NGO nongovernmental organization NID National Immunization Day NIPORT National Institute for Population Research and Training NN neonatal mortality ORS oral rehydration salts ORT oral rehydration therapy PHC Population and Housing Census PIP program implementation plan PNN postneonatal mortality PRSP poverty reduction strategy paper PSU primary sampling unit RTI reproductive tract infection SACMO sub-assistant community medical officer SBA skilled birth attendant SD standard deviation SMC Social Marketing Company STI sexually-transmitted infection SWAp sector-wide approach TBA traditional birth attendant TC-NAC Technical Committee of the National AIDS Council TFR total fertility rate TT tetanus toxoid Abbreviations • xxi TWFR total wanted fertility rate TWG Technical Working Group UESD Utilization of Essential Service Delivery Survey UNDP United Nations Development Program UNICEF United Nations Children’s Fund UP Union Parishad USAID United States Agency for International Development VAD vitamin A deficiency VAQ verbal autopsy questionnaire WHO World Health Organization Millennium Development Goal Indicators • xxiii MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators by sex Bangladesh 2014 Value Goal Female Male Total 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age 5 33.1 32.2 32.6 2. Achieve universal primary education 2.1 Net enrollment ratio in primary education1 91.4 88.6 89.9 2.3 Literacy rate of 15-24 year olds2 85.9 na na 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education3 na na 1.02 3.1b Ratio of girls to boys in secondary education3 na na 1.04 3.1c Ratio of girls to boys in tertiary education3 na na 0.64 4. Reduce child mortality 4.1 Under-5 mortality rate (per 1000 live births)4 48 44 46 4.2 Infant mortality rate (per 1000 live births)4 39 37 38 4.3 Proportion of 1 year-old children immunized against measles 86.4 85.9 86.1 5. Improve maternal health 5.1 Proportion of births attended by skilled health personnel5 na na 42.1 5.2 Contraceptive prevalence rate6 62.4 na na 5.3 Adolescent birth rate7 113 na na 5.4a Antenatal care coverage: at least one visit by skilled health professional5 63.9 na na 5.4b Antenatal care coverage: at least four visits by any provider5 31.2 na na 5.5 Unmet need for family planning 12.0 na na 6. Combat HIV/AIDS, malaria, and other diseases 6.1 Percentage of population age 15-24 with comprehensive knowledge of HIV/AIDS8 12.7 na na na = Not applicable 1 The ratio is based on reported attendance, not enrollment, in primary education among primary school age children (age 6-10). The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, Net enrollment ratio. 2 Refers to respondents age 15-24 who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrollment, among 6-10 year-olds for primary, 11-17 year-olds for secondary, and 18-24 year-olds for tertiary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a five-year reference period preceding the survey. 5 Rate refers to live births in the three years preceding the survey. 6 Percentage of currently married women age 15-49 using any method of contraception 7 Equivalent to the age-specific fertility rate for women age 15-19, expressed in terms of births per 1,000 women age 15-19 8 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention. Millennium Development Goal Indicators by residence Bangladesh 2014 Goal Urban Rural Total 7. Ensure environmental sustainability 7.1 Percentage of population using an improved drinking water source1 99.1 97.1 97.6 7.2 Percentage of population with access to improved sanitation2 52.2 46.2 47.8 1 Proportion whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, or rainwater collection. 2 Improved sanitation technologies are: flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet. xxiv • Map of Bangladesh Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY AND ECONOMY angladesh is located in the northeastern part of South Asia and covers an area of 147,570 square kilometers. It is almost entirely surrounded by India, except for a short southeastern frontier with Myanmar and a southern coastline on the Bay of Bengal (see map on facing page). It lies between latitudes 20° 34′ and 26° 38′ north and longitudes 88° 01′ and 92° 41′ east. The Moguls ruled the country from the 13th until the 18th century, when the British took over and administered the subcontinent until 1947. During British rule, Bangladesh was a part of India. In 1947, the independent states of Pakistan and India were created. The present territory of Bangladesh was a part of Pakistan. Bangladesh emerged on March 26, 1971, as an independent country on the world’s map following a war of liberation. Most of Bangladesh is low, flat land that consists of alluvial soil. The most significant feature of the terrain is the extensive network of rivers that is of primary importance to the socioeconomic life of the nation. Chief among these, lying like a fan on the face of the land, are the Ganges-Padma, Brahmaputra-Jamuna, and Megna rivers. The tropical climate of Bangladesh is dominated by seasonal monsoons. The country 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 through the end of February. The fertile delta is subject to frequent natural calamities, such as floods, cyclones, tidal bores, and drought. The administrative divisions of the country consist of 7 divisions, 64 districts, and 545 upazilas/thanas. Muslims make up almost 90 percent of the population of Bangladesh, Hindus account for about 9 percent, and other religions constitute the remaining 1 percent (BBS 2014). The national language of Bangladesh is Bangla, which is spoken and understood by all. Industry has emerged as the largest sector of the economy, contributing about 30 percent of the gross domestic product (GDP). The GDP has continued to grow over 6 percent in the last five years and exhibited a robust growth rate of 6.5 percent in fiscal year (FY) 2014-2015 (BBS 2015a). The overall growth was led by the manufacturing and construction sectors, which recorded impressive expansions of 20 and 7 percent, respectively, in FY 2014-2015. The accelerated growth in these sectors was mainly due to huge investments in large and medium-scale industry. Agriculture is the second largest sector of the economy, contributing 16 percent to the total GDP in FY 2014-2015. The largest contributor in the agricultural sector is crops and horticulture (9 percent) followed by the fishery sector (4 percent). The gross national income (GNI) per capita in Bangladesh has increased to US$1,314 in FY 2014-2015 (BBS 2015b). Bangladesh thus becomes a lower middle-income country based on a new income classification of world economies (World Bank 2015). Recent socioeconomic development of Bangladesh is reflected in the human development index (HDI) of the United Nations Development Program (UNDP 2013). Bangladesh’s HDI value for 2014 is 0.570—which is in the medium human development category—positioning the country at 142 out of 188 countries and territories (UNDP 2015). Between 1990 and 2014, the country’s HDI value increased from 0.386 to 0.570, an annual increase of about 1.64 percent. Among the eight South Asian countries, Bangladesh is in fifth position based on HDI rank, following Sri Lanka, Maldives, India, and Bhutan. B 2 • Introduction 1.2 POPULATION Bangladesh is the most densely populated country in the world, excluding city-states such as Singapore, Bahrain, and the Vatican. Table 1.1 summarizes the basic demographic indicators for Bangladesh. According to recent estimates from the Bangladesh Bureau of Statistics (BBS), the population of the country is about 158 million, with a population density of 1,070 persons per square kilometer in 2014. After Census 2011, the population of Bangladesh increased by 8 million, with an annual increase of more than 2.0 million. The growth rate between 2001 and 2011 censuses was 1.37 percent. The life expectancy at birth in Bangladesh is 71 years, with women having slightly longer lifespans than men (72 years versus 69 years). The country is now experiencing a demographic transition. The continuous decline of the natural growth rate is expected to lead to a small population increase in coming decades. In comparison with other countries in the region, Bangladesh is in an intermediate position between low-growth countries, such as Thailand, Sri Lanka, and Myanmar, and medium-growth countries, such as India and Malaysia (BBS 2011). The 2015 projections (medium variant) by the United Nations estimated that the population of Bangladesh in 2050 would be about 202 million (UN 2015). Table 1.1 Basic demographic indicators Demographic indicators from selected sources, Bangladesh 2011 and 2014 Indicators 20111 20142 Population (millions) 149.8 157.9 Intercensal growth rate (percent) 1.37 - Density (population/km2) 1,015 1,070 Percent urban3 28.0 - Life expectancy (year)4 Both 69.0 70.7 Male 67.9 69.1 Female 70.3 71.6 Source: 1 BBS 2012; 2 BBS 2015a; 3 BBS 2014; 4 BBS 2015b 1.3 POPULATION, FAMILY PLANNING, AND MATERNAL AND CHILD HEALTH POLICIES AND PROGRAMS Family planning was introduced in Bangladesh (then East Pakistan) in the early 1950s through the voluntary efforts of social and medical workers. The government of Bangladesh, recognizing the urgency of its goal to achieve moderate population growth, adopted family planning as a government sector program in 1965. The policy to reduce fertility rates has been repeatedly reaffirmed by the government of Bangladesh since the country’s independence in 1971. The first Five-Year Plan (1973-1978) emphasized “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 15 crore (i.e., 150 million) for sheer ecological viability of the nation” (GOB 1994). Beginning in 1972, the family planning program received virtually unanimous, high-level political support. All subsequent governments have identified population control as a top priority for government action. This political commitment plays a crucial role in the fertility decline in Bangladesh. In 1976, the government declared the rapid growth of the population to be the country’s number one problem and adopted a broad-based, multisectoral family planning program along with an official population policy (GOB 1994). Population planning was seen as an integral part of the total development process and was incorporated into the successive five-year plans. Policy guidelines and strategies for the population program are formulated by the National Population Council, which is chaired by the country’s prime minister. Introduction • 3 In the mid-1970s the government instituted the deployment of full-time, local family welfare assistants, who served as community-based family planning motivators and distributors. At its height a few years ago, this program had a staff of almost 24,000. During the same period, a social marketing program to promote the sale of birth control pills and condoms was initiated. The population program involves more than 200 nongovernmental organizations (NGOs). Since 1980 the family planning program has emphasized the importance of integrating health and family planning services. The goal is to provide an essential integrated package of high quality, client- centered reproductive and child health care, family planning, communicable disease control, and curative services at a one-stop service point. Since 1998 the health program in Bangladesh has drawn on the sector-wide approach (SWAp). The SWAp program aims to provide a package of essential, quality health care services that respond to population needs, especially those of children, women, the elderly, and the poor. The first SWAp—the Health and Population Sector Program (HPSP)—was formulated as part of the fifth Five-Year Plan (1998-2003). It was followed by the second SWAp, the Health, Nutrition and Population Sector Program (HNPSP), which began in 2003 and expired in June 2011. The Ministry of Health and Family Welfare (MOHFW) initiated the Health, Population, Nutrition Sector Development Program (HPNSDP) for five years, from July 2011 to June 2016. The HPNSDP is the SWAp for the overall improvement of health, population, and nutrition sectors. The main objectives of the HPNSDP are to create conditions that allow the Bangladeshi people to reach and maintain the highest attainable level of health as a fundamental human right and an issue of social justice. The government of Bangladesh (GOB) is working toward achieving Millennium Development Goals (MDGs). Of the eight MDGs, three relate to health (child mortality, maternal health, and HIV/AIDS and malaria), and these could exert a direct impact on the Bangladeshi population. Furthermore, three other goals (universal primary education, poverty eradication, and gender equity) closely relate to human resource development. The revised HPNSDP Program Implementation Plan (PIP) sets out sector-specific strategies to achieve its goal (MOHFW 2014). These strategies are as follows: • Streamline and expand the access to and quality of maternal, neonatal, and child health services, and, in particular, supervised deliveries (MDG 4 and MDG 5). • Revitalize various family planning interventions to attain replacement-level fertility. • Improve and strengthen nutritional services by mainstreaming nutrition within the regular Directorate General for Health Services (DGHS) and Directorate General for Family Planning (DGFP) services (MDG 1). • Strengthen preventive approaches and control programs for communicable diseases (MDG 6). • Expand noncommunicable disease control efforts at all levels by streamlining referral systems and strengthening hospital accreditation and management systems. • Strengthen the various support systems by increasing the health workforce at all service levels, including their capacity building and enhanced focus on coordinated implementation of operational plans, timely procurement, and effective logistic management, financial management, and monitoring and evaluation (M&E). • Strengthen drug management and improve quality drug provision. 4 • Introduction • Pursue priority institutional and policy reforms involving stewardship and oversight functions of the public sector, including quality assurance, community participation, and accountability. HPNSDP has introduced a Results Framework (RFW) with 8 goal levels and 32 intermediate outcome indicators to monitor progress and program impact. A Performance Monitoring Plan (PMP) also elaborates on MOHFW’s commitments to (1) collect specific information for the RFW indicators and (2) assess program progress for decision making. Recently, MOHFW elaborated on the M&E framework for the HPNSDP sector with the lists of the data sources, regular updating of the indicators, and analysis and reporting of results (PMMU 2015). The Bangladesh Demographic and Health Survey (BDHS) is identified as one of the major sources of data for up-to-date information on 6 goals and 12 output levels of RFW indicators of HPNSDP. These are used as a basis to confirm the occurrence of change. 1.4 ORGANIZATION OF THE 2014 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 1.4.1 Survey Objectives and Implementing Organizations The 2014 Bangladesh Demographic and Health Survey (BDHS) is the seventh DHS undertaken in Bangladesh, following those implemented in 1993-94, 1996-97, 1999-2000, 2004, 2007, and 2011. The main objectives of the 2014 BDHS are to: • Provide information to meet the monitoring and evaluation needs of the health, population, and nutrition sector development program (HPNSDP) • Provide program managers and policy makers involved in the program with the information they need to plan and implement future interventions The specific objectives of the 2014 BDHS were as follows: • To provide up-to-date data on demographic rates, particularly fertility and infant, and child mortality rates, at the national and divisional level • To measure the level of contraceptive use of currently married women • To provide data on maternal and child health, including antenatal care, assistance at delivery, postnatal care, newborn care, breastfeeding, immunizations, and prevalence and treatment of diarrhea and other diseases among children under age 5 • To assess the nutritional status of children (under age 5) and women by means of anthropometric measurements (weight and height), and to assess infant and child feeding practices • To provide data on knowledge and attitudes of women about sexually transmitted infections and HIV/AIDS • To measure key education indicators, including school attendance ratios • To provide community-level data on accessibility and availability of health and family planning services The 2014 BDHS was conducted under the authority of the National Institute of 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. ICF International of Rockville, Maryland, USA, provided technical assistance to the project as part of its international Demographic and Health Surveys (DHS) Program. The U.S. Agency for International Development (USAID) provided financial support. Introduction • 5 1.4.2 Sample Design The sample for the 2014 BDHS is nationally representative and covers the entire population residing in noninstitutional dwelling units in the country. The survey used a sampling frame from the list of enumeration areas (EAs) of the 2011 Population and Housing Census of the People’s Republic of Bangladesh, provided by the Bangladesh Bureau of Statistics (BBS). The primary sampling unit (PSU) for the survey is an EA created to have an average of about 120 households. Bangladesh is divided into seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is divided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, which are further subdivided into mohallas. A rural area in an upazila is divided into union parishads (UPs) and, within UPs, into mouzas. These divisions allow the country as a whole to be separated into rural and urban areas. The survey is based on a two-stage stratified sample of households. In the first stage, 600 EAs were selected with probability proportional to the EA size, with 207 EAs in urban areas and 393 in rural areas. A complete household listing operation was then carried out in all of the selected EAs to provide a sampling frame for the second-stage selection of households. In the second stage of sampling, a systematic sample of 30 households on average was selected per EA to provide statistically reliable estimates of key demographic and health variables for the country as a whole, for urban and rural areas separately, and for each of the seven divisions. With this design, the survey selected 18,000 residential households, which were expected to result in completed interviews with about 18,000 ever-married women (see Appendix A for the details of the sample design). Any analysis using the 2014 BDHS data requires that sampling weights be applied to ensure the actual representation of the survey results at the national and domain levels. Although the weighted distribution of urban-rural households in the survey was based on the urban-rural distribution in the 2011 population census, the sampling weights were adjusted to reflect a modified urban-rural household distribution recently reported by the BBS. After adjusting for undercount and including statistical metropolitan areas (SMAs) among the urban areas, the BBS estimated that the urban population was 28 percent (BBS 2014). The adjustment in the 2014 BDHS sampling weight was to generate a revised urban- rural population distribution and was not expected to lead to any significant differences in the overall survey indicators. 1.4.3 Questionnaires The 2014 BDHS used three types of questionnaires: a Household Questionnaire, a Woman’s Questionnaire, and a Community Questionnaire. The contents of the Household and Woman’s questionnaires were based on the MEASURE DHS Model Questionnaires. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a Technical Working Group (TWG) that consisted of representatives from NIPORT, Mitra and Associates, International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), USAID/Bangladesh, and ICF International (see Appendix D for a list of members). Draft questionnaires were then circulated to other interested groups and were reviewed by the 2014 BDHS Technical Review Committee (see Appendix D). The questionnaires were developed in English and then translated into and printed in Bangla. 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 age, sex, education, current work status, birth registration, and individual possession of mobile phones. The main purpose of the Household Questionnaire was to identify women who were eligible for the individual interview. Information was collected about the dwelling unit, such as the source of water, type of toilet facilities, materials used to construct the floor, roof, and walls, ownership of various consumer goods, and availability of hand washing facilities. In addition, this questionnaire was used to record the height and weight measurements of ever-married women age 15-49 and children under age 6. 6 • Introduction The Woman’s Questionnaire was used to collect information from ever-married women age 15-49. Women were asked questions on the following topics: • Background characteristics (e.g., age, education, religion, media exposure) • Reproductive history • Use and source of family planning methods • Antenatal, delivery, postnatal, and newborn care • Breastfeeding and infant feeding practices • Child immunizations and illnesses • Marriage • Fertility preferences • Husband’s background and respondent’s work • Awareness of AIDS and other sexually transmitted infections The Community Questionnaire was administered in each selected cluster during the household listing operation and included questions about the existence of development organizations in the community and the availability and accessibility of health services and other facilities. During the household listing operation, the geographic coordinates and altitude at the center of each cluster were also recorded using Garmin eTrex Legend H units1. A list of health facilities and health service providers in each selected EA was provided to the interviewing teams to verify information gathered in the Woman’s Questionnaires on the types of facilities accessed and health services personnel seen. The Community Questionnaire was administered to a group of four to six key informants who were knowledgeable about socioeconomic conditions and the availability of health and family planning services/facilities in the cluster. Key informants included community leaders, teachers, government officials, social workers, religious leaders, traditional healers, and health care providers among others. 1.4.4 Training and Fieldwork Fifty-four people were trained to carry out the listing of households, to delineate EAs, and to administer Community Questionnaires. They were also trained in the use of global positioning system (GPS) units to obtain locational coordinates for each selected EA. The training lasted a total of five days from May 14-20, 2014. A household listing operation was carried out in all selected EAs from May 21 to August 17, 2014, in four phases, each about three weeks in duration. Initially, 20 teams of two persons each were deployed to carry out the listing of households and to administer the Community Questionnaires. The number of teams was reduced to 19 in the third phase and to 11 in the final phase. In addition, ten supervisors were deployed to check and verify the work of the listing teams. Training for the fieldworkers of the main survey was conducted from June 1 to 26, 2014. A total of 164 fieldworkers were recruited based on their educational level, prior experience with surveys, maturity, and willingness to spend up to four months on the project. Training included lectures on how to complete the questionnaires, mock interviews between participants, and field practice. A former NIPORT staff member gave a talk about family planning methods and maternal and child health, including HPNSDP. Fieldwork for the BDHS was carried out by interviewing teams, each consisting of one male supervisor, one female field editor, five female interviewers, and one logistics staff person. Data collection was implemented in four phases, starting on June 28, 2014, and ending on November 9, 2014. The number of teams declined with each subsequent phase, starting with 20 teams in the first phase and ending with 16 teams by the end of data collection. Data quality measures were implemented through several activities. There were four quality control teams from Mitra and Associates, each comprised of one male and one female staff person. They were sent 1 http://buy.garmin.com/en-US/US/on-the-trail/discontinued/etrex-legend-h/prod30120.html Introduction • 7 to the field to visit the interviewing teams throughout the data collection period. Moreover, the professionals of the survey team made several visits to check the fieldwork. In addition, NIPORT monitored fieldwork by sending two quality control teams, each comprised of three members. The teams went to the field for about three weeks in each phase. They oversaw use of the household listings and maps, observed one household and one individual interview of each interviewer, and spot-checked the completed questionnaires. The teams also revisited half of the households of one completed cluster for each survey team and checked whether selected households were visited and eligible respondents were properly identified and interviewed. Debriefing sessions were held between fieldworkers’ tours to discuss problems encountered in the field, clarifications, and administrative matters. Data quality was also monitored through field check tables generated concurrently with data processing. The main purpose of the tables was to allow the quality control teams to advise field teams of problems detected during data entry. Representatives from USAID, The DHS Program, and NIPORT, and other Technical Review Committee members, also monitored fieldwork through several field visits. 1.4.5 Data Processing The completed 2014 BDHS questionnaires were periodically returned to Dhaka for data processing at Mitra and Associates. The data processing began shortly after fieldwork commenced. Data processing consisted of office editing, coding of open-ended questions, data entry, and editing of inconsistencies found by the computer program. Eight data entry operators and two data entry supervisors processed the data. Data processing commenced on July 24, 2014, and ended on November 20, 2014. The task was carried out using the Census and Survey Processing System (CSPro), a software jointly developed by the U.S. Census Bureau, ICF Macro, and Serpro S.A. 1.4.6 Coverage of the Sample Table 1.2 shows the results of the household and individual women’s interviews. Among a total of 17,989 selected households, 17,565 were found occupied. Interviews were successfully completed in 17,300, or 99 percent of households. A total of 18,245 ever-married women age 15-49 were identified in these households and 17,863 were interviewed, for a response rate of 98 percent. Response rates for households and eligible women are similar to those in the 2011 BDHS. The principal reason for nonresponse among women was their absence from home despite repeated visits to the household. The response rates do not vary notably by urban-rural residence. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Bangladesh 2014 Residence Total Result Urban Rural Household interviews Households selected 6,210 11,779 17,989 Households occupied 6,062 11,503 17,565 Households interviewed 5,930 11,370 17,300 Household response rate1 97.8 98.8 98.5 Interviews with women age 15-49 Number of eligible women 6,324 11,921 18,245 Number of eligible women interviewed 6,167 11,696 17,863 Eligible women response rate2 97.5 98.1 97.9 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 9 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 This chapter provides an overview of socioeconomic characteristics of the population, including household conditions, sources of drinking water, sanitation facilities, hand washing practices, availability of electricity, housing facilities, possession of household durable goods, and ownership of a homestead and land. Information on household assets is used to create an indicator of household economic status, the wealth index. This chapter also describes the demographic characteristics of the household population, including age, sex, educational attainment, and employment status. A household in the 2014 BDHS is defined as a person or group of related and unrelated persons who usually live together in the same dwelling unit(s), who have common cooking and eating arrangements, and who acknowledge one adult member as head of the household. A member of the household is any person who usually lives in the household. Information is collected from all usual residents of a selected household (de jure population) as well as persons who stayed in the selected household the night before the interview (de facto population). The difference between these two populations is very small, and all tables in this report refer to the de facto population, unless otherwise specified, to maintain comparability with other BDHS reports. Key Findings • Almost everyone (98 percent) in Bangladesh has access to an improve source of drinking water that is they are having water from pipe, tube well, protected well, rain or bottle. • One in 10 households uses an appropriate water treatment method, which includes boiling, bleaching, filtering, and solar disinfecting. The proportion has not changed since 2011. • Thirty-seven percent of households where a place of washing hands was observed had water and a cleansing agent for hand washing. In 2011, this proportion was 31 percent. • The proportion of households having an improved toilet facility that is not shared with other households increased from 34 percent in 2011 to 45 percent in 2014. Four percent of households lack toilet facilities. • The proportion of households with electricity increased from 60 percent in 2011 to 73 percent in 2014. Eleven percent of households use solar electricity; usage is 15 percent in rural and 3 percent in urban areas. • Eighty-two percent of households use solid fuel for cooking. • Household possession of mobile phones has increased sharply from 78 percent in 2011 to 89 percent in 2014; ownership is 93 percent in urban areas and 87 percent in rural areas. • One-third of the population is under age 15. • Thirteen percent of households are headed by a woman. • Twenty-three percent of men and 27 percent of women age 6 and over have not attended school. • Sixty-five percent of men and 24 percent of women age 8 and over are currently working. • Fifty-three percent of household members age 13 and older own a mobile phone; ownership is 64 percent in urban and 48 percent in rural areas. Forty-five percent of adolescents (age p15-19) own a mobile phone; male adolescents are twice as likely as female adolescents to own a mobile phone (63 percent versus 31 percent). 10 • Housing Characteristics and Household Population 2.1 HOUSEHOLD CHARACTERISTICS Physical characteristics of a household are used to assess the general wellbeing and socioeconomic status of its members. These characteristics include access to safe drinking water and sanitation facilities. Other characteristics are the structure of housing, its crowdedness, and the type of fuel used for cooking. 2.1.1 Water and Sanitation Access to safe water and sanitation are basic determinants of better health. Limited access to safe drinking water and sanitation facilities and poor hygiene are associated with skin diseases, acute respiratory infections (ARIs), and diarrheal diseases, the leading preventable diseases in Bangladesh. ARI remains the leading cause of child deaths in Bangladesh. Diarrheal deaths and prevalence of diarrheal diseases among children under age 5 have declined, although 5 percent of under-5 children were reported to have had diarrhea in the two-week period in 2011 (NIPORT et al. 2013). Table 2.1 presents information on household drinking water by urban-rural residence. Access to an improved source of drinking water is almost universal in Bangladesh (98 percent). The most common source of drinking water in urban areas is a tube well or borehole (67 percent), followed by water piped into the dwelling (14 percent), water piped to the yard or plot (9 percent), and a public tap or standpipe (8 percent). In contrast, a tube well or borehole is practically the only source of drinking water in rural areas (94 percent). For 76 percent of households, the source of drinking water is within the premises. One in five households spends less than 30 minutes round trip to obtain water. As expected, it takes longer to obtain drinking water in rural areas than in urban areas. Table 2.1 Household drinking water Percent distribution of households and de jure population by source, time to collect, and by treatment of drinking water, according to residence, Bangladesh 2014 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 99.1 97.0 97.6 99.1 97.1 97.6 Piped into dwelling 13.7 0.6 4.3 13.7 0.6 4.2 Piped to yard/plot 9.2 1.0 3.3 8.6 0.8 3.0 Public tap/standpipe 8.1 0.6 2.7 7.6 0.6 2.5 Tube well or borehole 67.1 93.9 86.4 68.3 94.3 87.2 Protected well 0.1 0.3 0.2 0.0 0.3 0.2 Rain water 0.2 0.5 0.4 0.2 0.4 0.3 Bottled water 0.9 0.1 0.3 0.7 0.1 0.3 Non-improved source 0.8 2.8 2.2 0.8 2.7 2.2 Unprotected well 0.0 0.9 0.6 0.0 0.8 0.6 Unprotected spring 0.0 0.4 0.3 0.0 0.4 0.3 Tanker truck/cart with drum 0.5 0.0 0.2 0.5 0.0 0.2 Surface water 0.3 1.5 1.2 0.3 1.5 1.2 Other 0.1 0.2 0.1 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 99.1 97.0 97.6 99.1 97.1 97.6 Time to obtain drinking water (round trip) Water on premises 78.7 74.3 75.5 78.6 74.1 75.4 Less than 30 minutes 17.7 21.2 20.2 17.8 21.2 20.3 30 minutes or longer 3.3 4.4 4.1 3.3 4.6 4.2 Don’t know/missing 0.3 0.1 0.2 0.3 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 18.8 0.8 5.8 18.6 0.7 5.6 Bleach/chlorine added 0.4 0.2 0.2 0.4 0.2 0.2 Strained through cloth 2.6 0.7 1.3 2.6 0.7 1.2 Ceramic, sand, or other filter 10.9 2.1 4.6 11.1 2.1 4.6 Other 0.2 0.1 0.2 0.2 0.1 0.1 No treatment 73.1 95.9 89.5 73.2 96.0 89.8 Percentage using an appropriate treatment method2 26.5 3.4 9.9 26.4 3.4 9.7 Number 4,844 12,456 17,300 21,101 56,225 77,326 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Housing Characteristics and Household Population • 11 Nationally, 10 percent of households use an appropriate water treatment method, which has not changed since 2011 (NIPORT et al. 2013). Rural households are much less likely than urban households to treat their water appropriately (3 percent and 27 percent, respectively). Overall, boiling water prior to drinking is the most common treatment method (6 percent). However, only one in five urban households boil the water for drinking, while less than 1 percent of rural households do so. Households without proper sanitation facilities have a greater risk of diseases like diarrhea, dysentery, and typhoid than households with improved sanitation facilities that are not shared with other households. Table 2.2 shows that 45 percent of households have an improved (not shared) toilet facility, which increased from 34 percent in 2011 (NIPORT et al. 2013). Another 24 percent of households use a facility that would be considered improved if it were not shared with other households. Facilities that are shared are not considered to be as hygienic as those that are not shared. About one-third of the households use a non-improved toilet facility (31 percent); 22 percent of households use pit latrines without slabs, and 3 percent use a hanging toilet. Four percent of households have no toilet facility, nearly unchanged since 2011, when 5 percent of households had no toilet facility (NIPORT et al. 2013). Rural households are more likely than urban households to have no toilet facility (5 percent versus 1 percent). Although the majority of households (65 percent) do not share their toilet, rural households are more likely than urban households to use a toilet facility that is not shared (67 versus 58 percent, respectively). However, rural households are twice as likely to have non-improved toilet facilities as urban households (36 compared with 19 percent). Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Bangladesh 2014 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 48.6 43.6 45.0 52.2 46.2 47.8 Flush/pour flush to piped sewer system 6.5 0.2 2.0 6.7 0.2 2.0 Flush/pour flush to septic tank 15.8 4.5 7.6 17.0 5.0 8.2 Flush/pour flush to pit latrine 1.3 0.7 0.9 1.3 0.7 0.9 Ventilated improved pit (VIP) latrine 11.1 10.9 11.0 11.9 11.6 11.7 Pit latrine with slab 13.8 27.3 23.5 15.3 28.7 25.1 Shared facility1 32.6 20.3 23.8 29.5 17.7 20.9 Flush/pour flush to piped sewer system 4.6 0.1 1.3 4.1 0.1 1.2 Flush/pour flush to septic tank 8.1 1.7 3.5 7.0 1.4 3.0 Flush/pour flush to pit latrine 1.0 0.3 0.5 0.9 0.2 0.4 Ventilated improved pit (VIP) latrine 7.4 4.0 5.0 6.9 3.7 4.5 Pit latrine with slab 11.5 14.3 13.6 10.7 12.3 11.8 Non-improved facility 18.9 36.0 31.2 18.3 36.1 31.3 Flush/pour flush not to sewer/septic tank/pit latrine 8.3 0.4 2.6 7.7 0.3 2.3 Pit latrine without slab/open pit 8.6 26.9 21.8 8.7 27.4 22.3 Hanging toilet/hanging latrine 1.0 3.9 3.1 1.0 4.2 3.3 No facility/bush/field 1.0 4.7 3.7 0.9 4.2 3.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Shared sanitation facility Not shared 57.7 67.3 64.6 61.8 71.2 68.7 Shared with 1-4 households 23.9 28.7 27.3 21.6 25.2 24.2 5-9 households 10.4 3.2 5.2 9.2 2.8 4.6 10 + households 7.9 0.8 2.8 7.3 0.7 2.5 Don’t know/missing 0.1 0.0 0.0 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,844 12,456 17,300 21,101 56,225 77,326 1 Shared facility of an otherwise improved type Hand washing, which protects against communicable diseases, is promoted by the government of Bangladesh and its development partners. Table 2.3 provides information on designated places for hand washing in households and on the use of water and cleansing agents for washing hands, according to place of residence (urban or rural), divisions, and wealth quintiles. 12 • Housing Characteristics and Household Population In the 2014 BDHS, interviewers were instructed to observe the place where household members usually wash their hands. They looked for regularity of water supply, observed whether the household had cleansing agents near the place of hand washing, and noted the location of the place of hand washing. The interviewers found designated places for hand washing in almost all the households (96 percent), an improvement since 2011, when 86 households had a designated place for hand washing (NIPORT et al. 2013). Twenty-nine percent of households have soap and water in the place where household members wash their hands, 8 percent have water and other cleansing agents (ash, mud, sand, etc.), and the majority (59 percent) have water only. Overall, 4 percent of households do not have water, soap, or any cleansing agent. Forty-eight percent of urban households have soap and water compared with 21 percent of rural households. Availability of hand washing facilities with soap and water varies across divisions, ranging from 32 percent of households in Dhaka and Chittagong to 20 percent in Barisal. The use of soap and water for hand washing increases with an increase in household wealth. For example, use of soap and water is lowest among households in the lowest wealth quintile (6 percent) and highest (75 percent) among those in the highest wealth quintile. Table 2.3 Hand washing: availability of cleansing agents Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Bangladesh 2014 Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed Number of households with place for hand washing observed Background characteristics Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 98.2 4,844 47.9 5.5 43.8 0.1 0.0 2.5 0.1 100.0 4,758 Rural 94.5 12,456 20.9 9.4 64.9 0.2 0.3 4.3 0.1 100.0 11,765 Division Barisal 90.7 1,071 19.9 8.7 68.4 0.0 0.0 3.0 0.0 100.0 972 Chittagong 92.9 3,098 31.8 4.3 59.6 0.1 0.1 4.1 0.0 100.0 2,879 Dhaka 96.6 6,047 31.6 8.9 56.9 0.0 0.3 2.1 0.1 100.0 5,843 Khulna 98.1 1,786 24.7 7.8 61.9 0.2 0.1 5.1 0.2 100.0 1,752 Rajshahi 96.8 2,125 28.3 10.0 54.1 0.5 0.3 6.7 0.0 100.0 2,058 Rangpur 97.8 2,023 27.4 13.1 57.5 0.2 0.2 1.6 0.1 100.0 1,979 Sylhet 90.6 1,150 21.2 4.1 64.6 0.8 0.0 9.2 0.1 100.0 1,042 Wealth quintile Lowest 89.9 3,523 5.7 9.2 76.7 0.1 0.7 7.4 0.1 100.0 3,166 Second 94.0 3,498 8.2 11.5 74.7 0.1 0.1 5.3 0.1 100.0 3,288 Middle 96.5 3,393 18.0 11.4 66.4 0.2 0.1 3.8 0.0 100.0 3,275 Fourth 98.0 3,447 33.9 8.0 55.8 0.2 0.1 1.9 0.2 100.0 3,377 Highest 99.4 3,438 74.5 1.7 22.6 0.2 0.0 0.8 0.1 100.0 3,418 Total 95.5 17,300 28.6 8.3 58.8 0.2 0.2 3.8 0.1 100.0 16,524 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent Table 2.4 shows that 25 percent of households have a designated place for hand washing, which is covered and located inside the dwelling. For 31 percent of households, this place is in open space but not shared, and for the remaining 44 percent of households the hand washing place is in an open space and shared. Urban households are more likely to have a covered place for hand washing located inside the dwelling (46 percent) compared with rural households (17 percent). Only 6 percent of households in the lowest wealth quintile were observed to have a place for hand washing that is covered and located inside the dwelling, compared with 68 percent of households in the highest wealth quintile. Housing Characteristics and Household Population • 13 Table 2.4 Hand washing: location Among households in which the place for washing hands was observed, percent distribution by type of place for hand washing, by background characteristics, Bangladesh 2014 Background characteristics Covered, inside dwelling Open space, not shared Open space, shared Total Number of households with place for hand washing observed Residence Urban 46.1 19.4 34.5 100.0 4,758 Rural 16.9 35.4 47.7 100.0 11,765 Division Barisal 14.0 26.4 59.6 100.0 972 Chittagong 29.1 27.6 43.3 100.0 2,879 Dhaka 29.2 26.9 43.8 100.0 5,843 Khulna 17.3 38.5 44.2 100.0 1,752 Rajshahi 23.9 35.0 41.1 100.0 2,058 Rangpur 23.1 42.5 34.2 100.0 1,979 Sylhet 23.5 22.0 54.4 100.0 1,042 Wealth quintile Lowest 5.6 33.3 61.1 100.0 3,166 Second 7.4 35.3 57.3 100.0 3,288 Middle 13.8 39.0 47.2 100.0 3,275 Fourth 28.8 30.5 40.5 100.0 3,377 Highest 68.3 16.6 15.2 100.0 3,418 Total 25.3 30.8 43.9 100.0 16,524 Note: Total may not sum to 100 percent due to missing cases. 2.1.2 Housing Characteristics Housing characteristics and household assets can be used to measure the socioeconomic status of household members. Figure 2.1 shows that 73 percent of households in Bangladesh have access to electricity, either from the national grid or solar power connections. Independently, the national grid covers 62 percent of households throughout the country, with more coverage in urban areas (91 percent) and less in rural areas (51 percent). In contrast, solar power is predominantly used in rural areas (15 percent, compared with 3 percent in urban areas) and independently serves 11 percent of households in Bangladesh. Overall, access to electricity, either from the national grid or solar power, has increased substantially in the last three years, from 60 percent in 2011 to 73 percent in 2014. This expansion took place mostly in rural areas (from 49 percent in 2011 to 65 percent in 2014) rather than in urban areas (from 90 percent in 2011 to 93 percent in 2014) (NIPORT et al. 2013). Figure 2.1 Availability of electricity by urban-rural residence 3 15 11 91 51 62 93 65 73 Urban Rural Total Percent Solar National grid National grid or solar BDHS 2014 14 • Housing Characteristics and Household Population Table 2.5 presents information on type of flooring material, type of roof and wall materials, and number of rooms for sleeping. Earth and sand are the most common flooring materials used in Bangladesh (68 percent). These materials are predominantly used in rural areas (82 percent), while in urban areas the most common flooring material is cement (61 percent). Tin is the most common roofing material in Bangladesh. Overall 85 percent of households live in dwellings with tin roofs. There is a large urban-rural difference in the use of cement or ceramic tiles for roofs. Households in urban areas are more than five times as likely to use cement tiles as households in rural areas. Tin is the predominant material of outer walls in 2014 (43 percent), while in the 2007 BDHS walls in 40 percent of households were made of natural materials such as cane, palm, trunks, dirt, or bamboo with mud (NIPORT et al. 2009). Twenty-six percent of households have walls made of cement. Rural households are more likely to have walls made of tin (48 percent) than urban households (30 percent). On the other hand, urban households are more than three times as likely to have cement walls (53 percent) as rural households (16 percent). The number of rooms used for sleeping indicates the extent of crowding in households. Overcrowding increases the risk of contracting infectious diseases, such as tuberculosis, measles, and meningitis (Aaby, P. 1988; Acevedo-Garcia, D. 2000; Alirol, E. et al. 2011). One in three households has only one room for sleeping. The proportion of households using one room for sleeping has decreased from 40 percent in 2007 to 35 percent in 2011 to 33 percent in 2014 (NIPORT et al. 2009; NIPORT et al. 2013). There are small differences in the number of rooms used for sleeping by urban-rural residence. Another measure of crowdedness is the number of persons per sleeping room households. The last panel in Table 2.5 shows that in two thirds of households a sleeping room is shared by one or two persons. In the remaining 35 percent of households, sleeping rooms are shared by three or more persons. Comparison with data from the 1993-94 BDHS reveals that the proportion of households with three or more persons per sleeping room has decreased from 65 percent in 1993-94 to 35 percent in 2014 (Mitra et al. 1994). This is an evidence that households are much less crowded in 2014 than two decades ago. There are only slight differences between urban and rural households in the extent of crowding. Indoor pollution has important implications for the health of household members. The type of fuel used for cooking, the place where cooking is done, and the type of stove used influence indoor air quality and the degree to which household members are exposed to the risk of respiratory infections and other diseases. Table 2.6 presents information on type of fuel used for cooking and place where cooking is done. In Bangladesh, the risk of indoor pollution from cooking fuel is limited because only 15 percent of households cook in the house; 68 percent of households cook in a separate building, and 17 percent cook outdoors. Urban households are much more likely than rural households to cook in the house (28 versus 10 percent, respectively). Table 2.5 Housing characteristics Percent distribution of households by housing characteristics, according to residence, Bangladesh 2014 Housing characteristics Residence Total Urban Rural Flooring material1 Earth, sand 32.5 81.5 67.8 Wood planks 0.4 0.2 0.2 Ceramic tiles 5.6 0.3 1.8 Cement 61.0 17.7 29.8 Roof materials Natural roof 0.2 1.7 1.3 Palm/bamboo 0.1 0.1 0.1 Wood plank/card board 0.1 0.0 0.0 Tin 70.0 90.8 85.0 Wood 0.2 0.2 0.2 Ceramic tiles 0.5 0.1 0.2 Cement 28.4 5.3 11.8 Roofing shingles 0.3 1.5 1.1 Other 0.1 0.3 0.2 Wall materials Jute stick/palm trunk 0.8 2.9 2.3 Mud/dirt 4.4 14.5 11.7 Bamboo with mud 4.5 8.9 7.7 Tin 30.2 48.3 43.3 Cement 52.6 15.9 26.2 Stone with lime/cement 1.6 0.5 0.8 Bricks 4.9 7.0 6.4 Wood planks 0.6 1.1 1.0 Other 0.3 0.9 0.7 Rooms used for sleeping One 37.2 31.7 33.2 Two 36.2 37.7 37.3 Three or more 26.7 30.6 29.5 Total 100.0 100.0 100.0 Persons per sleeping room 1-2 63.2 66.2 65.3 3-4 29.1 26.4 27.2 5-6 6.5 6.5 6.5 7+ 1.2 0.8 1.0 Total 100.0 100.0 100.0 Number 4,844 12,456 17,300 1“Other” flooring material is a combination of palm, bamboo, parquet, polished wood, and carpet Housing Characteristics and Household Population • 15 Overall, 82 percent of households use solid fuel, including wood, agricultural crops, animal dung, straw, shrubs, grass, and charcoal: 50 percent in urban areas and virtually all (95 percent) in rural areas. The proportion of households that rely on wood for fuel has increased from 45 percent in 2011 to 50 percent in 2014. The increase occurred in both urban (35 percent in 2011 to 37 percent in 2014) and rural areas (48 percent in 2011 to 55 percent in 2014). As expected, use of liquid petroleum gas, natural gas, and biogas is mostly limited to urban areas (48 percent). Reducing the proportion of the population that relies on solid fuels is one of the Millennium Development Goals. The 2014 BDHS shows that Bangladesh is gradually making progress toward this goal. The proportion of households that use solid fuel in Bangladesh continues to decline from 91 percent in 2007 to 86 percent in 2011 and to 82 percent in 2014 (NIPORT et al. 2009; NIPORT et al. 2013). 2.1.3 Household Possessions Possession of durable consumer goods is another useful indicator of household socioeconomic status. The possession and use of household durable goods have multiple effects and implications. For instance, access to a radio or television exposes household members to updated daily events, information, and educational materials. Similarly, a refrigerator prolongs food storage and keeps food fresh and hygienic. Ownership of transportation allows greater access to services away from the local area and enhances social and economic activities. Table 2.7 shows that mobile telephones are the most common information and communication device possessed in Bangladesh. Possession of mobile phones has increased sharply from 78 percent in 2011 to 89 percent in 2014. Mobile phones have been widely available in the majority of households since 2011. In rural areas possession of mobile phones increased from 75 percent in 2011 to 87 percent in 2014, while in urban areas the corresponding increase was from 89 percent in 2011 to 93 percent in 2014 (NIPORT et al. 2013). Table 2.6 Cooking amenity Percent distribution of households by place for cooking and type of cooking fuel, and percentage using solid fuel for cooking, according to residence, Bangladesh 2014 Residence Total Housing characteristic Urban Rural Place for cooking In the house 28.0 9.9 15.0 In a separate building 60.1 71.3 68.1 Outdoors 11.7 18.7 16.7 No food cooked in household 0.1 0.1 0.1 Total 100.0 100.0 100.0 Cooking fuel Electricity 1.2 0.1 0.4 LPG/natural gas/biogas 48.0 4.8 16.9 Kerosene 0.3 0.1 0.1 Coal/lignite 0.1 0.2 0.2 Charcoal 0.3 0.2 0.3 Wood 36.9 54.6 49.6 Straw/shrubs/grass 1.1 1.1 1.1 Agricultural crop 9.0 30.3 24.3 Animal dung 2.6 8.5 6.8 Other 0.4 0.1 0.2 No food cooked in household 0.1 0.1 0.1 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 50.0 94.9 82.3 Number 4,844 12,456 17,300 LPG = Liquid petroleum gas 1Includes coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung. Table 2.7 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Bangladesh 2014 Residence Total Possession Urban Rural Ownership of durable goods Radio 3.2 3.6 3.5 Television 70.6 33.0 43.5 Mobile telephone 93.4 86.7 88.5 Non-mobile telephone 4.2 0.5 1.6 Refrigerator 40.6 12.3 20.2 Almirah/wardrobe 59.9 38.6 44.6 Electric fan 85.9 48.5 59.0 DVD/VCD player 12.1 4.8 6.8 Water pump 10.9 5.7 7.1 IPS/generator 7.1 1.0 2.7 Air conditioning 1.3 0.1 0.4 Computer/laptop 11.8 2.4 5.1 Ownership of transport Car/truck/microbus 1.2 0.6 0.8 Autobike/tempo/CNG 1.1 2.0 1.8 Rickshaw/van 5.5 5.5 5.5 Bicycle 16.7 28.4 25.1 Motorcycle/motor scooter 8.0 5.7 6.4 Ownership of agricultural land Homestead 87.4 93.5 91.8 Other land 36.6 48.5 45.2 Neither 10.4 5.9 7.2 Ownership of farm animals Bulls/buffaloes 0.0 0.3 0.3 Cows 11.1 41.3 32.8 Goats/sheep 6.6 24.3 19.3 Chicken/ducks 23.7 67.0 54.9 Number 4,844 12,456 17,300 16 • Housing Characteristics and Household Population The proportion of households possessing a television has increased from 40 percent in 2011 to 44 percent in 2014. Televisions are more likely to be found in urban households (71 percent) than in rural households (33 percent). In contrast, possession of a radio has decreased from 8 percent in 2011 to 4 percent in 2014. A refrigerator is available in 20 percent of households, with urban households more than three times as likely (41 percent) as rural households (12 percent) to own one. Six in ten households possess an electric fan; 86 percent in urban areas and 49 percent in rural areas. Seven percent of households own a DVD/VCD player; 12 percent in urban areas and 5 percent in rural areas. Bicycling is the most common means of transportation in Bangladesh; 25 percent of households own a bicycle, and ownership is much more common in rural areas (28 percent) than in urban areas (17 percent). Only 6 percent of households own a rickshaw or van (person-driven three wheeler), with no difference between rural and urban households. Only 6 percent of households own a motorcycle/motor scooter. Ninety-two percent of households own a homestead, while 45 percent own land other than a homestead. Ownership of a homestead or other land is less common in urban than in rural areas. Ownership of land other than a homestead showed a slight decline from 47 percent in 2011 to 45 percent in 2014; 49 percent of urban households and 37 percent of rural households owned other land (NIPORT et al. 2013). Fifty-five percent of households own chicken or ducks, the most commonly owned type of livestock. One-third of households owns cows, and one in five households owns goats or sheep. As expected, rural households are more likely than urban households to own any type of livestock. 2.2 SOCIOECONOMIC STATUS INDEX The wealth index used in this survey is a measure that has been used in many DHS and other country-level surveys to measure inequalities: in household characteristics, in the use of health and other services, and in health outcomes (Rutstein et al. 2000). It serves as an indicator of household-level wealth that is consistent with expenditure and income measures (Rutstein 1999). The index is constructed using household asset data via principal components analysis. In its current form, which takes better account of urban-rural differences in scores and indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. Categorical variables are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area- specific indicators. The third step combines the separate area-specific factor scores to produce a nationally- applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. This three-step procedure permits greater adaptability of the wealth index in both urban and rural areas. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are obtained by assigning the household score to each de jure household member, ranking each person in the population by his or her score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Table 2.8 presents the wealth quintiles by urban-rural residence and administrative division. There are sharp differences between urban and rural areas. Half of the urban population (49 percent) is in the highest wealth quintile, compared with 9 percent in rural areas. Among the administrative divisions, people in Dhaka are more likely to fall in the highest wealth quintile than people in other divisions. In contrast, Rangpur and Sylhet divisions have the highest proportion of the population in the lowest wealth quintile (30 and 29 percent, respectively). Housing Characteristics and Household Population • 17 Table 2.8 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Bangladesh 2014 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 7.1 5.8 12.1 25.6 49.4 100.0 21,101 24.32 Rural 24.8 25.3 23.0 17.9 8.9 100.0 56,225 37.80 Division Barisal 21.1 30.1 19.8 15.0 14.0 100.0 4,883 28.55 Chittagong 14.5 17.6 22.2 22.7 23.1 100.0 14,998 35.93 Dhaka 16.7 16.1 16.1 23.0 28.0 100.0 26,248 35.48 Khulna 17.9 21.0 23.4 21.5 16.3 100.0 7,407 29.23 Rajshahi 23.3 21.9 24.3 18.9 11.5 100.0 8,729 28.12 Rangpur 30.4 26.2 22.1 12.9 8.5 100.0 8,575 24.19 Sylhet 29.4 21.8 18.6 14.5 15.8 100.0 6,484 31.04 Total 20.0 20.0 20.0 20.0 20.0 100.0 77,326 30.50 Table 2.8 also includes information on the Gini coefficient, which indicates the level of concentration of wealth. This ratio is expressed as a proportion between 0 and 1, 0 being an equal distribution and 1 being a totally unequal distribution. Wealth inequality, as measured by the Gini coefficient, is higher in rural than in urban areas (38 percent versus 24 percent). Inequality in wealth is similar in Dhaka and Chittagong (35 percent and 36 percent, respectively). Inequality in Dhaka has declined from 41 percent in 2011 to 35 percent in 2014. On the other hand, it increased slightly in Chittagong from 33 percent in 2011 to 36 percent in 2014. In all other divisions inequality shows a slight decline between 2011 and 2014 (NIPORT et al. 2013). 2.3 HOUSEHOLD POPULATION BY AGE AND SEX Table 2.9 shows the distribution of the de facto household population by age, sex, and residence. The 2014 BDHS enumerated a total of 77,313 persons (37,672 males and 39,641 females). The sex ratio is 95 males per 100 females. This is similar to the sex ratio of 93 males per 100 females obtained in the 2011 BDHS, but it is lower than the ratio of 100.3 males per 100 females obtained in the 2011 Census (BBS 2011). The marked difference in the sex ratio between the 2011 Census and the BDHS surveys could be because the census’s sex ratio is based on the de jure population, while the sex ratio obtained from the BDHS surveys is based on the de facto household population. The sex composition of the population does not vary markedly by urban-rural residence. One-third of the de facto household population (33 percent) is under age 15, and 10 percent is under age 5. People age 65 and older account for 6 percent of the total population. The proportion of population under age 15 is lower in urban than rural areas, as is the proportion of population older than age 65. Table 2.9 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Bangladesh 2014 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 10.2 9.0 9.6 11.3 9.9 10.6 11.0 9.6 10.3 5-9 10.6 9.8 10.2 12.3 11.0 11.6 11.8 10.7 11.2 10-14 10.3 10.9 10.6 13.1 11.8 12.4 12.3 11.5 11.9 15-19 9.7 11.9 10.9 9.3 11.3 10.3 9.4 11.5 10.5 20-24 7.7 10.7 9.2 6.4 9.5 8.0 6.7 9.8 8.3 25-29 9.1 9.7 9.4 7.0 8.8 7.9 7.6 9.1 8.3 30-34 7.5 8.4 8.0 6.3 7.6 7.0 6.7 7.9 7.3 35-39 7.0 6.3 6.7 6.1 5.9 6.0 6.3 6.0 6.2 40-44 6.5 6.0 6.2 5.4 5.2 5.3 5.7 5.4 5.6 45-49 5.2 4.8 5.0 4.4 4.5 4.4 4.6 4.6 4.6 50-54 4.2 3.1 3.6 4.6 3.1 3.8 4.5 3.1 3.8 55-59 3.4 3.0 3.2 3.4 3.8 3.6 3.4 3.6 3.5 60-64 3.2 2.2 2.7 3.4 2.8 3.1 3.4 2.6 3.0 65-69 2.1 1.4 1.7 2.5 1.7 2.1 2.4 1.6 2.0 70-74 1.5 1.2 1.4 2.0 1.2 1.6 1.9 1.2 1.5 75-79 0.8 0.6 0.7 1.0 0.5 0.8 1.0 0.5 0.8 80+ 0.8 0.9 0.9 1.5 1.3 1.4 1.3 1.2 1.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 10,443 10,778 21,221 27,229 28,862 56,092 37,672 39,641 77,313 18 • Housing Characteristics and Household Population The age-sex structure of the population is shown by the population pyramid in Figure 2.2. The pyramid is wider at the base than the top and narrows slightly at the youngest age group. This pattern is typical of a historically high-fertility regime that has recently started to stabilize or decline. Figure 2.3 shows the distribution of the male and female household populations by single years of age. The figure shows that age reporting is less accurate for males than for females. Age heaping is prominent at specific ages, such as 10 and 18, for males and females. Figure 2.2 Population pyramid Figure 2.3 Household age distribution by sex 0.0 1.0 2.0 3.0 4.0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 Percent Age (years) Women Men BDHS 2014 Housing Characteristics and Household Population • 19 Table 2.10 presents changes in the broad age structure of the population since 1989. The proportion of population under age 15 has declined from 43 percent in 1989 to 34 percent in 2014. In contrast, populations age 15-59 and age 60 and over have increased over time. Table 2.10 Trends in population by age Percent distribution of the de facto population by age group, selected sources, Bangladesh 1989-2014 Age group 1989 BFS 1989 CPS 1991 CPS 1993-1994 BDHS 1996-1997 BDHS 1999-2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS 2014 BDHS <15 43.2 43.2 42.7 42.6 41.0 39.2 38.2 36.3 35.3 33.5 15-59 50.9 50.9 51.2 51.2 53.1 54.4 55.1 56.6 56.5 58.0 60+ 5.9 5.9 6.0 6.2 5.9 6.4 6.6 7.1 8.2 8.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 BFS = Bangladesh Fertility Survey; CPS = Contraceptive Prevalence Survey; BDHS = Bangladesh Demographic and Health Survey Sources: Huq and Cleland 1990:38; Mitra et al. 1994:14; Mitra et al. 1997:9; NIPORT et al. 2001:11; NIPORT et al. 2005:13; NIPORT et al. 2009:12, NIPORT et al. 2013:20. 2.4 HOUSEHOLD COMPOSITION Information on household composition is critical to an understanding of family size and household headship, which can be used to plan meaningful population-based policies and programs. Household composition is also a determinant of general health status and well-being. Table 2.11 presents information on household composition. The majority (88 percent) of households are headed by men. The proportion of female-headed households has increased from 11 percent in 2011 to 13 percent in 2014, with no urban-rural difference. More than half of the households in Bangladesh are composed of two to four members. The overall average household size is 4.5 persons, as compared with 4.6 in 2011. The household size is slightly larger in rural (4.5 persons) than in urban areas (4.4 persons). 2.5 BIRTH REGISTRATION According to the amended Birth and Death Registration Act of 2004, which came into force in 2006, all children born in Bangladesh must be registered within 45 days of birth and have a birth certificate (http://bdlaws.minlaw.gov.bd/bangla_all_sections.php?id=921). The act empowers all union councils, municipalities, cantonment boards, city corporations, and Bangladesh missions to act as birth registration registrars. In 2010, the government initiated an online birth registration system with 5,082 offices administering registrations online. To keep the birth and death database permanent and dynamic, the government amended the existing law of birth and death registration in 2013 and announced the establishment of the Office of the Registrar General of Birth and Death, which is yet to be set up (http://br.lgd.gov.bd/english.html). Birth certificates are made mandatory for school enrolment, passports, marriage registrations, job applications, driving licenses, insurance policies, land registrations, voter registrations, and national identification cards. In the 2014 BDHS, information on birth registration was solicited for children under age 5. Table 2.12 shows that 2 in 10 children under age 5 had their births registered in 2014, and 17 percent of children had a birth certificate. Table 2.11 Household composition Percent distribution of households by sex of head of household and by household size; and mean size of household, according to residence, Bangladesh 2014 Residence Total Characteristic Urban Rural Household headship Male 87.3 87.6 87.5 Female 12.7 12.4 12.5 Total 100.0 100.0 100.0 Number of usual members 1 1.4 1.9 1.7 2 10.4 10.4 10.4 3 21.9 18.3 19.3 4 28.1 25.2 26.0 5 18.0 20.2 19.6 6 9.2 11.7 11.0 7 5.6 5.8 5.7 8 2.3 3.3 3.0 9+ 3.1 3.3 3.3 Total 100.0 100.0 100.0 Mean size of households 4.4 4.5 4.5 Number of households 4,844 12,456 17,300 Note: Table is based on de jure household members, i.e., usual residents. 20 • Housing Characteristics and Household Population Although the law requires that a newborn be registered within 45 days of birth, Table 2.12 indicates that children under age 2 are much less likely to be registered than children age 2-4 (13 and 25 percent, respectively). The registration of older children is primarily driven by the practice of asking parents to produce a child’s birth certificate for school admission. Table 2.12 shows that birth registration is higher in urban (23 percent) than in rural (19 percent) areas. There is no difference regarding the extent of birth registration among male and female children. Among the administrative divisions, the highest and lowest proportions of children whose births are registered are from Sylhet (26 percent) and Rajshahi (13 percent). Birth registration of children under age 5 for all groups is lower in 2014 than in 2011 (NIPORT et al. 2013). Further investigation is needed to determine reasons for this decline. Table 2.12 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Bangladesh 2014 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have a birth certificate Percentage registered Age <2 9.7 2.9 12.6 3,091 2-4 21.2 3.9 25.1 4,707 Sex Male 16.6 3.6 20.3 4,045 Female 16.6 3.4 20.0 3,753 Residence Urban 18.9 3.8 22.8 2,001 Rural 15.8 3.4 19.3 5,797 Division Barisal 15.9 4.7 20.6 450 Chittagong 18.4 2.7 21.1 1,702 Dhaka 16.6 3.1 19.7 2,687 Khulna 17.6 5.0 22.6 596 Rajshahi 9.2 3.8 13.0 807 Rangpur 15.1 3.6 18.7 776 Sylhet 21.8 4.6 26.3 780 Wealth quintile Lowest 11.6 3.8 15.4 1,652 Second 16.1 2.6 18.7 1,442 Middle 15.1 2.4 17.5 1,404 Fourth 17.0 3.4 20.4 1,583 Highest 22.9 5.1 28.0 1,717 Total 16.6 3.5 20.2 7,798 2.6 SCHOOL ATTENDANCE In the 2014 BDHS, information was collected about school attendance of household members age 6 to 24. Table 2.13 shows that the proportion of the population that attends school declines with age. Whereas 91 percent of children age 6-10 are in school, the percentage decreases to 82 percent for children age 11-15, and to 40 percent for children age 16-20. School attendance is higher among girls than among boys age 6- 15, but boys age 16-20 and age 21-24 are more likely to be in school than girls. These data may reflect the impact of recent efforts to promote universal education, especially among girls. Housing Characteristics and Household Population • 21 Table 2.13 School attendance Percentage of the de facto household population age 6-24 attending school, by age, sex, and residence, Bangladesh 2014 Age Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-15 84.1 85.0 84.8 86.3 89.4 88.6 85.2 87.2 86.7 6-10 91.8 90.4 90.7 91.0 92.6 92.2 91.4 91.4 91.4 11-15 75.7 79.1 78.3 81.8 86.1 85.0 78.9 82.6 81.7 16-20 46.9 46.2 46.4 36.5 34.6 35.2 41.1 39.6 40.0 21-24 27.3 21.4 23.3 17.8 10.3 12.6 21.5 14.5 16.7 School attendance rates for children under age 16 are slightly higher in rural areas than in urban areas. In contrast, urban men and women age 16-24 are more likely to be in school than their rural counterparts. School attendance among age groups has increased since 2011. For example, the proportion of children age 6-15 who are attending school has increased from 84 percent in 2011 (NIPORT et al. 2013) to 87 percent in 2014. 2.7 EDUCATION OF HOUSEHOLD POPULATION Education is one of the major socioeconomic influences on a person’s behaviors and attitudes. In general, the greater a person’s educational attainment, the more knowledgeable he or she is about the use of health services, family planning, and the health care of children. The government of Bangladesh enacted a mandatory primary education law in 1990 to achieve universal primary enrolment by 2005, which is in line with the UN Child Rights Convention. Bangladesh must provide free and equal primary education of quality for all children (GOB 1990). To meet the demand for education, the government of Bangladesh has increased investment in the educational sector. Education is divided into two broad categories, primary and secondary. In addition, the government has recently initiated opening up non-grade-level schools at pre-primary education. The government also implements non-formal education for adults to increase the literacy rate. To promote job- oriented education, skill development institutes that have a vocational and technical focus have increased over the years in various parts of the country. The National Education Policy of Bangladesh (MOE 2010) explicitly stipulated that education would be free up to the secondary level in the public sector and provided subsidies to create demand for education of the poor and of girls in an effort to meet MDG targets. 2.7.1 Educational Attainment of the Household Population For all household members age 6 or older, data were collected on the level of education last attended and the highest class completed at that level. The findings are presented in Tables 2.14.1 and 2.14.2. The majority of Bangladeshis age 6 and older have attended school. Twenty-three percent of men and 27 percent of women have never attended school. Gender difference in primary education is very little. However, men are more likely to complete secondary school or to attain a higher education compared with women (17 percent versus 12 percent). There has been an increase in the proportions of men and women who have completed secondary or higher education since 2011. For men, the proportion has increased from 15 percent to 17 percent, and for women it has increased from 10 percent to 12 percent in 2014. Changes in educational attainment by successive age groups indicate the long-term trend in a country’s educational achievement. The data show marked improvement in the educational attainment of both men and women over the years. The proportion of men with no education is notably higher (39 percent) among those age 45-49 than among boys age 10-14 (6 percent). Similarly, 50 percent of women age 45-49 have no education compared with only 3 percent of girls age 10-14. 22 • Housing Characteristics and Household Population Overall, levels of educational attainment are higher in urban than in rural areas (Tables 2.14.1 and 2.14.2). The proportions of men and women with no education are lower in urban areas (17 percent of men and 21 percent of women) than in rural areas (25 percent of men and 29 percent of women), while the proportions who have completed secondary or higher schooling are greater in urban areas (26 percent of men and 20 percent of women) than in rural areas (13 percent of men and 9 percent of women). On average, men and women living in urban areas have completed 2 more years of school than those in rural areas. There are also regional variations in educational attainment. Barisal division has the highest proportion of men and women with some education (83 percent of men and 82 percent of women). Table 2.14.1 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and older by highest level of schooling attended or completed and median years completed, according to background characteristics, Bangladesh 2014 Background characteristic No education Primary incomplete Completed primary1 Secondary incomplete Completed secondary2 More than secondary Total Number Median years completed Age 6-9 22.2 77.7 0.0 0.1 0.0 0.0 100.0 3,702 0.0 10-14 5.8 56.4 6.5 31.2 0.1 0.0 100.0 4,648 3.2 15-19 6.7 15.9 9.2 43.0 7.0 18.2 100.0 3,543 8.0 20-24 10.2 16.9 13.9 28.0 5.4 25.6 100.0 2,536 7.4 25-29 13.3 15.9 14.9 30.7 7.4 17.8 100.0 2,859 7.0 30-34 21.5 17.2 11.8 28.4 5.4 15.7 100.0 2,508 5.0 35-39 28.9 17.8 9.8 20.2 6.0 17.2 100.0 2,384 4.3 40-44 36.3 14.4 9.5 18.4 6.8 14.5 100.0 2,144 3.9 45-49 38.6 13.1 9.6 16.4 7.2 15.1 100.0 1,736 3.6 50-54 37.5 18.2 9.6 16.8 6.1 11.7 100.0 1,679 3.1 55-59 39.8 13.2 8.7 20.3 6.2 11.9 100.0 1,274 3.3 60-64 43.2 14.2 8.6 14.2 7.7 12.0 100.0 1,263 2.2 65+ 46.8 16.1 9.7 13.7 5.9 7.9 100.0 2,479 1.1 Residence Urban 16.8 23.8 8.2 25.1 6.0 20.1 100.0 9,161 5.6 Rural 25.2 30.6 9.2 22.0 4.4 8.6 100.0 23,604 3.2 Division Barisal 16.9 30.3 9.6 23.7 7.4 12.1 100.0 2,078 4.3 Chittagong 20.1 30.6 9.6 23.9 5.7 10.1 100.0 6,099 3.9 Dhaka 25.0 26.5 8.3 22.4 4.5 13.3 100.0 11,213 3.7 Khulna 20.1 28.0 7.1 26.7 5.8 12.3 100.0 3,184 4.3 Rajshahi 25.4 27.2 8.5 21.0 4.4 13.6 100.0 3,794 3.6 Rangpur 22.5 29.4 8.4 23.9 4.1 11.6 100.0 3,733 3.7 Sylhet 25.0 33.8 12.8 18.8 2.7 7.0 100.0 2,664 2.8 Wealth quintile Lowest 40.3 36.8 7.1 12.7 1.1 2.0 100.0 6,302 0.6 Second 28.7 34.2 10.6 19.9 2.3 4.3 100.0 6,704 2.4 Middle 21.8 29.0 10.9 25.5 4.6 8.2 100.0 6,541 3.9 Fourth 16.0 24.9 9.2 30.1 6.8 13.1 100.0 6,523 5.0 Highest 8.4 18.9 6.7 25.9 9.1 31.0 100.0 6,694 8.8 Total 22.9 28.7 8.9 22.9 4.8 11.8 100.0 32,765 3.8 Note: Total includes eight men with missing information on age. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. For men and women, wealth exerts a positive influence on educational attainment. For instance, 40 percent of men in the lowest quintile have never attended school compared with 8 percent of men in the highest quintile. While 45 percent of men in the lowest wealth quintile had no education in 2011, in 2014 this proportion has declined to 40 percent. For women, the corresponding proportions are 47 and 41 percent, respectively. Housing Characteristics and Household Population • 23 Table 2.14.2 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and older by highest level of schooling attended or completed and median years completed, according to background characteristics, Bangladesh 2014 Background characteristic No education Primary incomplete Completed primary1 Secondary incomplete Completed secondary2 More than secondary Total Number Median years completed Age 6-9 21.4 78.5 0.1 0.1 0.0 0.0 100.0 3,485 0.1 10-14 2.7 52.7 6.4 38.1 0.2 0.0 100.0 4,578 3.7 15-19 3.6 11.8 9.2 50.6 8.5 16.3 100.0 4,541 8.3 20-24 8.8 13.3 11.1 41.5 5.9 19.5 100.0 3,888 7.9 25-29 14.6 16.2 11.9 38.3 6.9 12.1 100.0 3,588 6.8 30-34 27.1 19.4 9.5 28.2 6.4 9.3 100.0 3,115 4.4 35-39 36.7 20.2 11.3 19.1 5.6 7.2 100.0 2,390 3.0 40-44 46.2 21.8 9.3 12.8 4.3 5.6 100.0 2,158 0.7 45-49 49.7 20.4 9.9 13.3 2.5 4.2 100.0 1,815 0.0 50-54 60.9 18.2 8.5 7.5 2.2 2.7 100.0 1,242 0.0 55-59 66.2 15.5 8.0 6.9 1.0 2.3 100.0 1,425 0.0 60-64 70.2 14.0 7.1 6.2 0.9 1.6 100.0 1,037 0.0 65+ 78.8 9.6 5.9 3.9 0.8 0.9 100.0 1,799 0.0 Residence Urban 21.1 23.8 8.1 27.2 5.8 14.0 100.0 9,609 4.6 Rural 28.8 28.2 8.4 25.9 3.3 5.3 100.0 25,454 3.1 Division Barisal 17.8 30.6 12.4 24.8 5.5 8.8 100.0 2,241 4.1 Chittagong 24.4 27.0 8.4 28.3 5.7 6.3 100.0 6,892 3.8 Dhaka 28.6 25.4 8.0 25.9 3.5 8.6 100.0 11,781 3.5 Khulna 24.8 26.8 6.7 30.2 3.8 7.7 100.0 3,456 3.8 Rajshahi 28.4 25.9 8.5 26.0 3.7 7.6 100.0 3,896 3.3 Rangpur 28.9 27.8 6.5 25.6 3.0 8.3 100.0 3,950 3.1 Sylhet 28.5 31.5 10.8 20.7 2.9 5.6 100.0 2,846 2.6 Wealth quintile Lowest 40.5 35.2 7.6 15.1 0.6 1.1 100.0 6,852 0.7 Second 32.6 30.8 9.3 22.9 1.9 2.5 100.0 6,836 2.3 Middle 25.5 27.5 8.5 30.3 3.5 4.7 100.0 7,086 3.6 Fourth 22.8 23.4 9.3 31.2 4.9 8.5 100.0 7,166 4.4 Highest 13.1 18.6 7.0 31.4 8.8 21.2 100.0 7,122 7.7 Total 26.7 27.0 8.3 26.3 4.0 7.7 100.0 35,063 3.5 Note: Total includes 1 woman with missing information on age. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. A comparison of the completed median years of schooling since 2000 is presented in Figure 2.4. In 2000, the completed median years of schooling was 2.6 for men and 1.2 for women. Between 2000 and 2014 the completed median years of schooling had increased to 3.8 among men and to 3.5 among women. Although the completed median years of schooling continues to be higher for men than for women, the gender difference has declined from 1.4 years in 2000 to 0.3 years in 2014. 24 • Housing Characteristics and Household Population Figure 2.4 Trend in completed median of years of schooling of men and women age 6 and over, 1999-2014 2.7.2 School Attendance Ratios The net attendance ratio (NAR) indicates participation in primary schooling for the population age 6-10 and participation in secondary schooling for the population age 11-17. The gross attendance ratio (GAR) measures participation at each level of schooling among those of any age. The GAR is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level. A NAR of 100 percent would indicate that all of those in the official age range for that level are attending at that level. The GAR can exceed 100 percent if there is significant over-age or under-age participation at a given level of schooling. Table 2.15 shows that the NAR at the primary level is 86 percent (86 percent for males and 87 percent for females) and the NAR at the secondary level is 43 percent (42 percent for males and 44 percent for females). The differences in NAR at the primary and secondary school levels between urban and rural areas are small. Among the administrative divisions, Dhaka has the lowest NAR and GAR at the primary level. Sylhet has the highest NAR and GAR at the primary level, but the lowest NAR and GAR at the secondary level. At the primary level, the NAR and GAR show no clear pattern by wealth quintile. The NAR and GAR at secondary school level are lowest among the children from the lowest wealth quintile. Table 2.15 also shows the Gender Parity Index (GPI), which represents the ratio of the NAR and GAR for females to the NAR and GAR for males. It is a more precise indicator of gender differences in the schooling system. A GPI greater than 1.00 indicates that a higher proportion of females than males attends school. The GPI at the primary and secondary levels is slightly higher than 1.00 indicating that gender differences in schools are in favor of girls. 2.6 2.7 2.9 3.4 3.8 1.2 1.6 2.1 2.9 3.5 BDHS 1999-2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS 2014 Years Men Women Housing Characteristics and Household Population • 25 Table 2.15 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Bangladesh 2014 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 84.2 85.3 84.8 1.01 113.6 116.7 115.1 1.03 Rural 86.0 88.0 87.0 1.02 119.6 124.2 121.8 1.04 Division Barisal 90.7 91.4 91.0 1.01 126.2 128.6 127.4 1.02 Chittagong 84.5 87.2 85.9 1.03 120.4 124.1 122.2 1.03 Dhaka 82.7 85.0 83.8 1.03 110.0 117.6 113.6 1.07 Khulna 91.5 90.1 90.8 0.98 121.1 121.3 121.2 1.00 Rajshahi 84.6 86.6 85.6 1.02 124.7 115.0 119.7 0.92 Rangpur 88.7 89.8 89.2 1.01 121.5 130.2 125.5 1.07 Sylhet 87.0 88.7 87.9 1.02 124.9 130.2 127.6 1.04 Wealth quintile Lowest 81.4 86.7 84.1 1.07 117.8 125.8 121.9 1.07 Second 87.8 87.2 87.5 0.99 118.0 130.8 123.8 1.11 Middle 88.6 90.1 89.3 1.02 122.8 124.6 123.7 1.01 Fourth 83.8 89.3 86.6 1.07 119.7 117.5 118.6 0.98 Highest 86.5 83.8 85.2 0.97 112.7 110.9 111.8 0.98 Total 85.6 87.4 86.4 1.02 118.2 122.3 120.2 1.04 SECONDARY SCHOOL Residence Urban 40.7 42.4 41.6 1.04 46.5 46.5 46.5 1.00 Rural 42.5 44.0 43.3 1.04 47.8 48.4 48.1 1.01 Division Barisal 43.5 46.8 45.1 1.08 47.2 50.9 49.1 1.08 Chittagong 40.8 42.5 41.7 1.04 46.5 47.5 47.0 1.02 Dhaka 42.4 42.3 42.4 1.00 49.6 46.4 47.9 0.94 Khulna 45.6 53.6 50.0 1.18 48.9 57.9 53.8 1.18 Rajshahi 44.1 47.6 45.8 1.08 48.7 52.2 50.4 1.07 Rangpur 45.3 42.4 43.7 0.93 49.3 45.4 47.2 0.92 Sylhet 33.1 35.6 34.4 1.08 37.5 41.0 39.3 1.09 Wealth quintile Lowest 28.4 30.8 29.6 1.08 32.7 33.4 33.1 1.02 Second 36.1 40.0 38.1 1.11 42.0 45.1 43.6 1.07 Middle 47.0 48.3 47.6 1.03 52.0 52.5 52.2 1.01 Fourth 48.6 48.0 48.2 0.99 54.3 51.6 52.9 0.95 Highest 50.1 49.7 49.9 0.99 56.1 55.7 55.9 0.99 Total 42.0 43.6 42.8 1.04 47.4 47.9 47.7 1.01 1 The NAR for primary school is the percentage of the primary-school-age (6-10 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (11-17 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary- school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of over-age and under-age students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Figure 2.5 shows that, for ages 5-14, girls have a higher level of school attendance than boys. The pattern reverses at age 16 and older. Attendance is highest at age 9 for boys and at age 11 for girls. 26 • Housing Characteristics and Household Population Figure 2.5 Age-specific attendance rates of the de facto population age 5-24 2.8 EMPLOYMENT The 2014 BDHS collected information regarding the working status of each person age 8 and older at the time of the survey. Table 2.16 shows that men are much more likely than women to be employed (65 percent and 24 percent, respectively). Table 2.16 also shows that the urban population is more likely to be employed than the rural population. For men, the proportion is 69 percent in urban and 63 percent in rural areas, and for women, the proportion is 25 percent and 24 percent, respectively. Table 2.16 Employment status Percentage of male and female de facto household population age eight and over working at the time of the survey, by age, sex, and residence, Bangladesh 2014 Male Female Age Urban Rural Total Urban Rural Total 8-9 1.2 0.9 1.0 1.4 0.5 0.7 10-14 10.9 9.7 10.0 7.7 2.6 3.9 15-19 43.6 39.6 40.8 21.1 12.8 15.1 20-24 73.4 74.9 74.4 30.6 26.7 27.9 25-29 90.7 91.9 91.5 35.3 37.0 36.5 30-34 96.9 97.2 97.1 36.0 41.5 39.9 35-39 98.6 98.2 98.4 39.7 41.4 40.9 40-44 96.0 98.2 97.5 38.1 43.3 41.8 45-49 98.8 97.5 97.9 33.4 38.2 36.8 50-54 94.3 94.8 94.6 22.8 26.5 25.5 55-59 90.4 89.7 89.9 23.8 26.1 25.6 60-64 78.8 81.9 81.1 12.3 16.1 15.2 65+ 50.8 48.4 48.9 5.8 6.2 6.1 Total 68.8 63.1 64.7 25.2 23.7 24.1 Number of persons 8,669 22,181 30,850 9,170 24,072 33,242 0 10 20 30 40 50 60 70 80 90 100 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age Male Female BDHS 2014 Housing Characteristics and Household Population • 27 2.9 OWNERSHIP OF MOBILE PHONES Information regarding ownership of mobile phones among household members age 13 and older was collected during the 2014 BDHS. Table 2.17 shows that 53 percent of the population owns a mobile phone. Urban people are more likely to own a mobile phone (64 percent) than rural people (48 percent). Men are almost twice as likely as women to own a mobile phone. In urban areas, 78 percent of men own a mobile phone compared with 50 percent of women. In rural areas the corresponding proportions are 66 percent and 33 percent, respectively. Men and women in the age groups 20-29 and 30-39 are more likely to own a mobile phone than other age groups. Among adolescents age 15-19, 45 percent own a mobile phone. Male adolescents are twice as likely to own a mobile phone as female adolescents. Adolescents in urban areas are slightly more likely to own mobile phones compared with those in rural areas (51 percent versus 43 percent). Table 2.17 Availability of mobile phone among household members Percentage of de-facto household members age 13 or more who have a mobile phone by age and sex, according to residence, Bangladesh 2014 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 13-14 20.4 3.1 11.5 13.2 2.7 7.9 15.0 2.8 8.8 15-19 66.8 38.1 50.8 61.5 27.8 42.5 63.0 30.7 44.9 20-29 92.1 67.1 78.2 88.2 48.9 64.9 89.5 54.2 69.0 30-39 91.7 65.5 78.3 84.6 44.5 63.1 86.8 50.6 67.6 40-49 86.3 52.1 69.7 74.5 33.3 53.3 78.2 38.8 58.3 50+ 64.6 28.8 48.7 48.1 13.9 32.6 52.2 17.5 36.6 Total 77.7 50.0 63.5 65.8 32.7 48.3 69.3 37.5 52.6 Characteristics of Respondents • 29 CHARACTERISTICS OF RESPONDENTS 3 his chapter presents the demographic and socioeconomic profile of ever married women age 15-49 interviewed in BDHS 2014. The information helps one to interpret findings and understand results presented in the report. The chapter begins by describing basic background characteristics, including age, marital status, residence, education, and wealth status. Information is also presented on exposure to mass media and employment status. The 2014 BDHS includes results from completed interviews with 17,863 ever-married women age 15-49. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Basic background characteristics of the 17,863 ever-married women are presented in Table 3.1. About half of the women (48.4 percent) are under age 30. The majority of women (94 percent) are currently married. Seven in ten respondents (72 percent of women) reside in the rural areas. The respondents are not evenly distributed across geographic divisions. More than one-third (35 percent) of the respondents live in Dhaka, 19 percent reside in Chittagong, 12 percent each in Rajshahi and Rangpur, 10 percent in Khulna, 7 percent in Sylhet, and 6 percent in Barisal. The proportion of sampled women in Chittagong and Rangpur divisions is similar to that in the 2011 BDHS. However, the proportion in three divisions has increased; in Dhaka by 2.5 percent, in Sylhet by 1.5 percent, and in Barisal by 0.6 percent. On the other hand, it decreased in two divisions; in Rajshahi by 3.1 percent and in Khulna by 1.7 percent. Twenty-five Table 3.1 Background characteristics of respondents Percent distribution of ever-married women age 15-49 by selected background characteristics, Bangladesh 2014 Background characteristic Weighted percent Weighted number Unweighted number Age 15-19 11.4 2,029 2,023 20-24 18.0 3,224 3,161 25-29 19.0 3,390 3,343 30-34 17.1 3,047 3,012 35-39 13.0 2,315 2,340 40-44 11.7 2,092 2,170 45-49 9.9 1,766 1,814 Marital status Currently married 94.4 16,858 16,830 Divorced/separated/ widowed 5.6 1,005 1,033 Residence Urban 28.3 5,047 6,167 Rural 71.7 12,816 11,696 Division Barisal 6.2 1,111 2,142 Chittagong 18.5 3,301 2,865 Dhaka 34.8 6,223 3,093 Khulna 10.3 1,838 2,581 Rajshahi 11.8 2,103 2,512 Rangpur 11.5 2,056 2,531 Sylhet 6.9 1,232 2,139 Education No education 24.9 4,455 4,206 Primary incomplete 18.0 3,223 3,148 Primary complete1 11.1 1,986 2,078 Secondary incomplete 31.5 5,628 5,645 Secondary complete or higher2 14.4 2,571 2,786 Religion Islam 90.1 16,096 16,135 Hinduism 8.3 1,476 1,592 Buddhism 1.3 234 100 Christianity (0.2) 44 32 Wealth quintile Lowest 18.8 3,359 3,251 Second 19.1 3,408 3,360 Middle 19.9 3,560 3,621 Fourth 21.0 3,758 3,769 Highest 21.1 3,778 3,862 Total - 17,863 17,863 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. T Key Findings: • Twenty-five percent of ever-married women age 15-49 have no education. The percentage of women with no education has decreased since 2007, and the percentage of women with secondary or higher education has gradually increased over the same period. • Forty-seven percent of women have no regular exposure to radio, television, or a newspaper. • Thirty-six percent of women were employed in the 12 months preceding the survey, with the highest percentages employed in raising of poultry/cattle (41 percent), semi-skilled services (14 percent), and factory or blue collar services (8 percent). 30 • Characteristics of Respondents percent of women age 15-49 have no education, while 14 percent of women have completed secondary or higher-level education. The vast majority of the respondents (90 percent) are Muslim, and 8 percent are Hindu. Very few of the respondents are Buddhist or Christian. 3.2 EDUCATIONAL ATTAINMENT Education is one of the most influential determinants of an individual’s knowledge, attitudes, and behaviors. The educational attainment of a population is an important indicator of the society’s stock of human capital and level of socioeconomic development. Education enhances the ability of individuals to achieve desired demographic and health goals. Table 3.2 presents differentials in the educational attainment of women by selected background characteristics. Table 3.2 Educational attainment Percent distribution of ever-married women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Bangladesh 2014 Highest level of schooling Total Median years completed Number of women Background characteristic No education Primary incomplete Completed primary1 Secondary incomplete Secondary complete or higher2 Age 15-24 7.8 14.9 11.9 47.6 17.8 100.0 7.4 5,253 15-19 5.1 14.9 11.8 50.7 17.5 100.0 7.5 2,029 20-24 9.5 14.9 12.0 45.6 18.0 100.0 7.4 3,224 25-29 15.0 16.8 12.3 39.1 16.8 100.0 6.6 3,390 30-34 27.0 19.9 10.0 27.9 15.3 100.0 4.3 3,047 35-39 37.4 19.9 11.3 19.1 12.3 100.0 2.8 2,315 40-44 46.3 21.9 9.4 13.0 9.4 100.0 0.7 2,092 45-49 49.8 19.6 10.2 13.6 6.8 100.0 0.0 1,766 Residence Urban 19.3 15.2 10.0 31.0 24.5 100.0 6.8 5,047 Rural 27.2 19.2 11.5 31.7 10.4 100.0 4.3 12,816 Division Barisal 15.1 20.8 15.9 28.8 19.3 100.0 4.9 1,111 Chittagong 21.6 16.6 9.6 36.3 16.0 100.0 6.3 3,301 Dhaka 27.2 17.1 11.0 29.9 14.8 100.0 4.5 6,223 Khulna 21.6 19.8 9.1 36.6 12.9 100.0 4.9 1,838 Rajshahi 25.5 18.4 11.7 31.0 13.4 100.0 4.5 2,103 Rangpur 27.2 19.1 9.6 30.9 13.1 100.0 4.4 2,056 Sylhet 31.8 19.1 16.0 23.6 9.4 100.0 3.9 1,232 Wealth quintile Lowest 45.5 24.4 11.9 17.0 1.2 100.0 1.0 3,359 Second 32.6 22.7 13.5 26.6 4.6 100.0 3.4 3,408 Middle 21.2 19.3 11.4 38.6 9.4 100.0 4.8 3,560 Fourth 18.8 15.6 12.0 38.3 15.3 100.0 6.4 3,758 Highest 9.4 9.4 7.2 35.3 38.7 100.0 9.2 3,778 Total 24.9 18.0 11.1 31.5 14.4 100.0 4.6 17,863 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Table 3.2 shows that 25 percent of ever-married women age 15-49 have never been to school, 18 percent have completed some primary education, 11 percent have completed all primary education, 32 percent have completed some secondary education, and 14 percent have completed all secondary education or continued on to higher education. Older women, women in rural areas, and those in the lowest wealth quintile are most likely to have no education. Urban-rural differences in education are prominent at the secondary and higher levels. For example, urban women are almost two and half times more likely than rural women to have completed secondary or higher education (25 percent and 10 percent, respectively). Between 13 and 19 percent of women in all geographic divisions have completed secondary or higher-level education except in Sylhet, where the percentage is only 9 percent. Sylhet also has the highest proportion of women with no education (32 percent). Women in the highest wealth quintile are most likely to complete secondary or higher-level education; 39 percent of women in the highest wealth quintile achieved this level. Characteristics of Respondents • 31 In Bangladesh, women age 15-49 have completed a median of 4.6 years of schooling. The differentials across subgroups of women are reflected in the medians. For example, the median number of years of schooling for women in the highest wealth quintile is 9.2 years compared with 1 year for women in the lowest quintile. Figure 3.1 Trends in education of ever-married women, 2007-2014 There have been improvements in educational attainment in Bangladesh over the past seven years. The percentage of ever-married women with no education has declined, from 28 percent in 2011 to 25 percent in 2014. Another indicator of progress in education is the median length of schooling. For women, it increased from 4.3 years in 2011 to 4.6 years in 2014 (NIPORT et al. 2013). 3.3 LITERACY Literacy is widely acknowledged as benefiting both the individual and society. Particularly among women, literacy is associated with positive outcomes, including intergenerational health and nutrition benefits. The ability to read and write empowers both women and men. Knowledge of the level of literacy that a population may attain is important for policymakers and program managers who design information materials. The 2014 BDHS defined literacy based on the respondent’s ability to read all or part of a sentence. To test respondents’ reading ability, interviewers carried a set of cards with simple sentences printed in Bangla. Respondents who had attended at least some secondary school were assumed to be literate. Respondents who had never been to school and those who had not attended school at the secondary level were asked to read the cards during the interview. Table 3.3 presents the findings. Table 3.3 indicates that 66 percent of ever-married women age 15-49 are literate. The level of literacy decreases as age increases; 86 percent of women age 15-24 are literate compared with 39 percent of women age 45-49. Literacy varies by urban-rural residence; 74 percent of urban women are literate, compared with 63 percent of rural women. 34 21 8 24 12 28 18 12 30 12 25 18 11 32 14 No education Primary incomplete Completed primary Secondary incomplete Secondary complete or higher Percent BDHS 2007 BDHS 2011 BDHS 2014 32 • Characteristics of Respondents Divisional differences in literacy are notable. The proportion of women who are literate ranges from 57 percent in Sylhet to 76 percent in Barisal. Literacy has improved in the past three years in all divisions except Sylhet. The improvement ranges from 1 percent in Khulna to 8 percent in Rangpur. There is also a marked difference in literacy level by household wealth, ranging from 41 percent among women in the lowest wealth quintile to 87 percent among women in the highest wealth quintile. Table 3.3 Literacy Percent distribution of ever-married women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Bangladesh 2014 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Age 15-24 65.4 8.9 11.6 14.1 100.0 85.9 5,251 15-19 59.7 8.7 12.3 19.4 100.0 80.6 6,614 20-24 63.6 9.2 11.6 15.6 100.0 84.4 3,224 25-29 55.9 8.3 12.9 22.9 100.0 77.1 3,390 30-34 43.2 7.9 12.0 36.9 100.0 63.0 3,047 35-39 31.4 9.3 12.1 47.1 100.0 52.8 2,315 40-44 22.4 7.8 12.5 57.3 100.0 42.7 2,092 45-49 20.3 7.2 11.6 60.8 100.0 39.1 1,766 Residence Urban 55.5 8.4 10.1 25.9 100.0 74.0 5,047 Rural 42.1 8.3 12.8 36.7 100.0 63.3 12,816 Division Barisal 48.1 12.0 15.8 23.9 100.0 76.0 1,111 Chittagong 52.3 7.6 9.8 30.3 100.0 69.6 3,301 Dhaka 44.7 8.4 12.5 34.4 100.0 65.6 6,223 Khulna 49.5 7.3 11.2 31.9 100.0 68.0 1,838 Rajshahi 44.4 7.6 12.7 35.2 100.0 64.7 2,103 Rangpur 44.1 7.2 12.2 36.5 100.0 63.5 2,056 Sylhet 33.0 11.7 12.6 42.5 100.0 57.4 1,232 Wealth quintile Lowest 18.2 7.8 15.1 58.9 100.0 41.1 3,359 Second 31.3 10.2 15.4 43.2 100.0 56.8 3,408 Middle 48.0 9.4 12.1 30.4 100.0 69.5 3,560 Fourth 53.6 8.6 11.5 26.3 100.0 73.7 3,758 Highest 74.1 6.0 7.0 12.9 100.0 87.1 3,778 Total 45.9 8.4 12.1 33.6 100.0 66.3 17,863 Note: Total includes a small number of women who had no card with the required language, are blind or visually impaired, or with missing information. 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 3.4 ACCESS TO MASS MEDIA Access to information through the media is essential to increase people’s knowledge and awareness of what takes place around them. The 2014 BDHS assessed exposure to media by asking respondents if they listened to the radio, watched television, or read newspapers or magazines at least once a week. To plan effective programs to disseminate information about health and family planning, it is important to know which subgroups of population are most likely to be reached by specific media. Table 3.4 shows that 51 percent of ever-married women age 15-49 watch television at least once a week, 6 percent read a newspaper at least once a week, and 3 percent listen to the radio at least once a week. Less than 1 percent of women are exposed to all three media sources each week. Close to half (47 percent) of women have no exposure to any of the mass media on a weekly basis. Characteristics of Respondents • 33 Table 3.4 Exposure to mass media Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Bangladesh 2014 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 5.5 51.2 4.3 0.4 45.8 2,029 20-24 5.3 57.1 2.8 0.5 41.4 3,224 25-29 6.9 52.7 3.1 0.6 45.4 3,390 30-34 6.6 51.2 2.6 0.4 47.0 3,047 35-39 5.6 47.6 1.7 0.1 50.9 2,315 40-44 6.3 45.8 1.6 0.3 53.3 2,092 45-49 4.8 46.0 2.1 0.2 52.8 1,766 Residence Urban 13.2 77.7 2.6 0.7 21.3 5,047 Rural 3.1 40.4 2.7 0.3 57.6 12,816 Division Barisal 7.6 38.5 2.0 0.3 59.6 1,111 Chittagong 5.2 54.8 2.6 0.3 43.6 3,301 Dhaka 7.6 58.1 2.6 0.5 40.3 6,223 Khulna 5.0 51.0 2.8 0.2 47.5 1,838 Rajshahi 4.4 50.3 2.6 0.4 48.5 2,103 Rangpur 4.6 39.8 3.9 0.4 56.8 2,056 Sylhet 4.4 35.0 1.4 0.2 64.1 1,232 Education No education 0.0 30.2 1.0 0.0 69.3 4,455 Primary incomplete 0.5 41.2 1.9 0.0 57.4 3,223 Primary complete1 1.0 45.6 2.3 0.1 53.0 1,986 Secondary incomplete 5.5 61.5 3.2 0.5 36.2 5,628 Secondary complete or higher2 27.8 80.0 5.6 1.7 16.7 2,571 Wealth quintile Lowest 0.9 10.2 1.6 0.2 88.2 3,359 Second 1.3 21.0 2.0 0.0 76.9 3,408 Middle 2.6 53.3 3.0 0.3 44.3 3,560 Fourth 4.1 73.1 3.0 0.5 25.4 3,758 Highest 19.6 89.7 3.5 1.0 9.0 3,778 Total 5.9 50.9 2.7 0.4 47.4 17,863 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Figure 3.2 shows the proportion of women listening to the radio every week has decreased markedly over the years, dropping from 19 percent in 2007, to 5 percent in 2011 and 3 percent in 2014. Television reaches the most women throughout the period (47 percent in 2007, 48 percent in 2011, and 51 percent in 2014). Younger women are more likely to watch television or listen to the radio than older women. There is a wide gap in media exposure by urban-rural residence. For example, the proportion of urban women who watch television once a week is 78 percent compared with 40 percent of rural women. Media exposure is positively related to the respondent’s educational level and economic status. Regular exposure to mass media is highest among women with secondary or higher education and women in the highest wealth quintile. 34 • Characteristics of Respondents Figure 3.2 Trends in exposure to mass media of ever-married women, 2007-2014 3.5 EMPLOYMENT The 2014 BDHS asked respondents a number of questions regarding their employment status, including whether they had worked in the 12 months before the survey. The results are presented in Table 3.5. At the time of the survey, 33 percent of ever-married women age 15-49 were currently employed. Three percent were not working, although they had worked in the 12 months prior to the survey, while the remaining 64 percent said that they had not been employed in the previous 12 months (Table 3.5). The proportion currently employed is lowest among women age 15-19 (16 percent) and peaks at 40 percent in the 40-44 age group. The level of employment increases with the number of children. Women who have five or more children are more likely to be employed (37 percent) compared with women with no children (23 percent). Rural women are more likely than urban women to be employed (34 percent compared with 31 percent). Variations are found across geographic divisions. The proportion of women who are employed ranges from 42 percent in Rajshahi to 18 percent in Sylhet. The proportion of women who are currently employed decreases with education. For example, 42 percent of women with no education are employed compared with 25 percent of women who completed secondary level. Women in the lowest wealth quintile are more likely to be currently employed compared with women in the highest wealth quintile (41 percent and 25 percent, respectively). 7 47 19 45 6 48 5 49 6 51 3 47 Newspaper Television Radio No media Percent BDHS 2007 BDHS 2011 BDHS 2014 Characteristics of Respondents • 35 Table 3.5 Employment status Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Bangladesh 2014 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 16.2 1.7 82.1 100.0 2,029 20-24 26.1 2.0 71.9 100.0 3,224 25-29 34.1 2.9 63.0 100.0 3,390 30-34 39.0 2.6 58.4 100.0 3,047 35-39 39.3 2.7 58.0 100.0 2,315 40-44 39.8 3.0 57.2 100.0 2,092 45-49 37.1 2.5 60.4 100.0 1,766 Marital status Currently married 31.9 2.4 65.7 100.0 16,858 Divorced/separated/ widowed 53.8 3.1 43.1 100.0 1,005 Number of living children 0 22.8 2.2 75.1 100.0 1,814 1-2 33.0 2.5 64.5 100.0 9,478 3-4 35.9 2.8 61.3 100.0 5,180 5+ 36.7 1.5 61.8 100.0 1,391 Residence Urban 31.1 2.2 66.6 100.0 5,047 Rural 33.9 2.6 63.5 100.0 12,816 Division Barisal 26.5 2.7 70.8 100.0 1,111 Chittagong 26.3 0.9 72.8 100.0 3,301 Dhaka 34.9 3.1 62.0 100.0 6,223 Khulna 33.9 3.3 62.9 100.0 1,838 Rajshahi 42.3 3.6 54.0 100.0 2,103 Rangpur 40.8 2.1 57.1 100.0 2,056 Sylhet 18.4 1.1 80.5 100.0 1,232 Education No education 42.1 3.1 54.8 100.0 4,455 Primary incomplete 37.5 3.1 59.4 100.0 3,223 Primary complete2 34.8 3.0 62.1 100.0 1,986 Secondary incomplete 26.6 1.9 71.5 100.0 5,628 Secondary complete or higher3 24.8 1.4 73.7 100.0 2,571 Wealth quintile Lowest 40.7 2.6 56.6 100.0 3,359 Second 36.7 4.0 59.3 100.0 3,408 Middle 32.8 2.5 64.7 100.0 3,560 Fourth 31.8 2.2 65.9 100.0 3,758 Highest 24.6 1.2 74.2 100.0 3,778 Total 33.1 2.5 64.4 100.0 17,863 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 2 Primary complete is defined as completing grade 5. 3 Secondary complete is defined as completing grade 10. 3.6 OCCUPATION Respondents who had worked in the 12 months preceding the survey were asked about their occupation. The results are presented in Table 3.6, which shows the distribution of employed women by occupation, according to background characteristics. Four in ten working women are engaged in poultry or cattle raising (41 percent), 14 percent work as semi-skilled labor, and 6 percent perform professional or technical services. Eight percent each of women are engaged in business and factory or blue collar services, and 7 percent each perform home-based manufacturing work or serve as domestic servants. The relationship between women’s occupation and age is mixed; younger women are more likely than older women to be engaged in factory work, semi-skilled labor services, and home-based manufacturing activities. In contrast, older women are more likely than younger women to work in business, in agriculture, or as domestic servants. 36 • Characteristics of Respondents Table 3.6 Occupation Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Bangladesh 2014 Background characteristic Profes- sional/ technical Business Factory worker, blue collar service Semi- skilled labor/ service Unskilled labor Farmer/ agri- cultural worker Poultry/ cattle raising Home based manu- facturing Domestic servant Other Missing Total Number of women Age 15-19 6.0 3.5 16.2 25.2 1.1 2.1 28.3 14.9 2.2 0.3 0.1 100.0 363 20-24 4.9 6.4 11.2 24.7 1.1 3.8 35.7 8.1 3.0 0.3 0.7 100.0 906 25-29 8.2 6.1 8.4 16.4 3.7 5.0 36.4 8.7 6.5 0.1 0.6 100.0 1,253 30-34 5.3 8.3 7.8 13.3 1.9 5.6 44.8 5.7 6.6 0.2 0.5 100.0 1,267 35-39 6.4 10.8 8.3 11.5 3.1 7.2 38.0 6.0 8.0 0.4 0.4 100.0 972 40-44 7.5 7.7 5.8 8.0 5.3 4.9 46.1 4.4 9.4 0.7 0.2 100.0 896 45-49 3.7 8.7 4.3 5.4 2.2 6.6 51.4 5.3 10.4 0.8 1.1 100.0 699 Marital status Married or living together 6.4 7.8 7.8 14.5 1.8 5.0 43.0 7.1 5.5 0.4 0.6 100.0 5,784 Divorced/separated/ widowed 3.3 6.4 13.0 12.7 12.7 8.0 18.1 5.0 20.2 0.4 0.1 100.0 572 Number of living children 0 14.0 3.5 16.7 25.7 0.9 1.8 20.6 10.5 4.9 1.0 0.4 100.0 453 1-2 8.3 7.3 8.0 17.6 3.1 4.9 37.2 6.8 6.0 0.3 0.5 100.0 3,368 3-4 2.3 8.9 8.0 9.0 2.7 6.1 47.0 6.7 8.2 0.3 0.8 100.0 2,004 5+ 0.3 8.4 3.9 3.9 2.7 7.9 57.4 6.2 8.6 0.5 0.1 100.0 531 Residence Urban 12.2 6.5 13.7 23.9 1.9 1.5 14.2 10.2 15.1 0.3 0.4 100.0 1,683 Rural 4.0 8.1 6.3 10.9 3.1 6.7 50.4 5.8 3.9 0.4 0.6 100.0 4,673 Division Barisal 10.7 6.9 3.4 10.5 3.2 1.4 46.2 7.7 7.9 2.0 0.2 100.0 324 Chittagong 7.1 5.7 9.2 18.1 0.6 11.9 31.7 9.7 5.6 0.4 0.1 100.0 897 Dhaka 6.3 7.5 11.9 18.1 3.1 2.6 36.2 6.0 7.7 0.2 0.2 100.0 2,365 Khulna 4.4 11.3 5.8 12.4 3.4 6.3 40.8 7.8 6.7 0.2 0.8 100.0 682 Rajshahi 4.6 9.2 5.9 11.2 2.2 3.3 48.7 9.4 4.0 0.4 1.2 100.0 967 Rangpur 5.3 5.5 2.8 7.6 3.1 9.1 55.3 4.3 5.7 0.1 1.1 100.0 881 Sylhet 9.5 8.0 13.4 10.5 6.6 3.8 27.5 2.6 17.2 0.8 0.1 100.0 240 Educational attainment No education 0.9 8.7 9.7 4.5 5.9 9.3 40.7 5.7 13.7 0.4 0.4 100.0 2,015 Primary incomplete 0.1 7.3 8.8 12.3 3.1 6.6 46.1 7.4 7.8 0.1 0.6 100.0 1,310 Primary complete1 0.6 7.5 9.7 17.3 1.3 1.9 44.7 11.0 5.3 0.2 0.4 100.0 751 Secondary incomplete 2.6 7.4 8.1 23.1 0.6 2.9 45.1 8.1 1.0 0.5 0.7 100.0 1,605 Secondary complete or higher2 48.3 6.0 2.0 23.4 0.0 0.5 16.0 2.7 0.1 0.5 0.7 100.0 675 Wealth quintile Lowest 0.5 5.9 6.7 4.1 6.6 13.3 45.1 8.9 7.5 0.4 0.9 100.0 1,457 Second 2.6 8.6 4.3 7.8 3.1 6.3 54.5 7.8 4.5 0.2 0.3 100.0 1,388 Middle 3.9 9.6 5.0 13.2 1.8 3.4 50.6 7.4 4.5 0.3 0.4 100.0 1,255 Fourth 5.1 8.1 14.7 22.4 1.1 0.8 32.9 6.5 7.6 0.6 0.3 100.0 1,280 Highest 24.0 5.6 12.1 29.9 0.3 0.4 12.5 2.8 11.2 0.4 0.8 100.0 976 Total 6.2 7.7 8.3 14.3 2.8 5.3 40.8 7.0 6.8 0.4 0.5 100.0 6,356 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Urban-rural residence has a marked effect on occupation. As expected, rural women are more likely than urban women to be engaged in agriculture, poultry or cattle raising, and unskilled labor or business. In contrast, women in urban areas are more likely to be engaged in professional or technical services, factory work or blue collar services, semi-skilled labor/services, home-based manufacturing work, and as domestic servants. About one in two women (48 percent) with secondary or higher levels of education are employed in professional or technical jobs, and about one in four work in semi-skilled services. In contrast, women with little or no education are more likely than those with more education to be engaged in factory or blue collar services and as domestic servants. The majority of women in the highest wealth quintile are engaged in professional/technical work (24 percent), worked in factory or blue collar services (12 percent), semi- skilled labor/service (30 percent), and as domestic servants (11 percent). The majority of women in the lowest wealth quintile are unskilled laborers and farmers or agriculture workers. Characteristics of Respondents • 37 3.7 EARNINGS, EMPLOYERS, AND CONTINUITY OF EMPLOYMENT Table 3.7 shows the percent distribution of ever-married women employed in the 12 months prior to the survey by type of earnings, type of employer, and continuity of employment. This table presents data by whether respondents work in the agricultural or nonagricultural sector. Overall, 8 in 10 women who were employed work for cash only, and 6 percent receive cash and in-kind payment. There are significant variations in cash payment between women who work in agriculture (80 percent) and those who do not work in agriculture (91 percent). Table 3.7 Type of employment Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Bangladesh 2014 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 79.7 90.9 84.9 Cash and in-kind 7.6 4.3 6.1 In-kind only 1.2 1.8 1.5 Not paid 11.2 2.9 7.4 Missing 0.1 0.2 0.2 Total 100.0 100.0 100.0 Type of employer Employed by family member 61.7 26.9 45.6 Employed by nonfamily member 14.0 58.4 34.7 Self-employed 24.1 14.4 19.5 Missing 0.2 0.3 0.2 Total 100.0 100.0 100.0 Continuity of employment All year 87.6 82.8 85.4 Seasonal 5.7 7.4 6.5 Occasional 6.5 9.5 7.9 Missing 0.2 0.3 0.3 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 3,371 2,952 6,356 Note: Total includes women with missing information on type of employment who are not shown separately. Agriculture work includes farmer, land owner, agricultural worker, fisherman, raiser of poultry/cattle The proportion of women in agricultural work who receive cash payment has declined from 90 percent in 2011 to 85 percent in 2014. At the same time, the proportion of women who were paid entirely in kind is almost similar to that in an earlier survey (about 2 percent) (NIPORT et al. 2013). Less than half of women (46 percent) are employed by family members, one in three women (35 percent) are employed by a nonfamily member, and 20 percent are self-employed. Women who work in agriculture are more likely than women who work in the nonagricultural sector to be employed by a family member (62 and 27 percent, respectively), while women who work in the nonagricultural sector are more often employed by a nonfamily member (58 and 14 percent, respectively). Eighty-five percent of employed women work all year round, and 15 percent work either seasonally (7 percent) or occasionally (8 percent). Continuity of employment varies by sector. Eighty-eight percent of women who work in the agricultural sector work year round, compared with 83 percent of women engaged in nonagricultural work. Twelve percent of women who are employed in agricultural sector are seasonal or occasional workers. Marriage and Sexual Activity • 39 MARRIAGE AND SEXUAL ACTIVITY 4 4.1 INTRODUCTION his chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhea and abstinence from sexual relations, and menopause. The chapter also includes information on more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Finally, measures of several other proximate determinants of fertility which, like marriage and sexual intercourse, influence exposure to the risk of pregnancy are presented: durations of postpartum amenorrhea, postpartum abstinence, and menopause. Marriage is a primary indication of the exposure of women to the risk of pregnancy and, therefore, is important for the understanding of fertility. Populations in which age at marriage is low tend to be populations with early childbearing and high fertility. For this reason, there is an interest in trends in age at marriage. Only women who had been married or were married were interviewed with the 2014 BDHS Woman’s Questionnaire. However, a number of the tables presented in this chapter are based on all women, both ever-married and never-married. For these tables, the number of ever-married women interviewed in the survey is multiplied by an inflation factor that equals the ratio of all women to ever married women, as reported in the Household Questionnaire. This procedure expands the denominators in those tables, so that they represent all women. The inflation factors are calculated by single years of age. When the results are presented by background characteristics, single-year inflation factors are calculated separately for each category of the characteristic. The definition of marriage is not universal for all countries and religions. In Bangladesh, it is common for a woman to wait several months or even years after formal marriage before starting to live with her husband. Since the 2014 BDHS is interested in marriage mainly as it affects exposure to the risk of pregnancy, interviewers were instructed to ask questions about marriage in terms of cohabitation rather than T Key Findings • Age at first marriage among women has risen slowly over the past two decades. The median age at first marriage among women age 20-49 increased from 14.4 years in 1993-94 to 16.1 years in 2014. • Fifty-nine percent of women age 20-24 now marry before age 18. Between 2000 and 2011, the percentage that married before age 18 changed very little. In the last three years, however, this percentage has dropped noticeably, from 65 percent in 2011 to 59 percent in 2014. • Seventy-eight percent of ever-married women were sexually active within the past four weeks, and another 12 percent were active within the past 1 to 12 months. • Thirteen percent of currently married women reported that their husbands lived elsewhere, and 5 percent of currently married women said they had not seen their spouse in the 12 months preceding the survey. • Almost 40 percent of women age 15-49 would have preferred to marry later than they actually did. Half of the women who married before age 18 would have preferred to marry later. 40 • Marriage and Sexual Activity formal marriage. Additionally, questions in the BDHS 2014 explore the consequences of marriage on education and employment. 4.2 CURRENT MARITAL STATUS Table 4.1 shows the current marital status of women age 15-49 by age. The proportion of never married women age 15-49 is 15 percent. This proportion falls sharply with increasing age. It declines from 55 percent for women age 15-19 to less than 1 percent among women age 35 or older. The low proportion of women age 25-29 who have never been married (4 percent) indicates that marriage is universal in Bangladesh and that more than nine in ten women marry before age 30. Eight in ten women (80 percent) are currently married. Three percent of women age 15-49 are widowed. The proportion of women who are widowed increases sharply with age and is mostly limited to older age groups: 8 percent of women age 40-44 and 13 percent of women age 45-49 are widowed. Divorce and separation are uncommon in Bangladesh. Two percent of women age 15-49 are either divorced or separated. The proportion divorced or separated does not vary markedly by age group. Table 4.1 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Bangladesh 2014 Marital status Total Percentage of respondents currently in union Number of respon- dents Age Never married Married Divorced Separated Widowed 15-19 54.8 44.2 0.4 0.5 0.1 100.0 44.2 4,485 20-24 15.5 83.0 0.8 0.6 0.2 100.0 83.0 3,816 25-29 4.1 92.0 0.8 1.7 1.4 100.0 92.0 3,534 30-34 1.2 94.6 0.7 0.9 2.6 100.0 94.6 3,084 35-39 0.8 92.3 0.9 2.1 3.9 100.0 92.3 2,334 40-44 0.6 89.0 0.8 1.5 8.1 100.0 89.0 2,105 45-49 0.2 85.5 0.4 1.5 12.5 100.0 85.5 1,769 Total 15.4 79.8 0.7 1.1 3.0 100.0 79.8 21,127 Table 4.2 shows the trend in the percentage of women who have never married by age group for the 1975-2014 period. The proportion of women who have never married affects fertility levels in a society like Bangladesh, where childbearing outside of marriage is uncommon. The proportion of never-married women age 15-19 has increased from 30 percent in 1975 to 55 percent in 2014. Similarly, the proportion of never- married women age 20-24 increased from 5 percent in 1975 to 19 percent in 1999-2000 and then declined with some fluctuations to 16 percent in 2014. Table 4.2 Trends in proportion never married Percentage of women who have never married, by age group, as reported in various surveys, Bangladesh 1975-2014 Age 1975 BFS 1983 CPS 1985 CPS 1989 BFS 1989 CPS 1991 CPS 1993- 1994 BDHS 1996- 1997 BDHS 1999- 2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS 2014 BDHS 10-14 91.2 98.0 98.7 96.2 96.4 98.5 95.2 95.2 92.7 88.6 u u u 15-19 29.8 34.2 47.5 49.0 45.8 46.7 50.5 49.8 51.9 52.1 52.8 54.3 54.8 20-24 4.6 4.0 7.1 12.0 9.3 12.3 12.4 17.2 18.5 15.2 14.3 13.4 15.5 25-29 1.0 0.7 1.0 2.3 1.6 2.8 2.2 3.4 4.2 4.2 4.3 3.0 4.1 30-34 0.2 0.4 0.1 0.3 0.5 0.5 0.3 0.5 0.1 1.2 0.6 1.2 1.2 35-39 0.4 - - 0.1 0.5 0.1 0.3 0.0 0.2 0.4 0.6 0.8 0.8 40-44 0.1 0.1 - 0.2 0.2 0.3 0.7 0.0 0.0 0.3 0.2 0.3 0.6 45-49 0.0 0.1 - 0.1 0.1 - 0.2 0.0 0.0 0.0 0.8 0.2 0.2 - = Less than 0.1 percent u = Unknown/not available Sources: 1975 BFS (MHPC 1978:49); 1983, 1985, 1989, and 1991 CPS (Mitra et al. 1993:24); 1989 BFS (Huq and Cleland 1990:43); 1993-1994 BDHS (Mitra et al. 1994:72); 1996-1997 BDHS (Mitra et al. 1997:82); 1999-2000 BDHS (NIPORT et al. 2001:78); 2004 BDHS (NIPORT et al. 2005: 93); 2007 BDHS (NIPORT et al. 2009:77); 2011 BDHS (NIPORT et al. 2013:49). Marriage and Sexual Activity • 41 4.3 AGE AT FIRST MARRIAGE Marriage is the leading social and demographic indicator of the exposure of women to the risk of pregnancy. Marriage in Bangladesh marks the point in a woman’s life when childbearing becomes socially acceptable. Age at first marriage has a major effect on childbearing because the risk of pregnancy depends primarily on the age at which women first marry. Women who marry early, on average, are more likely to have their first child at a young age and give birth to more children overall, contributing to higher fertility. As never-married women were not interviewed in the BDHS, tables on age at marriage were generated using expansion factors. The expansion factors are based on the assumption that the reporting of age and marital status in the Household Questionnaire is correct. This means that there was no bias in the reporting of age of ever-married women and that there were no errors in the reporting of marital status, especially of young women. Table 4.3 shows, by current ages, the percentages of women who have married, the percentages who have never married, and the median age at first marriage. Marriage occurs early for women in Bangladesh. Among women age 20-49, 71 percent married by age 18, and 85 percent married by age 20. Within each age cohort, the proportion of women marrying by a specific age increases. For example, among women age 25- 29, 69 percent married by age 18 and 94 percent married by age 25. The proportion of women marrying in their early teens continues to decline. For example, the proportion of women marrying by age 15 has declined by more than two-thirds over time, from 46 percent among women now age 45-49 to 16 percent among women age 15-19. Similarly, the proportion of women marrying by age 18 and age 20 decreases substantially from the oldest to the youngest cohort. Table 4.3 shows a slow but steady increase over the last three decades in the age at which Bangladeshi women first marry, from a median age of 15 years for women in their mid to late forties to 17.2 years for those in their early twenties. Table 4.3 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Bangladesh 2014 Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage Current age 15 18 20 22 25 15-19 16.3 na na na na 54.8 4,485 a 20-24 22.4 58.6 76.5 na na 15.5 3,816 17.2 25-29 30.7 68.7 83.1 88.7 93.7 4.1 3,534 16.4 30-34 35.5 72.8 88.2 93.3 96.8 1.2 3,084 16.0 35-39 39.8 77.1 89.5 94.5 97.0 0.8 2,334 15.6 40-44 45.3 80.1 90.9 95.3 97.4 0.6 2,105 15.3 45-49 46.2 80.7 91.8 96.1 98.1 0.2 1,769 15.3 20-49 34.4 71.0 85.3 na na 4.9 16,642 16.1 25-49 38.0 74.7 88.0 93.0 96.3 1.7 12,826 15.8 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women began living with their spouse or partner for the first time before reaching the beginning of the age group. A comparison of the 2014 BDHS survey results with findings from prior surveys confirms that the median age at first marriage for women in Bangladesh continues to increase. The median age at marriage among women age 20-49 has increased by almost two years, from 14.4 years in 1993-94 (Mitra et al. 2004) to 16.1 years in 2014. The legal age of marriage for women in Bangladesh is 18 years, but a large proportion of marriages still take place before the woman reaches her legal age. The 2014 BDHS found that 59 percent of women age 20-24 were married before age 18 (Figure 4.1). Between 2000 and 2011, the proportion who married 42 • Marriage and Sexual Activity before age 18 had hardly changed. But between 2011 and 2014 this proportion declined from 65 percent to 59 percent, the largest change ever observed between two BDHS surveys. Over the past two decades, the proportion of women marrying before the legal age has decreased by 14 percentage points overall from 73 percent in 1993-94 to 59 percent in 2014. Figure 4.1 Trends in proportion of women age 20-24 who were first married by age 18 Table 4.4 examines the median age at first marriage for women age 20-49 and 25-49, according to background characteristics. The median age at first marriage among women age 20-49 is 16.1 years. Urban women marry one year later than their rural counterparts (16.9 years versus 15.8 years). The median age at marriage varies among administrative divisions. It ranges from 15.3 years in Rangpur to 17.6 years in Sylhet. Women’s education shows a strong positive association with age at marriage. For example, women who have completed secondary or higher education marry almost five years later than those with no education. Similarly, age at marriage increases with household wealth. Women in the highest wealth quintile marry two years later than those in the lowest wealth quintile. 73 69 65 68 66 65 59 1993-94 BDHS 1996-97 BDHS 1999-00 BDHS 2004 BDHS 2007 BDHS 2011 BDHS 2014 BDHS Percent Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, according to background characteristics, Bangladesh 2014 Background characteristic Women age 20-49 25-49 Residence Urban 16.9 16.6 Rural 15.8 15.6 Division Barisal 16.1 15.8 Chittagong 16.8 16.5 Dhaka 16.2 15.9 Khulna 15.5 15.3 Rajshahi 15.5 15.3 Rangpur 15.3 15.0 Sylhet 17.6 16.9 Education No education 15.0 14.9 Primary incomplete 15.3 15.1 Primary complete1 15.7 15.5 Secondary incomplete 16.4 16.3 Secondary complete or higher2 19.9 19.6 Wealth quintile Lowest 15.3 15.2 Second 15.7 15.4 Middle 16.0 15.7 Fourth 16.3 15.8 Highest 17.6 17.3 Total 16.1 15.8 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/ partner. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Marriage and Sexual Activity • 43 4.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first marriage is often used as a proxy for first exposure to intercourse and risk of pregnancy. But these two events may not occur at the same time because some people may engage in sexual activity before marriage. To obtain insight into onset of sexual activity, the 2014 BDHS asked ever-married women how old they were when they first had sexual intercourse. It was recognized that the answer to this question might be biased since the respondent may have been uncomfortable providing information on premarital sex. In fact, the BDHS results show that virtually no ever-married women reported initiating sexual activity before they first married. Table 4.5 shows the percentage of women age 15-49 who had first sexual intercourse by specific ages, the percentage who never had sexual intercourse, and the median age of first sexual intercourse. The table was generated using the information on the age at first sex from the ever-married women interviewed in the BDHS and assuming that never-married women have not had intercourse. Given the conservative nature of the Bangladeshi society, that assumption is likely correct for many never-married women. However, it is clearly a source of potential for bias in the reporting of age at first intercourse, because some women who have never married are likely to have initiated sexual activity. It also must be recognized that not all ever married women who engaged in premarital sexual activity are likely to report that behavior in the survey, adding to the bias in the results shown in Table 4.5. Nevertheless, the data in Table 4.5 are useful since they document the information the BDHS was able to obtain on premarital sexual activity in Bangladeshi society. Table 4.5 shows that the median age at first sexual intercourse among women age 20-49 (16.2 years) is almost equal to the median age at first marriage (16.1 years). The median age at first sexual intercourse is higher among women age 20-24 than among older women. Looking at specific ages, 33 percent of women age 20-49 had sexual intercourse by age 15, which compares with 69 percent by age 18, and 83 percent by age 20. Five percent of women age 20-49 had never experienced sexual intercourse. Table 4.5 Age at first sexual intercourse Percentage of women age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Bangladesh 2014 Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number Median age at first intercourse Current age 15 18 20 22 25 15-19 15.0 na na na na 55.0 4,485 a 20-24 21.2 56.0 74.5 na na 15.6 3,816 17.4 25-29 29.8 66.3 81.3 86.9 91.7 4.2 3,534 16.5 30-34 34.0 70.6 85.9 90.8 94.3 1.2 3,084 16.1 35-39 39.0 75.2 87.2 92.1 94.7 0.8 2,334 15.7 40-44 43.9 78.2 88.5 92.7 94.5 0.6 2,105 15.4 45-49 45.1 78.8 89.7 93.8 95.5 0.2 1,769 15.4 20-49 33.3 68.8 83.2 na na 4.9 16,642 16.2 25-49 36.9 72.6 85.8 90.7 93.8 1.7 12,826 15.9 15-24 17.9 na na na na 36.8 8,301 a na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group 44 • Marriage and Sexual Activity Table 4.6 examines the median age at first sexual intercourse among women age 20-49 by background characteristics. Women living in rural areas tend to initiate sexual intercourse earlier than their urban counterparts. There is greater variation in median age at first sexual intercourse among administrative division than by urban or rural residence. Women in Sylhet are likely to start having sexual intercourse about two years later than women in Rangpur. Women age 25-49 who have completed secondary or higher education initiate sex about five years later than women with no education. Age at first sexual intercourse also increases with household wealth. 4.5 RECENT SEXUAL ACTIVITY In the absence of contraception, the possibility of pregnancy is positively related to the frequency of sexual intercourse. Thus, information on intercourse is important for refining measurement of exposure to pregnancy. All ever-married women were asked how long ago their last sexual contact occurred. As the length of time since their last sexual contact increased, the chance of becoming pregnant decreased. Table 4.7 shows the percent distribution of ever-married women age 15-49 by timing of their last sexual intercourse, according to background characteristics. The data show that 78 percent of ever-married women age 15-49 were sexually active during the four weeks preceding the survey. An additional 12 percent were sexually active in the 12 months preceding the survey, and 10 percent had their last sexual intercourse one or more years prior to the survey. Women in the oldest group (45-49), are the least likely to have had their last sexual intercourse in the past four weeks (64 percent) compared with the youngest women. More than 8 in 10 married women age 20-24, 25-29, and 30-34 had their last sexual intercourse in the four weeks preceding the survey. There are no noticeable variations in recent sexual activity by marital duration and by urban-rural residence. There are large variations in the timing of last sexual intercourse by administrative divisions. The proportion of women who were sexually active in the past four weeks ranges from 70 percent in Chittagong to 85-86 percent in Rajshahi and Rangpur. The relationship between a woman’s education and sexual activity shows no clear pattern; however, women with no education are the least likely to have been sexually active in the past four weeks (75 percent). In contrast, women in the lowest wealth quintile are the most likely to have had their last sexual intercourse in the past four weeks (80 percent) when compared with women in the higher quintiles. Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, according to background characteristics, Bangladesh 2014 Background characteristic Women age 20-49 25-49 Residence Urban 17.0 16.7 Rural 15.9 15.6 Division Barisal 16.2 15.8 Chittagong 17.0 16.6 Dhaka 16.3 16.0 Khulna 15.6 15.4 Rajshahi 15.6 15.4 Rangpur 15.4 15.1 Sylhet 17.8 17.1 Education No education 15.0 15.0 Primary incomplete 15.3 15.2 Primary complete1 15.8 15.6 Secondary incomplete 16.5 16.4 Secondary complete or higher2 a 19.7 Wealth quintile Lowest 15.3 15.2 Second 15.7 15.4 Middle 16.0 15.8 Fourth 16.4 15.9 Highest 17.9 17.6 Total 16.2 15.9 a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Marriage and Sexual Activity • 45 Table 4.7 Recent sexual activity Percent distribution of ever-married women age 15-49 by timing of last sexual intercourse, according to background characteristics, Bangladesh 2014 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 78.1 16.0 5.3 0.1 0.4 100.0 2,029 20-24 81.7 11.2 7.0 0.0 0.1 100.0 3,224 25-29 81.0 9.5 9.4 0.0 0.1 100.0 3,390 30-34 81.9 9.1 9.0 0.0 0.0 100.0 3,047 35-39 78.5 9.5 12.0 0.0 0.0 100.0 2,315 40-44 74.0 12.1 13.9 0.1 0.0 100.0 2,092 45-49 63.9 16.5 19.4 0.1 0.0 100.0 1,766 Marital status Married or living together 82.8 11.6 5.5 0.0 0.1 100.0 16,858 Divorced/separated/ widowed 0.1 9.2 90.0 0.0 0.7 100.0 1,005 Marital duration2 0-4 years 79.6 14.9 5.2 0.1 0.3 100.0 3,341 5-9 years 84.1 10.2 5.7 0.0 0.0 100.0 2,822 10-14 years 85.7 8.6 5.6 0.0 0.0 100.0 2,916 15-19 years 85.9 8.1 6.1 0.0 0.0 100.0 2,383 20-24 years 84.8 9.9 5.3 0.0 0.0 100.0 1,908 25+ years 78.6 15.8 5.4 0.1 0.0 100.0 2,920 Married more than once 81.3 14.2 4.5 0.0 0.0 100.0 569 Residence Urban 79.6 10.3 9.9 0.1 0.1 100.0 5,047 Rural 77.6 12.0 10.4 0.0 0.1 100.0 12,816 Division Barisal 75.1 16.4 8.3 0.0 0.2 100.0 1,111 Chittagong 69.9 14.3 15.8 0.0 0.1 100.0 3,301 Dhaka 79.2 10.9 9.7 0.1 0.1 100.0 6,223 Khulna 78.2 12.6 9.2 0.0 0.0 100.0 1,838 Rajshahi 84.8 8.7 6.3 0.0 0.2 100.0 2,103 Rangpur 85.5 8.0 6.4 0.0 0.1 100.0 2,056 Sylhet 73.6 11.6 14.8 0.0 0.1 100.0 1,232 Education No education 74.5 11.0 14.4 0.0 0.0 100.0 4,455 Primary incomplete 79.3 10.8 9.7 0.0 0.1 100.0 3,223 Primary complete3 80.2 10.8 9.0 0.0 0.0 100.0 1,986 Secondary incomplete 78.9 11.7 9.2 0.1 0.1 100.0 5,628 Secondary complete or higher4 79.4 13.3 7.2 0.0 0.1 100.0 2,571 Wealth quintile Lowest 80.3 10.8 8.9 0.0 0.1 100.0 3,359 Second 81.2 10.4 8.3 0.1 0.1 100.0 3,408 Middle 77.3 12.6 9.9 0.0 0.2 100.0 3,560 Fourth 75.7 11.5 12.7 0.0 0.1 100.0 3,758 Highest 76.6 12.2 11.2 0.0 0.0 100.0 3,778 Total 78.1 11.5 10.3 0.0 0.1 100.0 17,863 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 3 Primary complete is defined as completing grade 5. 4 Secondary complete is defined as completing grade 10. 4.7 SPOUSAL SEPARATION Repeated seasonal migration has the potential to lower birth rates. The effect of spousal separation in reducing fertility varies with the length of separation. It is expected that the cumulative impact of spousal separation is greatest in areas of relatively high fertility and low modern contraceptive prevalence. However, this has been difficult to ascertain as there have not been many studies to illustrate the effect of spouse separation on fertility. Table 4.8 shows the percentage of currently married women age 15-49 whose husband lives elsewhere and the frequency of the husband’s visits in the last 12 months. Overall, 13 percent of currently married women have a husband who lives elsewhere. Younger women, age 15-19 (19 percent), women who 46 • Marriage and Sexual Activity Table 4.8 Husband’s visit Percentage of currently married woman age 15-49 whose husband lives elsewhere, and among currently married women whose husband lives elsewhere, percent distribution by frequency of husband’s visit in the last 12 months, according to background characteristic, Bangladesh 2014 Background characteristic Percentage of women whose husband lives elsewhere Number of women Among currently married women whose husband lives elsewhere, frequency of husband’s visit to the household in the past 12 months Total Number of women 0 1-5 6-11 12+ Missing Age 15-19 18.8 1,984 35.0 43.2 15.9 5.5 0.5 100.0 374 20-24 16.7 3,166 40.6 37.3 11.9 9.6 0.6 100.0 529 25-29 13.6 3,249 47.1 32.5 10.3 10.1 0.0 100.0 441 30-34 12.1 2,919 49.0 30.3 14.0 5.7 1.0 100.0 354 35-39 10.6 2,153 41.8 35.6 12.4 9.3 0.8 100.0 227 40-44 5.9 1,874 36.8 37.0 20.2 6.0 0.0 100.0 111 45-49 4.4 1,512 36.0 44.6 11.6 7.7 0.0 100.0 66 Marital duration 0-4 years 20.1 3,341 36.1 40.8 13.6 9.3 0.3 100.0 671 5-9 years 13.9 2,822 43.3 35.3 11.9 8.7 0.8 100.0 392 10-14 years 12.3 2,916 49.5 30.7 12.0 7.3 0.5 100.0 359 15-19 years 12.1 2,383 49.4 28.7 14.9 6.3 0.7 100.0 289 20-24 years 9.9 1,908 41.7 42.1 8.2 7.3 0.8 100.0 188 25+ years 5.1 2,920 39.5 37.7 18.0 4.9 0.0 100.0 148 Married more than once 9.7 569 32.3 38.1 16.6 13.1 0.0 100.0 55 Residence Urban 9.7 4,709 40.8 35.4 15.4 7.6 0.7 100.0 458 Rural 13.5 12,149 42.6 36.4 12.5 8.1 0.4 100.0 1,644 Division Barisal 18.9 1,051 19.9 50.8 23.3 5.0 1.0 100.0 198 Chittagong 23.7 3,121 49.8 34.6 9.0 6.2 0.3 100.0 740 Dhaka 10.6 5,857 42.5 33.0 13.5 10.3 0.8 100.0 624 Khulna 9.5 1,729 39.8 35.1 15.1 9.6 0.5 100.0 164 Rajshahi 7.0 2,007 34.6 36.8 18.4 10.2 0.0 100.0 141 Rangpur 5.2 1,946 14.8 54.3 17.1 13.8 0.0 100.0 101 Sylhet 11.7 1,147 63.3 25.1 8.1 3.5 0.0 100.0 134 Education No education 5.9 3,949 43.6 33.0 14.2 8.7 0.4 100.0 232 Primary incomplete 9.4 3,032 46.6 30.8 17.1 4.1 1.3 100.0 285 Primary complete1 11.4 1,884 37.0 39.2 14.2 9.6 0.0 100.0 215 Secondary incomplete 15.9 5,477 46.7 35.5 10.6 6.8 0.5 100.0 873 Secondary complete or higher2 19.8 2,516 33.3 40.6 14.3 11.4 0.4 100.0 497 Wealth quintile Lowest 6.0 3,097 23.5 43.0 20.0 13.0 0.5 100.0 187 Second 9.5 3,223 34.7 36.8 19.8 8.7 0.0 100.0 305 Middle 14.5 3,394 44.0 32.8 15.3 7.1 0.9 100.0 494 Fourth 16.8 3,556 48.8 34.4 7.7 8.3 0.9 100.0 598 Highest 14.5 3,587 44.0 38.7 10.9 6.4 0.0 100.0 519 Total 12.5 16,858 42.2 36.2 13.1 8.0 0.5 100.0 2,102 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. have been married fewer than 5 years (20 percent), and rural women (14 percent) are more likely than other women to have husbands who live elsewhere. One in four women in Chittagong (24 percent) have husbands who live elsewhere compared with only 5 percent of women in Rangpur. The proportion of women with a husband who lives elsewhere increases with the woman’s education and wealth status. Only 6 percent of women with no education live apart from their husbands compared with 20 percent of those with secondary or higher education. Similarly, 6 percent of women in the lowest wealth quintile live separately from their husbands compared with 17 percent of women in the fourth quintile. Women whose husbands live elsewhere were asked how often their husband came to visit in the past 12 months. Forty-two percent of women say that their husband did not come home in the past 12 months, 36 percent reported that their husband visited 1 to 5 times, 13 percent visited 6 to 11 times, and 8 percent visited 12 or more times. Close to half of women age 30-34 and those married 10-14 and 15-19 years are more likely than other women to report that their husbands did not come home in the past 12 months. There is no substantial variation by urban-rural residence or educational attainment. The number of husband’s visits varied widely by administrative division: only 15 percent of women in Rangpur were not visited by their Marriage and Sexual Activity • 47 husbands in the past 12 months compared with 63 percent of women in Sylhet. The percentage of women whose husbands did not visit in the past year has a negative association with wealth quintile. Husbands of women in the three highest quintiles are less likely to visit their wives compared with those in the lower quintiles, possibly because they are more likely to be employed overseas rather than locally. 4.8 PERCEPTION TOWARD AGE AT FIRST MARRIAGE Table 4.9 shows the percentage of women age 15-49 by preferred age at marriage, according to background characteristics. Overall, more than 50 percent of women think that their marriage took place at an appropriate age, 39 percent would have preferred to marry later, and 8 percent would have preferred to marry at an earlier age. Older women (age 21-49) are more likely than younger women to say that their marriage took place at the right time (54 versus 28 percent). Half of the women (49 percent) who married before age 18 would have preferred to marry later. There are small urban-rural variations regarding preferred and actual age at first marriage. However, there are greater differences across divisions. Whereas 62-63 percent women in Sylhet and Chittagong think that their marriage was took place at the right age, only 43-44 percent of women in Rangpur and Khulna share this opinion. Seven in 10 women who have completed secondary or higher education think that they married at the right age compared with 51 percent of women with no education. Variations across wealth quintiles are less notable. It is interesting to note that 40 percent of women with no education and 39 percent of women belonging to the lowest quintile want to marry later than their actual age at marriage. Table 4.9 Preferred age at first marriage Percent distribution of women age 15-49 by preference for time of first marriage, according to background characteristics, Bangladesh 2014 Background characteristics Married at right time Preferred to marry earlier Preferred to marry later Missing Total Number of women Current age 15-17 27.5 11.6 59.6 1.4 100.0 879 18-20 48.3 9.0 40.9 1.8 100.0 1,799 21-49 53.6 7.2 38.0 1.2 100.0 15,186 Actual age at first marriage <18 40.8 8.8 49.4 1.0 100.0 13,657 18-20 87.3 2.9 7.4 2.3 100.0 3,183 21+ 86.9 6.0 5.0 2.1 100.0 1,024 Residence Urban 53.2 5.1 41.3 0.4 100.0 5,047 Rural 51.2 8.6 38.6 1.6 100.0 12,816 Division Barisal 49.8 12.1 35.8 2.4 100.0 1,111 Chittagong 61.9 3.6 32.6 1.9 100.0 3,301 Dhaka 50.9 8.8 39.4 0.8 100.0 6,223 Khulna 43.6 6.3 48.3 1.8 100.0 1,838 Rajshahi 47.7 3.0 48.1 1.2 100.0 2,103 Rangpur 43.4 9.4 46.1 1.1 100.0 2,056 Sylhet 63.3 14.8 21.0 1.0 100.0 1,232 Education No education 50.7 9.3 39.7 0.3 100.0 4,455 Primary incomplete 46.3 7.1 45.6 1.1 100.0 3,223 Primary complete1 47.6 7.5 43.7 1.2 100.0 1,986 Secondary incomplete 48.8 7.4 41.8 2.0 100.0 5,628 Secondary complete or higher2 70.1 5.7 22.3 1.9 100.0 2,571 Wealth quintile Lowest 47.9 11.6 39.3 1.2 100.0 3,359 Second 52.3 8.6 37.5 1.7 100.0 3,408 Middle 50.4 7.0 41.0 1.6 100.0 3,560 Fourth 50.2 5.9 42.4 1.5 100.0 3,758 Highest 57.4 5.3 36.6 0.6 100.0 3,778 Total 51.7 7.6 39.4 1.3 100.0 17,863 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Fertility • 49 FERTILITY 5 ertility is one of the three principal components of population dynamics that determine the size, structure, and composition of the population in any country. The focus on fertility is due to its important role in determining Bangladesh’s population growth rate and its impact on economic development. The government of Bangladesh (GOB), which has formulated a National Population Policy (MOHFW 2012), seeks to reduce fertility to replacement level by 2015. The Health, Population and Nutrition Sector Development Program (HPNSDP) of Bangladesh embraced program and strategies for reducing fertility through improved access to health, family planning, and nutrition services for the poor and geographically marginalized population (MOHFW 2011a, MOHFW 2011b). Examining current fertility levels, trends, and differentials in Bangladesh will help the policy makers and program managers to monitor and evaluate the HPNSDP. This chapter describes current and past fertility, cumulative fertility, birth intervals, age at first birth, and the reproductive behavior of adolescents. Most of the fertility measures are based on the birth history data collected during interviews with ever-married women age 15-49. In the 2014 BDHS each woman was asked a series of questions that could be used to construct a retrospective history of all of her births. To encourage complete reporting, the interviewer asked the respondent about the number of sons and daughters living with her, the number living elsewhere, and the number who had died. The interviewer then asked for a history of all births, including month and year, name, sex, and survival status of each birth. The interviewers were given extensive training in probing techniques designed to help respondents report this information accurately. F Key Findings • The total fertility rate for the three years preceding the survey is 2.3 births per woman, the same as in the 2011 BDHS. The aim of the 2011-2016 health sector program is to reach a fertility level of 2.0 births per woman by 2016. • Between the 2011 and 2014 BDHS, fertility declined or remained the same in 6 of 7 divisions. Dhaka is the only division where the total fertility rate increased from 2.2 to 2.3. • The total fertility rate in urban areas is nearly half a child lower than in rural areas (2.0 and 2.4 births per woman, respectively). • Khulna and Rangpur divisions have passed the fertility level target of 2.0 births per woman (1.9 births per woman), while Rajshahi and Barisal are close behind (2.1 and 2.2 births per woman, respectively). Sylhet has the highest fertility (2.9 births per woman). • Childbearing begins early in Bangladesh, with almost half of women age 25-49 giving birth by age 18 and nearly 70 percent giving birth by age 20. • Birth intervals are generally long in Bangladesh, with a median interval of 52 months. The median interval increased from 47 months in 2011. The proportion of women with a birth interval of less than 36 months declined from 32 percent in 2011 to 29 percent in 2014. • Thirty-one percent of adolescents age 15-19 in Bangladesh are already mothers or pregnant with their first child. This proportion has not changed in the last three years. 50 • Fertility The following measures of current fertility are derived from the birth history data: • Age-specific fertility rates1 (ASFRs) are expressed as the number of births per 1,000 women in a certain age group. They are a valuable measure to assess the current age pattern of childbearing. ASFRs are defined as the number of live births during a specific period to women in a particular age group, divided by the number of woman-years lived in that age group during the specified period. • The total fertility rate (TFR) represents the average number of children a woman would have by the end of her reproductive period if her experience followed the currently prevalent age- specific fertility rates. The TFR is calculated as the sum of the age-specific fertility rates multiplied by five (each age group covers five years of age). • The general fertility rate (GFR) is expressed as the annual number of live births per 1,000 women age 15-44, and the crude birth rate (CBR) provides a measure of the annual number of live births per 1,000 population. The various measures of current fertility are calculated for the three-year period preceding the survey, which roughly corresponds to the calendar years 2012-2014. A three-year period was chosen because it reflects the current situation without unduly increasing sampling error. Despite efforts to improve data quality, data from the BDHS are subject to the same types of errors that are inherent in all retrospective sample surveys: the possibility of omitting some births (especially births of children who died at a very young age) and the difficulty of accurately determining each child’s date of birth. These errors can bias estimates of fertility trends, which then have to be interpreted within the context of data quality and sample sizes. A summary of the quality of the BDHS data appears in the tables in Appendix C. 5.1 CURRENT FERTILITY Some current fertility measures are presented in Table 5.1 for the three-year period preceding the survey. ASFRs and the TFR for Bangladesh as a whole and for urban and rural areas are shown, along with the GFR and crude birth rate. The TFR is a useful measure of the level of recent fertility. The 2014 BDHS shows that the TFR for the three-year period before the survey is 2.3 children per woman. The overall age pattern of fertility, as reflected in the ASFRs, indicates that Bangladeshi women have a pattern of early childbearing (Figure 5.1). According to current fertility rates, on average, women will have 25 percent of their births before reaching age 20, 55 percent during their twenties, and 18 percent during their thirties. Fertility is 113 births per 1,000 women age 15-19, which increases to a peak of 143 births per 1,000 women age 20-24, and declines thereafter. 1 Numerators for 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 of the mother (in five-year groups) at the time of birth (determined by the mother’s date of birth). The denominators for the rates are the number of woman-years lived in each of the specified five-year age groups during the period 1-36 months preceding the survey. Because only women who had ever married were interviewed in the BDHS, the number of women in the denominator of the rates was inflated by factors calculated from information in the Household Questionnaire on the proportions ever married to produce a count of all women. Never-married women are presumed not to have given birth. Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Bangladesh 2014 Residence Total Age group Urban Rural 15-19 98 120 113 20-24 125 151 143 25-29 94 116 110 30-34 61 56 57 35-39 16 28 24 40-44 3 5 4 45-49 8 3 5 TFR(15-49) 2.0 2.4 2.3 GFR 79 94 90 CBR 20.8 22.8 22.2 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population Fertility • 51 The TFR in the rural areas is higher than in urban areas (2.4 compared with 2.0 births per woman). As the ASFRs show, the pattern of higher rural fertility is prevalent in all age groups. The urban-rural difference in fertility is most pronounced for women in the 20-24 age group (125 births per 1,000 women in urban areas versus 151 births per 1,000 women in rural areas). Figure 5.1 Age-specific fertility rates by urban-rural residence 5.2 FERTILITY DIFFERENTIALS Table 5.2 shows that fertility varies widely by administrative divisions. Khulna and Rangpur divisions have the lowest fertility (1.9 births per woman) and thus have achieved the aim of HPNSDP to reduce fertility to 2.0 births per woman by 2016. Rajshahi and Barisal, with TFRs of 2.1 and 2.2, respectively, are very close to achieving the HPNSDP aim. Although fertility is still high in Sylhet and Chittagong divisions, it has declined from that in the 2011 BDHS. Between the 2011 BDHS and the 2014 BDHS, the TFR in Sylhet declined from 3.1 to 2.9 births per woman and in Chittagong declined from 2.8 to 2.5 births per woman. The only division where fertility has increased is Dhaka. Since Dhaka Division constitutes about one-third of Bangladesh’s population, it has the largest impact on the national fertility rate. As expected, women’s education is associated with fertility. The TFR decreases from 2.4 births for women with no education to 2.0 births for women who have completed secondary or higher education. Fertility is also negatively associated with wealth; the difference in fertility between women in the lowest and highest wealth quintiles amounts to 0.8 child per woman, on average. As shown in Table 5.2, at the time of the survey, 5 percent of women age 15-49 reported that they were pregnant. Reports may be underestimates, especially in the case of pregnancies at early stages, because some women may be unaware of or unwilling to reveal their current status. The percentage of women currently pregnant is higher in rural areas than in urban areas (5 percent and 4 percent, respectively). The percentage of women age 15-49 currently pregnant varies by administrative division. Nine percent of women are currently pregnant in Sylhet, compared with 4 percent in Khulna and Rajshahi. The relationship between the percentage currently pregnant and education is U-shaped, rising from a low of 3 percent among women with no education to a high of 6 percent among women with some secondary education, and then dipping again to 5 percent among women who have completed secondary or higher education. Women in the lowest wealth quintile are more likely to be currently pregnant (7 percent) than women in the highest quintile (4 percent). 98 125 94 61 16 3 8 120 151 116 56 28 5 3 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Births per 1,000 women Age group Urban Rural BDHS 2014 52 • Fertility Table 5.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Bangladesh 2014 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 2.0 4.4 3.4 Rural 2.4 5.3 4.1 Division Barisal 2.2 5.3 4.2 Chittagong 2.5 5.4 4.4 Dhaka 2.3 4.9 3.7 Khulna 1.9 3.9 3.4 Rajshahi 2.1 4.3 3.5 Rangpur 1.9 4.5 3.7 Sylhet 2.9 8.5 4.9 Educational No education 2.4 3.0 4.2 Primary incomplete 2.5 5.3 4.1 Primary complete1 2.4 5.6 3.9 Secondary incomplete 2.4 6.3 3.4 Secondary complete or higher2 2.0 4.8 2.4 Wealth quintile Lowest 2.8 6.6 4.3 Second 2.4 5.7 4.2 Middle 2.2 4.7 4.1 Fourth 2.1 4.5 3.8 Highest 2.0 4.3 3.1 Total 2.3 5.1 3.9 Note: Total fertility rates are for the period 1-36 months prior to interview. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Table 5.2 also presents the mean number of children ever born to women age 40-49, which allows for a crude assessment of trends in fertility. Whereas TFR is a measure of current fertility, the mean number of children ever born to women age 40-49 is a measure of past or completed fertility. Although comparing completed fertility among women age 40-49 with the TFR can provide an indication of fertility change, it is vulnerable to the understatement of parity by older women. Findings on age at marriage and contraceptive use are also of critical importance in reaching a balanced judgment about fertility trends. Unless there is evidence of increased age at marriage and/or an appreciable use of contraception, it is unlikely that fertility has declined. In Bangladesh, the comparison of past and present fertility indicators, together with corresponding increases in contraceptive use and women’s age at marriage, suggests a decline of almost two children per woman, from 3.9 to 2.3 children. There has been a substantial decline in fertility in both urban and rural areas, in all regions, and for all wealth quintiles. The difference between current and completed fertility is highest in rural areas (1.7 births), in Barisal and Sylhet (2 births), and among women in the second and middle wealth quintiles (1.8 and 1.9 births). 5.3 FERTILITY TRENDS Trends in fertility can be assessed in two ways. The first way is to use retrospective data from birth histories collected in the 2014 BDHS. The second is to compare the TFR from the 2014 BDHS with estimates obtained in earlier surveys. Fertility • 53 Trends in fertility over time can be examined by comparing age-specific fertility rates from the 2014 BDHS for successive five-year periods preceding the survey, as presented in Table 5.3.1. The rates for older age groups become progressively more truncated for periods more distant from the survey date, because women age 50 and older were not interviewed in the survey. For example, rates cannot be calculated for women age 35-39 for the period 15- 19 years before the survey because these women would have been over age 50 at the time of the survey and therefore not eligible to be interviewed. Nonetheless, the results show that fertility has dropped substantially among all age groups over the past two decades. The largest fertility decline is observed between the two most recent five-year periods. Fertility decline is steepest among the cohort age 30-34, with a 58 percent decline (from 141 births to 59 births) between the period 15-19 years before the survey and the period 0-4 years before the survey. Trends in fertility in Bangladesh since the early 1970s can be examined by observing a time series of estimates produced from demographic surveys fielded over the last four decades, beginning with the 1975 Bangladesh Fertility Survey (BFS). The TFRs for the seven BDHS surveys since 1993-1994 and the three preceding surveys carried out since 1975 are presented in Table 5.3.2 and Figure 5.2, and age-specific fertility rates from 2004 to 2014 are presented in Figure 5.3. The data indicate that fertility in Bangladesh has been declining since the 1970s. The TFR declined sharply from 6.3 births per woman in 1971-1975 to 5.1 births per woman in 1984-1988, followed by another rapid decline in the next decade of 1.8 births per woman to reach 3.3 births per woman in 1994-1996. Following a decade-long plateau in fertility during the 1990s at around 3.3 births per woman, the TFR declined further by one child and remains at 2.3 births per woman since the 2011 BDHS. Table 5.3.2 Trends in current fertility rates Age-specific and total fertility rates (TFR) among women age 15-49, various sources, Bangladesh, 1975 to 2014 Age group Survey and approximate time period 1975 BFS (1971-1975) 1989 BFS (1984-1988) 1991 CPS (1989-1991) 1993-1994 BDHS (1991-1993) 1996-1997 BDHS (1994-1996) 1999-2000 BDHS (1997-1999) 2004 BDHS (2001-2003) 2007 BDHS (2004-2006) 2011 BDHS (2009-2011) 2014 BDHS (2012-2014) 15-19 109 182 179 140 147 144 135 126 118 113 20-24 289 260 230 196 192 188 192 173 153 143 25-29 291 225 188 158 150 165 135 127 107 110 30-34 250 169 129 105 96 99 83 70 56 57 35-39 185 114 78 56 44 44 41 34 21 25 40-44 107 56 36 19 18 18 16 10 6 4 45-49 35 18 13 14 6 3 3 1 3 4 TFR 15-49 6.3 5.1 4.3 3.4 3.3 3.3 3.0 2.7 2.3 2.3 Note: For the 1975 and 1989 BFS surveys, 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 BFS and BDHS surveys utilized full birth histories, while the 1991 CPS used an 8-year truncated birth history. Source: 1975 BFS (MOHPC, 1978:73); 1989 BFS (Huq and Cleland, 1990:103); 1991 CPS (Mitra et al., 1993:34); 1993-94 BDHS (Mitra et al., 1994:24); 1996-97 BDHS (Mitra et al., 1997:30); 1999-2000 BDHS (NIPORT et al., 2001:32); 2004 BDHS (NIPORT et al., 2005:50) ; 2007 BDHS (NIPORT et al., 2009:50); 2011 BDHS (NIPORT et al., 2013:60). Table 5.3.1 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time of the birth, Bangladesh 2014 Mother’s age at birth Number of years preceding survey 0-4 5-9 10-14 15-19 15-19 117 150 178 190 20-24 142 172 212 213 25-29 111 127 151 172 30-34 59 77 108 [141] 35-39 23 43 [57] - 40-44 5 [10] - - 45-49 [5] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 54 • Fertility Figure 5.2 Trends in total fertility rates, 1975-2014 An examination of the changes in the age-specific fertility rates in Table 5.3.2 and Figure 5.3 indicates that while the peak childbearing age has remained in the 20-24 age group, the largest absolute change in fertility also occurred in this age group, declining from 192 births per 1,000 women in the 2004 BDHS to 143 births per 1,000 women in the 2014 BDHS. Figure 5.3 Trends in age-specific fertility rates, 2004-2014 Figure 5.4 shows that in the 2014 BDHS, Khulna and Rangpur divisions have the lowest TFR (1.9 births per woman), and Sylhet division has the highest TFR (2.9 births per woman). The data indicate that in the last three years fertility has slightly declined in four divisions (Barisal, Chittagong, Rangpur, and Sylhet), remained the same in two divisions (Khulna and Rajshahi) and slightly increased in Dhaka division. Since Dhaka is by far the largest division—comprising one-third of Bangladesh’s population—the fertility rate of this division has a large impact on the national fertility rate. Changes in fertility over time should be interpreted with caution in the absence of sampling errors. 6.3 5.1 4.3 3.4 3.3 3.3 3.0 2.7 2.3 2.3 BFS 1975 BFS 1989 CPS 1991 BDHS 1993-94 BDHS 1996-97 BDHS 1999-2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS 2014 Births per woman 0 50 100 150 200 250 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Births per 1,000 women Age group 2004 BDHS 2007 BDHS 2011 BDHS 2014 BDHS Fertility • 55 Table 5.3.3 Current fertility by division Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by division, Bangladesh 2014 Division Bangladesh Age group Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet 15-19 100 117 113 118 127 118 93 113 20-24 151 167 129 142 135 122 176 143 25-29 103 118 121 80 97 79 152 110 30-34 56 60 70 35 41 37 85 57 35-39 22 26 28 7 17 15 65 24 40-44 1 5 4 4 2 0 14 4 45-49 0 14 4 1 3 2 2 5 TFR (15-49) 2.2 2.5 2.3 1.9 2.1 1.9 2.9 2.3 GFR 83 101 92 72 81 75 111 90 CBR 19.7 25.9 23.0 18.1 19.7 18.4 26.3 22.2 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate expressed per 1,000 population Figure 5.4 Trends in total fertility by division, 2011 and 2014 5.4 CHILDREN EVER BORN AND LIVING Table 5.4 shows the distribution of all women and currently married women by age and number of children ever born. It 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 mean number of children ever born for all women is 2.1, while currently married women have 2.5 births on average. Allowing for mortality of children, Bangladeshi women have, on average, 1.9 living children. Currently married women have an average of 2.2 living children. 2.3 2.8 2.2 1.9 2.1 2.1 3.1 2.2 2.5 2.3 1.9 2.1 1.9 2.9 Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Births per woman Division BDHS 2011 BDHS 2014 56 • Fertility Table 5.4 Children ever born and living Percent distributi

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