Bangladesh DHS Final Report (2011)

Publication date: 2013

Bangladesh Demographic and Health Survey 2011 B angladesh 2011 D em ographic and H ealth Survey BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 2011 National Institute of Population Research and Training Dhaka, Bangladesh Mitra and Associates Dhaka, Bangladesh MEASURE DHS ICF International Calverton, Maryland, U.S.A. January 2013 Cover motif: A tapestry by Rashid Chowdhury, 1984 Courtesy: H. E. Mr. Md. Abdul Hannan, Ambassador & Permanent Representative, Permanent Mission of Bangladesh to the UN Office and other International Organizations in Geneva and Vienna. This report summarizes the findings of 2011 Bangladesh Demographic and Health Surveys (BDHS) conducted under the authority of the National Institute of Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare and implemented by Mitra and Associates of Dhaka. ICF International provided financial and technical assistance for the survey through USAID/Bangladesh. The BDHS is part of the worldwide Demographic and Health Surveys program, which is designed to collect data on fertility, family planning, and maternal and child health. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID, the Government of Bangladesh, or donor organizations. Additional information about the 2011 BDHS may be obtained from: NIPORT Azimpur Dhaka, Bangladesh Telephone: 862-5251 Fax: 861-3362 http://www.niport.gov.bd Mitra and Associates 2/17 Iqbal Road, Block A Mohammadpur, Dhaka, Bangladesh Telephone: 911-5053 Fax: 912-6806 Additional information about the MEASURE DHS project may be obtained from: ICF International 11785 Beltsville Drive Suite 300 Calverton, MD 20705 USA Telephone: 301-572-0200 Fax: 301-572-0999 Email: reports@macrointernational.com Internet: http://www.measuredhs.com Suggested citation: National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. 2013. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, 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 MDG INDICATORS . xxiii MAP OF BANGLADESH . xxvi CHAPTER 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 2011 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 . 6 1.4.4 Training and Fieldwork . 8 1.4.5 Data Processing . 8 1.4.6 Coverage of the Sample . 8 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Household Characteristics . 12 2.1.1 Water and Sanitation . 12 2.1.2 Housing Characteristics . 14 2.1.3 Household Possessions . 16 2.2 Socioeconomic Status Index . 17 2.3 Household Population by Age and Sex . 18 2.4 Household Composition . 20 2.5 Birth Registration . 21 2.6 School Attendance . 22 2.7 Education of Household Population . 23 2.7.1 Educational Attainment of the Household Population . 23 2.7.2 School Attendance Ratios . 25 2.8 Employment . 27 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS . 29 3.1 Characteristics of Survey Respondents . 29 3.2 Educational Attainment . 31 3.3 Literacy . 34 3.4 Access to Mass Media . 36 3.5 Employment . 39 3.6 Occupation . 41 3.7 Earnings, Employers, and Continuity of Employment . 44 3.8 Sufficiency of Earning . 45 CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY . 47 4.1 Introduction . 47 4.2 Current Marital Status . 47 4.3 Polygyny . 49 4.4 Age at First Marriage . 50 4.5 Age at First Sexual Intercourse . 53 4.6 Recent Sexual Activity . 55 4.7 Spousal Separation . 56 iv • Contents CHAPTER 5 FERTILITY . 59 5.1 Current Fertility . 60 5.2 Fertility Differentials . 61 5.3 Fertility Trends . 63 5.4 Children Ever Born and Living . 65 5.5 Birth Intervals . 66 5.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 67 5.7 Menopause . 70 5.8 Age at First Birth . 70 5.9 Teenage Pregnancy and Motherhood . 71 CHAPTER 6 FERTILITY PREFERENCES . 73 6.1 Desire for More Children . 73 6.2 Desire to Limit Childbearing . 75 6.3 Ideal Family Size . 77 6.4 Fertility Planning . 78 6.5 Wanted Fertility Rates . 80 6.6 Spousal Agreement in Desired Number of Children . 81 CHAPTER 7 FERTILITY REGULATION . 83 7.1 Current Use of Contraception . 83 7.2 Differentials in Current Use of Family Planning . 84 7.3 Trends in Current Use of Family Planning . 86 7.4 Timing of Sterilization . 88 7.5 Knowledge and Use of Menstrual Regulation . 89 7.6 Sources of Family Planning Methods . 90 7.7 Use of Social Marketing Brands . 92 7.8 Contraceptive Discontinuation . 94 7.9 Need for Family Planning Services . 97 7.10 Future Use of Contraception . 100 7.11 Reasons for Not Intending to Use Contraception . 101 7.12 Exposure to Family Planning Messages . 102 7.13 Fieldworker Visits . 104 7.14 Satellite Clinics . 106 7.15 Community Clinics . 108 CHAPTER 8 INFANT AND CHILD MORTALITY . 111 8.1 Assessment of Data Quality . 112 8.2 Levels and Trends in Infant and Child Mortality . 113 8.3 Socioeconomic Differentials in Infant and Child Mortality . 115 8.4 Demographic Differentials in Infant and Child Mortality . 116 8.5 Perinatal Mortality . 118 8.6 High-risk Fertility Behavior . 119 CHAPTER 9 MATERNAL AND NEWBORN HEALTH . 121 9.1 Antenatal Care . 122 9.1.1 Antenatal Care Coverage . 122 9.1.2 Place of Antenatal Care . 124 9.1.3 Number of Antenatal Visits . 125 9.1.4 Tetanus Toxoid Injections . 126 9.2 Delivery Care . 128 9.2.1 Place of Delivery . 128 9.2.2 Caesarean Section . 128 9.2.3 Assistance during Delivery . 130 9.3 Postnatal Care for Mothers and Children . 132 9.3.1 Postnatal Checkup for Mother . 132 9.3.2 Postnatal Checkup for the Newborn . 135 9.4 Newborn Care . 137 9.4.1 Care of the Umbilical Cord . 138 9.4.2 Drying, Wrapping, and Bathing the Newborn . 140 9.4.3 Essential Newborn Care. 143 Contents • v CHAPTER 10 CHILD HEALTH . 145 10.1 Child’s Size at Birth . 145 10.2 Vaccination of Children . 146 10.2.1 Vaccination Coverage . 147 10.2.2 Differentials in Vaccination Coverage . 148 10.2.3 Trends in Vaccination Coverage . 149 10.3 Childhood Illness and Treatment . 150 10.3.1 Childhood Diarrhea . 150 10.3.2 Treatment of Diarrhea . 152 10.3.3 Feeding Practices during Diarrhea . 154 10.3.4 Acute Respiratory Infections (ARI) . 155 10.4 Fever . 157 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS . 161 11.1 Nutritional Status of Children . 162 11.1.1 Measurement of Nutritional Status among Young Children . 162 11.1.2 Data Collection . 163 11.1.3 Levels of Child Malnutrition . 165 11.1.4 Trends in Children’s Nutritional Status . 166 11.2 Breastfeeding and Complementary Feeding . 167 11.2.1 Initiation of Breastfeeding . 167 11.3 Breastfeeding Status by Age . 169 11.4 Duration of Breastfeeding . 172 11.5 Types of Complementary Foods . 173 11.6 Infant and Young Child Feeding Practices . 175 11.7 Prevalence of Anemia In Children . 178 11.8 Micronutrient Intake Among Children . 180 11.9 Household Iodized Salt Consumption . 182 11.10 Adult Nutritional Status . 183 11.10.1 Nutritional Status of Women . 183 11.10.2 Nutritional Status of Men . 186 11.11 Prevalence of Anemia in Women . 188 11.12 Micronutrient Intake Among Mothers . 190 11.13 Household Food Security . 191 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 197 12.1 Knowledge of HIV/AIDS and Transmission and Prevention Methods. 198 12.1.1 Knowledge of AIDS . 198 12.1.2 Knowledge of HIV Prevention Methods . 199 12.1.3 Comprehensive Knowledge about AIDS . 201 12.2 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 204 12.3 Knowledge of Means of Transmission of HIV . 205 12.4 Attitudes toward Negotiating Safe Sexual Relations with Husbands . 206 12.5 Self-reported Prevalence of Sexually Transmitted Infections (STIs) and STI Symptoms . 208 CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 211 13.1 Employment and Form of Earnings . 212 13.2 Women’s Control over their Own Earnings . 212 13.3 Freedom of Movement . 214 13.4 Women’s Empowerment . 215 13.5 Attitudes toward Wife Beating . 218 13.6 Indicators of Women’s Empowerment . 219 13.7 Current Use of Contraception by Women’s Empowerment . 220 13.8 Ideal Family Size and Unmet Need by Women’s Empowerment . 221 13.9 Reproductive Health Care by Women’s Empowerment . 222 13.10 Infant and Child Mortality and Women’s Empowerment . 223 CHAPTER 14 CAUSES OF DEATH IN CHILDREN UNDER AGE 5 . 225 14.1 Data Collection . 225 14.2 Assignment of Cause of Death . 226 vi • Contents 14.3 Causes of Death among Children under Age 5 . 227 14.4 Differentials in Cause of Under-5 Deaths . 228 14.5 Comparison of Cause-specific Mortality Rates between 2004 and 2011 . 231 14.6 Conclusion . 232 CHAPTER 15 OTHER ADULT HEALTH ISSUES. 233 15.1 Coverage rates for Blood Pressure and Blood Glucose Measurement . 234 15.2 Hypertension . 235 15.2.1 History of Hypertension. 236 15.2.2 Prevalence and Treatment of Hypertension . 237 15.3 Diabetes . 241 15.3.1 History of Diabetes . 242 15.3.2 Prevalence and Treatment of Diabetes . 243 CHAPTER 16 COMMUNITY CHARACTERISTICS . 247 REFERENCES . 251 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 259 A.1 Introduction . 259 A.2 Sampling Frame . 259 A.3 Sample Design . 260 A.4 Sampling Weight . 261 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 263 APPENDIX C DATA QUALITY TABLES . 275 APPENDIX D WHOLE BLOOD GLUCOSE VALUES . 281 APPENDIX E PERSONS INVOLVED IN THE SURVEY . 283 APPENDIX F QUESTIONNAIRES . 289 APPENDIX G SUMMARY INDICATORS . 429 Tables and Figures • vii TABLES AND FIGURES CHAPTER 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators . 2 Table 1.2 Eligibility for anthropometric measurements and biomarker testing, 2011 Bangladesh DHS . 6 Table 1.3 Results of the household and individual interviews . 9 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1 Household drinking water . 12 Table 2.2 Household sanitation facilities . 13 Table 2.3 Hand washing . 14 Table 2.4 Household characteristics . 15 Table 2.5 Household possessions . 16 Table 2.6 Wealth quintiles . 18 Table 2.7 Household population by age, sex, and residence . 18 Table 2.8 Trends in population by age . 20 Table 2.9 Household composition . 21 Table 2.10 Birth registration of children under age five . 22 Table 2.11 School attendance . 23 Table 2.12.1 Educational attainment of the male household population . 24 Table 2.12.2 Educational attainment of the female household population. 25 Table 2.13 School attendance ratios . 26 Table 2.14 Employment status . 27 Figure 2.1 Population pyramid . 19 Figure 2.2 Distribution of the de facto household population by single year of age and sex . 20 Figure 2.3 Age-specific attendance rates of the de facto population age 5-24 . 27 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS . 29 Table 3.1 Background characteristics of respondents . 30 Table 3.2.1 Educational attainment: Women . 32 Table 3.2.2 Educational attainment: Men . 33 Table 3.3.1 Literacy: Women. 35 Table 3.3.2 Literacy: Men . 36 Table 3.4.1 Exposure to mass media: Women . 37 Table 3.4.2 Exposure to mass media: Men . 38 Table 3.5.1 Employment status: Women . 40 Table 3.5.2 Employment status: Men . 41 Table 3.6.1 Occupation: Women . 42 Table 3.6.2 Occupation: Men . 43 Table 3.7 Type of employment: Women . 44 Table 3.8 Continuity of employment: Men . 45 Table 3.9 Sufficiency of earnings: Men . 46 Figure 3.1 Trends in age differential between spouses, 1999-2011 BDHS . 31 Figure 3.2 Trends in education of couples, 1999-2011 BDHS . 34 Figure 3.3 Percentage of ever-married women and men age 15 49 exposed to various media at least once a week . 39 viii • Tables and Figures CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY . 47 Table 4.1 Current marital status . 48 Table 4.2 Trends in proportion never married . 49 Table 4.3 Number of men’s wives . 50 Table 4.4 Age at first marriage . 51 Table 4.5 Median age at first marriage by background characteristics . 53 Table 4.6 Age at first sexual intercourse . 54 Table 4.7 Median age at first sexual intercourse by background characteristics . 55 Table 4.8 Recent sexual activity . 56 Table 4.9 Husband’s visits . 57 Figure 4.1 Trends in proportion of women age 20-24 who were first married by age 18 . 52 CHAPTER 5 FERTILITY . 59 Table 5.1 Current fertility . 60 Table 5.2 Fertility by background characteristics . 62 Table 5.3.1 Trends in age-specific fertility rates . 63 Table 5.3.2 Trends in current fertility rates . 64 Table 5.4 Children ever born and living . 65 Table 5.5 Birth intervals . 67 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 68 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 69 Table 5.8 Menopause . 70 Table 5.9 Age at first birth . 70 Table 5.10 Median age at first birth . 71 Table 5.11 Teenage pregnancy and motherhood . 72 Figure 5.1 Age-specific fertility rates by urban-rural residence . 61 Figure 5.2 Trends in total fertility rates, 1975-2011 . 64 Figure 5.3 Total fertility rates by division, 2007 and 2011 . 65 CHAPTER 6 FERTILITY PREFERENCES . 73 Table 6.1 Fertility preferences by number of living children . 75 Table 6.2 Desire to limit childbearing . 76 Table 6.3 Ideal number of children by number of living children . 77 Table 6.4 Mean ideal number of children . 78 Table 6.5 Fertility planning status . 79 Table 6.6 Wanted fertility rates . 80 Table 6.7 Comparison of desired number of children . 81 Figure 6.1 Fertility preferences among currently married women age 15-49 . 74 Figure 6.2 Trends in currently married women with two children who want no more children, 1993-2011 . 75 Figure 6.3 Trends in gap between wanted and unwanted fertility rates, 1993-2011 . 80 CHAPTER 7 FERTILITY REGULATION . 83 Table 7.1 Current use of contraception by age . 84 Table 7.2 Current use of contraception by background characteristics . 85 Table 7.3 Trends in current use of contraceptive methods . 86 Table 7.4 Timing of sterilization . 89 Table 7.5 Menstrual regulation . 89 Tables and Figures • ix Table 7.6 Use of menstrual regulation . 90 Table 7.7 Source of modern contraception methods . 90 Table 7.8 Knowledge of specific sources of family planning services . 92 Table 7.9 Use of pill brands . 93 Table 7.10 Use of condom brands . 94 Table 7.11 12-month contraceptive discontinuation rates . 95 Table 7.12 Reasons for discontinuation . 96 Table 7.13 Need and demand for family planning among currently married women . 99 Table 7.14 Future use of contraception . 100 Table 7.15 Preferred method of contraception for future use . 101 Table 7.16 Reason for not intending to use contraception in the future . 102 Table 7.17.1 Exposure to family planning messages: Women . 103 Table 7.17.2 Exposure to family planning messages: Men . 104 Table 7.18 Contact with family planning providers: type of service . 105 Table 7.19 Contact with family planning providers: type of fieldworker . 106 Table 7.20 Satellite clinics . 107 Table 7.21 Community clinics . 109 Figure 7.1 Contraceptive use by background characteristics . 85 Figure 7.2 Trends in contraceptive use among currently married women age 10-49, 1975-2011 . 87 Figure 7.3 Trends in contraceptive method mix among currently married women, age 10-49, from1991-2011 . 88 Figure 7.4 Distribution of current users of modern methods by source of supply . 91 Figure 7.5 Twelve-month contraceptive discontinuation rates for any reason . 96 Figure 7.6 Trends in unmet need for family planning among currently married women age 15-49, 2007 and 2011 BDHS . 100 CHAPTER 8 INFANT AND CHILD MORTALITY . 111 Table 8.1 Early childhood mortality rates . 113 Table 8.2 Trends in early childhood mortality . 114 Table 8.3 Early childhood mortality rates by socioeconomic characteristics . 115 Table 8.4 Early childhood mortality rates by demographic characteristics . 116 Table 8.5 Perinatal mortality . 118 Table 8.6 High-risk fertility behavior . 119 Figure 8.1 Trends in childhood mortality, 1989-2011 . 114 Figure 8.2 Under-5 mortality rates by socioeconomic characteristics . 116 Figure 8.3 Under-5 mortality rates by demographic characteristics . 117 CHAPTER 9 MATERNAL AND NEWBORN HEALTH . 121 Table 9.1 Antenatal care . 123 Table 9.2 Place of antenatal care . 125 Table 9.3 Number of antenatal care visits . 126 Table 9.4 Tetanus toxoid injections . 127 Table 9.5 Place of delivery . 129 Table 9.6 Assistance during delivery . 131 Table 9.7 Postnatal care for mothers and children . 133 Table 9.8 Timing of first postnatal checkup for the mother . 134 Table 9.9 Type of provider of first postnatal checkup for the mother . 135 Table 9.10 Timing of first postnatal checkup for the children . 136 Table 9.11 Type of provider of first postnatal checkup for the newborn . 137 Table 9.12 Type of instrument used to cut the umbilical cord . 138 Table 9.13 Application of material after the umbilical cord was cut . 140 x • Tables and Figures Table 9.14 Newborn care practices: Timing of drying and wrapping . 141 Table 9.15 Newborn care practices: Timing of first bath . 142 Table 9.16 Essential newborn care . 143 Figure 9.1 Trend in utilization of antenatal care from a medically-trained provider by division, 2007-2011 . 124 Figure 9.2 Trend in antenatal care visits, 2004-2011 . 126 Figure 9.3 Place of delivery by wealth quintile . 130 Figure 9.4 Trend in skilled attendance at deliveries . 132 Figure 9.5 Trend in utilization of postnatal care for women and children from a medically trained provider within two days of delivery, 2004-2011 . 133 Figure 9.6 Trend in use of appropriate cord care, 2007-2011 . 139 Figure 9.7 Trend in essential newborn care . 144 CHAPTER 10 CHILD HEALTH . 145 Table 10.1 Child’s size at birth . 146 Table 10.2 Vaccinations by source of information . 148 Table 10.3 Vaccinations by background characteristics . 149 Table 10.4 Prevalence of diarrhea . 151 Table 10.5 Diarrhea treatment. 152 Table 10.6 Diarrhea treatment with ORT and zinc . 153 Table 10.7 Source of ORS packets . 154 Table 10.8 Feeding practices during diarrhea . 155 Table 10.9 Prevalence and treatment of symptoms of ARI . 156 Table 10.10 Prevalence and treatment of fever . 158 Table 10.11 First source of treatment of fever . 159 Figure 10.1 Trends in vaccination coverage among children age 12-23 months . 150 Figure 10.2 Source of antibiotics . 157 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS . 161 Table 11.1 Nutritional status of children . 163 Table 11.2 Initial breastfeeding . 169 Table 11.3 Breastfeeding status by age . 170 Table 11.4 Median duration of breastfeeding . 173 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 174 Table 11.6 Infant and young child feeding (IYCF) practices . 177 Table 11.7 Prevalence of anemia in children . 179 Table 11.8 Micronutrient intake among children . 181 Table 11.9 Presence of iodized salt in household . 183 Table 11.10.1 Nutritional status of ever-married women . 184 Table 11.10.2 Nutritional status of ever-married men age 15-34 . 187 Table 11.10.3 Nutritional status of men age 35 and older . 188 Table 11.11 Prevalence of anemia in women . 189 Table 11.12 Micronutrient intake among mothers . 191 Table 11.13 Availability of meals every day . 192 Table 11.14 Frequency of skipping meals . 193 Table 11.15 Frequency of having less food in a meal . 193 Table 11.16 Frequency of having rice replacement . 194 Table 11.17 Frequency of having to ask food . 195 Table 11.18 Food security by background characteristics . 196 Tables and Figures • xi Figure 11.1 Nutritional status of children by age . 165 Figure 11.2 Trends in nutritional status of children under age 5, 2004, 2007, and 2011 . 167 Figure 11.3 Infant feeding practices by age . 171 Figure 11.4 IYCF indicators on breastfeeding status . 172 Figure 11.5 Trends in complementary feeding for breastfeeding children 6-9 months . 175 Figure 11.6 Percentage fed according to minimum standard of acceptable feeding practices . 178 Figure 11.7 Trends in nutritional status of ever-married women . 186 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 197 Table 12.1 Knowledge of AIDS . 199 Table 12.2 Knowledge of HIV prevention methods . 200 Table 12.3.1 Comprehensive knowledge about AIDS: Women . 202 Table 12.3.2 Comprehensive knowledge about AIDS: Men . 203 Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV: Women . 205 Table 12.5 Knowledge of transmission of HIV through unclean needles and unsafe blood transfusions 206 Table 12.6 Attitudes toward negotiating safer sexual relations with husband . 207 Table 12.7 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 209 Figure 12.1 Comprehensive knowledge about AIDS among ever-married women and men 15-49 . 204 Figure 12.2 Women and men seeking treatment for STIs . 210 CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 211 Table 13.1 Employment and cash earnings of currently married women . 212 Table 13.2 Control over women’s cash earnings . 213 Table 13.3 Freedom of movement . 215 Table 13.4 Participation in decision making . 216 Table 13.5 Women’s participation in decision making by background characteristics . 217 Table 13.6 Women’s attitude toward wife beating . 219 Table 13.7 Indicators of women’s empowerment . 220 Table 13.8 Current use of contraception by women’s empowerment . 221 Table 13.9 Women’s empowerment and ideal number of children and unmet need for family planning 222 Table 13.10 Reproductive health care by women’s empowerment. 223 Table 13.11 Early childhood mortality rates by women’s empowerment . 224 Figure 13.1 Number of decisions in which currently married women participate. 218 CHAPTER 14 CAUSES OF DEATH IN CHILDREN UNDER AGE 5 . 225 Table 14.1 Causes of death among children under five by age group . 228 Table 14.2 Causes of death among children under 5 by sex of child and residence . 229 Table 14.3 Causes of death among children under 5 by mother’s education . 230 Table 14.4 Causes of death among children under 5 by division . 231 Figure 14.1 Specific causes of death among children under age 5, 2004 BDHS and 2011 BDHS . 232 CHAPTER 15 OTHER ADULT HEALTH ISSUES. 233 Table 15.1 Coverage of testing for blood pressure and fasting blood glucose measurement among women and men age 35 and older . 235 Table 15.2 History of hypertension and actions taken to lower blood pressure . 237 Table 15.3.1 Blood pressure levels and treatment status by background characteristics: Women . 238 Table 15.3.2 Blood pressure levels and treatment status by background characteristics: Men . 239 Table 15.4 History of diabetes . 243 Table 15.5.1 Fasting plasma glucose values and treatment status: Women . 244 Table 15.5.2 Fasting plasma glucose values and treatment status by background characteristics: Men . 245 xii • Tables and Figures Figure 15.1 Prevalence of hypertension and pre-hypertension among women and men age 35 and older . 240 Figure 15.2 Awareness of hypertension and treatment status among hypertensive women and men age 35 and over . 241 Figure 15.3 Prevalence of diabetes and pre-diabetes among women and men age 35 and older . 246 Figure 15.4 Awareness of diabetes and treatment status among diabetic women and men age 35 and over . 246 CHAPTER 16 COMMUNITY CHARACTERISTICS . 247 Table 16.1 Distance to the nearest general services . 247 Table 16.2 Distance to the nearest education facility . 248 Table 16.3 Availability of income-generating organizations . 249 Table 16.4 Availability of family planning and health services . 249 Table 16.5 Means of transport to upazila headquarters . 250 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 259 Table A.1 Percent distribution of households by division and type of residence . 260 Table A.2 Sample allocation of clusters by division and type of residence . 260 Table A.3 Sample allocation of households by division and type of residence . 261 Table A.4 Sample allocation of completed women interviews by division and type of residence . 261 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 263 Table B.1 List of selected variables for sampling errors, Bangladesh 2011 . 263 Table B.2 Sampling errors: Total sample, BDHS 2011 . 264 Table B.3 Sampling errors: Urban sample, BDHS 2011 . 265 Table B.4 Sampling errors: Rural sample, BDHS 2011 . 266 Table B.5 Sampling errors: Barisal sample, BDHS 2011 . 267 Table B.6 Sampling errors: Chittagong sample, BDHS 2011 . 268 Table B.7 Sampling errors: Dhaka sample, BDHS 2011 . 269 Table B.8 Sampling errors: Khulna sample, BDHS 2011 . 270 Table B.9 Sampling errors: Rajshahi sample, BDHS 2011 . 271 Table B.10 Sampling errors: Rangpur sample, BDHS 2011 . 272 Table B.11 Sampling errors: Sylhet sample, BDHS 2011 . 273 APPENDIX C DATA QUALITY TABLES . 275 Table C.1 Household age distribution . 275 Table C.2.1 Age distribution of eligible and interviewed women . 276 Table C.2.2 Age distribution of eligible and interviewed men . 276 Table C.3 Completeness of reporting . 277 Table C.4 Births by calendar years . 277 Table C.5 Reporting of age at death in days . 278 Table C.6 Reporting of age at death in months . 279 APPENDIX D WHOLE BLOOD GLUCOSE VALUES . 281 Table D.15.5.1 Fasting whole blood glucose values and treatment status by background characteristics: Women . 281 Table D.15.5.2 Fasting whole blood glucose values and treatment status by background characteristics: Men . 282 Foreword • xiii FOREWORD The 2011 Bangladesh Demographic and Health Survey (BDHS) is the sixth national demographic and health survey designed to provide information on basic national indicators of social progress, including fertility, childhood mortality and causes of death, fertility preferences and fertility regulation, maternal and child health, nutritional status of mothers and children, awareness and attitudes towards HIV/AIDS, and prevalence of noncommunicable diseases. In addition to presenting the main findings 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 the previous BDHS surveys. Results illustrate that the Total Fertility Rate continues to decline—three of seven divisions are at replacement level. Contrarily, the Contraceptive Prevalence Rate (CPR) continues to increase, and in the last four years Sylhet division demonstrates the highest increase in CPR, followed by Chittagong. BDHS data show continued decline in childhood mortality, and Bangladesh is on-track to achieve the MDG 4 target by 2015. There is also evidence that Bangladesh is moving ahead in achieving MDG 5. Since the 2007 BDHS, deliveries attended by skilled providers and deliveries in health facilities have increased by more than 50 percent, and the equity gap between rich and poor has narrowed. However, improvement of the nutritional status of children is a great challenge for us—more than one in three children is still underweight. Similarly, challenges remain from the high prevalence of two major non-communicable diseases: hypertension and diabetes. One in three adult women and one in five adult men are hypertensive, while one in nine adult men and women suffer from diabetes. The findings of this report and its policy and programmatic implications are very important for monitoring and evaluation of the Health, Population and Nutrition Sector Development Program (HPNSDP). The need, however, for further detailed analysis of BDHS data remains. I hope that such analysis will be carried out by academicians, researchers, and program personnel to provide more in-depth knowledge for the future direction and effective implementation of the HPNSDP in the coming years. The successful completion of the 2011 BDHS was made possible by the contributions of a number of organizations and individuals. I would like to thank NIPORT, Mitra and Associates, and ICF International for their efforts in conducting the 2011 BDHS. I deeply appreciate the United States Agency for International Development (USAID), Bangladesh, for providing the financial assistance that has helped ensure the ultimate success of this important national survey. Md. Humayun Kabir Preface • xv PREFACE The 2011 Bangladesh Demographic and Health Survey (BDHS) is the sixth 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 and Associates. The financial support for the survey was provided by the United States Agency for International Development (USAID), Bangladesh. The 2011 BDHS is a nationwide sample survey of men and women of reproductive age that provides information on childhood mortality levels; fertility preferences; use of family planning methods; and maternal, child, and newborn health. Included are breastfeeding practices; nutrition levels, including the presence of anemia and iodine deficiency; knowledge and attitudes toward HIV/AIDS and other sexually transmitted infections; and community-level data on accessibility and availability of health and family planning services. The special feature of this survey is its provision of biomarker indices of adult male and female populations, which are instrumental in determining the increasing risk of noncommunicable diseases. Members of the Technical Review Committee (TRC), consisting of experts from government, nongovernment, and international organizations as well as researchers and professionals working in the health, nutrition, and population sectors, contributed their expert opinion in various phases of the survey implementation. A Technical Working Group (TWG) was also formed with the representatives from NIPORT; ICDDR,B; USAID, Bangladesh; ICF International; and Mitra and Associates for designing the survey questionnaires and implementing the survey. I would like to put on record my sincere appreciation to TRC and TWG members for their efforts in different stages of the survey. The preliminary results of the 2011 BDHS, with its key indicators, were released through a dissemination seminar in April 2012. This final report brings more comprehensive analysis of the survey results. Along with the key results, detailed findings and possible interpretations are presented. I hope this information will give a hand to the policymakers and program managers as they monitor and design programs and strategies for improving health and family planning services in the country. It is worth mentioning that this report is an outcome of contributions from professionals at NIPORT, NIPSOM, Mitra and Associates, Dhaka University, Jahangirnagar University, ICDDR,B, MEASURE Evaluation, Population Council, SMC, Save the Children, and Eminence. I would like to acknowledge with great appreciation the contributions of the individual authors for their contributions to 2011 BDHS final report. I am deeply indebted and grateful to all the professionals of the Research Unit of NIPORT for the successful completion of the survey. I also extend my thanks to ICF International and Mitra and Associates for completing the task in time. USAID, Bangladesh, deserves special thanks for providing technical and financial support for the survey. Shelina Afroza, PhD Contributors to the Report • xvii CONTRIBUTORS TO THE REPORT Mr. Shahidul Islam, Mitra and Associates Mr. Md. Moshiur Rahman, Population Council Mr. Md. Rabiul Haque, Dhaka University Dr. Mohd. Muzibur Rahman, Jahangeer Nagar University Ms. Shahin Sultana, National Institute of Population Research and Training Mr. Subrata K. Bhadra, National Institute of Population Research and Training Mr. Toslim Uddin Khan, Social Marketing Company Mr. Shamal Chandra Karmaker, Dhaka University Ms. Shumona Sharmin Salam, International Center for Diarrheal Disease Research, Bangladesh Dr. Muhibbul Abrar, MaMoni, Save the Children Dr. Santhia Ireen, International Center for Diarrheal Disease Research, Bangladesh Dr. Muttaquina Hossain, International Center for Diarrheal Disease Research, Bangladesh Ms. Rashida-E-Ijdi, Research Fellow, Measure Evaluation Mr. Md. Hamidul Huque, International Center for Diarrheal Disease Research, Bangladesh Ms. Shusmita Hossain Khan, Eminence Dr. Md. Shamim Hayder Talukder, Eminence Dr. Md. Shafiqul Islam, National Institute of Preventative and Social Medicine Ms. Sri Poedjastoeti, ICF International Ms. Adrienne Cox, ICF International Dr. Ahmed Al-Sabir, ICF International Prof. Nitai Chakraborty, Dhaka University Dr. Kanta Jamil, United States Agency for International Development, Bangladesh Dr. Peter Kim Streatfield, International Center for Diarrheal Disease Research, Bangladesh Dr. Shams El Arifeen, International Center for Diarrheal Disease Research, Bangladesh Dr. Tahmeed Ahmed, International Center for Diarrheal Disease Research, Bangladesh Dr. Ishtiaq Mannan, Chief of Party, MCHIP Special acknowledgement Dr. Kanta Jamil, Senior Monitoring, Evaluation and Research Advisor, Office of Population, Health, Nutrition, and Education, USAID, Bangladesh, for technical assistance at all steps of survey implementation, analysis, and report generation. 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 BP Blood pressure BRAC Bangladesh Rural Advancement Committee CBR Crude birth rate CDC The Centers for Disease Control and Prevention CPS Contraceptive Prevalence Survey CSBA Community-skilled birth attendant DBP Diastolic blood pressure 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 FPG Fasting plasma glucose 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 xx • Abbreviations HNPSP Health, Nutrition and Population Sector Program HPI Human Poverty Index 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 SBP Systolic blood pressure SD Standard deviation SHS Secondhand smoke SMC Social Marketing Company STI Sexually-transmitted infection SWAp Sector-Wide Approach Abbreviations • xxi TBA Traditional birth attendant TC-NAC Technical Committee of the National AIDS Council TFR Total fertility rate TT Tetanus toxoid 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 2011 Value Goal Female Male Total 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under five years of age 38.5 34.3 36.4 2. Achieve universal primary education 2.1 Net enrollment ratio in primary education1 76.6 73.0 74.8 2.3 Literacy rate of 15-24 year olds 81.9 67.8 74.9 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education na na 1.1 3.1b Ratio of girls to boys in secondary education na na 1.1 3.1c Ratio of girls to boys in tertiary education na na 0.6 4. Reduce child mortality 4.1 Under-five mortality rate (per 1000 live births)2 50 57 53 4.2 Infant mortality rate (per 1000 live births)2 37 48 43 4.3 Proportion of 1 year-old children immunized against measles 86.8 88.3 87.5 5. Improve maternal health 5.1 Proportion of births attended by skilled health personnel3 na na 31.7 5.2 Contraceptive prevalence rate4 61.2 na na 5.3 Adolescent birth rate5 118.3 na na 5.4a Antenatal care coverage: at least 1 visit by skilled health professional3 54.6 na na 5.4b Antenatal care coverage: at least 4 visits by any provider3 25.5 na na 5.5 Unmet need for family planning 13.5 na na 6. Combat HIV/AIDS, malaria and other diseases 6.1 Percentage of population 15-24 years with comprehensive knowledge of HIV/AIDS6 11.9 14.4 13.1 na = Not applicable 1 Net attendance ratio measured in BDHS approximates MDG indicator 2.1 2 Expressed in terms of deaths per 1,000 live births 3 Rate refers to live births in the three years preceding the survey 4 Percentage of currently married women age 15-49 using any method of contraception 5 Equivalent to the age-specific fertility rate for women age 15-19, expressed in terms of births per 1,000 women age 15-19 6 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. xxiv • Millennium Development Goal Indicators Millennium Development Goal Indicators by residence Bangladesh 2011 Goal Urban Rural Total 7. Ensure environmental sustainability 7.1 Percentage of population using an improved drinking water source1 99.4 98.2 98.5 7.2 Percentage of population with access to improved sanitation2 43.3 34.4 36.6 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. xxvi • Map of Bangladesh INDIA INDIA BURMA NEPAL Dhaka Khulna Chittagong Rajshahi Rangpur Sylhet Barisal BANGLADESH 0 100 20050 Kilometers ¯ Bay of Bengal Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY AND ECONOMY Bangladesh 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. It lies between latitudes 20° 34′ and 26° 38′ north and longitudes 88° 01′ and 92° 41′ east. The entire country has a tropical climate. The Moguls ruled the country from the 13th century until the 18th century, when the British took over and administered the subcontinent until 1947. During British rule, Bangladesh was 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 the world map as a sovereign state on March 26, 1971, after fighting a nine-month war of liberation. Most of Bangladesh is low, flat land that consists of alluvial soil. The most significant feature of the land is the extensive network of large and small rivers that are 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 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. For administrative purposes, the country consists of 7 divisions, 64 districts, and 545 upazilas/thanas (BBS, 2012a). 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, 2007). 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 to the gross domestic product (GDP). The GDP exhibited a robust growth rate of 6.7 percent in fiscal year (FY) 2010-2011 compared with 6.1 percent recorded in FY 2009-2010. The overall growth was led by the manufacturing and construction sub-sectors, which recorded impressive expansions of 10 and 6 percent, respectively, in FY 2010-2011. 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 20 percent to the total GDP in FY 2010-2011. The largest contributor in the agricultural sector is crops and horticulture (11 percent) followed by the fishery sector (4 percent). The average per capita income in Bangladesh has increased from US$599 during FY 2007-2008 to US$848 during FY 2011-2012 (BBS, 2008; MOF, 2012). Bangladesh is still struggling to emerge from poverty. Bangladesh ranks 146th among nations on the Human Development Index (HDI) as presented in the 2011 Human Development Report (UNDP, 2011). The HPI is a multidimensional measure of poverty for developing countries; it takes into account social exclusion, lack of economic opportunities, and deprivations in survival, livelihood, and knowledge. The country’s HDI value of 0.500 is above the average of 0.456 for countries in the low human development group and below the average of 0.548 for countries in South Asia. Countries in South Asia that are close to Bangladesh in its 2011 HDI rank and population size are Pakistan and Nepal, which rank 145th and 157th on the HDI, respectively. 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 from the 2001 and 2011 Population and Housing Census (PHC). According to the results of the 2011 PHC, the population of the country stood at about 149.8 million1, with a population density of 1,015 persons per square kilometer (BBS, 2012b). During the past century, the population of Bangladesh has increased exponentially. Between 2001 and 2011, about 19.8 million people were added to the population, which represents a 15 percent increase and a 1.37 percent annual growth rate. Between the 2001 and 2011 censuses, life expectancy in Bangladesh increased by about two years for males and by more than three years for females. Female life expectancy is slightly higher than male life expectancy (69 years versus 67 years). The country is now experiencing a demographic transition. The continuous decline of the natural growth rate is expected to lead to a smaller population increase in the coming decades. In comparison with other countries in the region, this population growth rate places Bangladesh 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, 2011a). The 2010 projections by the United Nations estimated that the population of Bangladesh in 2050 would be about 194 million (medium variant) and 226 million (high variant (UN, 2010). Table 1.1 Basic demographic indicators Demographic indicators from selected sources, Bangladesh, 2001 and 2011 Indicators Census 2001 Census 2011 Population (millions) 130.03 149.8 Intercensal growth rate (percent) 1.54 1.374 Density (population/km2) 881 1015 Percent urban 23.5 27.0 Life expectancy(year)* 2002 2010 Male 64.5 66.6 Female 65.4 68.8 Source: Bangladesh Bureau of Statistics (2012b) * Source: BBS, 2011b According to the National Population Policy, Bangladesh aims to achieve replacement level fertility by 2015 (MOHFW, 2009). Additionally, the Health Population Nutrition Sector Development Program (HPNSDP) plans to reduce the Total Fertility Rate (TFR) to 2.0 children per woman by 2016 (MOHFW, 2011). 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 the 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 1 According to BBS projection, the population on July 17, 2012 was 152.5 million. Introduction • 3 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 that have come into power have identified population control as the 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. 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 (MOHFW, 2004b). The current HPNSDP was initiated by the Ministry of Health and Family Welfare (MOHFW) for a period of 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 is working toward achieving Millennium Development Goals (MDGs). Of the eight MDGs, three are related 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) are closely related to human resource development. The HPNSDP Program Implementation Plan (PIP) document sets out the sector- specific strategies to achieve its goal (MOHFW, 2011). 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). 4 • Introduction • Expand noncommunicable disease control efforts at all levels by streamlining referral systems and strengthening hospital accreditation and management systems. • Strengthen support systems by increasing the health workforce at Upazila and at community clinic levels, including capacity building and enhanced focus on coordinated implementation of operational plan, management information system, and monitoring and evaluation functions. • Strengthen drug management and improve quality drug provision and procurement with information communication technology and additional staff to reduce the time between procurement and distribution. • Increase coverage and quality of services by strengthening coordination with other intra- and intersectoral and private sector service providers. • Pursue priority institutional and policy reforms, such as decentralization and local level planning, incentives for service providers in hard-to-reach areas, public-private partnerships, and a single annual work plan. 1.4 ORGANIZATION OF THE 2011 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 1.4.1 Survey Objectives and Implementing Organizations The 2011 Bangladesh Demographic and Health Survey (BDHS) is the sixth DHS undertaken in Bangladesh, following those implemented in 1993-94, 1996-97, 1999-2000, 2004, and 2007. The main objectives of the 2011 BDHS are to: • Provide information to meet the monitoring and evaluation needs of health and family planning programs, and • Provide program managers and policy makers involved in these programs with the information they need to plan and implement future interventions. The specific objectives of the 2011 BDHS were as follows: • To provide up-to-date data on demographic rates, particularly fertility and infant mortality rates, at the national and subnational level; • To analyze the direct and indirect factors that determine the level of and trends in fertility and mortality; • To measure the level of contraceptive use of currently married women; • To provide data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS; • To assess the nutritional status of children (under age 5), women, and men by means of anthropometric measurements (weight and height), and to assess infant and child feeding practices; • To provide data on maternal and child health, including antenatal care, assistance at delivery, breastfeeding, immunizations, and prevalence and treatment of diarrhea and other diseases among children under age 5; Introduction • 5 • To measure biomarkers, such as hemoglobin level for women and children, and blood pressure, and blood glucose for women and men 35 years and older; • To measure key education indicators, including school attendance ratios and primary school grade repetition and dropout rates; • To provide information on the causes of death among children under age 5; • To provide community-level data on accessibility and availability of health and family planning services; • To measure food security. The 2011 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 Calverton, Maryland, USA, provided technical assistance to the project as part of its international Demographic and Health Surveys program (MEASURE DHS). Financial support was provided by the U.S. Agency for International Development (USAID). 1.4.2 Sample Design The sample for the 2011 BDHS is nationally representative and covers the entire population residing in noninstitutional dwelling units in the country. The survey used as a sampling frame the list of enumeration areas (EAs) prepared for the 2011 Population and Housing Census, provided by the Bangladesh Bureau of Statistics (BBS). The primary sampling unit (PSU) for the survey is an EA that was created to have an average of about 120 households. Bangladesh has seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is subdivided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, and into mohallas within a ward. A rural area in the upazila is divided into union parishads (UP) and mouzas within a UP. These divisions allow the country as a whole to be easily 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 clusters in urban areas and 393 in rural areas. A complete household listing operation was then carried out in all 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). In addition, in a subsample of one-third of the households, all ever- married men age 15-54 were selected and interviewed for the male survey. In this subsample, a group of eligible members were selected to participate in testing of the biomarker component, including blood pressure measurements, anemia, blood glucose testing, and height and weight measurements. Table 1.2 shows which household members were eligible for which biomarker testing. 6 • Introduction Table 1.2 Eligibility for anthropometric measurements and biomarker testing, 2011 Bangladesh DHS Groups eligible for biomarker collection Weight measurement Height measurement Anemia testing Blood pressure measurement Blood glucose testing Children 0–6 months All households All households Children 6–59 months All households All households 1/3 households Ever-married women 12-34 years All households All households 1/3 households Ever-married women 35-49 years All households All households 1/3 households 1/3 households 1/3 households Ever-married women 50+ years 1/3 households 1/3 households 1/3 households 1/3 households Never-married women 35+ years 1/3 households 1/3 households 1/3 households 1/3 households Ever-married men 15-34 years 1/3 households 1/3 households All men 35+ years 1/3 households 1/3 households 1/3 households 1/3 households 1.4.3 Questionnaires The 2011 BDHS used five types of questionnaires: a Household Questionnaire, a Woman’s Questionnaire, a Man’s Questionnaire, a Community Questionnaire, and two Verbal Autopsy Questionnaires to collect data on causes of death among children under age 5. The contents of the household and individual 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 Centre for Diarrheal Diseases and Control, Bangladesh (ICDDR,B), USAID/Bangladesh, and MEASURE DHS (see Appendix E for a list of the TWG members). Draft questionnaires were then circulated to other interested groups and were reviewed by the 2011 BDHS Technical Review Committee (see Appendix E). The questionnaires were developed in English and then translated and printed into 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, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In addition, information was collected about the dwelling unit, such as the source of water, type of toilet facilities, materials used to construct the floors and walls, and ownership of various consumer goods. The Household Questionnaire was also used to record for eligible individuals: • Height and weight measurements • Anemia test results • Measurements of blood pressure and blood glucose The Woman’s Questionnaire was used to collect information from ever-married women age 12- 49. Women were asked questions on the following topics: • Background characteristics (e.g., age, education, religion, and 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 childhood illnesses • Marriage • Fertility preferences • Husband’s background and respondent’s work • Awareness of AIDS and other sexually transmitted infections • Food security Introduction • 7 The Man’s Questionnaire was used to collect information from ever-married men age 15-54. Men were asked questions on the following topics: • Background characteristics (including respondent’s work) • Marriage • Fertility preferences • Participation in reproductive health care • Awareness of AIDS and other sexually transmitted infections The Community Questionnaire was administered in each selected cluster during the household listing operation. Data were collected by administering the Community Questionnaire to a group of four to six community leaders who were knowledgeable about socioeconomic conditions and the availability of health and family planning services/facilities, in or near the sample area (cluster). Community leaders included such persons as government officials, social workers, teachers, religious leaders, traditional healers, and health care providers. The Community Questionnaire collected information 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 of each cluster were also recorded. The information obtained in these questionnaires was also used to verify information gathered in the Woman’s and Man’s Questionnaires on the types of facilities accessed and health services personnel seen. The Verbal Autopsy Questionnaires were developed based on the work done by an expert group led by the WHO, consisting of researchers, data users, and other stakeholders under the sponsorship of the Health Metrics Network (HMN). The verbal autopsy tools are intended to serve the various needs of the users of mortality information. Two questionnaires were used to collect information related to the causes of death among young children; the first questionnaire collected data on neonatal deaths (deaths at 0-28 days), and the second questionnaire collected data on deaths between four weeks and five years. These questionnaires were administered to mothers who reported the death of a child under age 5 in the five-year period prior to the 2011 BDHS survey or care taker who were knowledgeable about the symptoms and treatment preceding the death. The questionnaires contained both structured (pre-coded) questions and nonstructured (open-ended) questions. The following topics were covered in the Verbal Autopsy Questionnaires: • Identification including detailed address of respondent • Informed consent • Detailed age description of deceased child • Respondent’s account of illness/events leading to death • Maternal history, including questions on prenatal care, labor and delivery, and obstetrical complications • Information about accidental deaths • Detailed signs and symptoms preceding death • Mother’s health and contextual factors • Information on treatment module and information on direct, underlying contributing causes of death from the death certificate, if available. 8 • Introduction 1.4.4 Training and Fieldwork Forty-seven people were trained to carry out the listing of households, to delineate Enumeration Areas (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 seven days from May 11-21, 2011. A household listing operation was carried out in all selected EAs from May 22 to October 5, 2011 in four phases, each about three weeks in length. Initially, 19 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 15 in the second and third phases and to 6 in the final phase. In addition, six supervisors were deployed to check and verify the work of the listing teams. The Household, Woman’s and Man’s Questionnaires were pre-tested in March 2011. Four supervisors, 10 interviewers, and 4 biomarker staff were trained for the pretest. The questionnaires were pre-tested on 100 households, 100 women, and 70 men in one urban and one rural cluster in Comilla District and one urban and one rural cluster in Dhaka. Based on observations in the field and suggestions made by the pretest teams, revisions were made to the wording and translations of the questionnaires. Training for the main survey was conducted for four weeks from June 6 to July 5, 2011. A total of 173 fieldworkers were recruited based on their educational level, prior experience with surveys, maturity, and willingness to spend up to six months on the project. Training included (1) lectures on how to conduct an interview and complete the questionnaires, (2) mock interviews by participants, and (3) field practice. Fieldwork for the 2011 BDHS was carried out by 16 interviewing teams, each consisting of one supervisor, one field editor, five female interviewers, two male interviewers, and one logistics staff member. Data collection was implemented in five phases, starting on July 8, 2011 and ending on December 27, 2011. In addition, from January 2-19, 2012 there were re-visits to collect blood samples from respondents interviewed during Ramadan who had agreed to participate in blood testing, but declined to be tested during Ramadan. Data quality was ensured through four quality control teams, each comprised of one male and one female staff person. In addition, NIPORT monitored fieldwork by using extra quality control teams. Data quality was also monitored through field check tables generated concurrently with data processing. This was an advantage because the quality control teams were able to advise field teams of problems detected during data entry. In particular, tables were generated to check various data quality parameters. Fieldwork was also monitored through visits by representatives from USAID, ICF International, and NIPORT. 1.4.5 Data Processing The completed 2011 BDHS questionnaires were periodically returned to Dhaka for data processing at Mitra and Associates offices. The data processing began shortly after the start of fieldwork. Data processing consisted of office editing, coding of open-ended questions, data entry, and editing of inconsistencies found by the computer program. The data were processed by 16 data entry operators and two data entry supervisors. Data processing commenced on July 23, 2011 and ended on January 15, 2012. Data processing was carried out using the Census and Survey Processing System (CSPro), a joint software product of the U.S. Census Bureau, ICF International, and Serpro S.A. 1.4.6 Coverage of the Sample Table 1.3 shows the results of the household and individual women’s and men’s interviews. From a total of 17,964 selected households, 17,511 were found to be occupied. Interviews were successfully completed in 17,141 households, or 98 percent of all the occupied households. A total of 18,222 ever- married women age 12-49 were identified in these households, and 17,842 were interviewed, yielding a response rate of 98 percent. In one-third of the households, ever-married men over age 15 were eligible for Introduction • 9 interview. Of the 4,343 eligible men, 3,997, or 92 percent, were successfully interviewed. The 2011 response rates were similar to those in the 2007 BDHS. The principal reason for nonresponse among women and men was their absence from home despite repeated visits to the household. The response rates do not vary notably by urban-rural residence. Table 1.3 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Bangladesh 2011 Result Residence Total Urban Rural Household interviews Households selected 6,210 11,754 17,964 Households occupied 6,035 11,476 17,511 Households interviewed 5,868 11,273 17,141 Household response rate1 97.2 98.2 97.9 Interviews with ever-married women age 12-49 Number of eligible women 6,390 11,832 18,222 Number of eligible women interviewed 6,196 11,646 17,842 Eligible women response rate2 97.0 98.4 97.9 Interviews with ever-married men age 15-54 Number of eligible men 1,586 2,757 4,343 Number of eligible men interviewed 1,437 2,560 3,997 Eligible men response rate2 90.6 92.9 92.0 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter provides an overview of socioeconomic characteristics of the population, which includes conditions of the households, sources of drinking water, sanitation facilities, hand washing, 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 2011 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. T Key Findings • Access to an improved source of drinking water is almost universal (99 percent) in Bangladesh. • One in ten households uses an appropriate water treatment method. • The proportion of households with no toilet facilities declined from 8 percent in 2007 to 5 percent in 2011. One-third of the households have an improved toilet facility that is not shared with other households. • Six in ten households have electricity. This is a marked improvement from 2007, when only 47 percent of households had access to electricity. There is a wide urban-rural gap (90 and 49 percent, respectively). • Eighty-six percent of households use solid fuel for cooking. • Forty-five percent of households are exposed daily to secondhand smoke. • Possession of mobile phones has increased sharply from 32 percent in 2007 to 78 percent in 2011 (89 percent in urban areas and 75 percent in rural areas). • Thirty-five percent of the population is under age 15. • Eleven percent of households are headed by a woman. • Thirty-one percent of children under age 5 are registered, and 22 percent have a birth certificate. • One in four women and 29 percent of men are not educated. School attendance for all age groups between 6-24 years in 2011 has increased from that in 2007. • Sixty-four percent of men and 11 percent of women are currently working. 12 • Housing Characteristics and Household Population 2.1 HOUSEHOLD CHARACTERISTICS Access to basic utilities, sources of drinking water and water treatment practices, access to sanitation facilities, housing structure and crowdedness of dwelling spaces, and type of fuel used for cooking are physical characteristics of a household that are used to assess the general wellbeing and socioeconomic status of its members. This section provides information from the 2011 BDHS on drinking water, sanitation facilities, housing characteristics, and possession of basic amenities. 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 and diarrheal diseases remain the leading causes of child deaths in Bangladesh (NIPORT et al., 2005). Table 2.1 presents information on household drinking water by urban-rural residence. Access to an improved source of drinking water is universal in Bangladesh (99 percent). The most common source of drinking water in urban areas is a tube well or borehole (55 percent), followed by water piped into the 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 2011 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 99.4 98.2 98.5 99.4 98.2 98.5 Piped into dwelling 21.0 0.5 5.7 21.3 0.6 5.6 Piped to yard/plot 16.2 0.7 4.5 15.0 0.6 4.1 Public tap/standpipe 7.0 0.5 2.1 6.9 0.5 2.0 Tube well or borehole 54.6 95.8 85.5 55.7 95.8 86.0 Protected well 0.1 0.2 0.2 0.1 0.2 0.2 Protected spring 0.0 0.0 0.0 0.0 0.1 0.0 Rain water 0.3 0.5 0.4 0.3 0.4 0.4 Bottled water 0.3 0.0 0.1 0.2 0.0 0.1 Non-improved source 0.6 1.8 1.5 0.6 1.8 1.5 Unprotected well 0.0 0.3 0.2 0.0 0.3 0.2 Tanker truck/cart with drum 0.1 0.0 0.0 0.1 0.0 0.1 Surface water 0.4 1.4 1.2 0.4 1.4 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 99.4 98.2 98.5 99.4 98.2 98.5 Time to obtain drinking water (round trip) Water on premises 82.5 67.6 71.4 82.5 68.1 71.6 Less than 30 minutes 15.6 27.9 24.8 15.5 27.3 24.4 30 minutes or longer 1.8 4.4 3.7 1.9 4.6 4.0 Don’t know/missing 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 23.4 0.6 6.3 23.3 0.6 6.1 Bleach/chlorine added 0.4 0.3 0.3 0.4 0.3 0.3 Strained through cloth 1.0 0.3 0.5 1.1 0.3 0.5 Ceramic, sand or other filter 10.8 2.3 4.4 11.2 2.5 4.6 Other 0.4 0.6 0.6 0.4 0.6 0.5 No treatment 68.7 96.2 89.3 68.8 96.0 89.4 Percentage using an appropriate treatment method2 30.9 3.2 10.2 30.8 3.5 10.1 Number 4,305 12,836 17,141 19,158 59,752 78,909 1 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Housing Characteristics and Household Population • 13 dwelling (21 percent), water piped to the yard or plot (16 percent), and a public tap or standpipe (7 percent). In contrast, a tube well or borehole is practically the only source of drinking water in rural areas (96 percent). For 71 percent of households the source of drinking water is within the premises. One in four households spend 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. Nationally, 10 percent of households use an appropriate water treatment method. Rural households are much less likely than urban households to treat their water appropriately (3 percent and 31 percent, respectively). Overall, boiling water prior to drinking is the most common treatment method (6 percent). However less than 1 percent of rural households boil water, while almost one in four urban 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. Table 2.2 shows that 34 percent of households have an improved (not shared) toilet facility and 19 percent 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 half of the households use a non-improved toilet facility (47 percent); 31 percent of households use pit latrines without slabs, and 7 percent use a hanging toilet. Five percent of households have no toilet facility, an improvement since the 2007 BDHS, when 8 percent of households had no toilet facility (NIPORT, Mitra and Associates and Macro International, 2009). Rural households are more likely than urban households to have no toilet facility (6 percent versus 1 percent). Although the majority of households (60 percent) do not share their toilet, rural households are more likely than urban households to use a toilet facility that is not shared (62 versus 55 percent, respectively). Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Bangladesh 2011 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 39.6 31.7 33.7 43.3 34.4 36.6 Flush/pour flush to piped sewer system 6.5 0.1 1.7 6.8 0.1 1.8 Flush/pour flush to septic tank 12.7 3.1 5.6 13.5 3.7 6.1 Flush/pour flush to pit latrine 0.9 0.5 0.6 0.9 0.6 0.7 Ventilated improved pit (VIP) latrine 8.6 7.8 8.0 9.6 8.6 8.8 Pit latrine with slab 10.8 20.0 17.7 12.4 21.4 19.3 Composting toilet 0.0 0.0 0.0 0.0 0.0 0.0 Shared facility1 25.6 16.7 18.9 22.3 14.9 16.7 Flush/pour flush to piped sewer system 4.5 0.1 1.2 4.0 0.0 1.0 Flush/pour flush to septic tank 6.5 0.9 2.3 5.4 0.9 2.0 Flush/pour flush to pit latrine 0.8 0.3 0.4 0.7 0.3 0.4 Ventilated improved pit (VIP) latrine 6.0 3.8 4.4 5.2 3.5 3.9 Pit latrine with slab 7.7 11.6 10.6 7.1 10.2 9.4 Composting toilet 0.0 0.0 0.0 0.0 0.0 0.0 Non-improved facility 34.8 51.6 47.4 34.3 50.7 46.7 Flush/pour flush not to sewer/septic tank/pit latrine 18.1 0.1 4.6 17.4 0.1 4.3 Pit latrine without slab/open pit 13.8 37.1 31.3 14.1 36.6 31.2 Hanging toilet/hanging latrine 2.0 8.6 6.9 1.9 8.8 7.1 No facility/bush/field 0.9 5.8 4.6 0.8 5.2 4.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Shared sanitation facility Not shared 54.5 62.2 60.3 59.7 66.2 64.6 Shared with 1-4 households 25.6 33.9 31.8 23.0 30.2 28.5 5-9 households 11.7 3.3 5.4 10.0 2.9 4.6 10+ households 7.9 0.6 2.4 7.1 0.6 2.2 Don’t know/missing 0.2 0.1 0.1 0.3 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 4,305 12,836 17,141 19,158 59,752 78,909 1 Shared facility of an otherwise improved type 14 • Housing Characteristics and Household Population 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 quintile. In the 2011 BDHS, interviewers were instructed to observe the place where household members usually wash their hands. They looked for regularity of water supply and observed whether the household had cleansing agents near the place of hand washing. In 86 percent of households, the interviewers observed designated places for hand washing; urban households, households in Rangpur, and households in the highest wealth quintile were more likely to have this facility observed than other households. One in four households has soap and water in the place where household members wash their hands, 6 percent have water and other cleansing agents (ash, mud, sand, etc.), and the majority (67 percent) have water only. Overall, 2 percent of households do not have water, soap, or any cleansing agent. Forty-six percent of urban households have soap and water compared with 17 percent of rural households. Availability of hand washing facilities varies across divisions, ranging from 28 percent of households in Dhaka to 14 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 (4 percent) and highest (67 percent) among those in the highest wealth quintile. Table 2.3 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap and other cleansing agents, Bangladesh 2011 Background characteristics 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 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 92.8 4,305 46.3 3.5 48.7 0.1 0.1 1.2 0.1 100.0 3,997 Rural 83.7 12,836 17.0 6.9 73.1 0.0 0.1 2.9 0.1 100.0 10,738 Division Barisal 74.9 1,014 13.6 5.1 77.5 0.0 0.2 3.4 0.2 100.0 760 Chittagong 82.8 2,939 24.3 3.2 68.3 0.0 0.0 4.0 0.1 100.0 2,433 Dhaka 87.5 5,599 28.2 5.6 64.5 0.1 0.0 1.5 0.0 100.0 4,900 Khulna 84.7 2,024 20.3 5.5 72.9 0.0 0.2 0.9 0.2 100.0 1,714 Rajshahi 85.5 2,572 24.2 6.1 65.4 0.0 0.0 4.2 0.1 100.0 2,200 Rangpur 95.8 2,079 26.6 12.0 60.6 0.0 0.0 0.7 0.2 100.0 1,991 Sylhet 80.7 914 25.1 2.9 65.7 0.0 0.2 5.7 0.4 100.0 737 Wealth quintile Lowest 76.2 3,756 3.8 6.8 84.9 0.0 0.2 4.2 0.1 100.0 2,861 Second 81.5 3,481 8.5 7.9 79.3 0.0 0.0 4.2 0.1 100.0 2,835 Middle 85.3 3,325 12.7 6.9 77.7 0.0 0.0 2.5 0.2 100.0 2,835 Fourth 90.8 3,283 27.5 6.5 64.6 0.0 0.0 1.3 0.2 100.0 2,980 Highest 97.8 3,296 66.5 2.2 30.7 0.1 0.1 0.3 0.1 100.0 3,224 Total 86.0 17,141 24.9 6.0 66.5 0.0 0.1 2.4 0.1 100.0 14,736 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 2.1.2 Housing Characteristics Housing characteristics and household assets can be used to measure the socioeconomic status of household members. Cooking practices and cooking fuels also have an impact on health and the environment. Table 2.4 presents information on the availability of electricity, type of flooring material, number of rooms for sleeping, type of fuel used for cooking, and place where cooking is done. The table shows that 60 percent of households in Bangladesh have access to electricity. This is a marked Housing Characteristics and Household Population • 15 improvement from 2007, when only 47 percent of households had access to electricity. The increase in access to electricity is seen in rural and urban areas. In rural areas access to electricity increased from 37 percent in 2007 to 49 percent in 2011, and in urban areas access increased from 82 percent in 2007 to 90 percent in 2011 (NIPORT, Mitra and Associates and Macro International, 2009). However, access to electricity varies widely between urban (90 percent) and rural areas (49 percent). Earth and sand are the most common flooring materials used in Bangladesh (74 percent). These materials are predominantly used in rural areas (88 percent), while in urban areas the most common flooring material is cement (62 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 acute respiratory infections and skin diseases, which particularly affect children and the elderly. The proportion of households using one room for sleeping has decreased from 40 percent in 2007 to 35 percent in 2011. There are small differences in the number of rooms used for sleeping by urban-rural residence. 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 are all related to indoor air quality and the degree to which household members are exposed to the risk of respiratory infections and other diseases. In Bangladesh, the risk of indoor pollution from cooking fuel is limited because only 12 percent of households cook in the house; 64 percent of households cook in a separate building, and 23 percent cook outdoors. Urban households are much more likely than rural households to cook in the house (23 and 9 percent, respectively). Half of households in urban areas (51 percent) use solid fuel for cooking while virtually all rural households (99 percent) use solid fuel, including wood, agricultural crops, animal dung, straw, shrubs, grass, and charcoal. The proportion of urban households that rely on wood for fuel has decreased from 44 percent in 2007 to 35 percent in 2011. On the other hand, the use Table 2.4 Household characteristics Percent distribution of households by housing characteristics and percentage using solid fuel for cooking; and percent distribution by frequency of smoking in the home, according to residence, Bangladesh 2011 Housing characteristic Residence Total Urban Rural Electricity Yes 90.2 49.3 59.6 No 9.8 50.7 40.4 Total 100.0 100.0 100.0 Flooring material Earth, sand 32.1 88.3 74.1 Wood/planks 0.2 0.1 0.2 Palm/bamboo 0.0 0.0 0.0 Parquet or polished wood 0.0 0.0 0.0 Ceramic tiles 5.3 0.2 1.5 Cement 62.1 11.3 24.1 Carpet 0.2 0.0 0.1 Total 100.0 100.0 100.0 Rooms used for sleeping One 38.5 34.4 35.4 Two 34.7 37.5 36.8 Three or more 26.7 27.9 27.6 Missing 0.2 0.2 0.2 Total 100.0 100.0 100.0 Place for cooking In the house 22.8 8.8 12.3 In a separate building 63.0 64.7 64.3 Outdoors 13.9 26.4 23.3 Other 0.2 0.1 0.1 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.5 0.0 0.1 LPG/natural gas/biogas 48.4 1.3 13.1 Kerosene 0.6 0.0 0.2 Coal/lignite 0.0 0.0 0.0 Charcoal 0.3 0.1 0.2 Wood 35.0 47.7 44.6 Straw/shrubs/grass 1.8 1.0 1.2 Agricultural crop 9.5 39.1 31.7 Animal dung 3.8 10.4 8.7 Other 0.1 0.3 0.2 Total 99.9 100.0 100.0 Percentage using solid fuel for cooking1 50.4 98.4 86.3 Frequency of smoking in the home Daily 40.2 46.8 45.1 Weekly 3.2 2.5 2.7 Monthly 0.9 1.2 1.1 Less than monthly 3.1 2.6 2.7 Never 52.5 46.7 48.2 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Number 4,305 12,836 17,141 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung 16 • Housing Characteristics and Household Population of wood for fuel has increased in rural areas, from 44 percent in 2007 to 48 percent in 2011. As expected, use of liquid petroleum gas (LPG), natural gas, and biogas is 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 2011 BDHS shows that Bangladesh is slowly making some progress toward this goal; the proportion of the population that uses solid fuels in Bangladesh has declined from 91 percent in 2007 to 86 percent in 2011. Information on smoking was collected in the 2011 BDHS to assess the percentage of household members who are exposed to secondhand smoke (SHS), which is a risk factor for those who do not smoke. Pregnant women who are exposed to SHS have a higher risk of giving birth to a low birth weight baby (Windham et al., 1999). Also, children who are exposed to SHS are at a higher risk of respiratory and ear infections and poor lung development (U.S. Department of Health and Human Services, 2006). Table 2.4 provides information on the frequency of smoking in the home, which is used as a proxy for level of SHS exposure. Overall, 45 percent of households are exposed daily to SHS; rural households are more likely than urban households to be exposed to SHS (47 percent and 40 percent, respectively). 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 2.5 shows the percentages of urban and rural households that possess various durable commodities, means of transportation, and agricultural land and farm animals. Table 2.5 shows that televisions and mobile telephones are common information and communication devices possessed by most households. Possession of mobile phones has increased sharply, from 32 percent in 2007 to 78 percent in 2011 (NIPORT, Mitra and Associates and Macro International, 2009). About nine in 10 households in urban areas and more than seven in 10 households in rural areas possess mobile phones. Four out of ten households have a television. Urban households are more likely to possess a television (70 percent) than rural households (30 percent). Possession of a radio has decreased from 24 percent to 8 percent in the last four years, while ownership of a television has increased from 30 percent to 40 percent. A refrigerator is available in 14 percent of households, with urban households six times as likely (36 percent) as rural households (6 percent) to own one. More than 7 out of 10 households possess a table and a chair. More than half of all households possess an electric fan, with a higher percentage in urban areas than rural areas (86 percent and 41 percent, respectively). Twelve percent of households own a DVD/VCD player: 24 percent in urban areas and 8 percent in rural areas. Table 2.5 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Bangladesh 2011 Possession Residence Total Urban Rural Household effects Radio 6.9 8.7 8.2 Television 70.2 29.8 39.9 Mobile telephone 89.2 74.8 78.4 Non-mobile telephone 7.6 0.3 2.1 Refrigerator 35.6 6.2 13.5 Cupboard 54.3 28.7 35.2 Table 74.6 72.1 72.7 Chair 75.7 74.5 74.8 Electric fan 85.9 41.2 52.4 DVD/VCD player 23.8 8.1 12.1 Water pump 10.8 4.2 5.8 Means of transport Bicycle 16.6 28.4 25.4 Autobike 0.6 0.4 0.4 Motorcycle/scooter 7.1 4.9 5.4 Rickshaw/van 4.5 6.7 6.1 Ownership of agricultural land Homestead 90.4 95.8 94.4 Other land 38.6 49.4 46.6 Neither 8.7 3.9 5.1 Ownership of farm animals Bulls/Buffaloes 0.1 0.5 0.4 Cows 12.0 45.7 37.2 Goats/sheep 7.8 28.9 23.6 Chicken/ducks 24.7 70.3 58.9 Number 4,305 12,836 17,141 Housing Characteristics and Household Population • 17 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 little difference between rural and urban households. Ownership of a motorcycle is slightly higher in urban areas (7 percent) than in rural areas (5 percent). Ninety-four percent of households own a homestead, while 47 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 has declined slightly since 2004, from 52 to 47 percent, especially in rural areas, while ownership of a homestead has remained unchanged. Chicken or ducks, the most commonly owned type of livestock, are owned by 59 percent of households. Almost four out of ten households own cows, and one-quarter of households own goats or sheep. As expected, rural households are more likely than urban households to own each 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 2.6 presents the wealth quintiles by urban-rural residence and administrative division. More than half of the population (55 percent) residing in urban areas is in the highest wealth quintile, compared with 9 percent in rural areas. Among the administrative divisions, people living in Dhaka are more likely to fall in the highest wealth quintile than people living in other divisions. In contrast, Rangpur and Sylhet divisions have the highest proportion of the population in the lowest wealth quintile (30 and 24 percent, respectively). 18 • Housing Characteristics and Household Population Table 2.6 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Bangladesh 2011 Residence/ region Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 5.8 5.9 9.2 24.0 55.1 100.0 19,158 24.4 Rural 24.5 24.5 23.5 18.7 8.8 100.0 59,752 30.3 Division Barisal 20.7 28.4 24.7 17.7 8.5 100.0 4,603 30.7 Chittagong 15.3 19.6 21.0 24.5 19.7 100.0 15,386 33.1 Dhaka 19.1 16.2 17.1 18.3 29.3 100.0 25,126 40.6 Khulna 16.4 18.6 22.7 22.6 19.8 100.0 8,742 31.5 Rajshahi 21.3 21.9 23.2 21.1 12.5 100.0 11,001 30.4 Rangpur 30.0 27.4 18.2 15.4 8.9 100.0 8,916 29.1 Sylhet 24.0 17.4 19.0 18.1 21.5 100.0 5,135 34.3 Total 20.0 20.0 20.0 20.0 20.0 100.0 78,909 32.7 Table 2.6 also includes information on the Gini coefficient, which indicates the level of concentration of wealth (0 being an equal distribution and 1 being a totally unequal distribution). This ratio is expressed as a proportion between 0 and 1. Wealth inequality, as measured by the Gini coefficient, is higher in rural than in urban areas (30 percent vs. 24 percent. Inequality in wealth is highest in Dhaka (41 percent). 2.3 HOUSEHOLD POPULATION BY AGE AND SEX Table 2.7 shows the distribution of the de facto household population by age, sex, and residence. The 2011 BDHS enumerated a total of 77,514 persons (37,381 males and 40,133 females). The sex ratio is 93 males per 100 females. This is similar to the sex ratio of 95 males per 100 females obtained in the 2007 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’ 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. Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Bangladesh 2011 Age Urban Rural Total Total Male Female Total Male Female Total Male Female <5 10.4 9.4 9.9 12.2 11.0 11.6 11.7 10.6 11.2 5-9 11.3 10.1 10.7 13.4 12.0 12.7 12.9 11.6 12.2 10-14 11.4 10.8 11.1 12.7 11.7 12.2 12.4 11.5 11.9 15-19 8.8 11.9 10.4 8.8 10.6 9.8 8.8 10.9 9.9 20-24 8.5 11.7 10.1 7.0 9.9 8.5 7.3 10.3 8.9 25-29 8.8 9.8 9.3 6.5 8.6 7.6 7.1 8.9 8.0 30-34 7.6 7.5 7.5 6.1 6.5 6.3 6.4 6.8 6.6 35-39 6.8 6.3 6.6 5.6 5.5 5.5 5.9 5.7 5.8 40-44 6.0 5.9 6.0 5.1 5.4 5.2 5.3 5.5 5.4 45-49 5.4 5.1 5.3 4.9 4.5 4.7 5.0 4.7 4.8 50-54 4.3 2.8 3.5 4.6 3.4 4.0 4.5 3.3 3.9 55-59 3.7 2.8 3.3 3.0 3.1 3.0 3.2 3.0 3.1 60-64 2.3 2.1 2.2 3.1 2.6 2.8 2.9 2.5 2.7 65-69 1.8 1.0 1.4 2.3 1.6 2.0 2.2 1.5 1.8 70-74 1.4 1.1 1.3 2.0 1.5 1.7 1.9 1.4 1.6 75-79 0.5 0.5 0.5 1.0 0.6 0.8 0.9 0.6 0.7 80+ 0.8 1.0 0.9 1.7 1.5 1.6 1.5 1.3 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 9,318 9,749 19,067 28,063 30,384 58,447 37,381 40,133 77,514 Housing Characteristics and Household Population • 19 More than one-third of the de facto household population (37 percent) is under age 15, and 11 percent is under age 5. People age 65 and older account for just 6 percent of the total population. The proportion of the population under age 15 is somewhat lower in urban than rural areas, as is the proportion of the population older than age 65. The age-sex structure of the population is shown by the population pyramid in Figure 2.1. 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 2.2 shows the distribution of the male and female household populations by single years of age. The figure shows noticeable heaping at ages ending with 0 and 5, and heaping is more prominent among males than females. Ages ending with 1 and 9 are underreported. Figure 2.1 Population pyramid 8 6 4 2 0 2 4 6 8 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Percent Age Male Female BDHS 2011 20 • Housing Characteristics and Household Population Figure 2.2 Distribution of the de facto household population by single year of age and sex 0 1 2 3 4 5 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70+ Percent Single year of age Male Female BDHS 2011 Table 2.8 presents changes in the broad age structure of the population since 1989. The proportion of the population under age 15 has declined from 43 percent in 1989 to 35 percent in 2011. In contrast, the proportion of the population age 15-59 has increased over time, as has the proportion age 60 and over. Table 2.8 Trends in population by age Percent distribution of the de facto population by age group, selected sources, Bangladesh 1989-2011 Age group 1989 BFS 1989 CPS 1991 CPS 1993-1994 BDHS 1996-1997 BDHS 1999-2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS <15 43.2 43.2 42.7 42.6 41.0 39.2 38.2 36.3 35.3 15-59 50.9 50.9 51.2 51.2 53.1 54.4 55.1 56.6 56.5 60+ 5.9 5.9 6.0 6.2 5.9 6.4 6.6 7.1 8.2 Total 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 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 2.9 presents information on household composition. The majority (89 percent) of households are headed by men. Only 11 percent of households are headed by women. The proportion of female-headed households has dropped from 13 percent in 2007 to 11 percent in 2011, with the drop more marked in rural than urban areas. More than half of the households in Bangladesh are composed of two to four members. The average household size is 4.6 persons, as compared with 4.7 in 2007; household sizes are larger in rural (4.7) than in urban (4.4) areas. Housing Characteristics and Household Population • 21 Table 2.9 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 2011 Characteristic Residence Total Urban Rural Household headship Male 88.8 89.0 89.0 Female 11.2 11.0 11.0 Total 100.0 100.0 100.0 Number of usual members 1 1.3 1.9 1.7 2 9.5 8.6 8.8 3 20.2 17.7 18.3 4 27.7 24.8 25.5 5 19.5 20.2 20.0 6 11.1 12.7 12.3 7 5.0 6.4 6.0 8 2.7 3.3 3.1 9+ 3.1 4.5 4.1 Total 100.0 100.0 100.0 Mean size of households 4.4 4.7 4.6 Number of households 4,305 12,836 17,141 Note: Table is based on de jure household members, i.e., usual residents. 2.5 BIRTH REGISTRATION UNICEF supported the government’s program for birth registration in Bangladesh from 2001- 2006 in 28 districts and 4 city corporations. According to the amended Birth and Death Registration Act of 2004, which came into force in 2006, children born in Bangladesh must be registered and have a birth certificate. The government of Bangladesh set the target of universal registration for the end of 2008. This deadline was extended for children under age 18 to the end of June 2010. After this date a fee for registration was instituted. However, the registration of babies under age 2 remains free of charge. Birth certificates were made mandatory for 16 services, including school enrollment, passports, voter registration, and marriage registration. The local governmental and nongovernmental organizations (NGOs) are participating in birth registration for populations where they work. In 2009 a computerized birth registration system was introduced in Bangladesh on a pilot basis. Upon completion of the pilot, the system will be expanded to the entire country (UNICEF, nd). In the 2011 BDHS, information on birth registration was solicited for children under age 5. Table 2.10 presents the percentage of the de jure population under age 5 whose births are registered with the civil authorities, according to background characteristics. More than three in ten children (31 percent) have their births registered, and 22 percent of children under age 5 have a birth certificate. Although the vital registration system of the government requires that a newborn be registered within the shortest possible time, Table 2.10 indicates that children under age 2 are much less likely to be registered than children age 2-4 (13 and 41 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. 22 • Housing Characteristics and Household Population Table 2.10 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background characteristics, Bangladesh 2011 Background characteristic Children whose births are registered Number of children Percentage who had a birth certificate Percentage who did not have birth certificate Percentage registered Age <2 9.4 3.9 13.3 3,187 2-4 30.3 10.6 40.9 5,300 Sex Male 22.2 8.3 30.5 4,304 Female 22.7 7.8 30.5 4,183 Residence Urban 26.5 8.6 35.0 1,880 Rural 21.3 8.0 29.2 6,606 Division Barisal 24.4 9.2 33.6 476 Chittagong 24.5 6.7 31.2 1,956 Dhaka 19.2 7.6 26.9 2,646 Khulna 25.7 6.2 31.9 761 Rajshahi 17.5 8.5 26.0 1,077 Rangpur 22.8 10.2 33.1 924 Sylhet 31.7 11.7 43.5 646 Wealth quintile Lowest 17.2 6.3 23.5 2,066 Second 19.4 8.5 27.9 1,719 Middle 23.0 8.1 31.1 1,594 Fourth 24.8 7.3 32.1 1,613 Highest 30.0 11.0 41.0 1,494 Total 22.4 8.1 30.5 8,487 Table 2.10 shows that birth registration is higher in urban (35 percent) than in rural (29 percent) areas. There is no difference regarding the extent of birth registration among male and female children. Among the administrative divisions, 44 percent of children from Sylhet, and around one-third of children from Barisal, Chittagong, Khulna, and Rangpur divisions are registered. Only one-quarter of the children from Dhaka and Rajshahi are registered. Children from the highest wealth quintile are more likely to have their births registered (41 percent) than children from the lowest wealth quintile (24 percent). 2.6 SCHOOL ATTENDANCE In the 2011 BDHS, information was collected about school attendance of household members age 6 to 24. Table 2.11 shows that the proportion of the population that attends school declines with age. Whereas 88 percent of children age 6-10 are in school, the percentage decreases to 79 percent for children age 11-15, and to 34 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, which had a special focus on female education. 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 from that in the 2007 BDHS. For example, the proportion of children age 6-15 who are attending school has increased from 80 percent in 2007 (NIPORT, Mitra and Associates and Macro International, 2009) to 84 percent in 2011. Housing Characteristics and Household Population • 23 Table 2.11 School attendance Percentage of the de facto household population age 6-24 attending school, by age, sex, and residence, Bangladesh 2011 Background characteristic Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-15 81.7 82.3 82.2 82.9 85.8 85.2 82.3 84.1 83.7 6-10 86.3 86.9 86.7 87.7 88.8 88.6 87.0 87.9 87.7 11-15 76.7 76.9 76.8 77.8 82.3 81.2 77.2 79.6 79.0 16-20 44.6 40.1 41.3 35.1 27.0 29.2 38.9 32.6 34.3 21-24 24.5 17.5 19.6 14.5 6.9 9.0 18.5 10.9 13.1 2.7 EDUCATION OF HOUSEHOLD POPULATION Studies have shown that education is one of the major socioeconomic factors that influences 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 methods, 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. The country is responsible for providing 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 an opening up of non-grade-level schools, which offer pre-primary education. Government also is implementing nonformal 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. Tables 2.12.1 and 2.12.2 show the distribution of the male and female household populations age 6 and older by the highest level of education completed and the median number of years of education completed, according to background characteristics. The majority of Bangladeshis who are age 6 and older have attended school. Only one in four men and about one in three women have never attended school. There is no gender difference in primary education. However, men are more likely to have completed secondary school or have attained a higher education compared with women (15 percent versus 10 percent). There has been an increase in the proportions of men and women who have completed secondary or higher education since 2007. For men, the proportion has increased from 12 percent to 15 percent, and for women it has increased from 7 percent to 10 percent in 2011. 24 • Housing Characteristics and Household Population Table 2.12.1 Educational attainment of the male household population Percent distribution of the de facto male household populations age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Bangladesh 2011 Background characteristic No education Primary incomplete Completed primary1 Secondary incomplete Completed secondary or higher2 Don’t know/ missing Total Number Median years completed Age 6-9 28.5 71.4 0.0 0.1 0.0 0.0 100.0 4,002 0.0 10-14 5.8 60.9 3.6 29.5 0.2 0.0 100.0 4,624 3.0 15-19 7.4 17.7 11.5 43.3 20.2 0.0 100.0 3,302 6.4 20-24 12.6 16.8 13.5 29.9 27.2 0.0 100.0 2,738 6.1 25-29 17.1 15.8 14.5 29.5 23.0 0.0 100.0 2,651 5.2 30-34 24.3 17.8 11.6 23.2 23.1 0.0 100.0 2,410 4.6 35-39 31.1 16.9 10.2 19.5 22.3 0.0 100.0 2,197 4.2 40-44 33.6 15.1 9.3 18.5 23.5 0.0 100.0 1,983 4.1 45-49 37.1 17.9 8.4 17.5 19.0 0.0 100.0 1,881 3.1 50-54 42.0 16.7 10.2 16.0 15.1 0.0 100.0 1,689 1.9 55-59 38.4 12.1 8.1 16.9 24.6 0.0 100.0 1,194 3.9 60-64 44.9 15.0 13.4 11.1 15.6 0.0 100.0 1,085 1.4 65+ 50.4 15.1 10.5 14.1 10.0 0.0 100.0 2,419 0.0 Residence Urban 16.9 24.3 8.4 24.2 26.3 0.0 100.0 8,170 4.8 Rural 27.4 31.4 8.9 21.0 11.3 0.0 100.0 24,008 2.7 Division Barisal 17.9 34.1 9.1 24.2 14.7 0.0 100.0 1,821 3.7 Chittagong 22.2 33.0 8.7 22.7 13.5 0.0 100.0 5,809 3.3 Dhaka 26.6 27.5 8.5 20.4 17.1 0.0 100.0 10,374 3.3 Khulna 22.0 28.2 8.0 25.1 16.7 0.0 100.0 3,707 4.0 Rajshahi 26.5 27.9 8.3 21.6 15.8 0.0 100.0 4,623 3.3 Rangpur 27.6 29.0 9.3 21.4 12.7 0.0 100.0 3,764 3.1 Sylhet 24.4 34.5 11.3 19.9 9.9 0.0 100.0 2,080 2.7 Wealth quintile Lowest 45.0 37.1 7.6 9.3 1.0 0.0 100.0 6,143 0.0 Second 31.0 35.3 10.0 18.6 5.1 0.0 100.0 6,426 1.7 Middle 23.1 31.0 10.2 24.5 11.2 0.0 100.0 6,501 3.5 Fourth 16.9 26.0 9.4 28.6 19.0 0.0 100.0 6,386 4.6 Highest 9.2 19.4 6.7 27.2 37.5 0.0 100.0 6,721 7.6 Total 24.7 29.6 8.8 21.8 15.1 0.0 100.0 32,177 3.4 Note: Total includes one man with missing information on age. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. 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 (37 percent) among those age 45-49 than among boys age 10-14 (6 percent). Similarly, 54 percent of women age 45-49 have no education compared with only 4 percent of girls age 10-14. Overall, levels of educational attainment are higher in urban than in rural areas (Tables 2.12.1 and 2.12.2). The proportions of men and women with no education are lower in urban areas (17 percent of men and 22 percent of women) than in rural areas (27 percent of men and 32 percent of women), while the proportions who have completed secondary or higher schooling are greater in urban areas (26 percent of men and 19 percent of women) than in rural areas (11 percent of men and 7 percent of women). On average, men and women living in urban areas have completed almost two more years of school than those living in rural areas. There are also regional variations in educational attainment. Barisal division has the highest proportion of men and women with some education (82 percent of men and 79 percent of women) and Rangpur has the lowest (72 percent of men and 67 percent of women). Housing Characteristics and Household Population • 25 Table 2.12.2 Educational attainment of the female household population Percent distribution of the de facto female household populations age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Bangladesh 2011 Background characteristic No education Primary incomplete Completed primary1 Secondary incomplete Completed secondary or higher2 Don’t know/ missing Total Number Median years completed Age 6-9 24.1 75.8 0.0 0.1 0.0 0.0 100.0 3,923 0.0 10-14 4.1 55.6 4.4 35.8 0.1 0.0 100.0 4,597 3.5 15-19 5.8 12.5 9.6 52.8 19.3 0.0 100.0 4,383 6.9 20-24 9.8 14.4 12.5 44.9 18.3 0.0 100.0 4,135 6.5 25-29 18.7 18.8 11.8 33.5 17.2 0.0 100.0 3,564 4.9 30-34 30.9 20.8 10.6 21.8 15.8 0.0 100.0 2,717 3.8 35-39 41.3 18.7 10.0 17.8 12.3 0.0 100.0 2,297 1.9 40-44 49.0 18.7 10.4 13.4 8.5 0.0 100.0 2,206 0.0 45-49 54.4 18.9 10.0 10.9 5.8 0.0 100.0 1,878 0.0 50-54 62.2 16.7 9.3 8.1 3.7 0.0 100.0 1,305 0.0 55-59 67.9 12.2 8.9 7.6 3.3 0.0 100.0 1,208 0.0 60-64 73.9 13.7 6.7 4.4 1.2 0.0 100.0 1,001 0.0 65+ 81.3 9.7 5.2 3.1 0.6 0.0 100.0 1,925 0.0 Residence Urban 22.0 24.0 8.0 27.3 18.7 0.0 100.0 8,676 4.4 Rural 31.7 29.2 8.3 24.4 6.5 0.0 100.0 26,465 2.3 Division Barisal 20.6 32.2 11.3 26.6 9.4 0.0 100.0 2,087 3.7 Chittagong 27.1 28.1 8.0 27.9 8.8 0.0 100.0 6,819 3.2 Dhaka 30.3 27.1 8.1 23.3 11.2 0.0 100.0 11,248 2.8 Khulna 26.7 27.6 6.7 29.3 9.6 0.0 100.0 4,022 3.4 Rajshahi 31.4 27.2 8.6 24.0 8.8 0.0 100.0 4,872 2.6 Rangpur 33.5 28.1 6.9 23.2 8.3 0.0 100.0 3,847 2.0 Sylhet 31.6 28.9 10.9 22.1 6.5 0.0 100.0 2,246 2.3 Wealth quintile Lowest 46.8 34.7 6.5 11.5 0.4 0.0 100.0 6,573 0.0 Second 34.7 32.1 8.7 21.9 2.7 0.0 100.0 6,915 1.6 Middle 28.2 27.9 9.6 28.7 5.7 0.0 100.0 7,153 3.2 Fourth 22.9 25.7 9.3 31.2 10.9 0.0 100.0 7,226 4.1 Highest 15.8 19.9 7.0 30.8 26.6 0.0 100.0 7,275 6.1 Total 29.3 27.9 8.2 25.1 9.5 0.0 100.0 35,141 2.9 Note: Total includes three women with missing information on age. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Wealth exerts a positive influence on educational attainment. Women from the highest wealth quintile are more likely to be educated than other women. Men and women in the lowest wealth quintiles are less likely to have attended school. Among men, 45 percent of those in the lowest quintile have never attended school compared with 9 percent in the highest quintile. Differences by wealth are equally large among women; 47 percent of women from the lowest quintile have no schooling compared with 16 percent from the highest wealth quintile. A comparison of the 2007 and 2011 BDHS surveys shows a marked rise in completed median years of schooling. Over this four-year period, the completed median years of schooling among men have increased from 2.9 to 3.4 years. Similarly, the completed median years of schooling have increased from 2.1 to 2.9 among women. 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 2.13 provides 26 • Housing Characteristics and Household Population data on net attendance ratios and gross attendance ratios by sex and level of schooling. The NAR at the primary level is 75 percent (73 percent for males and 77 percent for females). The NAR at the secondary level is 38 percent (36 percent for males and 40 percent for females). Table 2.13 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Bangladesh 2011 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 72.1 73.6 72.8 1.02 108.6 106.1 107.4 0.98 Rural 73.3 77.4 75.4 1.06 114.3 116.7 115.5 1.02 Division Barisal 78.3 84.9 81.6 1.08 118.7 127.6 123.1 1.07 Chittagong 71.8 73.4 72.6 1.02 113.2 114.4 113.8 1.01 Dhaka 69.7 74.5 72.1 1.07 107.1 108.7 107.9 1.01 Khulna 78.8 83.3 81.0 1.06 117.8 118.4 118.1 1.00 Rajshahi 72.1 74.2 73.1 1.03 115.9 118.9 117.4 1.03 Rangpur 74.8 80.0 77.3 1.07 113.2 113.5 113.3 1.00 Sylhet 78.0 78.4 78.2 1.01 122.9 117.9 120.4 0.96 Wealth quintile Lowest 65.7 69.8 67.7 1.06 102.7 109.8 106.1 1.07 Second 74.5 78.0 76.2 1.05 124.0 124.4 124.2 1.00 Middle 73.3 82.0 77.7 1.12 119.9 119.6 119.7 1.00 Fourth 78.8 77.8 78.3 0.99 110.9 113.3 112.1 1.02 Highest 76.3 77.1 76.7 1.01 110.5 104.5 107.4 0.95 Total 73.0 76.6 74.8 1.05 113.1 114.4 113.7 1.01 SECONDARY SCHOOL Residence Urban 39.0 40.8 40.0 1.05 43.3 43.9 43.6 1.01 Rural 35.3 39.3 37.4 1.11 40.1 42.8 41.5 1.07 Division Barisal 42.8 43.0 42.9 1.00 46.8 46.5 46.6 0.99 Chittagong 34.5 39.5 37.1 1.15 39.2 44.3 41.9 1.13 Dhaka 35.0 36.9 36.0 1.05 39.1 39.6 39.4 1.01 Khulna 40.7 46.5 43.7 1.14 45.6 49.4 47.5 1.09 Rajshahi 36.2 38.6 37.4 1.07 42.3 41.7 42.0 0.99 Rangpur 37.9 43.8 40.9 1.16 41.9 46.5 44.2 1.11 Sylhet 31.4 35.6 33.5 1.14 36.5 39.5 38.0 1.08 Wealth quintile Lowest 15.8 22.4 19.0 1.42 18.0 24.0 20.9 1.33 Second 30.4 35.2 32.9 1.16 35.2 39.0 37.1 1.11 Middle 37.8 44.8 41.5 1.19 43.8 49.0 46.5 1.12 Fourth 47.1 45.9 46.4 0.98 53.0 50.0 51.4 0.94 Highest 51.9 49.1 50.5 0.95 56.0 52.1 54.0 0.93 Total 36.2 39.7 38.0 1.10 40.8 43.1 42.0 1.05 1 The NAR for primary school is the percentage of the primary-school age (age 6-10) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (age 11-17) 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. 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, and Sylhet has one of the highest NARs and GARs 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. However, at the secondary level, children in the highest wealth quintile have the highest NAR and GAR and children in the lowest wealth quintile have the lowest NAR and GAR (Table 2.13). Housing Characteristics and Household Population • 27 Table 2.13 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 attend school. The indexes for NAR and GAR at the primary level are slightly higher than 1.00 (1.05 versus 1.01), indicating that the gender gap is very narrow. Figure 2.3 shows that, for ages 5-14, girls have a higher level of school attendance than boys. The pattern reverses at age 15 and older. Attendance is highest at age 10 for boys and at age 11 for girls. Figure 2.3 Age-specific attendance rates of the de facto population age 5-24 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 (years) Male Female BDHS 2011 2.8 EMPLOYMENT The 2011 BDHS collected information regarding the working status of each person age 8 and older at the time of the survey. Table 2.14 shows that men are much more likely than women to be employed (64 percent and 11 percent, respectively). The proportion of people who are employed has decreased since 2007. For men, the proportion has decreased from 68 percent to 64 percent and for women, from 23 percent to 11 percent. The urban population is much more likely to be employed than the rural population. For men, the proportion is 67 percent urban versus 63 percent rural, and for women, the proportion is 18 percent urban and 8 percent rural, respectively. Table 2.14 Employment status Percentage of male and female de facto household population age eight and over who are working at the time of the survey, by age, sex, and residence, Bangladesh 2011 Age Male Female Urban Rural Total Urban Rural Total 8-9 1.4 1.0 1.1 2.2 0.5 0.8 10-14 10.4 8.9 9.3 9.6 1.6 3.4 15-19 44.4 42.8 43.2 15.9 5.0 7.9 20-24 69.5 75.4 73.7 20.8 11.6 14.1 25-29 91.2 92.9 92.4 29.2 12.9 17.2 30-34 97.3 96.5 96.8 27.2 12.9 16.8 35-39 98.0 98.4 98.3 25.3 14.0 17.0 40-44 97.3 97.7 97.6 20.4 13.0 14.9 45-49 97.7 97.6 97.6 22.2 12.6 15.2 50-54 94.8 96.4 96.0 14.1 10.9 11.6 55-59 89.6 88.8 89.0 11.1 6.1 7.2 60-64 70.2 81.5 79.3 5.2 5.1 5.1 65+ 43.8 49.7 48.6 2.6 2.2 2.3 Total 66.9 63.2 64.1 18.0 8.2 10.6 Number 7,721 22,409 30,130 8,245 24,885 33,130 Characteristics of Survey Respondents • 29 CHARACTERISTICS OF RESPONDENTS 3 his chapter presents the demographic and socioeconomic profile of the Bangladesh respondents in 2011. The profile 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 2011 BDHS includes results from completed interviews with 17,749 ever-married women age 15-491 and 3,997 ever-married men age 15-54. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Basic background characteristics of the 17,749 ever-married women and 3,997 ever-married men, age 15-49, are presented in Table 3.1. Half of the women (50 percent) and 26 percent of the men are under age 30. The majority of women (94 percent) and nearly all men (99 percent) are currently married. The majority of respondents (74 percent of women and 72 percent of men) reside in the rural areas. The respondents are not evenly distributed across geographic divisions. Almost one-third of respondents live in Dhaka. The distribution of sampled women by division is similar to that in the 2007 BDHS, except in Rajshahi division, which was divided into two administrative divisions, Rajshahi and Rangpur, between the two BDHS surveys; 15 percent of women resided in Rajshahi and 12 percent in Rangpur in the current survey. Twenty-eight percent of women and 26 percent of men age 15-49 have no education, while 12 percent of women and 18 percent of men have completed secondary- or higher-level education. The vast majority of the respondents (90 percent) are Muslims. Most of the remaining women and men are Hindus. Very few of the respondents are Buddhists or Christians. Because the male respondents in the 2011 BDHS come from the same households as the female respondents, it is possible to match married men to their spouses. Figure 3.1 shows the age differentials 1 The survey interviewed ever-married women age 12-49. However, less than 1 percent of ever-married women were age 12-14. These women have been removed from the data set, and the weights have been recalculated for the 15-49 age group. T Key Findings: • Twenty-eight percent of ever-married women and 26 percent of ever- married men age 15-49 have no education. The percentage of women and men with no education has decreased since 2007. However, the percentage of women and men with secondary or higher education has remained stable over the same period. • Forty-nine percent of women and 22 percent of men are not regularly exposed to any media source. • Fifteen percent of women were employed in the 12 months preceding the survey, with the highest percentages employed in factory or blue collar (25 percent) and semi-skilled services (22 percent). • The majority of working men consider their earnings moderately sufficient (62 percent) or sufficient (10 percent) to provide for their family’s basic needs. 30 • Characteristics of Survey Respondents between spouses for matched couples in the current and the three previous BDHS surveys. Not surprisingly, the husband is older than the wife for almost all couples. Since 2004, the percentage of couples for which the husband is less than 5 years older than the wife has increased, while the percentage of couples for which the husband is 15 years or more older than the wife has declined. Table 3.1 Background characteristics of respondents Percent distribution of ever-married women and men age 15-49 by selected background characteristics, Bangladesh 2011 Background characteristic Women Men Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 11.1 1,970 1,911 0.6 21 18 20-24 19.8 3,514 3,456 7.3 249 222 25-29 19.1 3,394 3,387 18.3 621 629 30-34 15.0 2,654 2,690 18.4 625 618 35-39 12.7 2,246 2,300 19.5 660 673 40-44 12.1 2,152 2,157 18.5 629 636 45-49 10.3 1,820 1,848 17.3 586 586 Marital status Currently married 93.7 16,635 16,616 99.1 3,360 3,355 Divorced/separated/ widowed 6.3 1,114 1,133 0.9 31 27 Residence Urban 26.0 4,619 6,179 28.0 949 1,224 Rural 74.0 13,130 11,570 72.0 2,442 2,158 Division Barisal 5.6 1,002 2,050 5.1 174 341 Chittagong 18.2 3,222 2,864 15.3 519 478 Dhaka 32.3 5,736 3,062 32.3 1,095 586 Khulna 12.0 2,139 2,640 12.7 430 530 Rajshahi 14.9 2,646 2,590 16.4 556 529 Rangpur 11.5 2,039 2,457 13.0 442 534 Sylhet 5.4 967 2,086 5.2 175 384 Educational attainment No education 27.7 4,912 4,629 26.2 890 823 Primary incomplete 18.4 3,264 3,199 24.3 823 830 Primary complete1 11.6 2,062 2,097 9.0 305 306 Secondary incomplete 30.3 5,383 5,458 22.4 758 753 Secondary complete or higher2 12.0 2,127 2,366 18.1 615 670 Religion Islam 90.0 15,980 15,758 89.6 3,038 2,971 Hinduism 9.5 1,689 1,907 9.9 337 394 Buddhism 0.2 44 36 0.2 6 5 Christianity 0.2 37 48 0.3 10 12 Wealth quintile Lowest 18.3 3,250 3,077 19.3 654 602 Second 19.6 3,487 3,315 19.6 666 636 Middle 20.1 3,567 3,403 19.1 647 644 Fourth 20.6 3,664 3,762 21.4 726 714 Highest 21.3 3,781 4,192 20.6 699 786 Total 15-49 100.0 17,749 17,749 100.0 3,392 3,382 50-54 na na na na 605 615 Total 15-54 na na na na 3,997 3,997 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. na = Not applicable Characteristics of Survey Respondents • 31 Figure 3.1 Trends in age differential between spouses, 1999-2011 BDHS 2 14 41 31 12 1 14 40 30 14 1 17 40 30 12 1 19 40 30 10 Wife older 0-4 years 5-9 years 10-14 years 15+ years Age difference 1999-2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS Percent 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. Tables 3.2.1 and 3.2.2 present differentials in the educational attainment of women and men by selected background characteristics. Table 3.2.1 shows that 28 percent of ever-married women age 15-49 have never been to school, 18 percent have completed some primary education, 12 percent have completed all primary education, 30 percent have completed some secondary education, and 12 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 pronounced at the secondary and higher levels. For example, urban women are almost three times more likely than rural women to have completed secondary or higher education (23 percent and 8 percent, respectively). Between 10 and 14 percent of women in all geographic divisions have completed secondary or higher-level education except in Sylhet, where only 7 percent of women have completed secondary or higher-level education. Sylhet also has the highest proportion of women with no education (35 percent). Women in the highest wealth quintile are most likely to complete secondary or higher-level education; 35 percent of women in the highest wealth quintile achieved this level. In Bangladesh, women age 15-49 have completed a median of 4.3 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 eight years compared with no years of schooling for women in the lowest quintile. 32 • Characteristics of Survey Respondents Table 3.2.1 Educational attainment: Women 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 2011 Background characteristic Highest level of schooling Total Median years completed Number of women No education Primary incomplete Completed primary1 Secondary incomplete Secondary complete or higher2 Age 15-19 8.1 14.9 12.3 54.9 9.9 100.0 6.1 1,970 20-24 10.2 16.0 13.6 47.6 12.6 100.0 6.0 3,514 25-29 18.5 19.4 12.3 34.1 15.7 100.0 4.9 3,394 30-34 30.7 21.2 10.9 21.9 15.2 100.0 3.7 2,654 35-39 40.8 19.0 10.3 17.7 12.2 100.0 2.0 2,246 40-44 48.7 19.0 10.5 13.5 8.3 100.0 0.0 2,152 45-49 54.3 19.4 9.8 11.1 5.4 100.0 0.0 1,820 Residence Urban 19.5 15.9 9.7 32.0 23.0 100.0 5.6 4,619 Rural 30.6 19.3 12.3 29.7 8.1 100.0 4.0 13,130 Division Barisal 16.3 21.7 16.0 33.8 12.3 100.0 4.6 1,002 Chittagong 24.8 16.4 11.1 35.0 12.7 100.0 4.7 3,222 Dhaka 28.1 18.7 11.5 27.8 14.0 100.0 4.2 5,736 Khulna 23.5 19.7 9.8 35.9 11.2 100.0 4.6 2,139 Rajshahi 30.4 18.8 11.8 29.0 10.0 100.0 4.1 2,646 Rangpur 34.1 18.1 10.0 27.1 10.7 100.0 3.6 2,039 Sylhet 34.8 16.9 16.6 24.4 7.3 100.0 3.7 967 Wealth quintile Lowest 51.3 25.1 10.0 13.2 0.3 100.0 0.0 3,250 Second 36.3 22.5 13.9 24.8 2.4 100.0 2.8 3,487 Middle 25.7 19.5 13.5 35.0 6.2 100.0 4.3 3,567 Fourth 17.9 16.8 12.8 38.9 13.7 100.0 5.2 3,664 Highest 10.8 9.3 7.9 37.4 34.6 100.0 8.0 3,781 Total 27.7 18.4 11.6 30.3 12.0 100.0 4.3 17,749 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Differentials in educational attainment across groups of ever-married men are similar to those of women. Younger men, those in urban areas, and those in the higher wealth quintiles are more likely to be educated than other men. The percentage of men with no education is lower than that of women (26 and 28 percent, respectively), and the percentage of men who have secondary or higher education is higher than that of women (18 and 12 percent, respectively) (Table 3.2.2). There have been improvements in educational attainment in Bangladesh over the past four years. The percentage of ever-married women and men with no education has declined. For women, the percentage has declined from 34 percent in 2007 to 28 percent in 2011, and for men it has declined from 31 percent in 2007 to 26 percent in 2011. However, the proportion of women and men who have completed secondary school or higher remained unchanged between 2007 and 2011. Another indicator of progress in education is the median length of schooling. For women, it increased from 3.2 years in 2007 to 4.3 years in 2011, and for men it increased from 2.7 years to 3.9 years. Characteristics of Survey Respondents • 33 Table 3.2.2 Educational attainment: Men Percent distribution of ever-married men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Bangladesh 2011 Background characteristic Highest level of schooling Total Median years completed Number of men No education Primary incomplete Completed primary1 Secondary incomplete Secondary complete or higher2 Age 15-19 * * * * * * * 21 20-24 16.6 32.0 10.5 30.4 10.6 100.0 4.1 249 25-29 17.3 24.3 13.8 31.2 13.3 100.0 4.6 621 30-34 26.0 24.4 9.3 20.9 19.5 100.0 3.9 625 35-39 26.9 25.0 6.7 20.0 21.4 100.0 3.7 660 40-44 31.0 20.5 6.7 18.6 23.2 100.0 3.7 629 45-49 34.8 23.8 7.3 18.0 16.0 100.0 2.3 586 Residence Urban 15.8 21.1 8.7 23.4 31.0 100.0 6.6 949 Rural 30.3 25.5 9.1 21.9 13.1 100.0 3.1 2,442 Division Barisal 14.9 34.9 11.9 21.0 17.4 100.0 4.0 174 Chittagong 25.6 28.2 9.2 19.8 17.2 100.0 3.5 519 Dhaka 26.0 21.7 8.4 22.6 21.3 100.0 4.3 1,095 Khulna 21.5 25.1 9.0 26.1 18.3 100.0 4.4 430 Rajshahi 29.7 22.5 9.6 22.5 15.7 100.0 3.6 556 Rangpur 29.7 23.2 8.4 21.4 17.4 100.0 3.4 442 Sylhet 33.1 24.4 8.7 22.7 11.2 100.0 3.1 175 Wealth quintile Lowest 53.6 29.9 7.0 8.7 0.9 100.0 0.0 654 Second 35.1 30.5 10.0 19.8 4.5 100.0 1.8 666 Middle 24.9 28.1 11.7 24.0 11.2 100.0 3.6 647 Fourth 14.7 22.3 10.2 29.5 23.4 100.0 6.0 726 Highest 5.5 11.5 6.2 28.7 48.2 100.0 8.9 699 Total 15-49 26.2 24.3 9.0 22.4 18.1 100.0 3.9 3,392 50-54 36.3 25.7 7.3 15.6 15.1 100.0 1.7 605 Total 15-54 27.8 24.5 8.7 21.3 17.7 100.0 3.7 3,997 Note: An asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Figure 3.2 shows the educational differences between spouses in matched couples. The proportion of couples who have some education continues to increase, growing from 44 percent in 1999-2000 to 60 percent in 2011, and the percentage in which neither spouse is educated continues to decline, dropping from 25 to 14 percent. For more than one-fourth of couples, only one partner is educated. The probability that the husband is the only educated partner has decreased, while the probability that the wife is the only educated partner remained unchanged between 2007 and 2011. 34 • Characteristics of Survey Respondents Figure 3.2 Trends in education of couples, 1999-2011 BDHS 44 21 10 25 49 20 11 20 55 14 15 16 60 11 15 14 Husband and wife: both educated Husband educated, wife not Wife educated, husband not Husband and wife: neither educated 1999-2000 BDHS 2004 BDHS 2007 BDHS 2011 BDHS Percent 3.3 LITERACY Literacy is widely acknowledged as benefiting both the individual and society. Particularly among women, literacy is associated with many 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 2011 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. Tables 3.3.1 and 3.3.2 present the findings. Tables 3.3.1 and 3.3.2 indicate that 63 percent each of ever-married women and men age 15-49 are literate. The level of literacy decreases as age increases; 84 percent of women age 15-19 are literate compared with 36 percent of women age 45-49. Literacy varies by urban-rural residence; 72 percent of urban women are literate compared with 60 percent of rural women (Table 3.3.1). Characteristics of Survey Respondents • 35 Divisional differences in literacy are notable. The proportion of women who are literate ranges from 56 percent in Rangpur to 73 percent in Barisal. There is also a marked difference in literacy level by household wealth, ranging from 36 percent among women in the lowest wealth quintile to 85 percent among women in the highest wealth quintile. Table 3.3.1 Literacy: Women 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 2011 Background characteristic Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Can read a whole sentence Can read part of a sentence Cannot read at all Age 15-19 64.8 8.7 10.2 16.2 100.0 83.6 1,970 20-24 60.2 11.4 9.5 18.9 100.0 81.0 3,514 25-29 49.9 10.9 11.2 28.0 100.0 72.0 3,394 30-34 37.1 10.2 12.2 40.4 100.0 59.6 2,654 35-39 29.9 10.2 9.1 50.8 100.0 49.2 2,246 40-44 21.8 9.7 10.0 58.3 100.0 41.5 2,152 45-49 16.5 9.4 10.2 63.7 100.0 36.1 1,820 Residence Urban 55.0 8.8 8.4 27.6 100.0 72.3 4,619 Rural 37.8 10.8 11.1 40.3 100.0 59.7 13,130 Division Barisal 46.1 15.2 11.3 27.3 100.0 72.5 1,002 Chittagong 47.7 9.9 9.7 32.6 100.0 67.3 3,222 Dhaka 41.8 10.0 10.7 37.5 100.0 62.4 5,736 Khulna 47.1 9.3 10.6 32.9 100.0 66.9 2,139 Rajshahi 39.0 10.8 9.6 40.5 100.0 59.4 2,646 Rangpur 37.8 7.4 10.7 44.1 100.0 55.8 2,039 Sylhet 31.7 14.5 11.1 42.6 100.0 57.3 967 Wealth quintile Lowest 13.6 10.5 11.6 64.3 100.0 35.7 3,250 Second 27.3 11.3 13.0 48.3 100.0 51.6 3,487 Middle 41.3 11.2 11.5 36.0 100.0 63.9 3,567 Fourth 52.5 11.3 10.3 25.8 100.0 74.1 3,664 Highest 72.0 7.1 5.9 14.8 100.0 85.1 3,781 Total 42.3 10.2 10.4 37.0 100.0 62.9 17,749 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 36 • Characteristics of Survey Respondents Differentials in literacy rate by the selected background characteristics among men are similar to those among women (Table 3.3.2). Table 3.3.2 Literacy: Men Percent distribution of ever-married men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Bangladesh 2011 Background characteristic Secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Can read a whole sentence Can read part of a sentence Cannot read at all Missing Age 15-19 * * * * * * * 21 20-24 41.0 11.5 16.4 31.1 0.0 100.0 68.9 249 25-29 44.5 11.5 14.7 28.9 0.4 100.0 70.7 621 30-34 40.3 7.5 15.7 36.4 0.0 100.0 63.6 625 35-39 41.5 8.1 12.9 37.2 0.3 100.0 62.5 660 40-44 41.8 8.3 11.0 38.6 0.0 100.0 61.2 629 45-49 34.1 7.6 10.5 47.8 0.0 100.0 52.2 586 Residence Urban 54.4 9.5 10.8 24.8 0.5 100.0 74.7 949 Rural 35.1 8.5 14.3 42.0 0.0 100.0 57.9 2,442 Division Barisal 38.4 11.8 19.9 29.6 0.0 100.0 70.1 174 Chittagong 37.1 11.4 13.1 38.4 0.0 100.0 61.6 519 Dhaka 43.9 8.7 10.6 36.5 0.4 100.0 63.1 1,095 Khulna 44.4 8.6 15.7 31.2 0.0 100.0 68.6 430 Rajshahi 38.1 6.5 15.4 39.7 0.2 100.0 60.1 556 Rangpur 38.8 6.3 12.6 42.2 0.1 100.0 57.7 442 Sylhet 33.9 12.5 14.4 39.2 0.0 100.0 60.8 175 Wealth quintile Lowest 9.5 8.4 12.3 69.6 0.0 100.0 30.3 654 Second 24.3 10.2 15.4 49.8 0.2 100.0 49.9 666 Middle 35.2 10.0 18.7 36.1 0.0 100.0 63.9 647 Fourth 52.8 9.5 14.0 23.3 0.3 100.0 76.4 726 Highest 76.9 5.7 6.8 10.3 0.3 100.0 89.4 699 Total 15-49 40.5 8.8 13.3 37.2 0.2 100.0 62.6 3,392 50-54 30.7 8.2 10.7 50.3 0.2 100.0 49.5 605 Total 15-54 39.0 8.7 12.9 39.2 0.2 100.0 60.6 3,997 Note: Total includes a small number of men who had no card with the required language, are blind or visually impaired, or with missing information. An asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 1 Includes men who attended secondary school or higher and men 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 2011 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 3.4.1 shows that 48 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 5 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 (49 percent) of women have no exposure to any of the mass media on a weekly basis. The proportion of women listening to the radio every week has decreased markedly over the years, dropping from 33 percent in 2004, to 19 percent in 2007, and to 5 percent in 2011. Television reached the most women throughout the period (46 percent in 2004, to 47 percent in 2007, and 48 percent in 2011). Characteristics of Survey Respondents • 37 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 read a newspaper once a week is 15 percent compared with 3 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. Table 3.4.1 Exposure to mass media: Women Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Bangladesh 2011 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 4.1 53.6 6.8 0.9 43.0 1,970 20-24 6.1 52.9 5.1 0.6 44.2 3,514 25-29 6.4 51.6 4.8 0.7 45.4 3,394 30-34 6.7 48.8 4.4 0.5 48.9 2,654 35-39 8.6 43.8 5.1 0.5 52.6 2,246 40-44 6.7 43.0 3.3 0.2 54.9 2,152 45-49 4.6 39.5 3.6 0.2 58.0 1,820 Residence Urban 15.4 77.9 3.4 1.1 20.9 4,619 Rural 3.1 38.0 5.2 0.4 58.6 13,130 Division Barisal 3.9 32.8 7.9 0.3 61.1 1,002 Chittagong 5.9 48.8 5.1 0.7 49.0 3,222 Dhaka 9.3 58.1 3.8 0.8 40.3 5,736 Khulna 5.0 48.7 5.3 0.3 47.4 2,139 Rajshahi 4.0 46.7 5.4 0.3 49.3 2,646 Rangpur 4.3 33.5 4.3 0.5 63.1 2,039 Sylhet 4.9 41.1 4.0 0.5 57.1 967 Educational attainment No education 0.0 27.8 2.7 0.0 70.5 4,912 Primary incomplete 0.5 39.5 3.8 0.1 57.9 3,264 Primary complete1 1.5 46.1 4.9 0.2 50.8 2,062 Secondary incomplete 5.7 61.0 6.0 0.5 36.0 5,383 Secondary complete or higher2 35.6 79.9 7.4 2.9 15.0 2,127 Wealth quintile Lowest 0.5 12.9 2.9 0.1 85.1 3,250 Second 1.2 21.0 5.0 0.3 74.9 3,487 Middle 2.4 42.9 6.1 0.4 52.8 3,567 Fourth 4.4 69.8 5.3 0.5 27.7 3,664 Highest 21.4 88.6 4.2 1.5 10.2 3,781 Total 6.3 48.4 4.7 0.5 48.8 17,749 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Men are more likely to be exposed to each type of mass media than women. For instance, 29 percent of men age 15-49 read a newspaper at least once a week compared with 6 percent of women (Table 3.4.2). Three percent of men are exposed to all three media sources each week compared with less than 1 percent of women. Similar to the trend observed with women, the proportion of men who regularly listen to the radio has decreased over the last seven years from 52 percent in 2004 to 38 percent in 2007 and to 10 percent in 2011. This may account for the decrease in the proportion of men exposed to all three types of media: dropping from 10 percent in 2007 to 3 percent in 2011. 38 • Characteristics of Survey Respondents Table 3.4.2 Exposure to mass media: Men Percentage of ever-married men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Bangladesh 2011 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 men Age 15-19 * * * * * 21 20-24 25.1 75.9 12.1 2.9 21.2 249 25-29 30.1 78.4 10.9 3.2 16.8 621 30-34 31.2 73.3 9.7 3.7 23.3 625 35-39 28.4 75.4 9.0 2.5 22.2 660 40-44 32.4 71.2 9.3 3.1 24.0 629 45-49 26.9 72.8 10.1 2.0 23.9 586 Residence Urban 48.5 86.7 6.3 3.6 10.8 949 Rural 22.0 69.7 11.5 2.6 26.1 2,442 Division Barisal 25.7 69.4 14.8 2.8 24.0 174 Chittagong 25.3 70.8 9.8 2.2 25.2 519 Dhaka 34.9 78.2 9.2 3.6 19.1 1,095 Khulna 30.6 73.1 10.4 2.8 23.5 430 Rajshahi 25.5 73.4 12.1 3.0 21.6 556 Rangpur 26.9 77.2 6.9 1.6 19.7 442 Sylhet 26.2 66.2 11.2 3.5 28.9 175 Educational attainment No education 0.2 58.7 7.7 0.0 39.1 890 Primary incomplete 8.7 72.5 11.7 1.2 25.1 823 Primary complete1 23.1 78.1 9.3 2.2 18.4 305 Secondary incomplete 45.9 82.1 11.8 5.8 12.7 758 Secondary complete or higher2 82.1 88.7 9.3 6.0 5.3 615 Wealth quintile Lowest 4.1 54.3 8.3 0.3 42.6 654 Second 12.0 64.0 11.5 2.1 31.3 666 Middle 22.8 75.2 13.4 2.1 20.1 647 Fourth 37.9 84.0 10.2 4.8 12.2 726 Highest 66.9 92.6 7.0 4.8 4.9 699 Total 15-49 29.4 74.4 10.0 2.9 21.8 3,392 50-54 24.0 59.8 8.4 3.4 35.6 605 Total 15-54 28.6 72.2 9.8 3.0 23.9 3,997 Note: An asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Characteristics of Survey Respondents • 39 Figure 3.3 confirms that men are much more likely to be exposed to each type of mass media than women. For both men and women, exposure to television is more common than exposure to other media types. Figure 3.3 Percentage of ever-married women and men age 15 49 exposed to various media at least once a week 22 3 10 74 29 49 1 5 48 6 No media All three media Radio Television Newspaper Women Men Percent BDHS 2011 3.5 EMPLOYMENT The 2011 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 for women and men are presented in Tables 3.5.1 and 3.5.2. At the time of the survey, 13 percent of ever-married women age 15-49 were currently employed. Two percent were not working although they had been employed in the 12 months prior to the survey, while the remaining 85 percent said that they had not been employed in the previous 12 months (Table 3.5.1). The proportion currently employed is lowest among women age 15-19 (6 percent) and peaks at 16 percent in the 30-34 age group. Women who are divorced, separated, or widowed are much more likely to be employed than currently married women. Women who have 0-2 children are around twice as likely as those with five or more children to be employed. Urban women are more likely than rural women to be employed (21 percent compared with 10 percent). Small variations are found across geographic divisions. The proportion of women who are employed ranges from 16 percent in Dhaka to 9 percent in Barisal. The proportion of women who are currently employed decreases with education, except for women with secondary or higher education. For example, 16 percent of women with no education are employed compared with 10 percent of women who attended but have not the completed secondary level. Women in the lowest and highest wealth quintiles are most likely to be currently employed (15 percent and 16 percent, respectively). 40 • Characteristics of Survey Respondents Table 3.5.1 Employment status: Women Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Bangladesh 2011 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 6.2 2.0 91.8 100.0 1,970 20-24 12.1 1.6 86.3 100.0 3,514 25-29 14.8 2.0 83.2 100.0 3,394 30-34 15.6 1.9 82.6 100.0 2,654 35-39 14.4 2.3 83.4 100.0 2,246 40-44 13.6 1.8 84.6 100.0 2,152 45-49 14.2 1.2 84.6 100.0 1,820 Marital status Currently married 11.6 1.7 86.7 100.0 16,635 Divorced/separated/ widowed 36.6 3.7 59.7 100.0 1,114 Number of living children 0 14.7 3.0 82.2 100.0 1,867 1-2 15.0 1.7 83.2 100.0 8,889 3-4 11.0 1.7 87.3 100.0 5,359 5+ 8.2 1.3 90.5 100.0 1,635 Residence Urban 21.2 1.5 77.2 100.0 4,619 Rural 10.3 1.9 87.8 100.0 13,130 Division Barisal 9.3 2.5 88.2 100.0 1,002 Chittagong 10.9 1.4 87.7 100.0 3,222 Dhaka 15.7 1.8 82.5 100.0 5,736 Khulna 12.8 1.8 85.5 100.0 2,139 Rajshahi 13.3 2.3 84.4 100.0 2,646 Rangpur 12.8 2.1 85.1 100.0 2,039 Sylhet 10.5 1.0 88.6 100.0 967 Educational attainment No education 15.5 2.3 82.2 100.0 4,912 Primary incomplete 12.7 2.4 84.9 100.0 3,264 Primary complete2 10.4 1.6 88.0 100.0 2,062 Secondary incomplete 9.6 1.2 89.2 100.0 5,383 Secondary complete or higher3 20.2 1.6 78.3 100.0 2,127 Wealth quintile Lowest 14.9 3.3 81.9 100.0 3,250 Second 11.0 1.8 87.3 100.0 3,487 Middle 10.5 1.6 87.8 100.0 3,567 Fourth 13.8 1.6 84.6 100.0 3,664 Highest 15.6 1.0 83.4 100.0 3,781 Total 13.2 1.8 85.0 100.0 17,749 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. Characteristics of Survey Respondents • 41 Practically all men were employed in the 12 months preceding the survey (Table 3.5.2). There are small variations in the employment status of men by background characteristics. Table 3.5.2 Employment status: Men Percent distribution of ever-married men age 15-49 by employment status, according to background characteristics, Bangladesh 2011 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Currently employed1 Not currently employed Age 15-19 * * * * 21 20-24 98.3 0.8 0.9 100.0 249 25-29 98.6 1.2 0.2 100.0 621 30-34 99.0 0.8 0.3 100.0 625 35-39 98.4 0.8 0.8 100.0 660 40-44 99.5 0.3 0.2 100.0 629 45-49 98.5 0.6 0.8 100.0 586 Marital status Married or living together 98.8 0.7 0.5 100.0 3,360 Divorced/separated/ widowed (92.0) (8.0) (0.0) (100.0) 31 Residence Urban 98.5 0.8 0.7 100.0 949 Rural 98.8 0.8 0.5 100.0 2,442 Division Barisal 98.8 1.2 0.0 100.0 174 Chittagong 97.9 0.9 1.2 100.0 519 Dhaka 98.5 0.8 0.7 100.0 1,095 Khulna 99.4 0.2 0.5 100.0 430 Rajshahi 98.9 0.9 0.2 100.0 556 Rangpur 99.4 0.6 0.0 100.0 442 Sylhet 98.3 1.1 0.6 100.0 175 Educational attainment No education 98.7 0.8 0.5 100.0 890 Primary incomplete 99.4 0.1 0.5 100.0 823 Primary complete1 97.6 1.4 1.0 100.0 305 Secondary incomplete 98.9 0.7 0.4 100.0 758 Secondary complete or higher2 98.0 1.3 0.7 100.0 615 Wealth quintile Lowest 98.7 1.0 0.4 100.0 654 Second 99.4 0.3 0.3 100.0 666 Middle 98.6 0.8 0.5 100.0 647 Fourth 98.7 0.9 0.4 100.0 726 Highest 98.1 0.9 1.0 100.0 699 Total 15-49 98.7 0.8 0.5 100.0 3,392 50-54 96.3 1.3 2.4 100.0 605 Total 15-54 98.3 0.9 0.8 100.0 3,997 Note: An asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 3.6 OCCUPATION Respondents who had worked in the 12 months preceding the survey were asked about their occupation. The results are presented in Tables 3.6.1 and 3.6.2, which show the distributions of employed women and men by occupation, according to background characteristics. 42 • Characteristics of Survey Respondents One in four working women are engaged in factory or blue collar services, 22 percent work as semi-skilled labor, and 13 percent each perform professional or technical services and home-based manufacturing work (Table 3.6.1). The relationship between women’s occupation and age is mixed; younger women are more likely than older women to be engaged in factory work, blue collar services, 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. Table 3.6.1 Occupation: Women Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Bangladesh 2011 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 6.6 3.7 32.5 27.7 0.4 0.9 0.0 19.6 6.6 0.0 2.0 100.0 162 20-24 9.9 3.6 29.8 29.1 1.1 2.9 0.8 15.1 6.3 0.5 0.9 100.0 480 25-29 14.5 4.5 22.1 27.3 0.9 6.7 0.6 12.9 9.8 0.4 0.3 100.0 570 30-34 16.9 4.9 23.0 20.6 0.9 7.5 0.7 12.6 10.8 1.1 1.0 100.0 462 35-39 14.1 7.2 22.9 17.9 1.2 7.9 0.2 11.3 14.2 2.7 0.3 100.0 374 40-44 11.4 5.3 24.9 17.0 1.7 8.0 1.2 10.8 18.8 0.8 0.0 100.0 331 45-49 10.0 8.9 24.7 12.4 1.2 11.0 0.0 6.7 22.7 1.9 0.5 100.0 280 Marital status Married or living together 14.5 5.1 23.9 24.6 1.1 6.1 0.6 13.5 9.4 0.8 0.6 100.0 2,210 Divorced/separated/ widowed 3.6 6.4 30.8 11.0 1.1 8.9 0.6 7.7 26.4 2.6 0.9 100.0 449 Number of living children 0 16.4 3.9 31.1 25.5 0.6 1.9 0.0 8.8 7.6 1.6 2.6 100.0 331 1-2 16.6 5.2 23.4 25.0 1.0 5.3 0.5 12.2 9.5 1.1 0.4 100.0 1,489 3-4 5.0 5.6 25.1 18.1 1.4 10.1 0.9 14.1 18.9 0.5 0.3 100.0 683 5+ 0.5 8.4 27.2 8.7 1.5 13.3 1.6 16.9 19.5 2.4 0.0 100.0 156 Residence Urban 15.1 4.9 35.1 21.6 0.4 0.4 0.0 6.2 15.1 0.4 0.7 100.0 1,051 Rural 11.1 5.6 18.4 22.8 1.5 10.6 1.0 16.6 10.4 1.5 0.6 100.0 1,608 Division Barisal 9.1 9.9 17.8 28.2 1.2 9.1 0.0 12.8 10.0 1.8 0.3 100.0 118 Chittagong 13.7 4.1 24.7 18.8 1.3 4.6 0.6 21.5 10.2 0.2 0.3 100.0 396 Dhaka 14.8 5.4 31.6 21.7 0.0 1.8 1.0 7.3 13.9 1.4 1.0 100.0 1,005 Khulna 10.2 4.7 26.6 23.7 1.7 3.6 0.6 16.4 11.5 1.0 0.0 100.0 311 Rajshahi 10.8 6.1 16.0 30.1 2.5 5.6 0.3 16.2 10.8 1.4 0.3 100.0 414 Rangpur 10.2 4.1 18.7 17.0 1.5 26.6 0.0 10.1 11.0 0.3 0.7 100.0 304 Sylhet 13.9 5.9 21.2 16.2 1.8 11.6 0.0 9.2 17.4 2.0 0.9 100.0 111 Educational attainment No education 0.1 7.5 30.5 8.0 1.9 12.1 0.6 11.4 25.9 1.4 0.5 100.0 874 Primary incomplete 1.0 5.1 32.9 18.2 1.8 9.4 0.9 17.9 11.6 0.3 0.9 100.0 492 Primary complete1 1.0 4.4 38.4 27.9 0.9 4.3 1.3 13.1 7.3 0.2 1.3 100.0 247 Secondary incomplete 6.1 4.7 21.2 42.1 0.2 2.1 0.3 17.1 4.1 1.7 0.4 100.0 584 Secondary complete or higher2 63.5 2.7 3.8 25.8 0.0 0.0 0.2 2.8 0.0 0.9 0.4 100.0 462 Wealth quintile Lowest 1.1 4.2 27.3 9.7 2.6 15.9 0.2 15.0 22.4 1.6 0.0 100.0 589 Second 4.8 4.3 23.2 19.2 1.8 10.8 1.0 21.8 11.1 1.1 1.1 100.0 444 Middle 9.2 6.8 18.4 31.5 0.7 5.9 0.4 17.3 8.2 0.9 0.6 100.0 434 Fourth 15.0 7.7 31.6 25.2 0.4 0.6 0.7 8.0 9.1 0.9 0.9 100.0 565 Highest 29.5 4.0 22.8 27.5 0.0 0.7 0.7 4.3 9.2 0.8 0.6 100.0 626 Total 12.7 5.3 25.0 22.3 1.1 6.6 0.6 12.5 12.2 1.1 0.6 100.0 2,659 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 agricultural and home-based manufacturing work. In contrast, women in urban areas are more likely to be engaged in professional or technical services, factory work or blue collar services, and as domestic servants. Characteristics of Survey Respondents • 43 Two in three women (64 percent) with secondary or higher levels of education are employed in professional or technical jobs, and one in four works 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 lowest wealth quintile work in factory or blue collar services (27 percent) and as domestic servants (22 percent). Thirty-four percent of employed men age 15-49 are engaged in farming and agricultural activities, and 25 percent are engaged in business services (Table 3.6.2). Younger men are more likely than older men to be engaged in factory work or blue collar services and semi-skilled labor services, while older men are more likely than younger men to work in professional or technical jobs and work in agriculture. Table 3.6.2 Occupation: Men Percent distribution of ever-married men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Bangladesh 2011 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 men Age 15-19 * * * * * * * * * * * * 19 20-24 3.1 17.9 18.6 23.8 7.9 27.9 0.0 0.0 0.0 0.0 0.8 100.0 247 25-29 3.2 20.3 13.7 19.5 9.2 32.0 0.0 0.0 0.1 0.8 1.3 100.0 620 30-34 5.4 28.0 12.8 15.0 8.3 27.9 0.4 0.2 0.0 0.7 1.2 100.0 623 35-39 7.4 27.9 8.7 16.2 7.6 30.9 0.0 0.0 0.0 0.1 1.2 100.0 655 40-44 6.4 27.7 7.1 12.9 5.7 37.8 0.2 0.3 0.0 1.5 0.3 100.0 628 45-49 5.9 22.1 8.3 13.7 5.5 42.6 0.0 0.3 0.0 1.0 0.6 100.0 581 Marital status Married or living together 5.5 24.7 10.7 16.1 7.3 33.7 0.1 0.1 0.0 0.8 0.9 100.0 3,342 Divorced/separated/ widowed (0.0) (13.1) (18.6) (3.6) (7.1) (49.7) (0.0) (0.0) (0.0) (0.0) (8.0) (100.0) 31 Residence Urban 9.8 32.4 17.5 23.8 7.0 7.5 0.0 0.1 0.0 1.0 1.0 100.0 943 Rural 3.8 21.6 8.1 13.0 7.5 44.1 0.2 0.1 0.0 0.7 0.9 100.0 2,431 Division Barisal 7.2 24.3 8.9 12.6 9.4 35.2 0.0 0.5 0.0 0.7 1.2 100.0 174 Chittagong 3.9 24.7 13.5 18.5 9.8 26.8 0.0 0.4 0.0 0.9 1.4 100.0 513 Dhaka 6.3 27.0 15.1 19.7 5.9 23.9 0.0 0.0 0.0 1.1 1.0 100.0 1,087 Khulna 4.9 27.7 6.6 15.5 4.5 40.7 0.0 0.0 0.0 0.0 0.2 100.0 428 Rajshahi 5.0 21.7 5.0 12.8 7.6 45.1 0.7 0.2 0.0 0.8 1.1 100.0 555 Rangpur 6.0 19.9 8.1 10.9 9.4 44.9 0.0 0.0 0.0 0.2 0.6 100.0 442 Sylhet 4.6 24.1 12.9 13.6 7.9 33.8 0.0 0.0 0.3 1.5 1.2 100.0 174 Educational attainment No education 0.2 13.4 12.8 10.9 13.4 48.0 0.0 0.3 0.1 0.2 0.8 100.0 886 Primary incomplete 0.2 21.0 12.2 14.7 10.4 41.1 0.0 0.1 0.0 0.3 0.1 100.0 819 Primary complete1 0.0 27.8 12.7 20.9 6.0 30.8 0.0 0.0 0.0 0.3 1.4 100.0 302 Secondary incomplete 1.3 33.6 11.5 20.3 3.1 27.6 0.2 0.2 0.0 1.6 0.7 100.0 755 Secondary complete or higher2 28.1 33.1 4.0 17.7 0.3 12.8 0.4 0.0 0.0 1.3 2.2 100.0 611 Wealth quintile Lowest 0.1 8.9 11.0 9.9 15.5 52.7 0.0 0.3 0.0 0.8 1.0 100.0 651 Second 1.0 15.6 10.5 11.8 11.8 48.7 0.0 0.0 0.1 0.3 0.3 100.0 664 Middle 3.8 23.2 8.6 15.6 4.9 40.9 0.2 0.2 0.0 1.3 1.2 100.0 643 Fourth 7.4 30.1 13.7 20.5 3.8 22.8 0.2 0.2 0.0 0.5 0.9 100.0 723 Highest 14.4 43.8 9.7 21.6 1.3 6.8 0.2 0.0 0.0 0.9 1.3 100.0 692 Total 15-49 5.5 24.6 10.8 16.0 7.3 33.8 0.1 0.1 0.0 0.8 0.9 100.0 3,374 50-54 5.2 21.3 8.0 8.7 4.1 50.1 0.0 0.1 0.0 0.9 1.6 100.0 591 Total 15-54 5.4 24.1 10.3 14.9 6.8 36.3 0.1 0.1 0.0 0.8 1.0 100.0 3,965 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. As in the case of women, men from the wealthiest households are most likely to be engaged in professional or technical jobs, business, and semi-skilled labor services, while men from the poorest households are most likely to work as farmers or unskilled labor. 44 • Characteristics of Survey Respondents 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 and continuity of employment. This table also presents data on whether respondents work in the agricultural or nonagricultural sector. Overall, nine in ten women who were employed work for cash only and 6 percent receive cash and in-kind payment. There are only small variations between women who work in agriculture and those who do not work in agriculture. Table 3.7 Type of employment: Women 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 (agricultural or non-agricultural) employment, Bangladesh 2011 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 88.9 90.5 90.1 Cash and in-kind 7.7 5.5 5.9 In-kind only 2.1 2.1 2.1 Not paid 1.2 1.2 1.2 Missing 0.0 0.7 0.7 Total 100.0 100.0 100.0 Type of employer Employed by family member 17.1 13.8 14.4 Employed by nonfamily member 68.0 73.2 72.2 Self-employed 14.9 12.2 12.7 Missing 0.0 0.7 0.7 Total 100.0 100.0 100.0 Continuity of employment All year 51.6 79.3 73.7 Seasonal 25.5 7.5 11.0 Occasional 22.9 12.5 14.6 Missing 0.0 0.7 0.7 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 523 2,120 2,659 Note: Total includes women with information missing on type of employment who are not shown separately. The proportion of women in agricultural work who receive cash payment has increased from 75 percent in 2007 to 90 percent in 2011. At the same time, the proportion of women who were paid entirely in kind has also declined from 4 percent in 2007 to 2 percent in 2011. Seven in ten women (72 percent) are employed by a nonfamily member, 14 percent are employed by family members, and 13 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 (17 and 14 percent, respectively), while women who work in the nonagricultural sector are more often employed by a nonfamily member (73 and 68 percent, respectively). Seventy-four percent of employed women work all year round, and 26 percent work either seasonally (11 percent) or occasionally (15 percent). Continuity of employment varies by sector. Fifty-two percent of women who work in the agricultural sector work year round, compared with 79 percent of women engaged in nonagricultural work. Forty-eight percent of women who are employed in the agricultural sector work are seasonal or occasional workers. In contrast with women (74 percent), 95 percent of men work year round, while 5 percent work either seasonally or part of the year (Table 3.8). Small variations are observed in the employment patterns by background characteristics. As expected, men who completed secondary or higher education and men in the highest wealth quintile are more likely to work throughout the year than men in other groups. Characteristics of Survey Respondents • 45 Table 3.8 Continuity of employment: Men Percent distribution of ever-married men age 15-49 currently working by continuity of employment, according to background characteristics, Bangladesh 2011 Background characteristic Worked throughout the year Seasonally/ part of the year Once in a while Number of men Age 15-19 * * * 19 20-24 93.2 6.1 0.7 245 25-29 93.5 5.0 1.4 613 30-34 96.7 2.5 0.9 618 35-39 94.6 4.9 0.3 650 40-44 93.2 6.0 0.9 626 45-49 97.0 2.8 0.2 577 Marital status Married or living together 94.8 4.4 0.8 3,319 Divorced/separated/widowed (98.1) (1.9) (0.0) 29 Residence Urban 97.1 2.4 0.5 935 Rural 94.0 5.1 0.9 2,412 Division Barisal 94.7 4.9 0.4 172 Chittagong 91.3 7.5 1.2 508 Dhaka 96.8 2.6 0.5 1,078 Khulna 95.5 4.3 0.1 428 Rajshahi 93.5 5.5 1.0 550 Rangpur 96.5 1.9 1.3 439 Sylhet 91.1 8.1 0.8 172 Educational attainment No education 93.1 6.4 0.3 879 Primary incomplete 93.9 5.2 0.9 818 Primary complete1 96.2 3.3 0.5 298 Secondary incomplete 95.2 3.2 1.6 750 Secondary complete or higher2 97.4 2.3 0.3 602 Wealth quintile Lowest 90.7 8.7 0.4 645 Second 93.4 5.8 0.9 662 Middle 93.5 4.8 1.7 638 Fourth 97.6 2.0 0.5 716 Highest 98.5 1.0 0.4 686 Total 94.8 4.4 0.8 3,347 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. 3.8 SUFFICIENCY OF EARNING The 2011 BDHS asked male respondents who usually work throughout the year whether their earnings from work were sufficient to provide for their family’s basic needs. The results are presented in Table 3.9. The majority of men (62 percent) say that their earnings are moderately sufficient, 10 percent say that they are sufficient, and 28 percent report earnings less than sufficient. There is no noticeable variation in earnings by age and rural-urban residence. 46 • Characteristics of Survey Respondents Men in Rajshahi are more likely than men in other divisions to say that their earnings are sufficient. As expected, sufficiency of earnings increases with the men’s education and wealth status. For example, 21 percent of men with secondary or higher-level schooling had sufficient earnings compared with 6 percent of men with no education. Similar patterns are observed in earnings by wealth quintile; 19 percent of men in the highest wealth quintile have sufficient earnings compared with 2 percent in the lowest wealth quintile. Table 3.9 Sufficiency of earnings: Men Percent distribution of ever-married men age 15-49 currently working by sufficiency of earnings, according to background characteristics, Bangladesh 2011 Background characteristic Sufficient Moderately sufficient Not sufficient Missing Total Number of men Age 15-19 * * * * * 19 20-24 8.8 74.0 17.2 0.0 100.0 245 25-29 12.0 61.0 27.0 0.0 100.0 613 30-34 8.3 66.0 25.8 0.0 100.0 618 35-39 10.6 63.5 25.9 0.1 100.0 650 40-44 11.2 58.7 30.0 0.0 100.0 626 45-49 10.8 54.6 34.7 0.0 100.0 577 Marital status Married or living together 10.4 61.9 27.6 0.0 100.0 3,319 Divorced/separated/widowed (5.6) (60.8) (33.7) (0.0) (100.0) 29 Residence Urban 12.8 62.5 24.7 0.0 100.0 935 Rural 9.5 61.7 28.8 0.0 100.0 2,412 Division Barisal 9.5 71.0 19.5 0.0 100.0 172 Chittagong 7.5 57.8 34.6 0.0 100.0 508 Dhaka 10.5 66.5 23.0 0.0 100.0 1,078 Khulna 8.7 65.3 26.0 0.0 100.0 428 Rajshahi 16.3 57.0 26.7 0.0 100.0 550 Rangpur 9.1 60.2 30.7 0.0 100.0 439 Sylhet 7.6 47.8 44.3 0.3 100.0 172 Educational attainment No education 6.0 53.7 40.2 0.1 100.0 879 Primary incomplete 6.9 64.3 28.9 0.0 100.0 818 Primary complete1 10.9 68.3 20.8 0.0 100.0 298 Secondary incomplete 10.6 66.1 23.3 0.0 100.0 750 Secondary complete or higher2 21.1 62.2 16.7 0.0 100.0 602 Wealth quintile Lowest 2.2 55.3 42.5 0.0 100.0 645 Second 7.4 61.4 31.1 0.1 100.0 662 Middle 9.2 64.5 26.3 0.0 100.0 638 Fourth 13.5 65.7 20.8 0.0 100.0 716 Highest 18.8 62.3 18.9 0.0 100.0 686 Total 10.4 61.9 27.7 0.0 100.0 3,347 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. Marriage and Sexual Activity • 47 MARRIAGE AND SEXUAL ACTIVITY 4 4.1 INTRODUCTION his chapter focuses on the key factors other than contraception that affect women’s chances of becoming pregnant. These key factors include marriage, polygyny, and sexual activity. Marriage indicates the onset of exposure to the risk of pregnancy for most women, and thus it is an important fertility indicator. This chapter includes information on several direct measures of the beginning of exposure to pregnancy and level of exposure: for example, age at first marriage, age at first sexual intercourse, and recent sexual activity. Only women who had been married or were married were interviewed with the 2011 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 is equal to 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. A similar procedure is used for the sample of ever- married men. 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 2011 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 formal marriage. 4.2 CURRENT MARITAL STATUS Table 4.1 shows the current marital status of women and men age 15-49 by age. In Bangladesh, a substantially greater proportion of men than women age 15-49 have never married: 36 percent of men T Key Findings • There is evidence of a continuing rise in age at first marriage among women, while age of men at first marriage has not been changing rapidly. • The percentage of women age 25-49 who were married by age 15 has decreased from 52 percent among women age 45-49 to 17 percent among women age 15-19. • Bangladeshi men marry more than eight years later than women. The median age at first marriage among women age 25-49 is 15.5 years compared with 24.2 years for men the same age. • Seventy-seven percent of ever-married women were sexually active within the past four weeks and 12 percent were active within the past 1 to 12 months. • Twelve percent of currently married women reported that their husbands live elsewhere (due to migration). Forty-three percent of these women were not visited by their husbands in the last 12 months. 48 • Marriage and Sexual Activity compared with 15 percent of women. The proportion who have never married falls sharply with age among both women and men. Among women, the decline is from 54 percent in the age group 15-19 to less than 1 percent among women age 35 or older. Among men, it falls from 98 percent in the age group 15-19 to less than 1 percent among men age 40 or older. The low proportion of women age 25-29 who have never been married (3 percent) indicates that marriage is universal in Bangladesh and that more than nine in ten women marry before age 30. Similarly, only 2 percent of men age 35-39 have never been married, indicating that more than nine in ten men marry before age 35. Eight in ten women (80 percent) and more than six in ten men (63 percent) are currently married or cohabiting. Three percent of women and less than 1 percent of men age 15-49 are widowed. The proportion of women who are widowed increases sharply with age and is mostly limited to older age groups: 7 percent of women age 40-44 and 13 percent of women age 45-49 are widowed. Divorce and separation are uncommon in Bangladesh, with the proportion among women being slightly higher than among men. Two percent of women age 15-49 are either divorced or separated compared with less than 1 percent of men of the same age. The proportion divorced or separated does not vary markedly by age group among either women or men. Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Bangladesh 2011 Age Marital status Total Percentage of respondents currently in union Number of women and men Never married Married Divorced Separated Widowed WOMEN 15-19 54.3 44.7 0.6 0.4 0.0 100.0 44.7 4,306 20-24 13.4 83.7 1.3 1.2 0.4 100.0 83.7 4,058 25-29 3.0 93.2 1.0 1.4 1.3 100.0 93.2 3,501 30-34 1.2 94.3 1.0 1.7 1.8 100.0 94.3 2,686 35-39 0.8 91.9 1.4 1.3 4.6 100.0 91.9 2,264 40-44 0.3 89.8 0.8 1.9 7.2 100.0 89.8 2,158 45-49 0.2 82.3 1.5 2.7 13.3 100.0 82.3 1,824 Total 14.7 80.0 1.0 1.4 3.0 100.0 80.0 20,797 MEN 15-19 97.9 2.1 0.0 0.0 0.0 100.0 2.1 1,017 20-24 70.2 29.6 0.1 0.1 0.0 100.0 29.6 835 25-29 29.2 69.4 0.8 0.6 0.0 100.0 69.4 877 30-34 11.2 88.4 0.0 0.4 0.0 100.0 88.4 704 35-39 2.0 97.5 0.2 0.1 0.1 100.0 97.5 674 40-44 0.6 98.4 0.1 0.2 0.7 100.0 98.4 633 45-49 0.9 98.2 0.0 0.4 0.5 100.0 98.2 591 Total 15-49 36.4 63.0 0.2 0.3 0.2 100.0 63.0 5,331 50-54 0.3 99.2 0.0 0.4 0.1 100.0 99.2 607 Total 15-54 32.7 66.7 0.2 0.3 0.1 100.0 66.7 5,938 Table 4.2 shows trends in Bangladesh by age in the percentage of women who have never married, for the 1975-2011 period. The proportion of women who have never married affects fertility levels in a society like Bangladesh, where childbearing outside marriage is uncommon. The proportion of never-married women age 15-19 has increased from 30 percent in 1975 to 54 percent in 2011. Similarly, the proportion of never-married women age 20-24 first increased from 5 percent in 1975 to 19 percent in 1999-2000; then it declined steadily to 13 percent in 2011. Marriage and Sexual Activity • 49 Table 4.2 Trends in proportion never married Percentage of women who have never married, by age group, as reported in various surveys, Bangladesh 1975-2011 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 10-14 91.2 98.0 98.7 96.2 96.4 98.5 95.2 95.2 92.7 88.6 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 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 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 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 35-39 0.4 - - 0.1 0.5 0.1 0.3 0.0 0.2 0.4 0.6 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 45-49 0.0 0.1 - 0.1 0.1 - 0.2 0.0 0.0 0.0 0.8 0.2 - = Less than 0.1 percent u = Unknown/not available Sources: 1975 Bangladesh Fertility Survey (BFS) (MHPC, 1978:49); 1983, 1985, 1989, and 1991 Contraceptive Prevalence Surveys (CPSs) (Mitra et al., 1993:24); 1989 BFS (Huq and Cleland, 1990:43); 1993-1994 Bangladesh Demographic and Health Survey (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) 4.3 POLYGYNY There are predominantly two types of marital unions; monogamous and polygynous. The distinction between the two types has social significance and probable fertility implications, although the association between union type and fertility is complex and not well understood. Polygyny, the practice of having more than one wife, influences the frequency of sexual intercourse and thus may have an effect on fertility. The extent of polygyny was measured in the 2011 BDHS by asking all currently married female respondents whether their husband or partner had other wives (co-wives) and, if so, how many. Currently married men were also asked whether they had one or more wives or partners with whom they were living. Table 4.3 shows the proportion of currently married men who are in polygynous unions, by background characteristics. Overall, less than 1 percent of married men in Bangladesh are in a polygynous union, i.e., they have two or more wives. Polygyny is found among men age 30 years and over. There is no variation in the extent of polygyny by other background characteristics. 50 • Marriage and Sexual Activity Table 4.3 Number of men’s wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Bangladesh 2011 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 * * 100.0 21 20-24 100.0 0.0 100.0 247 25-29 100.0 0.0 100.0 609 30-34 99.8 0.2 100.0 622 35-39 98.8 1.2 100.0 657 40-44 98.8 1.2 100.0 623 45-49 98.8 1.2 100.0 580 Residence Urban 99.2 0.8 100.0 941 Rural 99.3 0.7 100.0 2,420 Division Barisal 100.0 0.0 100.0 172 Chittagong 99.4 0.6 100.0 515 Dhaka 98.8 1.2 100.0 1,078 Khulna 99.6 0.4 100.0 425 Rajshahi 99.8 0.2 100.0 555 Rangpur 99.3 0.7 100.0 442 Sylhet 99.1 0.9 100.0 173 Educational attainment No education 98.7 1.3 100.0 885 Primary incomplete 99.0 1.0 100.0 812 Primary complete1 100.0 0.0 100.0 301 Secondary incomplete 99.5 0.5 100.0 751 Secondary complete or higher2 99.9 0.1 100.0 612 Wealth quintile Lowest 98.9 1.1 100.0 647 Second 99.3 0.7 100.0 658 Middle 99.2 0.8 100.0 640 Fourth 99.5 0.5 100.0 719 Highest 99.5 0.5 100.0 696 Total 15-49 99.3 0.7 100.0 3,360 50-54 98.6 1.4 100.0 602 Total 15-54 99.2 0.8 100.0 3,963 Note: An asterisk denotes a figure based on fewer than 25 unweighted cases and has been suppressed. 1 Primary complete is defined as completing grade 5. 2 Secondary complete is defined as completing grade 10. 4.4 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. Because never-married men and 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 men and women and that there were no errors in the reporting of marital status, especially of young women and men. Table 4.4 shows, by current ages, the percentages of women and men 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, 74 percent married by age 18, and 86 percent married by age 20. Men in Bangladesh tend to marry later in life than women. Among men age 20-49, only 6 percent Marriage and Sexual Activity • 51 married by age 18, and 18 percent married by age 20. Overall, only 19 percent of men age 25-54 married at or before age 20, and more than half (56 percent) married at or before age 25. Within each age cohort, the proportion of women marrying by specific ages is substantially larger when compared with men. For example, in the 25-29 age cohort, almost three-quarters (73 percent) of women married by age 18 and 95 percent by age 25. In contrast, only 5 percent of men in the same age cohort are married by age 18 and 59 percent married by age 25. The proportion of women marrying in their early teens continues to decline. Across age cohorts, the proportion of women marrying by age 15 has declined by two-thirds over time, from 52 percent among women age 45-49 to 17 percent among women age 15-19. Similarly, the proportion of women marrying by age 18 and age 20 decreases substantially from the oldest cohort to the youngest cohort. Changes in the proportion of men marrying by specific ages over time are much smaller and do not follow a clear pattern. When looking at age cohorts, Table 4.4 shows a slow but steady increase over the past 25 years in the age at which Bangladeshi women first marry, from a median age of 14.9 years for women in their mid- to late forties to 16.6 years for those in their early twenties. The pattern differs for men. The median age at marriage among men decreases, but only slightly, from 24.5 years for men age 45-49 to 23.8 years for men age 25-29. Overall, men marry more than eight years later than women. The median age at first marriage among men age 25-49 is 24.2 years, and the median age at first marriage among women in the same age group is 15.5 years, indicating large differences in age between husbands and wives. Table 4.4 Age at first marriage Percentage of women and men age 15-49 who were first married, by specific exact ages and median age at first marriage, according to current age, Bangladesh 2011 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 WOMEN 15-19 17.2 na na na na 54.3 4,306 a 20-24 29.1 64.9 79.8 na na 13.4 4,058 16.6 25-29 35.2 72.8 86.1 91.2 95.3 3.0 3,501 16.0 30-34 39.3 74.4 87.4 92.7 95.8 1.2 2,686 15.8 35-39 42.4 77.6 88.1 92.7 96.4 0.8 2,264 15.5 40-44 48.8 81.4 90.8 95.8 97.3 0.3 2,158 15.1 45-49 51.9 82.4 92.8 96.6 98.5 0.2 1,824 14.9 20-49 39.0 74.0 86.4 na na 4.3 16,491 15.8 25-49 42.2 76.9 88.6 93.4 96.4 1.4 12,434 15.5 MEN 15-19 0.0 na na na na 97.9 1,017 a 20-24 0.0 4.4 12.2 na na 70.2 835 a 25-29 0.0 5.3 18.8 36.5 58.7 29.2 877 23.8 30-34 0.0 8.0 20.2 36.9 57.8 11.2 704 24.0 35-39 0.0 7.0 20.3 33.4 53.7 2.0 674 24.5 40-44 0.0 4.3 17.7 31.7 54.6 0.6 633 24.4 45-49 0.0 6.8 18.5 32.9 52.8 0.9 591 24.5 20-49 0.0 5.9 17.8 na na 21.9 4,314 a 25-49 0.0 6.3 19.1 34.5 55.8 10.3 3,479 24.2 20-54 0.0 6.2 18.2 na na 19.2 4,922 a 25-54 0.0 6.6 19.4 34.5 55.5 8.8 4,087 24.2 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women or men began living with their spouse or partner for the first time before reaching the beginning of the age group A comparison of the 2011 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 one and a half years over the past decade, from 14.2 years in 52 • Marriage and Sexual Activity 1996-1997 (Mitra et al., 1997) to the current figure of 15.8 years. On the other hand, comparing the results for men across surveys indicates that the median age at marriage among men has remained relatively stable since 2004 when the median age at marriage for men age 25-59 was 24.2 years (NIPORT et al., 2005). The legal age of marriage in Bangladesh for women is 18 years, but a large proportion of marriages still take place before the legal age. The 2011 BDHS found that 65 percent of women age 20-24 were married before age 18 (Figure 4.1). Over the past two decades, the proportion of women marrying before the legal age has decreased from 73 percent in 1989 to 65 percent in 2011. Figure 4.1 Trends in proportion of women age 20-24 who were first married by age 18 73 73 69 65 68 66 65 1989 BFS 1993-94 BDHS 1996-97 BDHS 1999-00 BDHS 2004 BDHS 2007 BDHS 2011 BDHS Percent Table 4.5 examines the median age at first marriage for women age 20-49 and 25-49, and for men age 25-54, according to background characteristics. Urban women age 25-49 marry one year later than their rural counterparts (16.2 years versus 15.3 years). The median age at marriage shows a greater variation among administrative divisions; for women age 25-49, it ranges from 17.2 years in Sylhet to 14.7 years in Rangpur. Women’s education shows a strong positive association with age at marriage. For example, women who have completed secondary or higher education marry five years later than those with no education. Similarly, the median age at marriage increases with household wealth. Women from the highest wealth quintile marry two years later than those from the lowest wealth quintile. The median age at first marriage for men displays similar patterns and associations by educational attainment and household wealth to those observed for women. By administrative division, the highest median age at first marriage for men age 25-54 is observed in Dhaka (24.7 years), while the lowest is observed in Rajshahi (22.4 years). Men with no education get married almost two years earlier than men with some secondary education (20.7 years versus 23.2 years). The median age at marriage for men also increases with the wealth quintile. Marriage and Sexual Activity • 53 Table 4.5 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, and median age at first marriage among men age 25-54, according to background characteristics, Bangladesh 2011 Background characteristic Women age Men age 25-54 20-49 25-49 Residence Urban 16.5 16.2 a Rural 15.6 15.3 23.6 Division Barisal 15.7 15.4 24.4 Chittagong 16.6 16.3 a Dhaka 15.8 15.6 24.7 Khulna 15.3 15.1 23.9 Rajshahi 15.2 15.1 22.4 Rangpur 15.0 14.7 22.7 Sylhet 17.5 17.2 a Educational attainment No education 14.8 14.7 20.7 Primary incomplete 14.9 14.8 21.6 Primary complete1 15.4 15.4 22.6 Secondary incomplete 16.3 16.2 23.2 Secondary complete or higher2 19.9 19.6 a Wealth quintile Lowest 15.1 15.0 22.3 Second 15.3 15.0 22.7 Middle 15.5 15.2 23.8 Fourth 16.0 15.6 24.8 Highest 17.4 17.0 a Total 15.8 15.5 24.2 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. a = Omitted because less than 50 percent of the respondents began living with their spouses/partners 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. 4.5 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 2011 BDHS asked ever- married respondents how old they were when they first had sexual intercourse. It was recognized that the answers to this questions might be biased since respondents, especially female respondents, might be 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. However, the information for men show some Bangladeshi males are engaging in premarital sexual activity and are willing to report the activity. Table 4.6 shows the percentage of men 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 men interviewed in the BDHS and assuming that never-married men have not had intercourse. Given the conservative nature of the Bangladeshi society, that assumption is likely correct for many never-married men; however, it is clearly a source of potential for bias in the age at first intercourse results since at least some of the never- married population is likely to have initiated sexual activity. It also must be recognized that not all ever- married men who engaged in premarital sexual activity are likely to have reported that behavior in the BDHS, adding to the bias in the results in Table 4.6. Nevertheless, the results in Table 4.6 are useful since they document the information the BDHS was able to obtain on premarital sexual activity in Bangladeshi society. 54 • Marriage and Sexual Activity Table 4.6 shows that the median age at first sexual intercourse among men age 25-54 (23.7 years) is earlier than the median age at first marriage (24.2 years). The median age at first sexual intercourse is somewhat lower among men age 25-34 than among older men. Looking at specific ages, only 1 percent of men age 25-54 had sexual intercourse by age 15, which compares with 23 percent by age 20, 39 percent by age 22, and 58 percent by age 25. Men in younger age cohorts initiate sex later than their older counterparts. For example, 61 percent of men of age 25-29 had their first sexual intercourse by age 25 compared with 56 percent of men age 45-49. Table 4.6 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Bangladesh 2011 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number Median age at first intercourse 15 18 20 22 25 15-19 0.1 na na na na 97.9 1,017 a 20-24 0.6 6.1 13.1 na na 70.2 835 a 25-29 1.2 8.1 22.8 40.2 60.5 29.4 877 23.3 30-34 1.2 11.0 25.3 42.1 61.4 11.2 704 23.0 35-39 1.0 10.6 24.9 38.2 57.1 2.0 674 24.0 40-44 0.8 7.5 21.2 36.2 56.9 0.6 633 24.0 45-49 1.0 9.5 21.8 36.4 55.5 0.9 591 23.9 20-49 1.0 8.7 21.3 a a 21.9 4,314 a 25-49 1.1 9.3 23.3 38.8 58.5 10.3 3,479 23.6 15-24 0.3 na na na na 85.4 1,852 a 20-54 1.0 8.9 21.5 a a 19.2 4,922 a 25-54 1.1 9.5 23.2 38.6 58.1 8.8 4,087 23.7 na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had intercourse for the first time before reaching the beginning of the age group Table 4.7 examines the median age at first sexual intercourse by background characteristics. Because the median age at first marriage and the median age at first sexual intercourse for women are the same, the variation by background characteristics in age at first sexual intercourse is the same as that for age at first marriage (Table 4.5). For men age 25-54, the highest median age at first sexual intercourse is observed in Chittagong (25.0 years), while the lowest is observed in Rajshahi (22.2 years). Men with no education have their first sexual encounter more than two years earlier than men with secondary incomplete education (20.4 years versus 22.7 years). Median age at first sexual intercourse also increases with wealth quintile, from 21.9 years among the poorest men to 24.3 years among men in the highest wealth quintile. Marriage and Sexual Activity • 55 Table 4.7 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, and median age at first sexual intercourse among men age 25-54, according to background characteristics, Bangladesh 2011 Background characteristic Women age Men age 25-54 20-49 25-49 Residence Urban 16.6 16.4 a Rural 15.6 15.4 23.0 Division Barisal 15.7 15.4 23.6 Chittagong 16.6 16.4 25.0 Dhaka 15.9 15.7 24.3 Khulna 15.4 15.2 23.4 Rajshahi 15.3 15.1 22.2 Rangpur 15.0 14.8 22.3 Sylhet 17.6 17.3 a Educational attainment No education 14.8 14.7 20.4 Primary incomplete 14.9 14.9 21.0 Primary complete1 15.5 15.4 21.8 Secondary incomplete 16.3 16.2 22.7 Secondary complete or higher2 a 19.7 a Wealth quintile Lowest 15.2 15.1 21.9 Second 15.3 15.1 22.3 Middle 15.5 15.3 23.3 Fourth 16.0 15.7 24.3 Highest 17.5 17.2 a Total 15.8 15.6 23.7 a = Omitted because less than 50 percent of the respondents had 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. 4.6 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 and men 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 4.8 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 77 percent of ever-married women age 15-49 were sexually active during the four weeks preceding the survey. An additional 12 percent had been sexually active in the 12 months preceding the survey, and 11 percent had their last sexual intercourse one or more years prior to the survey. There is no noticeable variation in recent sexual activity by marital duration or urban-rural residence. The oldest women, age 45-49, are the least likely to have had their last sexual intercourse in the past four weeks (61 percent) when compared with the youngest women. More than eight in ten married or cohabiting women (82 percent) had their last sexual encounter in the past four weeks preceding the survey whereas less than 1 percent of those previously married had an encounter within the past four weeks. There are large variations by administrative divisions in the timing of last sexual intercourse. The proportion of women who were sexually active in the past four weeks ranges from 83 to 85 percent in Rajshahi and Rangpur to 69 percent in Chittagong. 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 (74 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 other quintiles. 56 • Marriage and Sexual Activity Table 4.8 Recent sexual activity Percent distribution of ever-married women age 15-49 by timing of last sexual intercourse, according to background characteristics, Bangladesh 2011 Background characteristic Timing of last sexual intercourse Never had sexual intercourse Total Number of women Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 81.7 13.3 4.1 0.0 0.8 100.0 1,970 20-24 78.7 12.5 8.5 0.1 0.1 100.0 3,514 25-29 80.0 10.0 9.9 0.1 0.0 100.0 3,394 30-34 81.2 9.4 9.2 0.1 0.0 100.0 2,654 35-39 78.5 10.2 11.0 0.1 0.1 100.0 2,246 40-44 73.7 11.9 14.1 0.2 0.0 100.0 2,152 45-49 61.1 16.6 22.2 0.1 0.0 100.0 1,820 Marital status Married or living together 82.4 11.8 5.6 0.1 0.1 100.0 16,635 Divorced/separated/ widowed 0.3 10.2 88.8 0.0 0.7 100.0 1,114 Marital duration2 0-4 years 80.3 14.9 4.1 0.1 0.6 100.0 3,088 5-9 years 83.2 10.5 6.3 0.0 0.0 100.0 3,011 10-14 years 83.5 9.5 6.8 0.2 0.0 100.0 2,823 15-19 years 86.0 8.9 5.0 0.1 0.0 100.0 2,269 20-24 years 84.6 10.6 4.6 0.2 0.0 100.0 1,830 25+ years 78.1 15.3 6.6 0.1 0.0 100.0 2,896 Married more than once 84.0 11.7 4.3 0.0 0.0 100.0 719 Residence Urban 78.3 10.5 11.0 0.0 0.2 100.0 4,619 Rural 76.9 12.2 10.7 0.1 0.1 100.0 13,130 Division Barisal 75.3 16.4 8.1 0.1 0.1 100.0 1,002 Chittagong 68.7 15.0 15.8 0.2 0.2 100.0 3,222 Dhaka 77.9 10.4 11.4 0.1 0.1 100.0 5,736 Khulna 78.8 11.1 9.7 0.1 0.3 100.0 2,139 Rajshahi 82.5 10.8 6.7 0.0 0.0 100.0 2,646 Rangpur 84.6 9.3 5.8 0.0 0.2 100.0 2,039 Sylhet 70.1 12.8 16.8 0.2 0.0 100.0 967 Educational attainment No education 74.0 11.6 14.3 0.0 0.0 100.0 4,912 Primary incomplete 80.2 10.2 9.5 0.1 0.0 100.0 3,264 Primary complete3 79.3 11.4 9.2 0.1 0.1 100.0 2,062 Secondary incomplete 76.9 12.8 10.0 0.1 0.2 100.0 5,383 Secondary complete or higher4 78.9 12.0 8.4 0.2 0.5 100.0 2,127 Wealth quintile Lowest 80.0 10.1 9.6 0.1 0.2 100.0 3,250 Second 79.5 11.5 8.7 0.1 0.2 100.0 3,487 Middle 76.5 12.6 10.7 0.1 0.1 100.0 3,567 Fourth 75.0 12.1 12.6 0.1 0.2 100.0 3,664 Highest 75.6 12.1 12.1 0.1 0.2 100.0 3,781 Total 77.2 11.7 10.8 0.1 0.1 100.0 17,749 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. Marriage and Sexual Activity • 57 Table 4.9 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, 12 percent of currently married women have a husband who lives elsewhere. Younger women, age 15-19 (18 percent), women who have been married for less than 5 years (20 percent), and rural women (13 percent) are most likely to have husbands who live elsewhere. Almost one in four women in Chittagong (23 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 19 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 16 percent of women in the highest quintiles. Table 4.9 Husband’s visits Percentage of currently married women age 15-49 whose husband lives elsewhere, and among currently married women whose husband lives elsewhere, percent distribution by frequency of husband’s visits to the household in the last 12 months, according to background characteristic, Bangladesh 2011 Background characteristic Percentage of women whose husband lives elsewhere Number of currently married women Among currently married women whose husband lives elsewhere, frequency of husband’s visits to the household in the past 12 months Total Number of women 0 1-5 6-11 12+ Missing Age 15-19 18.1 1,925 23.7 41.2 17.8 15.8 1.5 100.0 348 20-24 15.6 3,396 44.8 31.5 11.1 10.4 2.2 100.0 530 25-29 14.3 3,262 51.5 25.2 8.2 12.6 2.4 100.0 468 30-34 11.7 2,532 45.6 30.7 7.7 12.6 3.3 100.0 295 35-39 8.4 2,081 46.9 35.5 9.3 7.2 1.1 100.0 175 40-44 6.3 1,937 42.3 32.2 10.2 14.0 1.4 100.0 122 45-49 5.7 1,501 36.5 34.9 7.8 19.0 1.8 100.0 86 Marital duration1 0-4 years 19.5 3,088 28.5 36.7 16.0 17.0 1.8 100.0 602 5-9 years 14.9 3,011 46.7

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