Egypt - Demographic and Health Survey - 1993

Publication date: 1993

Egypt Demographic and Health Survey 1992 National Population Council ~DHS Demograbhic and Health Surveys Macro International Inc. Egypt Demographic and Health Survey 1992 Fatma H. EI-Zanaty Hussein A. A. Sayed Hassan H. M. Zaky Ann A. Way National Population Council Cairo, Egypt Macro International inc, Calverton, Maryland USA November 1993 This report summarizes the findings of the 1992 Egypt Demographic and Health Survey (EDHS) conducted by the National Population Council. Macro International Inc. provided technical assistance. Funding was provided by the U.S. Agency for International Development (USAID). The EDHS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information about the Egypt survey may be obtained from the National Population Council, P.O. Box 1036, Cairo, Egypt (Telephone 3638207; Fax 3639818; and Telex 94086 USRAH CAIRO). Additional information about the DHS program may be obtained by writing to: DHS, Macro International Inc., 11785 BeltsviUe Drive, Calverton, MD 20705 (Telephone 301-572-0200 and Fax 301- 572-0999). CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii Map of Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxvi CHAPTER 1 I.I 1.2 1.3 1.4 1.5 1.6 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Demographic and Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Socioeconomic Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Population Policy and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Objectives and Organization of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 2.1 2.2 2.3 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Household Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 CHAPTER 4 4.1 4.2 4.3 4,4 4.5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of Family Planning Methods and Source . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Exposure to Family Planning Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Attitudinal Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 First Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 iii CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Page CURRENT USE OF FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Levels and Differentials in Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . 67 Trends in Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Trends in Current Use of Family Planning by Residence . . . . . . . . . . . . . . . . . . . . . . . 73 Reasons for Choosing Current Method of Family Planning . . . . . . . . . . . . . . . . . . . . 76 Problems with Current Method of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Sources for Modem Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Accessibil ity of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 CHAPTER 6 6.1 6.2 USE OFTHE PILL AND IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Pill Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 IUD Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 NONUSE OF FAMILY PLANNING AND INTENTION TO USE . . . . . . . . . . . . . . 95 Discontinuation Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Reasons for Discontinuing Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Future U~ of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Reasons for Nonuse of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Preferred Methods of Family Planning among Nonusers . . . . . . . . . . . . . . . . . . . . . . . 99 CHAPTER 8 8.1 8.2 8.3 8A FERTIL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Ideal and Actual Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 CHAPTER 9 9.1 9.2 9.3 9.4 9.5 9.6 PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . 111 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Marital Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Marriage between Relatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . 117 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 CHAPTER 10 10.1 10.2 10.3 10.4 10.5 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Assessment of Dala Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Socioeconomic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Demographic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 High-Risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 iv CHAPTER 11 11.1 11.2 11.3 11.4 Page MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Nature of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Immunization of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Childhood Illness and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 CHAPTER 12 12.1 12.2 12.3 INFANT FEEDING AND MATERNAL AND CHILD NUTRIT ION . . . . . . . . . . . 149 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 CHAPTER 13 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 HUSBANDS' SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Husbands' Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Background Characteristics of Husbands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Comparison between Characteristics of Husbands and Wives . . . . . . . . . . . . . . . . . . 165 Knowledge o f Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Differentials in Knowledge and Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . 171 Intention to Use Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Attitudes about Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Fertility Desires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Wife 's Status in the Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Typical Family Expenditure and Wife 's Contribution to the Household Budget . . . . 185 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 APPENDIX A SURVEY STAFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 APPENDIX B B.I B.2 B.3 B.4 B.5 SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Sample Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Sample Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Sample Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Results of Sample Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 APPENDIX C ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 APPENDIX D DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 V Table 1.1 Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4.1 Table 2.4.2 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 TABLES Page Survey timetable, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . 13 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . 15 Population by age, 1988 and •992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . 18 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . 19 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 vii Table 3.11 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Children bom to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Knowledge of family planning methods and source for methods . . . . . . . . . . . . 46 Trends in knowledge of family planning methods and source . . . . . . . . . . . . . . . 47 Knowledge of family planning methods and source for methods by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 First source of family planning information . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Sources influencing women to seek information about family planning . . . . . . . . 51 Exposure to family planning messages on radio and television . . . . . . . . . . . . . . 52 Exposure to family planning messages through print media/community meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Attitudes toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Belief that religion allows or forbids family planning . . . . . . . . . . . . . . . . . . . . 57 Approval of use of specific family planning methods . . . . . . . . . . . . . . . . . . . . 57 Ever use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Trends in ever use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . 59 Ever use of family planning methods by background characteristics . . . . . . . . . . 61 First method used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Source of first method used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Number of children at first use of family planning . . . . . . . . . . . . . . . . . . . . . . 65 Reproductive intentions at time of first use of family planning . . . . . . . . . . . . . . 66 Current use of family planning by residence . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Current use of family planning by method . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Trends in current use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Trends in the family planning method mix . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Trends in current use of family planning by residence . . . . . . . . . . . . . . . . . . . . 74 Current use of family planning by govcmorate . . . . . . . . . . . . . . . . . . . . . . . . . 75 viii Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 5.12 Table 5.13 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 6.10 Table 6.11 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 8.1 Page Reasons for choosing current method of family planning . . . . . . . . . . . . . . . . . . 77 Problems with current method of family planning . . . . . . . . . . . . . . . . . . . . . . . 78 Sources for modem family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Trends in the sources of family planning methods . . . . . . . . . . . . . . . . . . . . . . 81 Sources of family planning methods by residence . . . . . . . . . . . . . . . . . . . . . . . 82 Reasons for choosing current source of family planning methods . . . . . . . . . . . . 83 Time to source of supply for modem family planning methods . . . . . . . . . . . . . 84 Quality of pill usc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Action taken if forgot to take the pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Use of social marketing brand pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Cost of method for pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Amount willing to pay for pills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Cost of consultation for pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Information received at pharmacies about the pill . . . . . . . . . . . . . . . . . . . . . . . 90 Service delivery indicators for pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Cost of method for IUD users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Amount willing to pay lot 1UD insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Service delivery indicators for IUD users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Reasons for discontinuing usc of family planning . . . . . . . . . . . . . . . . . . . . . . . 96 Future use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Reasons for not using family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Preferred method of family planning for future use . . . . . . . . . . . . . . . . . . . . . 100 Fertility prcfcrcnccs by number of l iving children . . . . . . . . . . . . . . . . . . . . . . 101 ix Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Page Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Mean ideal number of children by background characteristics . . . . . . . . . . . . . 108 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Marital exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Consanguinity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . 117 Median duration of postpartum insusceptibility by background characteristics . . 119 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . 120 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Trend in infant mortality, 195(I-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . 124 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . 126 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . 131 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 11.5 Table 11.6 Table 11.7 Table 11.8 Table 11.9 Table 11.10 Table 11.11 Table 11.12 Table 11.13 Table 11.14 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Table 12.5 Table 12.6 Table 12.7 Table 12.8 Table 13.1 Table 13.2 Table 13.3 Table 13.4 Table 13.5 Table 13.6 Page Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . 142 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Breastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Median duration and I~'cquency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . 154 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . 156 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . 157 Anthropometric indicators of maternal nutritional status . . . . . . . . . . . . . . . . . 159 Differentials in maternal anthropometric indicators . . . . . . . . . . . . . . . . . . . . . 160 Husbands' background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Husbands' level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Husbands' access to mass media by background characteristics . . . . . . . . . . . . 164 Couples' age difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Couples' level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Husbands' knowledge of family planning methods and source for methods . . . . 167 xi Table 13.7 Table 13.8 Table 13.9 Table 13.10 Table 13.11 Table 13.12 Table 13.13 Table 13.14 Table 13.15 Table 13.16 Table 13.17 Table 13.18 Table 13.19 Table 13.2(I Table 13.21 Table 13.22 Table 13.23 Table 13.24 Table 13.25 Table 13.26 Table 13.27 Table 13.28 Page Husbands' f i~t source of family planning information . . . . . . . . . . . . . . . . . . 168 Husbands' exposure to media messages about family planning . . . . . . . . . . . . . 169 Husbands' use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Ever use of family planning among couples . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Current use of family planning among couples . . . . . . . . . . . . . . . . . . . . . . . . 171 Husbands' knowledge and use of family planning methods by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Husbands' future use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Husbands' reasons for nonusc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Husbands' approval of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Wives' perceptions of husband's approval of family planning . . . . . . . . . . . . . 175 Husbands' perceptions of wil~z's approval of family planning . . . . . . . . . . . . . . 176 Husbands' belief that religion allows or forbids family planning . . . . . . . . . . . 176 Husbands' approval of use of specific methods of family planning . . . . . . . . . . 177 Husbands' problems with spccific methods of family planning . . . . . . . . . . . . . 178 Husbands' objection to wi lt seeing male doctor . . . . . . . . . . . . . . . . . . . . . . . 179 Husbands' desire for more children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Husbands who want no more children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Husbands' ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Husbands' and wives' perceptions of main infiucncc on decision to have another child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Husbands' and wives' perceptions of wife's position,in family . . . . . . . . . . . . . 184 Husbands' and wives' opinions as to who should have the last word on household decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Husbands' and wives' belief that husband should have last word on household decisions, according to residence . . . . . . . . . . . . . . . . . . . . . . . . . . 185 xii Table 13.29 Table 13.30 Table B. 1 Table B.2 Table B.3.1 Table B.3.2 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Table C.9 Table C. 10 Table C.11 Table D. 1 Table D.2 Table D.3 Table D.4 Table D.5 Table D.6 Page Husbands' opinions as to the typical family expenditure . . . . . . . . . . . . . . . . . 186 Wives' contributions to the household budget . . . . . . . . . . . . . . . . . . . . . . . . 187 Distribution of target sample and number of primary sampling units (PSUs) by governorate and sector (urban-rural) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Primary sampling units by govemoratc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Sample implementation: Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Sample implementation: Husbands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 List of selected variables for sampling errors, Egypt 1992 . . . . . . . . . . . . . . . . 219 Sampling errors - Entire sample, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . . . . . 220 Sampling errors- Urban, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Sampling errors - Rural, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Sampling errors - Urban Govcrnorates, Egypt 1992 . . . . . . . . . . . . . . . . . . . . 223 Sampling errors - Total Lower Egypt, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . 224 Sampling errors - Urban Lower Egypt, Egypt 1992 . . . . . . . . . . . . . . . . . . . . 225 Sampling errors - Rural Lower Egypt, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . 226 Sampling errors - Total Upper Egypt, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . 227 Sampling errors - Urban Upper Egypt, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . 228 Sampling errors - Rural Upper Egypt, Egypt 1992 . . . . . . . . . . . . . . . . . . . . . 229 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Age distribution of eligible and intcrvicwed women . . . . . . . . . . . . . . . . . . . . 234 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 xiii Figure 1.1 Figure 1.2 Figure 1.3 Figure 1.4 Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 4.5 Figure 5.1 Figure 5.2 Figure 5.3 Figure 5.4 FIGURES Page Trend in population size by sex, Egypt 1937-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Trend in crude birth rate, Egypt 1985-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Trend in crude death rate, Egypt 1985-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Organization of the 1992 EDHS staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Population pyramid of Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Median number of years of education by sex and age . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Percentage of ever-married women with no education, by place of residence . . . . . . . 26 Total fertility rates by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Total fertility rates, Egypt 1979-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Age-specific fertility rates for 5-year periods preceding the survey . . . . . . . . . . . . . . . 35 Percentage of women who gave birth before age 15 and before age 20, by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Percentage of teenagers who have begun childbearing, by place of residence . . . . . . . 43 Number of family planning methods known by place of residence . . . . . . . . . . . . . . . 49 Exposure to family planning broadcasts by place of residence . . . . . . . . . . . . . . . . . . . 53 Couple approval of family planning use from the wife's perspective by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Ever use of family planning, Egypt 1980-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 First family planning method used by level of education . . . . . . . . . . . . . . . . . . . . . . . 63 Current use of family planning methods, currently married women 15-49 . . . . . . . . . . 68 Current use of family planning methods by place of residence . . . . . . . . . . . . . . . . . . . 69 Current use of family planning methods, Egypt 1980-1992 . . . . . . . . . . . . . . . . . . . . . 72 Change in method mix, Egypt 1984-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 XV Figure 5.5 Figure 5.6 Figure 6.1 Figure 6.2 Figure 6.3 Figure 7.1 Figure 7.2 Figure 8.1 Figure 8.2 Figure 9.1 Figure 9.2 Figure 10.1 Figure 10.2 Figure 11.1 Figure 11.2 Figure 11.3 Figure 12.1 Figure 12.2 Figure 13.1 Figure 13.2 Figure 13.3 Figure 13.4 Page Current use of family planning methods by governoratc . . . . . . . . . . . . . . . . . . . . . . 76 Source for family planning methods, current users of modcm methods . . . . . . . . . . . . 80 Quality of pill use among current pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Pill brands used by current pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Service delivery indicators among ever users of the IUD . . . . . . . . . . . . . . . . . . . . . . . 94 Reasons for discontinuing use of family planning methods . . . . . . . . . . . . . . . . . . . . . 97 Preferred method among nonusers who intend to use in the future . . . . . . . . . . . . . . . 100 Fertility preferences, currently married women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . 102 Percentage of currently married women who want no more childrcn by place of residence, 1988 and 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Median age at first marriage, all women 25-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Percentage of births whose mothers arc amcnorrhcic or abstaining . . . . . . . . . . . . . . 118 Infant mortality, Egypt 1950-1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Infant mortality by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Antenatal care indicators by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Delivery at health facility by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Percentage of children 12-23 months who arc fully vaccinated, by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Distribution of children by breastf~:cding status according to age . . . . . . . . . . . . . . . . 151 Median duration of breastfeeding, by place of residence . . . . . . . . . . . . . . . . . . . . . . 155 Percentage of husbands who have no education, by place of residence . . . . . . . . . . . 163 Comparison of levels o f education o f husbands and wives . . . . . . . . . . . . . . . . . . . . . 166 Percentage of husbands who disapprove of the use of family planning, by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Percentage of husbands who would object if wife visited a male doctor for family planning, by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 xvi Figure 13.5 Figure 13.6 Figure B. 1.1 Figure B.1.2 Figure B.1.3 Page Fertility preferences of husbands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Opinions of husbands and wives as to person with main influence on decision to have another child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Distribution of sampling points, Urban Govemorates, Egypt Demographic and Health Survey 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Distribution of sampling points, Lower Egypt, Egypt Demographic and Health Survey 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Distribution of sampling points, Upper Egypt, Egypt Dcmographic and Health Survey 1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 xvii FOREWORD The 1992 Egypt Demographic and Health Survey (EDHS) is the most recent in a series of surveys carded out in Egypt to provide information on fertility and child mortality levels, family planing awareness, approval and use and basic indicators of maternal and child health. The EDHS findings are important in monitoring trends in these variables and in understanding the factors which contribute to differentials in fertility and contraceptive use among various population subgroups. The EDHS also provides a wealth of health-relatcd information for mothers and their children. These data arc especially important for under- standing the factors that influence the health and survival of infants and young children. In addition to providing insights into population and health issues in Egypt, the EDHS also hopefully will lead to an improved global understanding of population and health problems as it is one of more than 50 surveys implemented through the Demographic and Health Surveys program. A total of 22 months was spent in preparing and carrying out the various activities of the 1992 EDHS, including fieldwork, data processing, and analysis of the survey rcsults. The main findings from the EDHS are presented in this report. This report summarizes basic information on fertility levels, childbearing intentions, and contra- ceptive knowledge and use in Egypt. It also looks at key maternal and child health indicators including the extent to which mothers reccive trained medical care during pregnancy and at the time of delivery and, for young children, the extent of immunization coverage and the prevalcncc and treatment of diarrheal disease. The 1992 survey is the second Demographic and Health Survey to be conducted in Egypt; the first was carried out in 1988. The availability of data on a periodic basis provides analysts and policymakers with the relevant information to monitor trends. The challenge that remains is to use the information collected in the two rounds of the DHS as a basis for evaluating and modifying family planning and health service delivery in Egypt. Survey data are only truly useful when they are employed to improve the efficiency of population and health programs in Egypt. Finally, I would like to express my appreciation to the EDHS team on their devotion and sincere efforts to complete the planned activities and this basic analysis of the findings. Prof. Dr. Mahcr Mahran Minister of Population and Family Welfare xix ACKNOWLEDGMENTS The 1992 Egypt Demographic and Health Survey (EDHS) represents the continuing commitment in Egypt to efforts to obtain data on fertility behavior and contraceptive practice. The survey also reflects the strong interest in information on key maternal health and child survival issues. The wealth of demographic and health data that the survey provides will be of great use in evaluating the performance of the family planning and health programs and in charting future directions for these programs. Preparations for the EDHS started in January 1992 under the supervision of the National Population Council (NPC). The Cairo Demographic Center (CDC) provided office space for the EDHS headquarters staff. Technical and financial assistance was provided by Macro Intemational Inc. through the international Demographic and Health Surveys (DHS) program. Funds from USAID/Cairo under the Population/Family Planning II Project financed the EDHS. I would like to express my gratitude to Dr. Maher Mahran, Minister of Population and Family Welfare. He provided strong and continuing support to the project and has shown great intcrcst in the survey results. Although it is not possible to acknowledge all of the individuals who contributed to the EDHS, I would like to especially acknowledge some individuals whose efforts were very important in completing the survey. Dr. Hussein A. A. Sayed, Senior Consultant, deserves my deepest gratitude for his valuable com- ments and advice during the various survey activities. My thanks and appreciation also are extended to Dr. Madany D. Mostafa, who served as a sampling consultant. Dr. Hassan H. M. Zaky, the EDHS Assistant Director, Dr. Gihan A. Shawky, Associate Director for Data Processing, and Dr. Enas M. Hussein, Associate Director for Sampling, were instrumental in the successful completion of the survey activities. Mr. Abdel Hakim M. Abdel Hakim, the Fieldwork Coordi- nator, ably supervised the field team. Dr. Rashad Hamed coordinated the successful data processing effort. Dr. Effat Fakher El-Din and Dr. Abdel Monem Darwesh were instrumental in carrying out the anthropometric training. My sincere gratitude and appreciation go to Dr. Ann Way who has worked closely with us on all phases of EDHS. Her spirit and devotion were instrumental throughout the survey and during the preparation of this report. My thanks also are extended to Dr. Alfredo Aliaga, for his advice and guidance in designing the sample. Mr. Trevor Croft deserves my deepest thanks for his assistance in data processing and tabulations required for this report. I gratefully acknowledge Dr. Carol Carpenter-Yaman, Director, and Mrs. Amani Selim, Project Management Specialist, Office of Population, USAID/Cairo, for their support and valuable input throughout the survey activities. xxi I am deeply indebted and grateful to all EDHS field and office staff. Without their participation and commitment, this project would have bccn impossible. Finally, 1 would like to express my appreciation for all the assistance received from the office staff and administrative and financial departments of the National Population Council during the survey. Dr. Fatma H. EI-Zanaty Technical Director 1992 Egypt Demographic and Health Survey xxii SUMMARY OF FINDINGS Fertility and Family Planning The results of the 1992 Egypt Demographic and Health Survey (EDHS) indicate that limility and family planning behavior in Egypt has changed dramatically since 198ll. The fertility rate has fallen to 3.9 births per woman from a level of more than 5 births in 1980. Virtually all couples know about lamily phm- ning, and around two-thirds have experience in using a method at some time. At the time of the survey, 47 percent of couples were using family planning to achieve their childbearing goals, which is almost double the level of current use reported in 1980 (24 percent). Almost all users employ modem methods, principally the IU D (28 percent) and the pill ( 13 percent). The shill in the method mix toward greater reliance on the IUD is one of the major trends observed when the EDHS results were compared with the findings of the 1980 Egypt Fertility Survey (EFS). In 1980, two of three users relied on the pill and only one in six employed the IUD. By 1992, almost three in five users relied on the IUD and only around one in four were using the pill. Both the public and private sectors play an important role in the provision of family planning services in Egypt. Current users of the pill obtain their supply largely from pharmacies, while users of the IUD are about equally divided between those obtaining services from private doctors or government facilities. The EDHS results indicate that family planning methods are easily accessible to users. Overall, 58 percent of current users of modem family planning methods live less than 30 minutes from the place where they obtained their method. Physical access to services also does not appear to be a major barrier to the adoption of family planning by nonusers. There is virtually no difference between the travel times to tamily planning sources reported by users and nonusers, and few nonusers cite reasons relating to physical access when asked why they do not intend to use family planning in the future. Cost also does not seem to be a major barrier to the use of family planning. Comparatively [cw users obtain their methods free of charge, and most indicate a willingness to pay more. Although pill users pay comparatively little for supplies (usually 50 piastres or less for a packet), more than three-quarters indicate a willingness to pay at least 1 Egyptian pound per packet and more than one-fifth arc willing to pay 5 pounds or more. IUD users, for whom the median cost of services is almost 8 Egyptian pounds, also indicate a willingness to pay more. Eight in ten IUD users would pay 10 pounds for the method, and one in two would be willing to pay 25 pounds or more. The results of the husbands' survey carried out as part of the EDHS confirm that husbands play a significant role in fertility and family planningdecisionmaking. Men are concerned about limiting family size and are supportive of family planning; three in five husbands say that they do not want more children and around eight in ten approve of the use of family planning. The age at which women first marry is another important determinant of fertility levels. The EDHS results suggest that there has been a steady increase over the past 20 years in the age at marriage in Egypt. The median age at marriage among women 25-29 (19.9 years), is 1.6 years higher than the median age among women 45-49. Although the EDHS findings show rapid progress in lowering fertility and increasing use of family planning, there remain a number of areas of concem. One is the large variation in fertility levels and use of family planning by residence. At current fertility levels, a rural woman may expect to have an average of 4.9 xxiii children, two children more than a woman residing in an urban area. Fertility rates are much higher in rural Upper Egypt (6.0 births per woman) than in rural Lower Egypt (4.1 births per woman). Marked differences in the level of family planning use by residence are also observed. Urban women are more likely to use family planning and to employ an IUD than rural women. The highest level of current use is found in the Urban Govemorates (59 percent) and the lowest in Upper Egypt (31 perecnt) The differential in use between rural Lower Egypt and rural Upper Egypt is particularly striking; 51 percent of married women in rural Lower Egypt are using family planning methods compared to 24 percent in rural Upper Egypt. A key concern for the Egyptian family planning program is the rate at which users discontinue use of contraception and the reasons for the discontinuations. The EDHS results show that almost three in ten users stop using within twelve months of starting. Six percent become pregnant unintentionally, 4 pcreent want to get pregnant, 13 percent stop because they experience side efli~cts or health problems, and 7 percent stop for other reasons. The one-year discontinuation rate lor the pill (42 percent) is three times the rate for the IUD (13 percent). Side effects and health conccms arc the major reasons for stopping usc of both the pill and the IUD. The EDHS results also suggest that many pill users are at incrcased risk of an unplanned pregnancy because they fail to lake the pilI correctly. For some, remembering to take the pill daily is a problem, while others believe that it is necessary to take the pill only when the husband is present in the household Other pill users do not have a pill packet available because they arc "resting" from the pill. Information collected in the EDHS on the interaction between providers find users at the time that the pill or the IUD was adopted indicates that providers in both the public and private sectors need to improve counseling for family planning clients. Increased follow-up is also ncedcd to reduce the rate of discon- tinuation. Despite the steady reduction in lcrtility levels, many couples arc having more children than they consider ideal. At current lertility levels, the average woman in Egypt has 1.2 births more than she wants. In rural Upper Egypt, actual tcrtility exceeds wanted fertility by 1.7 births. Many births are not only unwanted, but more than 60 percent carry higher than average risks of morbidity and mortality for thc mother and child because of the mother's age (under 18 or over 34), high birth order (3 or more) or a short Nrth interval (less than 24 months). The substantial unmet need for family planning in Egypt indicates that there is potential lor further increases in contraceptive use. One in five currently married women is considered to be in need el lamily planning. These are women who want no more children, or want to delay the next birth, but are not using fiunily planning. Maternal and Child Health The EDHS results document the rapid decline in infant and child mortality that has bccn taking place in Egypt. Estimates suggest that infant mortahty decreased by around half between 1972 and 1992. Nevertheless, in the five-year period preceding thc EDHS, 62 of 1,000 children died belore reaching their first birthday and 85 of 1,000 died before reaching age five. Mmlality levels fire higher in rural than in urban areas, and the highest levels are observed in rural Upper Egypt. The EDHS results suggest that spacing births can potentially reduce childhood mortality; a child born less than two years after an older sibling is three times as likely to dic bclore his fifth birthday as a child born xxiv after an interval of four or more years. Reducing the number of high parity births and births to young mothers would also contribute to a lowering of childhood mortality. The care that a mother receives during pregnancy and at the time of childbirth allccts the health and survival of both the mother and the child. The EDHS findings indicate that the majority of Egyptian mothers do not receive adequate antenatal care. For births in the five years preceding the survey, only 53 percent of the mothers reported receiving any antenatal care, and only 23 percent had four or more consultations with a medical provider during pregnancy (the minimum level of antenatal care considered acceptable). For three in five births, mothers received at least one tetanus toxoid injection during pregnancy. Although still low, the coverage rate for tetanus toxoid is more than five times the level reported in the 1988 EDHS. Almost three-quarters of births in the five years preceding the survey took place at home. Most were assisted by dayas (traditional birth attendants) or relatives and friends. Only two in livc births were assisted by doctors or nurses. One of the primary mechanisms for improving child survival is increasing the proportion o f children vaccinated against the major preventable childhood diseases. The EDHS results indicate that almost all young children receive at least some vaccinations; only 4 percent of children age 12-23 months have not had any immunizations. However, many children have not received the full primary course of iinmunizations; only two-thirds of young children arc fully immunized. Diarrheal disease and acute respiratory infections (ARI) arc among the leading causes uf infant and child deaths in Egypt. Thirteen percent of children under age five were reported to havc had diarrhea during the two week period belore the survey. Seven in ten mothers reported thai they did something to treat the diarrhea. Forty-five percent of children suffering from diarrhea were taken to a health facility lot advice or treatment, and 43 percent of children received some lorm of oral mhydration therapy (ORT) (i.e., a solunon made from an oral mhydration salt (ORS) packet, a recommended home fluid (sugar-salt-water solution), or increased fluids). Only 29 percent of mothers of children with diarrhea reported that ORS packets were used in preparing the solution used to treat the diarrhea. However, virtually all mothers nf young children know about these packets. Overall, seven in ten mothers of children under age live havc used ORS packets in treating diarrhea at some time. Eight percent of children under age five were reported to have experienced cough and rapid breathing (symptoms of acute respiratory infection (ARI)) during the two weeks belore the survey. Six in ten of these children were taken to a health facility lot advice or treatment. Only one in five children with AR[ symptoms was given nothing to treat the illness. Undemutrition contributes to child deaths. The EDHS lbund that 24 percent of Egyptian children were stunted or short in relation to their age, as compared to an international reference population. Stunting reflects the long-term effects of poor diet and may also be the outcome of chronic illness. Three percent of the children are wasled or thin for their age. Wasting is the result of acute undemutrition over a short period of time and may be an outcome of sudden, severe illness. One in eleven children are underweight for their age. Bmasffeeding practices and the timing of the introduction of supplemental leeds arc important determinants of the health and nutritional status of inl)nts and young children. Almost all young children in Egypt are breastlizd for some period of time. The median duration of breastlceding (19.1 months) is moderately long. However, supplemental leeds and liquids arc introduced cmnparatively early, the median duration lor which a child receives breast milk only is 1.8 months. Nearly one in live bmastfcd children less than eight months of age was given a bottle with a nipple on the day before the interview. XXV Egypt MEDITERRANEAN SEA 5 2,3 24. 2.5 26 t8 19 / 20 RED SEA 22 URBAN GOVERNORATES 1 Cairo 2 Alexandria 3 Port Said 4 Suez LOWER EGYPT 5 Damietta 6 Dakahlia 7 Sharkia 8 Kalyubia 9 Kafr El-Sheikh 10 Gharbia 11 Menoufia 12 Behera 13 Ismallia UPPER EGYPT 14 Giza 15 Beni Suef 16 Fayoum 17 Menya 18 Assiut 19 Souhag 20 Qena 21 Aswan FRONTIER GOVERNORATES 22 New Valley 23 Matrouh 24 North S,nal 25 South Sinai 26 Red Sea xxvi CHAPTER 1 INTRODUCTION 1.1 Geography Egypt is situated at the northeast comer of the African continent. The total area of Egypt covers approximately one million square kilometers; however, only 6 percent of this area is inhabited (Central Agency for Population Mobilization and Statistics (CAPMAS), 1993b). Administratively, Egypt is divided into 26 govemorates. Four of these govemorates are totally urban (Cairo, Alexandria, Port-Said and Suez). Nine govemorates are found in the Nile Delta (Lower Egypt), which extends from Cairo to the Mediterranean Sea, and eight are located in the Nile Valley (Upper Egypt). An additional five frontier govemorates are found on Egypt's western and eastern boundaries (see map). Each govemorate is divided administratively into smaller units (kism/shiakha in urban areas and markaz/villages in rural areas). 1.2 Demographic and Health Indicators Population Size, Density and Distribution On the first of July, 1993, the population of Egypt was estimated to be 56,984 ~ million, with a sex ratio of around 104.3 (CAPMAS, 1993a). This figure represents an increase of around 9 million from the reported de facto population in the 1986 Census. Figure 1.1 shows that, since 1937, the population has more than tripled in size, increasing from only around 16 million to 57 million in 1993. Projections indicate that, by the year 2025, the population will exceed 90 million; at that point Egypt will rank 17th among the world's most populous countries (United Nations, 1991). Currently, the majority of Egypt's population lives in rural areas. However, the urban population has been growing rapidly; in 1990, it represented 47 percent of the total population, compared to 44 percent at the time of the 1986 Census data and 37 percent in 1960 (UNDP, 199t). If the urban growth continues at its current rate, Egypt will be mostly urban by the year 2025, with only around 25 percent of its Fx)pulation living in rural areas. For Egypt as a whole, the population density averages 1,035 persons per square kilometer of inhabited area. The average density varies widely by govemorate, fluctuating from a low of 22 persons per squareki lometerinSueztoahighof31,699inCairo(CAPMAS, 1993b). Within Egypt's metropolitan areas, some areas are extremely crowded. For example, a number of kisms in Cairo have population densities of more than 100,000 persons per square kilometer, and population density reaches its maximum in a kism in Alexandria, where the density is 128,000 per square kilometer. Fertility According to information from the vital registration system (which was established in Egypt in 1912), fertility levels generally have been high in Egypt for the past 50 years, decreasing only gradually between the early 1930s and the mid-1980s, when the decline accelerated. Over this period, the crude birth rate (CBR) 1Excludes 2,579 million who were living abroad. M~lhon Figure 1.1 Trend in Population Size by Sex, Egypt 1937-1992 60 50 37 40 31 30 26 ~ l 20 16 1 u 1937 1947 1960 1966 1976 Source CAPMAS, 1993b 1986 1993 fell from a level of 50 births per thousand population to 34.5 births per thousand population in 1973, when it began to rise again) Figure 1.2 shows that, since 1985, the decline in fertility has been continuous, with the CBR failing below 30 per thousand in 1992 (CAPMAS, 1993b). As a result of the past high fertility, the age structure of the Egyptian population is very young, with around 40 percent of the population under 15 years of age in 1993. Mortality Mortality levels started their serious decline after the World War II, with the crude death rate (CDR) dropping from around 30 deaths per thousand population to about 15 deaths per thousand during the sixties. As shown in Figure 1.3, the CDR continued to decline from 9.4 deaths per thousand in the mid- 1980s to 7.4 per thousand in 1992 (CAPMAS, 1993b). Infant and child mortality represent the majority of all deaths, and these rates still are considered high in Egypt. However, there is evidence that they have declined sharply during the period since World War II. The estimated infant mortality rate for the period 1985-90 was about 65 per thousand live births. The IMR is expected to continue to decline to a level less than 40 per thousand by the year 2000-2005 (United Nations, 1991). 2The decline has been attributed to various factors, including the effects of the war and of delays in marriage. However, recent studies suggest that structural changes in the age distribution, resulting from the changes in fertility and mortality conditions during the period 1930-1950, were also responsible for the trend (Bucht and EI-Badry, 1986). Births per 1,000 40 0_ 38 0 36 0 34 0 32 0 30 0 28 0 Figure 1.2 Trend in Crude Birth Rate Egypt 1985-1992 38 7 379 375 31 5 1985 1986 1987 1988 1989 1992 Source CAPMAS, 1993b Deaths per 1,000 95 Figure 1,3 Trend in Crude Death Rate Egypt 1985-1992 9O 85 8O 75 70 1985 81 r i i ~ I 1986 1987 1988 1989 1990 Source CAPMAS. 1993b 1992 The impact of mortality decline was reflected on the increased expectation of life at birth. It reached around 60.3 years in 1990, compared to 46.1 years in 1960 (UNDP, 1991). In conjunction with the declines in both the fertility and mortality rates, the health status of the Egyptian population has improved in response to govemmental eflons. The government increased the proportion of the total budget expended on health from 2.4 percent in 1980 to 2.8 percent in 1991 (World Bank, 1993). As a result, the population per physician declined from 1,900 in 1970 to 1,320 in 1990, and the population per nurse also decreased from 2,320 to 490 during the same period. 1.3 Socioeconomic Indicators The Egyptian economy has been experiencing drastic changes during thc last several decades. It was characterized by a centralist approach in the ill'ties and sixties, when the market was mainly dominated by the public sector. In the seventies, the "open-door" policy shaped the decade. Since the eighties, the government has been adopting an economic liberalization program that gives the private sector a greater share in the economic market. Economic reform has achieved tangiblc results in rostoring both cxternal and internal economic equilibria. In the fiscal year 1991/92, the Gross Domcstic Product (GDP) reacbed 125,485 million Egyptian pounds (L.E.) (Central Bank, 1993). This figure rcprescnts an avcrage annual increase of 3.9 percent over the GDP at the time that the second five-year plan period started in 1986/87 (at constant 1986/87 prices). The inflation rate (based on the consumer price index) decreased drastically in 1991/92 to 9.7 percent, compared to 20.7 percent in 1991//91. The drop in the inflation rate is reflected in the stabilization of the exchange rate at 3.3 L.E. to the dollar for the past two years. As a result, the demand lor the Egyptian pound increased, and savings dcposits in Egyptian pounds rose. As for the state budget of 1991/92, the deficit was lcss than half the 1990/91 budget deficit. As a result, the ratio of deficit to the GDP fell to 5.2 percent. With respect to the external transactions, the surplus in the balance of payments showed a substantial increase, reaching U.S. $3.8 billion during 1991/92. This is compared with a surplus of U.S. $1.4 billion recorded for the first time in the previous year (Central Bank, 1993). The leading earners of foreign currency in the economy are workers' remittances, tourism revenues, Suez Canal dues, and oil exports. Although the economic indicators show that the economy is improving, Egypt is ranked at the lower end of the human development index (UNDP, 1991). However, a number of key human development indicators have improved ovcr time. Among these improvments are: Primary enrollment rates in schools have jumped from 75 percent in 1970 to 98 percent in 1990, while for the secondary stage, the rate increased from 35 percent to 82 percent for the same period. In addition, the primary pupil/teacher ratio declined from 38 to 25 pupils/teacher. Female education has improved. Illiteracy among women age 10 and over decreased from 71 percent in 1976 to 63 percent in 1986, according to the 1976 and 1986 population censuses. Female enrollment rates increased dramatically, from 57 percent in 1970 to 90 percent in 1990 for the primary stage. For secondary education, the rate also increased, from 23 percent to 71 percent. 4 The investment allocation for education has increased. The share in total investment during the period 1982/83-1986/87 was 1.8 percent, while the same sham was 2.3 percent for the five-year period 1987/88-1991/92. The Gross National Product per capita has doubled during the last 20 years to reach US $610 in 1991 (World Bank, 1993). 1.4 Population Policy and Programs The population problem in Egypt has three interrelated dimensions; namely, high rates of population growth, unbalanced population distribution, and human resource constraints including illiteracy that affect the productivity of the labor force. Efforts to raise awareness and discussions about the sensitivity and complexity of the population problem began in Egypt in the 1930s. A "National Committee for Population Matters" was established by the govemment in 1953 (one year after the revolution) to examine the population situation and identify the best course of action that should be followed by the government. Egypt has had three formal population policies; the first national policy was introduced in 1973 and was followed by an implementation plan for the period 1973-1982 and the second population policy issued in 1980. Following the national population conference that was held in March 1984 under the chairmanship of the President of Egypt, the National Population Council (NPC) was established, and the third National Population Policy was adopted in 1986. The 1986 population policy m cognized seven principles necessary for the achievement of its basic objectives. These principles include: 1) Each family has the right to decide on the appropriate number of childm n to have and to obtain information about the means to enable them to achieve their decision within the framework of religion, Egypt's civilization and the values of its society; 2) the avoidance of the use of abortion or sterilization as a means of family planning; 3) recognition of the citizen's right to migrate and to move from place to place within Egypt or abroad; 4) adoption of a positive incentive system based on increased awareness of the role of the individual and the community and the avoidance of any methods of coercion, negative incentives or punitive methods; 5) educational, cultural and health development of the individuals to help them to become a source of productive energy; 6) local government bodies am considem d the base for implementation of all programs; and 7) encouragement of voluntary efforts and community participation in the solution of the problem. Targets for key indicators relating to population growth am set by the Egyptian government. The target-setting process significantly improved over the years, especially with the availability of basic population and family planning data, which has served as the basis for periodically updating the targets since the 1986 policy was adopted. In 1991, the NPC introduced a population strategy with targets for the rate of natural incm ase, crude birth rate, total fertility rates, and contraceptive pm valence (National Population Council, 1991). The targets are as follows: The crude birth rate is to bc reduced to 27 per thousand in the year 1997 and 26 per thousand in 2002. The rate of natural increase in the years 1997 and 2002 will bc reduced to 2.0 percent and 1.9 percent, respectively. The total fertility rate will be reduced to 3.5 in 1997 and 3.1 in 2002. Current contraceptive prevalence will increase to 55 percent and 59 percent in the year 1997 and 2002, respectively. In sum, Egypt, which was one of the first countries to adopt formal population policies and objectives, has already achieved a demographic breakthrough as a result of changes in key demographic variables. The success of this process is reflected in the evaluation of the population program's performancc during the 1980s. According to a review of the performance of family planning programs in 98 countries, the Egyptian program was categorized in 1989 as at the top of the moderate group, which represents a significant improvement over previous program performance which was described as weak (Mauldin and Ross, 1991). 1.5 Health Policies and Programs Health for all by the year 2000 is the main health objective of the Egyptian Government. The Ministry of Health (MOH) has long given high priority to implementing this objectivc, developing a national system of health facilities providing scrvices at all levels (central, governoratc and local). The MOH is especially concerned with increasing the coverage of the health care system, especially in rural areas, emphasizing preventive care and children's immunization. Primary health care for all, and especially maternal and child health care, havc recently gained significant additional momentum from the Egyptian Government. The Egyptian health policy emphasizes: Provision of health services lor all, with adherence to social justice and more attention to upgrading medical care suitable to the individual's income levcl; Reduction of mortality and morbidity; Improved health care quality; Increased coverage of child immunization programs; Expansion of the national health care financial system and introduction and/or development of other types of health insurance; Development of the cost-recovery system and a greater role for the priw~tc sector; Provision of health education and health messages and studies relating to health economics; Continual upgrading of the health information system; Review and modification of health legislation on a periodic basis to cope with social changes; and Improved management of the health services system. 1.6 Object ives and Organ izat ion of the Survey The 1992 Egypt Demographic and Health Survey (EDHS) is the latest in a scrics of national-level population and health surveys in Egypt) It was implemented under the supervision of the National Popu- lation Council (NPC) with financial support from the United States Agency for International Development (USAID). Macro International Inc. provided technical assistance for the survcy through thc international Demographic and Health Surveys program. 3In addition to the first EDHS conducted in 1988 (Sayed et al., 1989), these surveys include the 1979-1980 Egypt Fertility Survey (EFS) (Hallouda et al., 1983), the 1980 and 1984 Contraceptive Prevalence Surveys (ECPS) (Khalifa et al., 1982 and Sayed et al., 1985) and the 1991 Egypt Maternal and Child Health Survey (EMCHS) (Abdel-Azeem et al., 1993). Survey Objectives The primary objective of the EDHS is to provide data on fertility and mortality, family planning, and maternal and child health. The survey obtained detailed information on these issues from a sample of ever- married women in the reproductive ages. In addition, a subsample of husbands was interviewcd in an effort to obtain information on their fertility preferences and the role which they play in family planning decisionmaking. The EDHS information is intended to assist policymakers and administrators to evaluate cxisting programs and to design new strategies for improving family planning and health services in Egypt. A secondary objective is to enhance the capabilities of institutions in Egypt to collect, process and analyze population and health data so as to facilitate the implementation of future surveys of this type. Organization and Timetable Figure 1.4 presents the organizational structure of the 1992 EDHS staff. A list of the staff involved in each phase of the EDHS is included in Appendix A. A detailed timetable is shown in Table 1.1. The organization, training and supervision of the staff participating at the various stages of the survey arc described below. Figure 1,4 Organization of the 1992 EDHS Staff CoRsul[ants ] Tec hnlca4 1 Director I Asslslanl Director I Associate Directors r Da~ao P[dlCet~s;n g I I Data P[ocesslng Staff Office and Admlnls[raWe/ Financial Staff ] Fieldwork Coordinator I l ont ] Interwew~ng Staff Relntervlewln9 Statf Table 1.1 Survey timetable~ Egypt 1992 Activity Starting Date Duration Development of the sample design Quick-count operation Recruitment and training of listing staff Listing and refisting Sample selection Questionnaire design Preparation of training manuals and other documents Printing the pretest materials Pretest Finalization of qucstaonnaires Recruitment of field staff Printing survey materials Training of field staff Fieldwork Remterviews Office editing Data entry Computer editing Preliminary report Detailed tabulations Final report preparation January 1992 1 month May 1992 3 months August 1992 3 weeks September 1992 1 month October 1992 2 weeks April 1992 I month May 1992 3 months May 1992 2 weeks May 1992 2 weeks August 1992 I month September 1992 I month September 1992 1 month October 1992 4 weeks November 1992 2 months December 1992 5 weeks November 1992 3 months November 1992 3 months December 1992 3 months M~ch 1993 2 weeks Aprd 1993 I month July 1993 4 months Sample Design The 1992 Egypt Demographic and Health Survey covered over 11,000 households, which were scattered in 21 governorates. One of the key concerns in the design of the sample was the need 1o provide reliable estimates of fertility levels and contraceptive use for Egypt as a whole, and for urban and rural areas separately. Other domains for which reliable estimates were desired included the Urban Govemorates, Upper Egypt, and Lower Egypt. In addition, estimates of key indicators for the women's sample were needed at governorate level. In order to allow for the govemorate-level estimates, the number of households selected from each governorate is disproportionate to the size of the population in the governorate; thus, the EDHS sample is not self-weighting at the national level. The 1992 EDHS sample was selected in three stages. The sampling units at the first stage were shiakhas/towns in urban areas and villages in rural areas. The frame for the selection of these primary 8 sampling units (PSUs) was based on 1986 census data, which were provided by the Central Agency for Public Mobilization and Statistics (CAPMAS). During the first stage selection, 377 PSUs were sampled (169 in urban areas and 208 in rural areas). The second stage of selection involved several steps. First, maps were obtained for each shiakha and village that had been selected at the first stage and divided into a number of roughly equal-sized parts. One of the pans was then selected from each PSU. In both urban and rural PSUs, a quick-count operation was carried out in the field to provide the information which was used to divide the selected pan into a number of segments of roughly equal size. Two segments from urban areas and one segmcnt from rural areas were then chosen as the secondary sampling units. After the secondary sampling units (SSUs) were selected, a household listing was obtained for each SSU. Using the household listing, a systematic random sample of households was chosen for the EDHS. A subsample of one-third of the households in every segment was selected for the husband survey. All ever- married women 15-49 who were present in the household on the night before the interview were eligible for the survey. The husbands' sample covered men who were currently married to eligible women. A more detailed description of the sample design is included in Appendix B. Sampling errors for key variables are presented in Appendix C. Sample Implementation Two different field operations were conducted during the sample implementation phase of the 1992 EDHS. A quick count for the PSUs selected in shiakhas/towns and villages was the first field operation. The objective of the quick count was to obtain an estimate of the number of households in the part to serve as the measure of size for the second stage selection. Experience in the 1988 EDHS, in which a quick-count operation was carried out in only the urban PSUs, indicated that there was frequently significant variation between the target and the actual number of households in rural areas. This variation was largely due to the imprecision in assigning measures of size in some rural PSUs, which involved measuring the residential area on a map, many of which were out of date. Therefore, it was decided to carry out a quick count in both urban and rural areas. Prior to the quick-count operation, maps were obtained for each shiakha or town selected for the urban sample and for villages included in the rural sample that had more than 20,000 population. These maps were divided into approximately equal-sized parts, and one part was randomly selected for the quick-count operation. For villages with less than 20,000 population, the quick count was carried out for the entire village. It should be noted that the quick count for a rural area covered both the main village and all associated hamlets. The one-week training course held prior to the quick-count field operation included both classroom instruction and practical training in shiakhas and villages not covered in the survey. The quick-count operation, which covered all 377 PSUs, was carried out between mid-May and mid-July 1993. A group of 52 field staff participated in the quick-count operation. The staff was divided into 15 teams, each composed of one supervisor, one cartographer and one counter. As a quality control measure, 10 percent of the parts were selected, and a second count obtained. If the difference between the first and second counts was within 2 percent, the first count was accepted; otherwise, another visit was made to the field to resolve the discrepancy between the two counts. There were only a few cases in which a third visit was required. The second field operation during the sample implementation phase involved a complete listing of all of the households living in the 546 segments chosen during the second stage of the sample selection. Prior to the household listing, 38 listing staff attended a one-week training course, which involved both classroom lectures and field practice. After the training, 11 listing teams were formed. Each team consisted of a supervisor and two listers. The listing operation started on September 10th and was completed by mid-October. Segments were relisted when the hum ber of household in the listing differed markedly from that expected based on the quick- count figures. Questionnaire Development and Pretest The 1992 EDHS involved three types of questionnaires: a household questionnaire, an individual questionnaire for women, and an individual questionnaire for husbands. These questionnaires were based on the model survey instruments developed for the international Demographic and Health Surveys program. In particular, the household and women's questionnaires were built on the DHS model "A" questionnaire for high contraceptive prcvalcnce countries. Additional questions on a number of topics not covercd in the DHS model questionnaire were included in both the household and individual questionnaires. The questionnaires were pretested in May 1992, following a two-week training course Ior supcrvisors and interviewers. Two supervisors, two field editors and ten interviewers participated in the pretest. Interviewer comments and tabulations of the pretest results were reviewed during the process of modifying the questionnaires. An English translation of the final Arabic language questionnaires is included in Appendix E. The household questionnaire obtained a listing of all usual household members and visitors and identified those present in thc household during the night beforc the interviewer's visit. For each of the individuals included in the listing, information was collected on the relationship to the household head, age, sex, marital status, educational level, occupation and work status. Finally, the household questionnaire also included questions on characteristics of the physical and social environment of the houschold (e.g., availability of electricity, source of drinking water, household possessions, ctc.), which are assumed to be related to the health and socioeconomic status of the household. The individual questionnaire for women was administered to all ever-married women age 15-49. It obtained information on the following topics: Background characteristics Reproduction Knowledge and use of family planning Other issues relating to contraception Fertility preferences Maternal care and breastfeeding Immunization and health Marriage Husband's background, residence and women's work The women's questionnaire included a monthly calendar, which was used to record fertility, contraceptive use, marriage, spousal absence, migration, and employment histories for a nearly six-year period beginning in January 1987. In addition, the interviewing teams measured the height and weight of all children who were bom since January 1987 and of their mothers. 10 The husbands' questionnaire was administered to all men who were currently married to an eligible woman in the households included in the husbands' survey subsample. The husbands' questionnaire was similar but shorter than the women's questionnaire. It included questions relating to background characteristics, lifetime childbearing, fertility preferences, knowledge, use and attitudes toward family planning, and the status of women. Data Collection Activities Staff Recruitment. Candidates for the positions of interviewer and field editor were idcnti fled in two ways. First, advertisements in newspapers attracted a number of applicants. Second, the Ministry of Social Affairs (MOSA) nominated a number of its female personnel, who were working to ful fill the mandatory one- year period of governmental service for university graduates. All candidates for the field staff positions were interviewed, and only those who were qualified were accepted in the training program. All candidates for the interviewer and field editor positions were recent university graduates. Another basic qualification was a willingness to work in any ofthc govemoratcs covcrcd in the survey. With few exceptions, interviewers who had previous experience in surveys were not accepted in the training program. This decision was taken to reduce any bias that might result from their previous cxperiencc and to ensure that all trainees had a similar background. However, previous survey experience was a basic quail fication for the candidates for the positions of supervisor and assistant supervisor. Training Materials. A variety of materials were developed for use in training personnel involved in the fieldwork. A lengthy interviewer's manual giving general guidelines to follow in conducting an interview, as well as specific instructions for asking particular questions in the qucstionnairc, was prepared and given to all field staff. In addition, a chart to convert months from the Islamic calendar to the Gregorian calendar was designed for the 74 months before the EDHS and distributed to all field workers. Other training materials included special manuals describing the duties of the team supervisors and the rules for field editing. Instructions regarding the anthropometric data collection were included in a manual that was made available to the interviewers who were trained as measurers and team supervisors. SupervisorandInterviewerTraining. Interviewer training for the 1992 EDHS data collcction began in the first week of October 1992. Seventeen supervisors, 14 assistant supervisors, plus 97 interviewers participated in the training program. A special training program for supervisors and assistant supervisors was conducted during a three-day period prior to the main fieldwork training. This training focused specifically on the supervisor's duties, but also covered the questionnaire in order to give supervisors a head start prior to the main training program. The training program, which was held in Cairo for four weeks, included: general lectures related to family planning and public health; specific sessions with visual aids on how to fill out the questionnaire; opportunities for role playing and mock interviews; four days of field practice in areas not covcrcd in the survey; and five quizzes. Trainees who failed to show interest in the survey, did not attcnd the training program on a regular basis, or failed the first three tests were disquali fled immediately. The training was originally planned for three wceks, but because of disruptions due to the October 12 earthquake, the training program was extended for an additional week. 11 At the beginning of the third week of the training, a preliminary list was compiled of the 20 trainees who had performed best during both the classroom and field exercises. Those trainees were further examined in order to select 12 field editors. A special training session was held for the field editors following their selection. About 45 trainees plus all assistant supervisors were selected tot anthropometric training. This training included both classroom lectures and practice measurement in a nursery sehooh At the end of the program, the 36 best trainees were selected to serve as measurers during the EDHS fieldwork. At the end of the training course, 63 of the 97 candidates originally recruited for the interviewer training were selected to work as field editors, interviewers and measure~ in the EDHS fieldwork. Fieldwork. Fieldwork for the survey including initial interviews, callbacks, and reinterviews began on November 7, 1992 and was completed on February 8, 1993. A total of 91 staff, including one fieldwork coordinator, one assistant fieldwork coordinator, 13 supervisors, 13 assistant supervisors, 12 field editors and 51 interviewers were responsible for the data collection. All supervisors and assistant supervisors were male, while field editors and interviewers were female. The field staff was divided into 12 teams; each team had a supervisor, assistant supervisor, a field editor and four or five interviewers. Usually two of the interviewers in the team and the field editor plus the assistant supervisor were specially trained to collect the height and weight measurements. During the fieldwork, each team worked in two govemorates, except Cairo and lsmailia. At the beginning of the fieldwork, visits were made to all of the areas in which earthquake damagc had occurred in order to check and, if neccssary, update the original household listings. Listings were checked in Cairo, Giza, Kalyubia, Fayoum, Menya, Bcni Suef and Ismailia. Only a few segmcnts had experienced significant damage, and, even in those segments, 70 percent or more of tile houscholds listed initially were found at their original addrcsscs. Thus, the earthquake did not adversely affect the EDHS sample. After the initial fieldwork was completed, a random sample of up to 10 percent of the interviews were reinterviewed as a quality control measure. In the reinterview, a shorter version of the questionnaires was used. Household and individual questionnaires which were incomplete or had errors that could not be corrected in the office were also assigned for callbacks. Special teams were organized to handle callbacks and reinterviews. During the reinterview and callback phase of the survey, interviewers were not allowed to work in the governorates in which they had participated in the initial fieldwork. Data Processing Activities Office Editing. The central office of the EDHS was responsible for collecting questionnaires from supervisors as soon as a cluster was completed. Questionnaires were coded and reviewed for consistency and completeness by office editors. To provide feedback for the field teams, the office editors were asked to write a summary report of problems for each PSU. The report was then reviewed by one of the two senior staff assigned to supervise the work of the office editors. When there were serious errors lbund in one or more questionnaires from a cluster, the team supervisor was contacted in order to ensure that the problem would not occur in other clusters in which the team was working. Machine Entry and Editing. The data were entered and edited on microcomputers using the Integrated System for Survey Analysis (ISSA), a package program specially developed to process DHS data. ISSA allows range, skip and most consistency errors to bc detected and corrected at the entry stage, 12 substantially reducing the time required for the processing of data. The machine entry and editing phase began while interviewing teams were still in the field. The data entry personnel used eight IBM-compatible microcomputers to process the EDHS questionnaires. During the machine entry 20 percent of each segment was reentered for verification. One of the computers was assigned for this process. Working six days per week in two shifts, the data entry personnel completed the machine entry and editing of the data in three months. Coverage of the Sample Table 1.2 summarizes the results of the household and individual interviews. A total of 11,304 households were selected; of these households, 10,760 were successfully interviewed. As noted, an eligible respondent for the women's survey was defined as an ever-married women between the age of 15 and 49 years present in the household on the night before the interview. A total of 9,978 eligible respondents were identified, and of these women, 9,864 (99 percent) were interviewed. A total of 3,027 men were identified as eligible for the husbands' survey, i.e, they were resident in a household selected for the husband subsample and married to a woman between the ages of 15 and 49. Of the eligible men, 2,466 were sucessfully interviewed (82 percent). Table 1,2 Results of the household and individual interviews Number of households and eligible women and husbands and response rates by urban-rural residence and place of residence, Egypt 1992 Place of residence Urban Lower Egypt Upper Egypt Interview Gover- results Urban Rural notates Total Urban Rural Total Urban Rural Total Households sampled Households found Households interviewed Household response rate Eligible women Eligible women interviewed Eligible woman response rate Eligible husbands Eligible husbands interviewed Eligible husband response rate 6082 5222 3243 4215 1551 2664 3846 1299 2559 11304 5874 5076 3132 4121 1506 2615 3697 1236 2461 10950 5726 5034 3039 4067 1481 2586 3654 1206 2448 10760 97.5 99.2 97.0 98.7 98.3 98.9 98.8 97.6 99.5 98.3 4725 5253 2517 3864 1215 2649 3597 993 2604 9978 4673 5191 2487 3812 1200 2612 3565 986 2579 9864 98.9 98.8 98.8 98.7 98.8 98.6 99.1 99.3 99.0 98.9 1426 1601 773 1175 360 815 1079 293 786 3027 1196 1270 664 947 295 652 855 237 618 2466 83.9 79.3 85.9 80.6 81.9 80.0 79.2 80.9 78.6 81.5 13 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter describes the general characteristics of the sample population, including age and sex composition, residence, education, housing facilities, household possessions and exposure to mass media. The highlighted factors are those that influence nuptiality, fertility, and contraceptive behavior, as well as maternal care and child morbidity and mortality. 2.1 Characteristics of the Household Population The 1992 EDHS questionnaire included two questions distinguishing between the dejure (persons who are usual residents in the selected household) and the de facto (persons who spent the nigh1 before the interview in the household) populations. This report uses the de facto definition, unless stated othcrwise. Age and Sex Table 2.1 and Figure 2.1 show the distribution of the de facto household population by five-year age groups? according to sex and urban-rural residence. The sex ratio for the population as a whole is 98.5 Table 2.1 Household population by age T residence and sex Percent distribution of the de facto household population by five-year age groups, according to urban rural residence and sex, Egypt 1992 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 04 12.1 11.4 11.7 16.9 15.3 16.1 14.7 13.5 14.1 5-9 13.0 12.8 12.9 15.8 15.2 15.5 14 5 14.1 14.3 I0-14 13.1 12.5 12.8 14.3 13.2 13.7 13.7 12.8 13.3 15 19 10.4 100 10.2 11.3 10.7 11.0 10.9 10.4 10.6 20-24 7.6 8.7 8.2 6.6 7.8 7.2 7.0 8.2 7.6 25-29 7 5 8.4 7.9 6.5 7.5 7.0 7.0 7.9 7.4 30-34 7.1 7.3 7 2 5.5 6.0 5.7 6.2 6.6 6.4 35-39 5.8 6.8 6 3 4.8 5.2 5.0 5.3 5.9 5.6 40-44 5.9 5.5 5.7 4.0 4.4 4.2 4.9 4.9 4.9 45-49 4.3 4.3 4.3 3.4 3.3 3.4 3.8 3.8 3.8 50-54 3.2 3.5 3.4 2.6 2.9 2.8 2.9 3.2 3.0 55-59 3.1 2 8 2.9 2.5 2.4 2.4 2.8 2.6 2.7 60-64 2.4 2.7 2.5 2.2 2.5 2.4 2.3 2.6 2.4 65-69 2.0 1.5 1.8 1.6 1.6 1.6 1.8 1.5 1.7 7(I-74 1 3 1.1 1.2 1.0 1.2 1.1 1.1 1.1 1.1 75-79 0.6 0.3 (I.4 0.4 0.3 0.3 0.5 0.3 0.4 80 + 11.5 0.5 0.5 0.6 0.6 0.6 0 5 0.6 0.5 Total 100.0 100.0 100 0 100.0 100.0 100.0 100.0 100.0 100.0 Number 13517 13650 27167 15771 16095 31866 29288 29745 59033 1Single-year age distributions are presented in Appendix D, which reviews the quahty of the EDHS data. 15 Age 80+ 75 7.( 70 7~ 65 69 60 64 55 59 50 54 45 49 40 44 35 39 30 34 25-29 20 24 1519 10 14 59 O4 20 Figure 2,1 Population Pyramid of Egypt Male ~ I Female 15 10 5 0 5 10 15 20 Percent EDHS 1992 males for every 100 females. The age pattern is typical of a country with relatively high fertility in the recent past, i.e., a much greater concentration of the population in younger than older age groups. The urban age distribution has a narrower base (i.e, is less concentrated at the younger ages) and a broader spread than the rural distribution; the diffcrcnces in the age distributions lor the two groups are a result of the lower fertility and mortality levels in urban arcas comparcd to rural arcas. Table 2.2 presents the distributions of the dc facto household populations by broad age groups for the 1988 and 1992 DHS surveys. The distributions are nearly identi- cal. Dependency ratios also are shown. The age depend- ency ratio is the ratio of non-productive persons (persons age 0 to 14 and age 65 and over) to persons age 15 to 64. The dependency ratio indicates that, in Egypt, for every person in the productive age groups, there arc 0.8 persons under age 15 or over age 64. Household Size and Composition Table 2.2 Population by age~ 1988 and 1992 Percent dxstnbutxon of the tx)pulation by broad age group. 1988 EDHS and 1992 EDHS 1988 1992 Age group EDHS EDHS Less than 15 41.2 41.7 15-64 55.0 54.6 65+ 3.8 3 7 Household characteristics affect the social and eco- Total 100.0 100.0 nomic well-being of the members of the household. Large I)ependency ratio 81.8 83.2 household size may be associated with crowding, which can lead to unfavorable health conditions. Houschold hcad- ship is another important indicator of household welfare. Households headed by females, usually have limited financial resources. Finally, the data on household composition provide the basis for an analysis of relationship structure, distinguishing nuclear from cxlendcd households. 16 Information on the size and composi- tion of sampled households is shown in Table 2.3. Unlike the two earlier tables, Table 2.3 is based on de jure members, i.e., usual resi- dents. Of all households covered, 12 percent are headed by women. There is almost no dif- ference between urban and rural areas in the percentage of female-headed households. There are, on average, 5.6 persons in an Egyptian household. Only one in eight households includes 2 or less persons, and one in five has 8 or more persons. Urban households are considerably smaller, on aver- age, than rural households (4.9 persons and 6.5 persons, respectively). Many rural house- holds are quite large. For example, around one in three rural households has 8 or more persons compared to only one in nine urban households. Taking account of adult household members age 15 and over only, the large ma- jority of households are composed of two re- lated adults of the opposite sex or of three or more related adults. Single adult households are relatively rare, comprising only 6 percent of all households. In rural areas, there are al- most twice as many households with three or more related adults as households with two related adults (61 percent and 32 percent, re- spectively). In urban areas, households arc more evenly divided between these two types. Only 1 percent of households include foster children, i.e., children under the age of 15 who live in households in which neither their natural mother nor their natural father is resident. Education of the Household Population Table 2,3 Household composition Percent distribution of households by sex of head of household, household size, and relationship structure, and percentage of households with foster children, according to urban-rural residence, Egypt 1992 Characteristic Urban Rural Total Household headship Male 87.4 89.1 88.2 Female 12.6 111.9 11.8 Total 100.0 100.0 100.0 Number of usual members l 5.2 37 44 2 10.3 6.6 8.5 3 12.1 7 9 10 1 4 18.6 11.1 15.0 5 18.6 12.3 15 6 6 14.7 13.6 14.2 7 9.2 12.6 10.8 8 5,3 I0 1 7.6 9+ 5.9 22.1 13.6 Total 100.0 100,0 l(XhO Mean size 4.9 6.5 5 6 Relationship structure One adult 6 1 5.1 5.6 Two related adults' Of opposite sex 42.3 32.2 37.5 Of same sex 1.7 1 5 1.6 Three or more related adults 49.2 611.8 54.7 Other 0.6 0.3 11.4 Total Households with foster children 100.0 1011.11 100.0 12 12 1.2 Number of households 5651 51/19 10760 Note: Table is based on de Jure members, Le,, ususal residents. Foster children are those under age 15 living in households with neither their mother nor their father present. Education has been identified in the literature as an important variable affecting demographic and health behavior. Higher education is usually associated with use of family planning methods and better health practices. The education system in Egypt has evolved over a long period of time. There have been many changes, especially in the number of years of compulsory schooling. Currently, basic education is compulsory for the first 8 years, starting at age six. A further three-year period, known as the secondary 17 stage, is not compulsory. Although many students pay to attend private schools, particularly in urban areas, public education at all levels including universities is free. Tables 2.4.1 and 2.4.2 present data on the educational composition of the population age five and over obtained from the EDHS household questionnaire. The results highlight the gap in educational attainment that exists between men and women in Egypt. Overall, 78 percent of men have attended school compared to only 59 percent of women. The median number of years of schooling for males (5.3 years) is more than twice the median number for females (2.3 years). The improvements that have occurred in public education in recent decades can be examined by looking at the changes in the educational indicators across successive age cohorts (see Tables 2.4.1 and 2.4.2). Both sexes show a rapidly increasing level of education although females continued to lag behind males until recently. For example, the median number of years of schooling for men in the 25-29 age group is 11.5 years compared to 4.0 years for women in the same cohort. In younger cohorts, the sex differentials arc narrower; the gap in the median number of years of schooling is less than four years for the 20-24 age group and less than one year for those under age 20 (sec Figure 2.2). Table 2.4.1 Educational level of the male bousehoJd population Percent distribution of the de facto male household population age five and over by highest level education attended, according to selected background characteristics, Egypt 1992 of Prunary Completed Number Median Background Sonic through secondary/ of number characteristic None prtmary secondary higher Mtssmg Total persons of years Age group 5-9 28,4 71 4 0.1 00 0,0 100.0 4249 I 1 10-14 5.8 42.2 51,9 0.1 0,0 100,0 4025 6,1 15-19 78 127 657 13,8 0.0 1000 3194 9,5 20-24 11 0 11,5 20,4 56.9 0 1 100,0 2(k53 12,2 25 29 14 7 20 5 16,0 48.7 0 1 10011 2036 11 5 31) 34 169 23.// 163 43.7 0 1 1000 1822 8.9 35-39 223 24,7 172 35.8 0.0 1000 1546 6.4 4044 28.9 22,2 17.9 309 0.0 100.0 1430 5.9 4549 365 2011 17.7 259 0.0 1000 1128 52 50-54 42 3 20.8 17 3 19.0 0.5 100,11 846 3.5 55-59 48 9 23.1 I 1.3 16 7 0.0 100.0 810 I 0 60-64 56 1 25 5 9.1 9 4 0.0 100.0 680 0 0 65+ 68,6 15 8 8.2 7 5 0,0 100.0 1165 0 0 Urban-rural residence Urban 15.0 29 0 27.6 28 4 0,0 100 0 11886 6 7 Rural 29 4 33 7 23 4 13,5 0 (I 100 0 131 I0 4 0 ]>lace of residence Urban Governorates 13.6 284 29.1 28.9 00 1000 6130 6.9 Lower Egypt 22.9 32.6 25.8 18.6 0,0 1000 10474 5 2 Urban 14.7 3113 277 27.3 00 1000 3130 6.6 Rural 26 5 33 6 25.0 14.9 0 0 100,0 7344 4.5 Upper Egypt 28.6 32 2 22 3 16.9 0 I 100,0 8392 4.2 Urban 18 5 28 9 24.1 28 4 0.1 l 1)0 (I 2626 6.4 Rural 33 2 33 7 21 4 11.7 0 0 100 0 5765 3.2 Total 22 5 31 4 25 4 20 6 0.0 1 (R) 0 24995 5 3 18 Table 2.4.2 Educational level of the female household population Percent distribution of the de facto female household population age five and over by highest level of education attended, according to selected background characteristics, Egypt 1992 Primary Completed Number Median Background Some through secondary] o[ number characteristic None primary secondary higher Missing Total persons of years Age group 5-9 37.6 62.4 0.0 0.0 00 11~) 11 4199 09 10-14 16.0 35.9 48.1 0.0 0.0 100.0 3819 5.4 15-19 23.6 11.0 51.6 13.7 0.0 100.0 30911 8.9 20-24 33.9 I 1.7 12.7 41 7 0.0 100 0 2445 8 4 25-29 40,8 18.8 10.0 30 5 0.0 100 0 2355 4.0 30-34 42.1 24 2 8.5 25.2 0.0 100.0 1956 3.1 35-39 464 25.1 10.1 18.4 0.0 100.0 1768 2.3 40-44 53.6 22.9 10,9 12.5 0.1 100.0 1457 0,0 45-49 59.1 20.7 I 1,8 8.4 0.0 100 0 1131 011 50-54 65 6 22.4 6.0 6.0 0.0 100.0 948 0.0 55-59 70.7 21.3 4.0 3.9 0 2 100.0 759 0 0 60-64 76.6 17.0 4 5 1 8 t) 0 It)0 t) 763 t) 0 65+ 88.1 8,0 2 3 I 4 0 3 100 0 1040 0 0 Urban-rural residence Urban 26.0 29.2 23 2 21.6 0.0 100 0 12(~16 5 0 Rural 53,7 26.4 14,3 5.6 00 1000 13638 00 Place of resJdence Urban Governorates 23.9 27.9 24.8 23.4 0 0 100.0 6089 5.7 Lower Egypt 40.2 29 8 18.8 11.2 0.0 100.0 111773 2.2 Urban 26.3 31.5 22.0 20.1 0.0 1 (X).tl 3173 4 6 Rural 46,0 29.1 17.4 7 4 01) 100 0 76(X) 1 0 Upper Egypt 52 7 25.1 13.8 8.4 0.0 100.0 8872 0.0 Urban 30.0 29.4 21.2 19.4 0.0 100.0 2834 4.2 Rural 63 3 23.1 10.4 3.2 0 0 100 0 6038 0 0 Total 40.7 27.7 18.5 131 00 1000 25733 23 There is a notable difference in educational attainment between urban and rural residents. The median number of years of schooling for urban men is 6.7 years, almost 3 years more than for rural men. The differential is even greater for females. On average, urban women have spent 5 years in school compared to less than 1 year among rural women. By place of residence, the Urban Govornorates show the highest medians and rural Upper Egypt the lowest medians for both females and males. The low level of educational attainment of women in rural Upper Egypt is particularly striking. For example, while around half of women in rural Lower Egypt have attended school, only about one-third of women in rural Upper Egypt have gone to school. School Enrollment Table 2.5 presents the percentage of the household population 6-24 years of age who are enrolled in school. Around eight in ten children age 6-15 are enrolled in school. Enrollment after age 15 drops substantially; only 43 percent of the population age 16-20 are attending school and, among those in their early twenties, only 11 percent are still in school. School enrollment rates are higher for urban than rural residents, particularly among those age 16 and over. 19 Figure 2.2 Median Number of Years of Education by Sex and Age M~d,.lrl ye,lrc of F,du, 311c/q 14 12 18 5-9 ~0 ]4 15 19 2c%24 25 29 30 34 35-39 40 4,1 45 49 50 54 ~ 5.a f)ll ('}4 Age : bHS 1992 Table 2.5 School enrollment Percentage of the de facto household population age 6-24 years enrolled m school, by age group, sex, and urban rural residence, Egypt 1992 Male Female Total Age group Urban Rural Total Urban Rural Total Urb~m Rural Total 6-10 92.5 86.0 88.7 92,0 68.1 78.2 92.2 77.0 83.5 11 15 83.6 73.6 77.9 84.0 56.1 68.3 83.8 65.1 73.3 6 15 88.1 80.0 83.5 88.2 62.5 73.6 88 2 71.4 78.6 16-21/ 58 3 43.8 511.4 53.4 23.3 36.7 55 8 33.3 43.5 21-24 19.4 10 4 15.0 12.9 2.4 7.7 16.0 6 1 11.1 In the population as a whole, males are more likely than females to be enrolled in school in all age groups, with the differential being greatest for the 16-20 age group. Sex differentials in school enrollment are less noticeable for urban residcnts than for rural residents. 20 2.2 Household Environment The EDHS household questionnaire obtained information on basic housing characteristics and household possessions. These data contribute to an understanding of the economic status of the household and environmental conditions in which the EDHS respondents live. Housing Characteristics Table 2.6 presents the distribution of households by selected housing characteristics. Availability of electricity, source of drinking water, type of sanitation facilities, type of flooring material, and persons per sleeping mom are aspects of the household environment that relate to the socio-economic level of the household and may have important influences on the health status of household members, especially children. Overall, more than 90 percent of households in Egypt have electricity. Rural households are somewhat less likely to have electricity in all or part of their dwelling than are urban households (88 percent and 98 percent, respectively). By place of residence, the percentage of bouseholds with electricity varies from 83 percent in rural Upper Egypt to 99 pei'cent in the Urban Govemorates. Both access to safe drinking water and adequate sanitation facilities are important determinants of health conditions. In Egypt, four-fifths of all households have access to piped water, primarily in their residence, although 10 percent rely on a public tap. Most of the remaining households use well water; less than 5 percent obtain drinking water from the Nile, canals or other sources. In urban areas, virtually all households have piped water, but in mraI areas, only 61 percent of households have access to piped water. By place of residence, piped water is universally available to households in the Urban Govemorates. Households in Lower Egypt arc somewhat more likely to have access to piped water than those in Upper Egypt (76 percent and 69 percent, respectively). Households in rural Upper Egypt are the least likely to report use of piped water for drinking; only 56 percent have piped water, and about a third of these households obtain water from a public tap. Table 2.6 also presents inlormation on sanitation facilities. Overall, only 27 percent of households have modem flush toilets, 47 percent have traditional toilets, mainly with bucket flush, and 9 percent have no facilities. Among urban households, the variation in the percentage without toilet facilities is small, from less than 1 percent in the Urban Govemoratcs to 5 percent in urban areas in Upper Egypt. However, households in rural Upper Egypt are flvc times more likely than households in mral Lower Egypt to have no toilet facilities (32 percent and 6 percent, respectively). Regarding types of flooring material, one in two households live in dwellings having cement tile floors, 15 percent have cement floors, and threc in tcn have earttVsand floors. Earth/sand floors are more common in rural areas (60 percent), especially rural Upper Egypt (75 percent), than in other areas. Rural households are also more likely to have cement rather than cement tile floors. Cement tiles are the most common flooring material in urban dwellings, especially in the Urban Govcmorates (80 percent). It should be noted that the percentage of households in urban Upper Egypt living in dwellings with earth/sand floors is 16 percent, more than twice that in urban Lower Egypt (6 percent). Information on the number of rooms that a household used for sleeping was collected in order to provide a measure of crowding. Table 2.6 reveals that 50 percent of households had one or two persons per sleeping room, and a third had three to four persons per sleeping room. The overall mean is 3 persons per sleeping room. Urban households appear to be somewhat less crowded than rural households; the mean number of persons per slecping room is 2.7 in urban areas compared to 3.4 in rural areas. By place 21 Table 2.6 Housing characteristics Percent distribution of households with eligible women by housing characlerislics, according to urba~l-rural residence and place of residence. Egypt 1992 Characteristic Urban Rural Urban Lower Egypt Upper Egypt Gover- norates Total Urban Rural Total Urban Rural Total Electricity Yes, in all 97.4 83.4 98.2 92.3 97.9 89.2 82.9 94.9 76.2 90.7 Yes, in part 1.0 4.5 0.6 2.3 1.1 2.9 4.8 1.9 6.5 2.7 No 1.6 12.1 1.2 5.4 1.0 7.8 12.3 3.2 17 3 6.6 Total 100.0 IO0.O lO0+O 100.0 100,0 100.0 100.0 100.0 100,o 100.0 Source of drinking water Piped water 96.9 61.1 99.3 76.3 97.9 64.8 68.7 911.4 56.6 79.9 Piped into residence 91.8 44.9 95,2 65.7 94.2 50.6 53.6 81.7 38.0 69.6 Public tap 5.1 16.2 4.1 10.6 3.7 14.3 15.1 8.7 18.6 11/.4 Well water 1,9 30.4 0.3 17.2 0.8 26.0 25.5 6.9 35.8 15.4 Well in residence 1.4 16.0 0.2 9.1 0.7 13.6 14 1 5.3 19.11 8.4 Public well 0.5 14,4 0.1 8.1 0 1 12 4 11.4 1.7 16.8 7 1 Nile/canal 0.1 5.5 0.1 4 6 0,0 7.(I 2.4 0.2 3.7 2.7 Other 1.1 3.0 0.3 1.9 1.3 2.2 3.4 2.5 3.9 2.0 Total 100.0 1 (~1.0 100.0 100.0 100.0 I i)0,0 100.1) 1 iX).0 100 0 100.0 Sanitation facility Modem flush toilet 46.3 5.7 57.6 16.7 35.1 6.9 14.9 34.1 4.2 27.0 Traditional w/tank flush 3.7 1,5 3.4 2.3 3.7 1.5 2.6 4.5 1.4 2.7 Traditional w/bucket flush 44.7 50.2 36.6 61.9 57.8 64.1 38.4 47.5 33.3 47.3 Pit toilet/latrine 3.6 24.3 2.0 14.2 1.9 21/.8 21 7 9.3 28.6 13.4 Barrel/tank 0.1 0,3 0.0 0.5 0.3 0.6 0.0 0.1 0.0 0.2 No facility 1.6 17.9 0.5 4.4 1.1 6 1 22.4 4.5 32 3 9.3 Other 00 0.1 0.0 0.0 0.0 0,1 0.1 0.0 0.2 0.1 Missing 0.0 0.0 0.0 0.0 0.1 0.0 0 0 0.1) 0.0 0.0 Total 100.0 100.0 100,0 100,0 100.0 100.0 11)00 100,(i 100.0 100,0 Flooring Earth/sand 5.7 60.1 1.0 33.4 5.8 48 1 53.7 16,2 74 6 31.5 Parquet/polished wood 1.9 0.1 1.9 0.9 2.2 0.2 0.6 1.5 11.1 1.0 Ceramic tiles 0.5 0.1 0.5 0.2 0.5 0.0 0 3 0.5 0.2 0.3 Cement tiles 75.8 18.4 79.8 41.0 73 3 23.8 32.4 69.5 11.7 48.5 Cement 9.6 20.9 8.6 21.8 I 1.8 27.2 l 1.8 9.4 13.2 15.0 Wall-to-wall carpet 4.7 0.3 5.7 1.9 4.5 0.5 I).9 2.5 0.1 2.6 VinyI 1.8 0.1 23 0.7 1.7 0.1 I).2 0.6 0.11 1.0 Other 0.1 0.1 0.1 0.0 0.1 0.0 11.1 I).0 0.1 0.1 Missing 0.1 0.0 0.2 0.0 0.0 0 0 0.0 0.0 ii 0 0.1 Total 100.0 100.0 100.0 100.0 100.0 1000 I110.0 1 (it).() 100.0 100.11 Persons per sleeping room 1-2 59.9 39.3 60.1 49.8 62.7 42.9 42.5 56.2 34.9 50.1 3-4 31.3 43.9 31.1 39,7 29.8 45./) 39.4 33 4 42.7 37.3 5-6 6.3 12.2 6.4 8.3 5.5 9.7 12.2 6.8 15 2 9.1 7 + 2.5 4.6 2.3 2.2 2.0 2.4 5.9 3 5 7.2 3.5 100.0 100.0 100.0 100.1) 3.4 2.7 3.0 2.6 5109 2879 4299 1492 Total 100.0 Mean persons per room 2.7 Number of households 5651 ] 00 0 100. 0 ] 00 .0 100 (,I 100. 0 3.1 3 3 2.9 3.6 3.0 2806 3582 12811 2302 10760 22 of residence, the mean varies from a low of 2.7 in the Urban Govemorates to a high of 3.6 in rural Upper Egypt. The latter mean is significantly greater than the mean for rural Lower Egypt (3.1), suggesting that rural households in Upper Egypt experience greater crowding than those in Lower Egypt. Household Durable Goods and Other Property Table 2.7 provides information on household ownership of major durable goods and other property. With regard to durable goods, around eight in ten households in Egypt own a television, seven in ten own a washing machine, and more than half own a radio, a cooking stove and a refrigerator. There are striking differences between urban and rural areas in the percentage of households possessing various durable goods. For example, only two-thirds of rural households own a television compared to 96 percent of urban households. The largest urban-rural differential is observed in the case of cooking stoves; 83 percent of urban households have stoves, compared to only 27 percent of rural households. Households in rural Upper Egypt are the least likely to possess any of the durable goods (with the exception an electric fan). Table 2.7 Household durable goods Percent distribution of households possessing various household effects, means of transportation, property and farm animals/implements, according to urban-rural residence and place of residence, Egypt 1992 Characteristic Urban Urban Lower Egypt Upper Egypt Gover- Rural norates Total Urban Rural Total Urban Rural Total Household effects Radio 72.0 50.7 76.8 61.7 68.5 58 1 50.1 65 1 41 7 61.9 Television 95.6 67.5 99.5 81.8 93.4 75.6 68.9 89.2 57.5 82.2 Video 10.6 0.9 14.1 2.9 6.6 0.9 3.2 7.3 0.9 6.0 Electric fan 64.7 30.4 68.1 37.5 56.4 27.5 45.7 66.9 33.9 48.4 Cooking stove 82.7 27.4 90.6 51.5 78.1 37.3 35.1 70.4 15.4 56.5 Water heater 41.3 5.5 50.0 15.0 31.9 6.1 14.9 33.0 4.8 24.3 Refrigerator 78.2 29.5 84.3 44.8 71.9 30.4 43.8 71.7 28.4 55.1 Washing machine 86.6 52.3 89.8 73.7 87.6 66.3 50.4 78.0 35.2 7(I.3 Sewing machine 25.0 10.9 26.0 17.1 24.8 12.9 13.5 22.7 8.5 18.3 Means of transportation Bicycle 12.4 13.3 8.2 14.2 14.3 14.1 14.9 19.4 12.4 12.8 Car/mormcycle 9.4 3.1 11.4 4.1 5.4 3.4 5.1 9.4 2.8 6.4 Bus/minivan/other vehicle 2.2 2,0 2.0 2.4 2.3 2.5 1.9 2.6 1.5 2.1 Property Residential/commercial bldg. 9.6 6.1 7.6 8.0 12.0 5.9 8.0 11.1 6.3 7.9 Farm/other land 6.3 38.9 3.4 29.2 10.1 39.4 27.6 8.0 38.4 21.8 Farm animals/implements Livestock/poultry 10.4 61.6 3.3 47.5 18.7 62.8 44.6 16.8 60.1 34.7 Farm implements 1.0 6.0 0.3 5.3 2.4 6.8 3.6 0.8 5.1 3.4 Number of households 5651 5109 2879 4299 1492 2806 3582 1280 2302 10760 With respect to ownership of a means of transportation, only 13 percent of households own a bicycle, and 6 percent or less report owning a car or motorcycle or other vehicle (bus, minivan, etc.). Urban households are more likely to own a car or motorcycle than rural households. 23 The EDHS also collected information on ownership of residential and commercial buildings and of farms or other land. Overall, only one in thirteen households in Egypt own residential or commercial property, and only one in five own a farm or other land. As ex- pected, rural households have an advantage with respect to the ownership of a farm or other land and urban households are some- what more likely to own residential/commer- cial buildings. Among rural households, how- ever, only two in five own any land, and only one in ten urban households own residential or commercial property. Finally, the EDHS collected informa- tion on the possession of livestock and poul- try and of mechanized farm equipment (e.g., a tractor), Overall, 35 percent of all house- holds in Egypt own livestock or poultry. The labor intensive nature of farming is evident in the fact that only 3 percent own mechanized farm equipment. Rural households are more likely to report ownership of these items than urban households. Six in ten rural households own livestock or poultry, and 6 percent own mechanized farm equipment. 2.3 Background Characteristics of Survey Respondents General Characteristics Table 2.8 presents the distribution of the respondents to the women's questionnaire by selected background characteristics, in- cluding age, marital status, residence, educa- tion, religion and employment status. The questionnaire was administered to ever-mar- ried women age 15-49. Of the ever-marricd women in the sample, 93 percent are cur- rently married, 5 percent are widowed and 2 percent are divorced. Table 2.8 Background characteristics of respondents Percent distribution of ever-married women by selected background characteristics, Egypt 1992 Number of women Background Weighted Un- characteristic percent Weighted weighted Marital status Married 92.8 9153 9148 Widowed 5.2 510 508 Divorced 2.0 201 208 Age group 15-19 4.3 423 437 20-24 13.8 1362 1384 25-29 20.4 2013 1993 30-34 18.6 1838 1819 35-39 17.3 1709 1721 40-44 14.3 1411 1404 45-49 11.2 l 108 l 106 Urban-rural residence Urban 46.6 4596 4673 Rural 53.4 5268 5191 Place of residence Urban Governorates 23 9 2357 2487 Lower Egypt 41.2 4067 3812 Urban 12.3 1210 120(/ Rural 29.(I 2857 2612 Upper Egypt 34.9 3440 3565 Urban 10.4 1029 986 Rural 24.4 2411 2579 Education No education 48.4 4771 4638 Some primary 21.1 2078 2096 Primary through secondary 11.1 1093 1160 Completed secondary/hxgher 19.5 1922 1970 Work status Working for cash 14.8 1464 1447 Not working for cash 85 2 8400 8417 Religion Muslim 94.5 9317 9320 Christian 5.5 547 544 All women 100.0 9864 9864 Two questions were used in the individual questionnaire to ascertain the age of respondents: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained to probe in those situations where respondents did not know their age or date of birth; and, as a last resort, interviewers were instructed to record their best estimate of the respondent's age. The five-year age distribution for respondents is shown in Table 2.8. The percentages in the 15-19 and 20-24 age groups are smaller than the percentages in the 25-29 group; this reflects the fact that the EDHS interviewed an ever-married sample and that there has been a trend toward delaying marriage in Egypt. This trend is described in detail in Chapter 9. 24 At the time of the survey, the majority of respondents were living in rural areas, while 47 percent lived in urban areas. By place of residence, 41 percent resided in Lower Egypt, 35 percent in Upper Egypt, and 24 percent in one of the four Urban Governorates. Table 2.8 shows the distribution of the respondents according to the level of education attained. Almost one in two respondents has never attended school, around 21 percent attended but did not complete the primary level, 11 percent completed the primary level and/or some secondary, and 20 percent completed the secondary or higher level. Table 2.8 also examines the extent to which respondents reported that they were working at a job for which they were paid in cash. Such employment is assumed to compete with childbearing and child- rearing. Only one in seven respondents is working at a job for which she is paid cash. Nearly all of the respondents are Moslems. Only 6 percent are Christian. Differentials in Education Table 2.9 gives an overview of the relationship between the level of education and other back- ground characteristics. The relationship between age and education is not uniform. The proportion of respondents with no education exhibits a U-shaped curve with age. The higher proportion of women who Table 2.9 Levelofeducation Percent distribution of ever married women by highest level of education attended, according to selected background characteristics, Egypt 1992 Level of education Primary Completed Number Background Some through secondary/ of characteristic None primary secondary higher Total women Age group 15-19 53.3 16,7 24.4 5.6 100.0 423 20-24 48.1 14.8 12.4 24.7 100.0 1362 25-29 44.1 19.4 9.7 26.9 I00.0 2013 30-34 42.4 24.3 8.6 24.7 100.0 1838 35-39 46.8 25,1 10.3 17.8 100.0 1709 40-44 54.0 22.5 11.2 12.3 100.0 1411 45-49 59.7 20.0 12.2 8.1 100.0 1108 Urban-rural residence Urban 29,5 22.8 15.8 31.8 100.0 4596 Rural 64.8 19.5 6.9 8.7 100.0 5268 Place of residence Urban Govemorates 27.2 22.4 17.1 33.4 100.0 2357 Lower Egypt 51.3 21.3 10.6 16.8 100.0 4067 Urban 30.0 24.1 16.9 28.9 100.0 1210 Rural 60 3 20.2 7.9 11.6 I00.0 2857 Upper Egypt 59 4 19.8 7.6 13.2 100.0 3440 Urban 34.4 22.3 11.7 31.6 100.0 1029 Rural 70.1 18.8 5.8 5.3 IO0.O 2411 Work status Working for cash 21.2 10.0 4.6 64.2 100.0 1464 Not working for cash 53.1 23.0 12.2 11,7 100.0 8400 Total 48.4 21.1 11.1 19.5 100.0 9864 25 never attended school in the 15-19 and 20-24 age groups than in the 25-29 group should not be interpreted as a decline in educational attainment among young females. Since only ever-married women were interviewed, the respondents in the 15-19 and 20-24 age groups include a disproportionate share of women who married early and, thus, were likely to have lower educational levels than women in the age cohort as a whole. The level of education varies greatly according to residence. Nearly two-thirds of rural women never attended school compared to 30 percent of urban women, and more than three times as many urban women as rural women have completed the secondary level (32 percent and 9 percent, respectively). By place of residence, the percentage who have never attended school is somewhat greater among women living in urban areas in Lower Egypt (30 percent) and Upper Egypt (34 percent) than among women in the Urban Govemorates (27 percent). Among rural women, the regional differences arc greater, 70 percent of women in rural Upper Egypt have never attended school compared to 60 percent in rural Lower Egypt (see Figure 2.3). As expected, working for cash is associated with higher educational atlainment. The percentage of working women with at least some secondary education is 64 percent compared to only 12 percent among women who are not working. Figure 2,3 Percentage of Ever-Married Women with No Education, by Place of Residence Percenl 80 60 40 20 / 0 ~ Urban Total Urban Rural Total Urban Rural Governorates Lower Egypt Upper Egypl EDHSt992 Access to Media Women were asked if they usually read a newspaper at least once a week and the number of hours that they listened to the radio and television each day. This information is important because it provides an indication of the level of exposure of women to the mass media, which are used to convey family 26 planning and health messages to the population. Table 2.10 shows that 25 percent of ever-married women read a newspaper at least once a week, 82 percent watch television daily and 67 percent listen to the radio daily. The relationship between age and exposure to mass media is not strong; however, the youngest and the oldest age groups are the least likely to be exposed to either print or broadcast media. Reflecting lower literacy levels, rural women are much less likely to report that they read a newspaper weekly. They also are less likely to be exposed to television or radio on a daily basis. By place of residence, women residing in the Urban Govemorates are more likely to have been exposed to media than their counterparts in Lower Egypt and Upper Egypt. Women in rural Upper Egypt are the group that is least exposed to any of the mass media. As expected, there is a positive association between exposure to mass media and level of education, particularly with regard to exposure to print media. Concerning work status, women who are working for cash are more likely to be exposed to the various media than women who do not work. This probably is due at least in part to the association between education and employment discussed earlier. Table 2.10 Access to mass medna Percentage of ever-married women who usually read a newspaper once a week, watch television daily, or listen to the radio daily, by selected background characteristics, Egypt 1992 Read Watch Listen to Number Background newspaper television radio of characteristic weekly daily daily women Age group 15-19 12.6 80.0 62.6 423 20-24 24.7 81.8 68.1 1362 25 29 29.1 84.6 70.0 2013 30-34 28.0 82.9 66.0 1838 35-39 23.7 81.7 65.7 1709 40-44 21.7 82.1 65.1 1411 45-49 19.1 80.1 63.9 1108 Urban-rural residence Urban 41.5 91.0 77.1 4596 Rural 9.7 74.8 57.4 5268 Place of residence Urban Governorates 45.7 92.7 82,1 2357 Lower Egypt 19.7 85.7 70.4 4067 Urban 38.7 93.5 77.3 1210 Rural 11.7 82.4 67,5 2857 Upper Egypt 15 6 71.2 51.3 3440 Urban 34.9 84. [ 65.3 I029 Rural 7.3 65.7 45.3 2411 Education No education 0 4 73.3 54.7 4771 Some primary 12.7 85.6 68.4 2078 Primary through secondary 52.8 93.5 79,6 1093 Completed secondary/higher 8(I.8 95.0 86.6 1922 Work status Working for cash 59.6 87.5 76.1 1464 Not working fur cash 18.4 81.4 64.9 8400 Total 24.5 82.3 66.5 9864 27 CHAPTER 3 FERTILITY The fertility measures presented in this chapter are based on the retrospective reproductive histories of women age 15-49 interviewed in the Egypt DHS survey (EDHS). In collecting these histories, each woman was asked the number of sons and daughters living with her, the number living elsewhere, and the number who had died. She was then asked for a history of all her births, including the month and year each child was born, name, sex, and if dead, the age at death, and if alive, the current age and whether the child was living with the mother. Based on this information, measures of current fertility and cumulative fertility are examined. 3.1 Current Fertility Measures of Current Fertility The level of current fertility is the most important topic in this report because of its direct relevance to population policies and programs. Several measures of current fertility, including age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate are presented in Table 3.1 for the three-year period preceding the survey, a period covering principally the calendar years 1990-1992. The three-year period was chosen for calculation of these rates (rather than a shorter or longer period) as a compromise between three criteria: to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. Age-specific fertility rates are useful in order to understand the age pattern of fertility. Numerators of age-specific fertility rates are calculated by isolating live births which occurred in the 1-36 months preceding the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of birth (determined from the date of birth of mother). The denominators of these rates are the number of woman-years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. Although information on fertility was obtained only for ever-married women, the age-specific rates are presented for all women (regardless of marital status); data from the household questionnaire on the age structure of the population of never-married women is used to calculate the all-women rates. This procedure assumes that women who have never been married have had no children. The total fertility rate (TFR) shown for women 15-49 and women 15-44 is a useful means of examining the overall level of fertility. The TFR is calculated by summing the age-specific fertility rates. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. ~The distribution of all children by calendar year of birth shows a slight deficit of b~rths in calendar year 1987 and an excess of births in calendar year 1986 (see Table D.4). The apparent transference of births out of 1987 was greater for dead children than for living children. This pattern has been noted in other DHS surveys; it is believed to be the result of transference of births by interviewers out of the period for which the health and calendar data were collected (January 1987 through the date of the survey). 29 Table 3.1 Current fertility Age-specific arid cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban- rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt Gover- Age group Urban Rural notates Total Urban Rural Total Urban Rural Total 15-19 28 89 24 54 23 64 98 42 122 63 20-24 145 269 121 222 164 247 258 179 295 208 25-29 188 256 188 215 171 235 259 205 287 222 30-34 130 180 121 133 123 137 208 160 231 155 35-39 64 117 56 77 60 85 135 89 161 89 40-44 26 61 26 37 19 45 66 37 82 43 45-49 2 10 2 5 0 7 11 3 15 6 TFR 15-44 2.9t 4.86 2.68 3.69 2.80 4.07 5.12 3.56 5.89 3.90 TFR 15-49 2.92 4.91 2.69 3.72 2.80 4,10 5,18 3,58 5,97 3.93 GFR 98 169 92 128 96 141 177 117 205 136 CBR 23,3 35.0 21.9 28.4 22.8 30.7 36.2 27.1 40.l 29.7 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15 44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population The general fertility rate (GFR) represents the annual number of births in a population per 1,000 women age 15-44. The crude birth rate (CBR) is the annual number of births in a population per 1,000 persons. Both these measures are estimated using the birth history data for the three-year period before the survey and the age-sex distribution of the household population. Fertility Levels Current fertility estimates are presented in Table 3.1 for Egypt as a whole and for major geographic areas. The total fertility rate indicates that, if fertility rates were to remain constant at the level prevailing during the period 1990-92, an Egyptian woman would bear 3.9 children during her lifetime. In rural areas, the TFR is 4.9 births per woman, two children higher than the rate for urban areas (2.9 births per woman). Considering the variation by place of residence, the TFR for the Urban Govemorates (2.7 births) is one child lower than the rate for Lower Egypt (3.7 births) and more than two children lower than the level for Upper Egypt (5.1 births). Of particular note is the much higher fertility in rural Upper Egypt than in rural Lower Egypt (see Figure 3.1). Women in rural Upper Egypt are having an average of six births, almost two births more than women living in rural areas in Lower Egypt. There is also a significant but much smaller differential in the urban fertility rates between the two regions. According to the EDHS results, the crude birth rate for the period 1990-92 was 29.7 births per 1,000 persons, and the general fertility rate for the same period was 136 births per 1,000 women. Residential differentials in these fertility measures exhibit a pattern similar to the differentials in the TFR, with the lowest levels observed in urban areas, particularly the Urban Govemorates, and the highest levels found for rural Upper Egypt. 30 Figure 3,1 Total Fertility Rates by Place of Residence BirThs per woman 6] 41 37 / Total Urban Rural Urban To~al Urban Rural Governorates Lower Egypl Upper Egypl EDHS1992 Age Pattern of Fertility The age pattern of fertility indicates that Egyptian women have children early in the childbearing period. At the current age-specific rates shown in Table 3.1, an Egyptian woman will have given birth to 1.4 children---more than one-quarter of her lifetime births--by age 25 and to 2.5 births--more than 6(I percent of her lifetime births~by age 30. The age pattern of fertility varies somewhat by residence, with the peak childbearing years coming somewhat later among urban women compared to rural women. As Figure 3.2 shows, urban age-specific fertility rates are highest in the 25-29 age group (188 births per 1,000 women), followed closely by the rate for the 20-24 group (145 births per 1,000 women). Rural fertility rates peak among women 20-24 (269 births per 1,000 women), followed closely by the rate for women 25-29 (256 births per 1,000 women). The results in Table 3.1 and Figure 3.1 also show that fertility levels among teenagers and women age 35 and over are substantially higher in rural areas than in urban areas. For example, at current levels, only one in thirty-five urban women 15-19 would give birth annually compared to around one in eleven rural women. Age-specific rates among women age 35 and over are twice as high in rural as in urban areas. The urban-rural differentials in fertility for these groups are particularly significant since women 15-19 and age 35 and over have been shown to have the highest risks of pregnancy-related morbidity and mortality. 31 300 Figure 3.2 Age-specific Fertility Rates by Urban-rural Residence Births per 1 000 women 25O 20O 1 5O 100 50 0 15-19 20 24 25-29 30 34 35-39 40 44 45-49 Age EDHS1992 Fertility Trends and Differentials Table 3.2 presents current total fertility rates and the mean number of children ever bom (CEB) to women age 40-49 (completed fertility) for major subgroups of the population. Although vulnerable to understatement of parity by older women, comparisons of completed fertility among women aged 40 or more with the total fertility rate provide an indication of the direction and the magnitude of fertility change in Egypt during the past 20-25 years. Overall, the results in Table 3.2 suggest that there has been a decline of more than 30 percent in fertility levels in Egypt during this period. The substantial residential differentials in current fertility described above are also evident in the completed fertility measures. The fertility decline implied by a comparison of the TFR with completed fertility has been relatively faster in the Urban Govemorates and Lower Egypt than in Upper Egypt. Differentials by education and work status are notable. The level of fertility is negatively associated with educational attainment. Women who completed secondary school or higher have the lowest level of current fertility (2.9 births per woman) while those with no education have the highest level (5.0 births per woman). Moreover, there is a difference of almost one child between the TFR for women with some primary education and the TFR for women who completed the primary level but not the secondary level. Lower fertility has apparently characterized women with a secondary or higher education Ior some time; the TFR for the three-year period before the survey is virtually identical to the mean number of children ever born to women 40-49. 32 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40-49, by selected background character- istics, Egypt 1992 Mean number of children Total ever bom Background fer tihty to women characteristic rate I age 40-49 Residence Urban 2.91 4.66 Rural 4.91 6.84 Region Urban Govemorates 2.69 4.44 Lower Egypt 3.70 5.81 Urban 2.80 4.64 Rural 4.10 6.37 Upper Egypt 5.17 6.72 Urban 3.58 5.29 Rural 5.97 7.46 Education No education 5.03 6.45 Some primary 3.98 5.73 Primary through secondary 3.03 4.60 Completed secondary/higher 2.91 2.91 Work status Working for cash 2.90 4.05 Not working for cash 4.1(/ 5.98 Total 3 93 5.71 IWomen age 15-49 years Current fertility levels arc lower among women working for cash than among those who are not working for cash. Working women have also clearly been at the forefront of the transition to lower fertility for a long period of time; completed fertility among working women 40-49 is nearly two children lower than the completed fertility among women who were not working for cash. Table 3.3 examines the trend in fertility in Egypt by comparing the results of the EDHS with those of earlier surveys. Fertility levels in Egypt have steadily declined, from 5.3 births per woman in the late 1970s to 4.4 births for the period 1988-91, 4.1 births for the period 1990-91 and 3.9 births for the period 1990-92 (see Figure 3.3). 33 Table 3.3 Trends in fertility Age-specific fertihty rates (per 1,000 women) and total fertdity rate, Egypt 1979-1992 EFS ECPS EDHS EMCHS EDHS 1979- 1983- 1986- I990- i990 Agegroup 19801 19841 19882 19911 19922 15-19 78 73 72 73 63 20-24 256 205 220 207 208 25-29 280 265 243 235 222 30-34 239 223 182 158 155 35 39 139 151 118 97 89 40-44 53 42 41 41 43 45-49 12 13 6 14 6 TFR 15-49 5.28 4.85 4.41 4.13 3.93 TFR 15-44 5 22 4.79 4.38 4.06 3.91) tRates are R,r the 12-month period preceding the survey 2Rates are for the 36-month perkxl preceding the survey Source: EFS - Hallouda et al., 1983, Volume I1, Table 4.16 1984 ECF'S - Unpublished results 1988 EDHS - Sayed et al., 1989, Table 3 2 EMCHS - AbdeI-Azeem et al, 1993, Table 7.14 B~rths per woman Figure 3.3 Total Fertility Rates Egypt 1979-1992 1979 1980 1983 1984 1986 1988 1990 19!)1 1990 1992 34 Finally, further evidence of the decline in fertility is found in Table 3.4, which pmsenLs age-specific fertility rates for successive five- year periods, using data from the respondents' birth histories. The age-specific schedule of rates is progressively truncated 2 as the time before the survey increases. The results in Table 3.4 and Figure 3.4 confirm that fertility has fallen substanti',dly among all age groups, with the most rapid decline occurring in the 15-19 age group. Overall, the cumulative fertility rate for women 15-30 decreased by 27 percent, from 3.6 births per women during the period 15-19 years before the survey to 2.6 births per women in the five-year period preceding the EDHS. The decline clearly gained momentum during the ten-year period immediately before the survey. Table 3.4 Age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age, Egypt 1992 Number of years preceding the survey Mother's age 0 4 5 9 10-14 15-19 15-19 69 112 124 135 20-24 224 258 287 278 25-29 231 271 292 308 30-34 170 208 245 [243] 35-39 102 134 [1641 40-44 45 [49] 45-49 151 Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. Figure 3.4 Age-specific Fertility Rates for 5-year Periods Preceding the Survey Births per 1,000 women 350 30O 25O 2O0 150 100 ~ I 5O 0 15 19 i i i i i 20 24 25-29 30-34 35-39 40-44 45-49 Age EDHS1992 2The rates are truncated because they do not include the fertility experience of women who were m the childbearing ages daring the period for which the rates are calculated but who were age 50 or older at the time of the EDHS and, thus, not interviewed in the EDHS. 35 Table 3.5 presents fertility rates forever-married women by duration since first marriage for five-year periods preceding the survey. These rates are similar to the ones presented in Table 3.4 and are subject to similar problems of truncation. Declines are observed in the rates for all marriage durations, with the declines being greater at longer marriage durations. For example, during the ten-year period before the survey, fertility rates declined by only 4 percent among the women married less than five years compared to 33 percent among women married 20-24 years. Table 3.5 Fertility by marHal duration Fertility rates fi~r ever-married women by duration since first marriage in years, for five-year periods preceding the survey, Egypt 1992 M arri age duration at birth Number of years preceding the survey 0-4 5-9 10-14 15-19 <4 363 378 386 386 5-9 249 301 331 346 10-14 18(1 231 267 303 15-19 127 165 233 12441 20-24 75 112 [2081 25-29 38 [731 Note: Fertility rates are per 1,000 women. Estimates enclosed zn brackets are truncated. 3.2 Children Ever Born and Living The distribution of women by the number of children ever bom is presented in Table 3.6 for all women 3 and for currently married women. In the EDHS questionnaire, the total number of children ever born was ascertained by a sequence of questions designed to maximize recall. Lifetime fertility reflects the accumulation of births over the past 30 years and, therefore, its relevance to the current situation is limited. However, the information is useful in looking at how average family size varies across age groups and lbr estimating the level of primary infertility. The results for currently married women in Table 3.6 differ markedly from those for the sample as a whole. These differences are due to the large number of women, particularly in the younger age groups, who have not yet married. Differences at older ages are minimal and generally retlect the impact of marital dissolution. 3Data from the household questionnaire on the age structure of the population of never-married women is used to calculate the all-women distribution. This procedure assumes that women who have never been married have had no children. 36 According to Table 3.6, an Egyptian woman has an average of 2.7 births. Out of that number, 2.3 children are still alive, indicating that mortality claimed 15 percent of the children ever born to each woman. Cumulative fertility is very low among women 15-19; it increases by one birth or more for each five-year age group, among women under age 40. Women 45-49 years of age, who are approaching the end of their childbearing period, have had an average of 6 births. Reflecting the high levels of fertility prevailing during the 30-year period when these women were having their children, around one in eight has had 10 or more births. The data also indicate that primary sterility is very low in Egypt. The percent childless among women nearing the end of the reproductive period, age 45-49, is only 4 percent. Table 3.6 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Egypt 1992 Number of children ever born (CF, B) Number Mean no. Mean no, Age of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL. WOMEN 15-19 92,5 5.8 1.4 03 0.0 0.0 0.0 00 0.0 00 0.0 100.0 3037 0.09 0.09 20-24 54.2 18 .3 14.3 8.5 3.5 0.9 0.2 0 0 0.0 0.0 0.0 100.0 2405 0.93 0.84 I5-29 20.9 12,4 20.2 19.0 15 4 6.5 3.4 1.6 0.3 0.2 0.1 100.0 2324 2.41 2.15 30-34 9.6 5.9 15.2 17.6 16.4 14.2 9 2 6,6 2.8 1.5 0.9 100.0 1933 3.72 3.25 35-39 5.7 2.8 10,0 15.8 15.4 14.2 12 1 10,1 6,7 3.6 3.6 100.0 1754 4.71 4.00 40-44 5.7 3.6 7.4 11.1 12,2 117 12.2 I1,0 80 65 10.6 1000 1444 5,48 4.52 45-49 4.3 2.4 6.0 8.3 10,2 I 1 9 14 .4 11.9 I0 3 7 2 13 0 100.0 I 119 6,01 4.73 Total 35.8 8.2 10.7 10.9 94 7.1 5.8 4.5 2.9 I 9 27 ltX) 11 14015 2.73 231 CURRENTLY MARRIED WOMEN 15-19 45.9 41.9 10.1 2.0 Ol O0 00 0.0 O0 00 0,0 I00.0 415 (168 0.64 20-24 18.6 32.1 25.5 15.4 6.3 I 7 0 4 11,11 0.0 0.0 0.0 100.0 1324 I 65 1.49 15-29 8.2 13.7 23.6 22,0 18.2 7 7 4.0 1.9 (1.4 0.2 111 100 0 1956 2 81 2 52 30-34 4.6 5.7 15.6 18,8 17 6 15 1 9.6 7.2 3.0 1.7 1.11 100 0 1743 3 97 3 46 35-39 2.9 1.9 9.7 16.2 15.8 14 8 12 9 10.7 7.3 3,8 3.9 100.0 1582 4.95 4.21 40-44 2.5 2.8 7.0 11 5 13.11 11.7 13 I 11,3 8.5 7.1 11,5 100.0 1231 5,78 4.80 45-49 3.0 1.3 5.7 82 101 11,5 13 ,7 122 I I3 83 14,7 100.0 902 6.31 5.01 Tclal 8.5 11.4 15.3 15 8 13.6 10.0 8 1 6 3 4.2 2.8 3.9 100.0 9153 3.88 3.31 3.3 Birth Intervals There is a considerable body of research to indicate that short birth intervals are deleterious to the health of babies. This is particularly true for babies born at intervals of less than 24 months. Table 3.7 shows the percent distribution of births in the five years preceding the EDHS by the number of months since the previous birth. These findings indicate that women favor long birth intervals since around 69 percent of all children are born at least two years after their siblings. Moreover, more than one in three births is bom after an interval of 3 years, and almost one in five is born after 4 years or longer. The ovcrall median birth interval is around 30 months. 37 Table 3.7 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic charactertstics, Egypt 1992 Number of months since prewous birth Characteristic 7-17 18-23 24-35 36-47 48+ Me&an number of months ~g/ l ) ber s ince (If previou~ Total btrths blah Age of mother 15-19 29.6 32.3 34.0 4.1 0.0 100.0 59 22.8 20-29 20.2 18 7 36.3 15.9 8 9 1011 0 3180 26.5 30-39 10.8 14.0 33.1 16.8 25 4 100 0 2937 33.{) 40 + 6.6 10.1 24.0 17.9 41.4 100.0 679 41.4 Birth order 2-3 18.8 17.9 32.4 16.3 14.6 100.0 3047 28.0 4-6 12.4 13.6 34.2 16.2 23 5 100.0 2538 31.6 7 + 10.5 15.8 35.5 16.9 21.2 100.0 1271 31.3 Sex of pr ior b i r th Male 13.9 15.9 33.8 16 2 2/).3 100.0 3414 30.4 Female 16.11 16.0 33 6 16.6 17 9 100 0 3442 29.4 Survival of prior birth Living 13 3 15.5 34.6 16 8 19.8 1 (XI 0 6124 3116 Dead 28 8 19,9 25.5 12.8 12.9 100.0 731 24 4 Urban- rura l residence Urban 14.1 12.9 29.4 17.0 26.7 100.0 2397 33.1 Rural 15 4 17 6 36.0 16.11 15.1 100,0 4458 28.9 Place of r~ ldence Urban Governorates I 0,9 12.0 29.9 17 6 29.6 100,0 1157 34 8 Lower Egypt 15 2 15 7 31 9 17,1 20.0 100.0 26511 3/I.6 Urban 15.7 1 I 0 27 3 19 7 26.3 100.0 584 34.5 Rural 15.1 17.1 33 2 16.4 18 2 100 0 21166 29.9 Upper Egypt 16.2 17 6 36.6 15.2 14 3 T00 0 3048 28.3 Urban 18.3 16 1 30.2 13.7 21 8 1000 656 29.4 Rural 15 6 18.0 38.4 15,7 12,3 100.0 2392 28.2 Education No education 14.6 17.2 34.8 15.9 17.5 100.0 3790 29.4 Some primary 12.2 15 0 33.7 16.4 22 7 100 0 1495 31.5 Primary through secondary 16.3 14 9 28.3 17.9 22 7 100 0 572 31.6 Completed secondary/higher 19 3 13 3 32.3 17.4 17 7 100 0 999 29.8 Work status Working for cash 14 3 13 3 32 1 18 5 21.8 II111.11 8411 31.8 Not wor~ng for cash 15.0 16 3 33 9 16 1 18 7 100 t) 6015 29 7 Total 14.9 15.9 33.7 16.4 19.1 100.0 6855 29.9 Note. First-order births are excluded. The interval for multiple births ts the number of months since the preceding pregnancy that ended in a live birth. 38 Regional differentials in the length of the birth interval are evident in Table 3.7. In urban areas, especially in the Urban Govemorates and in Lower Egypt, almost three in four births are born 24 months or longer after the previous birth. The median birth interval in urban areas is 33 months, more than 4 months longer than the rural median. Even in rural areas, however, two in three births are born 2 years or longer after the preceding birth. Younger women have shorter birth intervals than older women. The median birth interval for women 15-19 (23 months) is below the minimum safe interval. Among older mothers, the median interval gradually increases with the age of the mother from 27 months among women 20-29 to 41 months among women age 40 and older. The median birth interval increases slightly with birth order and is one month longer in the case of male than female births. As expected, intervals following a child who died are shorter (24 months) than those following living children (30 months). Surprisingly, the length of the birth interval does not vary greatly with the mother's educational or her work status. 3.4 Age at First Birth The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of mother and child. In many countries, postponement of first births, reflecting an increase in the age at marriage, has contributed greatly to overall fertility decline. The proportion of women who become mothers before the age of 20 also is a measure of the magnitude of adolescent fertility, which is a major health and social concern in many countries. Table 3.8 presents the distribution of Egyptian women by age at first birth, according to their current age. For women 25 years and over, the median age at first birth is presented in the last column of the table. The results show that the proportion of women having births before age 20 decreases with the age of the mother (see Figure 3.5). Among women 45-49, for example, nearly one in two became mothers before the age of 20, one in four gave birth before age 18, and 6 percent gave birth before age 15. Among women in the 25-29 cohort, in contrast, only around one-third had given birth before age 20, one in five gave birth before age 18 and 3 percent gave birth before age 15. Table 3.8 Age at first birth Percent distribution of women 1549 by age at first birth, according to current age, Egypt 1992 Current age Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 92.5 0.4 4.5 2.6 NA NA NA 100.0 3037 a 20-24 54.2 2.2 12.3 14.2 11.8 5.4 NA 100.0 2405 a 25-29 20.9 3.4 16.6 17.0 15.6 17.8 8.9 100.0 2324 21.7 30-34 9.6 3.3 18.2 18.9 17.0 16.4 16.5 100.0 1933 21.0 35-39 5.7 4.0 15.0 19.9 1%8 17.2 20.5 100.0 1754 21.2 40-44 5.7 5.5 17.7 16 9 16.6 16.5 21 2 100.0 1444 21.0 45-49 4.3 6.2 20.4 19.5 15.5 16.9 17.1 100.0 1119 20.5 NA = Not applicable aLess than 50 percent of the women in age group x to x+# have had a birth by age x 39 60 50 40 30 20 10 0 Figure 3.5 Percentage of Women Who Gave Birth before Age 15 and before Age 20 by Age Group Percen[ 20-24 25-29 30-34 Age 35 3 @ 40-44 45-49 EDHS 1992 The median age at first birth increases across age cohorts, from 20.5 years among women 45-49 years of age to 21.7 years among women 25-29. Thcse changes parallel the increases in the median age at first marriage that took place during this period (see Chapter 9). Table 3.9 compares the median age at entry into motherhood for diftizmnt subgroups of the population and examines the trend across age cohorts for these groups. The measures are presented only for women 25- 29 years to ensure that half of the women have already had a birth. Residential and educational difli~rentials arc in the expected direction. The median age at first birth is highest in urban areas (22.8 years), particularly the Urban Govcrnora/es (23.1 yea~). In rural areas, the median age at first births is more than one year higher in Lower Egypt than in Upper Egypt (20.4 years and 19.3 years, respectively). The median age at first birth is inversely associated with the level of education, ranging from 19.7 years among women with no education to 21.8 years among those who completed primary or some secondary schooling. 40 Table 3.9 Median age at first birth Median age at first birth among women age 25-49 years, by current age and selected background characterisucs, Egypt 1992 Current age Background Ages characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Urban-rural residence Urban 23.8 22.8 22.6 22.6 21.4 22 8 Rural 20.3 19.7 20.0 19.9 19.6 19.9 Place of residence Urban Govemorates 23.8 23.5 23.2 22.8 21.6 23.1 Lower Egypt 21.6 20.6 21.1 20.8 20.2 20.9 Urban 24.2 (22.0) 22.7 21 9 20.9 22.6 Rural 20.9 20.1 20.4 20.4 19.8 20.4 Upper Egypt 2(I.3 20.1 20.2 19.9 19.7 20.1 Urban 23.3 (22.3) 21.6 22.4 21 1 22.2 Rural 19.4 19.0 19.6 18.9 19 4 19.3 Education No education 19.5 19.3 19.8 19.9 19.8 19 7 Some primary 20.7 (20.0) 20.7 20.5 19.7 2/I.4 Primary through secondary 21.4 (21.4) 21.8 22.7 21.8 21.8 Completed secondary/higher a 25.9 26.8 26.3 25.8 a Work status Working for cash Not working for cash Total a 25.2 25.3 25.7 24.(} a 21.1 20.3 20.5 20 5 20.1 2(I.5 21.7 21.0 21.2 21.0 20.5 21.2 Note: Medians in parentheses are based on 25-49 women. The medians for the 15 19 cohort and the 20-24 cohort could not be determined because half of the women have rtot yet had a birth. aMedians were not calculated for these cohorts because less than 51) percent of women in the age group x to x+4 have had a birth by age x. 3.5 Teenage Pregnancy and Motherhood Table 3.10 shows the percentage of women age 15-19 who are mothers or pregnant with their first child. This statistic is of major social and health concern because of its association with highcr morbidity and mortality for both mothers and their children. In addition, teenage pregnancy has a substantial limiting effect on the educational opportunities of young mothers. The overall level of teenage childbearing is 10 pcrecnt, of which 8 percent have already given birth and 2 percent are pregnant with their first child. Among those teens who have given birth, two-thirds had their first child before age 18 (see Table 3.8). 41 Table 3.10 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by seleczed background characteristics, Egypt 1992 Percentage who are: Percentage who have Pregnant begun Number Background with fkst child- of characteristic Mothers child bearing women Age 15 0.4 0.8 1.2 707 16 1.2 2.6 3.9 695 17 5.0 1.1 6.1 671 18 10.2 2.6 12.8 697 19 17.1 3.7 20.8 654 Urban-rural residence Urban 3.8 1.3 5.1 1304 Rural 10 5 3.4 13.9 1691 Place of residence Urban Governorates 3.8 1.2 5.0 561 Lower Egypt 5.7 2.5 8.3 1346 Urban 3.4 1.4 4.8 346 Rural 6.5 2.9 9.4 1002 Upper Egypt 12.3 3.2 15.5 1047 Urban 4.6 1.6 6.1 352 Rural 16.1 4.0 20.1 701) Educathm No education 16.5 5.0 21.4 710 Some primary 10.5 4.4 14.9 344 Primary through secondary 4.2 0.9 5.1 1589 Completed secondary/higher 1.9 2.0 3.9 425 Work status Working for cash 4.1 0.0 4.1 97 Not working for cash 7.6 2.5 10.1 2942 Total 7.5 2.4 9.9 3037 Significant residential differences in the level of teenage childbearing are observed in the EDHS results. The level in rural areas (14 percent) is almost three times the level in urban areas (5 percent). By place of residence, the percentage varies from only 5 percent in Urban Governorates to 20 percent in rural Upper Egypt (see Figure 3.6). The level of teenage fertility is also strongly associated with education and work status. The lowest levels are observed for women who completed secondary school or higher (4 percent) and those who are working (4 percent). The inverse relationship between education level and teenage fertility is very evident. Women with no education and those who drop out before completing the primary level show the highest levels of teenage childbearing (21 percent and 15 percent, respectively). 42 Figure 3,6 Percentage of Teenagers Who Have Begun Childbearing by Place of Residence Percent Urban Total Urban Rural Total Urban Govemorates Lower Egypt Upper Egypt Rural EDHS1992 Table 3.11 shows the distribution of teenagers according to the number of children ever bom. Generally, teenagers who have given birth have had only one child. Only one in five teenage mothers has had two or more births. As expected, the likelihood that a teenager will have given birth increases with age, peaking at 22 percent among those 19 years of age. The likelihood that a teenage mother will have had more than one birth also increases with age, reaching a level of 30 percent among nineteen-year-olds. Table 3.11 Children born to teenagers Percent distribution of women 15-19 by number of children ever born (CEB), Egypt 1992 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB women 15 99.6 0.4 0.0 100.0 0 00 690 16 98.7 1.3 0.0 100.0 0.01 643 17 94.5 4.9 0.6 100.0 0.06 608 18 87.9 9.9 2.1 100.0 0.15 586 19 78.1 15.2 6.7 100.0 0 30 509 Total 92.5 5.8 1.7 100.0 0.09 3037 43 CHAPTER 4 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING Knowledge of family planning methods and places to obtain them are crucial elements in the decision of whether and which methods to use. A positive attitude about family planning is an additional prerequisite to use. Data collected in the EDHS on knowledge of methods and sources, the channels through which Egyptian women receive information about family planning, and attitudes about the use of family planning methods are presented in this chapter. The chapter also looks at the level of ever use of family planning and, for ever users, the circumstances surrounding the first use of family planning, including the first method used, the source that provided this method, and the motivation for using (i.e., to space or limit). 4.1 Knowledge of Family Planning Methods and Source The level of knowledge of family planning methods was measured in two ways: . Respondents were first asked an open-ended question about which contraceptive methods they had heard of. All methods named in response to this question were recorded as spontaneously recognized (unprompted knowledge). . When a respondent failed to mention any of the methods listed in the questionnaire, the interviewer would describe the method and ask if the respondent had heard about it. All methods recognized by the respondent after the method was described were recorded as known after probing (prompted knowledge). Inform ation on knowledge was collected for eight modem methods (the pill, I UD,injection, Norplant, vaginal methods (foam, jelly, cream, sponge or diaphragm), the condom, female sterilization, and male sterilization), and three traditional methods (periodic abstinence, withdrawal, and prolonged breast feeding). In addition, provision was made in the questionnaire to record any other methods named spontaneously by respondents. In this analysis, only the overall levels of knowledge are presented, i.e, respondents are classified as knowing a method regardless of whether they recognized it spontaneously or after hearing it described. Thus, knowledge of a family planning method in the 1992 EDHS as in all other DHS surveys is defined simply as having heard of a method. No questions were asked to elicit depth of knowledge, such as how a specific method is used. Table 4.1 indicates that knowledge of at least one method is practically universal among ever-married women. Moreover, virtually all women who recognized at least one method were familiar with a modem method. Among modem methods, the pill (99 percent) and IUD (99 percent) are the most widely known methods, followed by injection (81 percent). The proportion of ever-married women knowing about female sterilization is 70 percent, and 54 percent know about the condom. The least recognized modem method, male sterilization, was known by only 13 percent of ever-married women. The percentage of women who recognized Norplant (46 percent) seems high, particularly since Norplant was not approved for general use IEgypt and Jordan are the only two DHS countries that included prolonged breastfeeding in the list of family planning methods on which respondents were prompted. 45 Table 4.1 Knowledge of family planning methods and source for methods Percentage of ever-married women and currently married women who know specific family planning methods and who know a source (for information or services), by specific methods, Egypt 1992 Know method Know a source Ever- Currently Ever- Currently Family planning married married married married method women women women women Any method 99.5 99.6 92.0 92.9 Any modern method 99.4 99.5 92.0 92.9 Modern method Pill 99.3 99.4 89.5 90.4 IUD 98.7 98.9 86.4 87.5 Injecnon 81.1 81.8 59.2 60.1 Norplant 46.0 47.3 29.5 30.3 Diaphragm/foam/jelly 36.8 37.5 29.4 30.0 Condom 53.7 55.0 45.7 46.9 Female sterilization 70,(I 70.6 59.9 60.6 Male sterilization 12.5 12,8 9.5 9.7 Any traditional method 77.0 77.6 19.7 20.2 Periodic abstinence 31.2 32.0 19.7 20.2 Withdrawal 27.6 28.4 NA NA Prolonged breast feeding 71.8 72.3 NA NA Other traditional methods 2.4 2.5 NA NA Number of women 9864 9153 9864 9153 NA - Not apphcable at the time of the survey. However, there was considerable press coverage of Norplant during the period immediately prior to EDHS, which may help to explain the relatively high level of recognition of the method. Traditional methods are less likely to be recognized than modem methods (77 percent and 99 percent, respectively). The most widely known 'traditional method is prolonged breastfeeding, which is recognized by 72 percent of women. With respect to knowledge of a source for modem methods, most womcn (92 percent) are aware of a place where they can obtain family planning services. There is some variation in knowledge of source by method: ever-married women are most likely to know about a source for the pill (90 percent) and IUD (86 percent) and least likely to know about male sterilization (10 percent) and vaginal methods (29 percent). 46 Trends in Knowledge of Methods and Sources Using information from three earlier surveys as well as the 1992 EDHS, 2 Table 4.2 shows the upward trend in the level of contraceptive knowledge during the 1980s. Overall, the percentage of ever- married women knowing any method increased from 90 percent in 1980 to almost 100 percent in 1992. Considering individual methods, the largest increase is observed in the knowledge of injection; only 16 percent had heard about injection in 1980 compared to 81 percent in 1992. There also has been a significant increase in knowledge in the case of the condom, vaginal methods, female sterilization, and the IUD. The smallest increase is in pill knowledge, which was already high in 1980 (89 percent). Table 4.2 Trends in knowledge of family planning methods and source Percentage of ever-married women who know specific family planning methods and who know a source (for family planning information or services), Egypt, 1992 EDHS, 1988 EDHS, 1984 ECPS and 1980 EFS Know method Know source Family planning EDHS EDHS ECPS EFS EDHS EDHS method 1992 1988 1984 1980 1992 1988 Any meth~ 99.5 98.(I 85.4 89.7 92 0 95.2 Any rn~lern method 99.4 97.8 85.2 92.0 95.2 M(~lern method Pill 99.3 97.4 84.9 89.4 89.5 93.9 IUD 98.7 93.3 74.9 69.6 86.4 87.2 Injection 81.1 60.5 35.3 15.6 59.2 47.9 Vaginal methods 36.8 39.6 27.8 13.8 29.4 36.6 Condom 53.7 43.3 21.5 25.9 45.7 40.2 Female sterilization 7/I.0 53.5 20.5 42.5 59 9 50.2 Male sterilization 12.5 9.6 5.3 6.0 9 5 8.4 Any traditional method 77.0 67.3 30.0 NA 19.7 20.0 Safe period 31 2 22.1 11.3 14.0 19 7 20.0 Withdrawal 27.6 13.4 6.9 9.8 NA NA Prolonged breastfeeding 71.8 64.8 24.7 NA NA NA Other traditional methods 2.4 4.6 1.3 NA NA NA Number of women 9864 8911 10013 8788 9864 8911 Source: Sayed eta[., 1988, Table 4.1 - = Not available NA -- Not applicable 2Differences in the probing techniques used in the four surveys may have some effect on the observed trends. In all of the surveys, the respondent was first asked to name all of the methods about which she had heard, and the interviewer then probed to find out whether the respondent recognized methods that she had not spontaneously mentioned. In the ECPS, the interviewer used only the name when probing whale, in the EFS and the EDHS, both the name of the method and a brief description were used. 47 Table 4.2 also shows the change in the proportion knowing a source between 1988 and 1992. 3 Comparing the 1992 data, there has been a small decrease in the proportion of women reporting knowledge of a source both for any method and for any modem method. This change is largely attributable to decreases in the proportions reporting knowledge of a source for the pill and vaginal methods. Source knowledge increased for most other methods, including injection, condom, female sterilization, and male sterilization. Differentials in Knowledge of Methods and Sources Table 4.3 presents the percentage of currently married women who know any method of contraception and any modem method and the percentage who know a source of a modem method by back- Table 4.3 Knowledge of famtly planning methods and source for methods by background characteristics Percentage of currently married women who know any family planning method and any modern method and who know a source (for family planning information or services), and the mean number of methods and modem methods known, by selected background characteristics, Egypt 1992 Mean Mean Know a Know no. of Know a no of source for Number Background any methods modem modern modem of characteristic method known method methods method women Age 15-19 98.2 4.9 97.9 4.1 82 8 415 20-24 99 6 5.8 99.6 4 6 91 4 1324 25-29 99.7 6.5 99.7 5 1 93.6 1956 30 34 100.0 6.8 99.9 5.3 95 5 1743 35-39 99.6 6.5 99.6 5.1 94.1 1582 40-44 99.4 6.7 99.4 5.3 93.3 1231 45-49 99 4 6.3 99.3 4 9 90.5 902 Urban- rura l residence Urban 99.8 7.3 99.8 5.6 97.9 4281 Rural 99.4 5.6 99.3 4.5 88.5 4873 Place of residence Urban Governorates 99.9 7.5 99.9 5.7 98 7 2201 Lower F.gypt 100.0 6.5 100.0 5.1 97 6 3746 Urban 100.0 7.1 100.0 5.5 99.1 1120 Rural 101,1.0 6.2 100 0 4.9 97.0 2626 Upper Egypt 99.0 5.5 98.8 4.5 83.4 3207 Urban 99.5 6.9 99.5 5.4 94.7 960 Rural 98.7 4.9 98 5 4 1 78.6 2247 Education No educauon 99.3 5.4 99.1 4 4 87.7 4363 Some primary 99.8 6.3 99,8 5 1 95.2 1913 Primary through secondary 100.0 7.1 100.0 5,5 98 1 1010 Completed secondary/hngher 11111.0 8 3 100.0 6.1 99.7 1867 Work status Working for cash 100.0 7.9 99.9 5.9 98,1 1317 Not working for cash 99.5 6.1 99 5 4.9 92,0 7836 Total 99.6 6.4 99.5 5 0 92 9 9153 3The 1988 EDHS differed somewhat from the 1992 EDHS in the manner in which the information on knowledge of source was obtained. In 1988 EDHS, a woman who reported knowing about a method was asked where would she go to obtain the method ff she wanted to use it, while in the 1992 EDHS, the question was: Do you know where a person could go to get (Method)? 48 ground characteristics. Because knowledge of any family planning method orany modem method is almost universal in Egypt, the table also includes the mean number of methods known and the mean number of modem methods known. Differentials in the proportions knowing any method, any modem method and a source for a modem method are generally minimal. Of most significance is the fact that nearly one-fifth of women living in rural areas in Upper Egypt who know about at least one modem method are not able to name a place where a person can obtain a method. There are significant differences in the mean number of methods known across the subgroups shown in Table 4.3. By age, there is a difference of almost two methods in the mean number of methods known between women in the 15-19 age group, where the mean is lowest (4.9 methods) and the 30-34 age group, where the mean is highest (6.8 methods). A marked difference in the mean number of methods known is evident between urban and rural areas (7.3 methods and 5.6 methods, respectively). Women from rural Upper Egypt are particularly limited in the number of methods that they recognize; the mean number of the methods known among women from rural Upper Egypt is 4.9 compared to 6.2 methods for women in rural Lower Egypt (Figure 4.1). Figure 4,1 Number of Family Planning Methods Known by Place of Residence Mean number 10 6 0 Urban Total Urban Rural Total Urban Governorates Lower Egypt Upper Egypt Rural EDHS1992 Education level clearly is related to the number of methods recognized by a woman; the mean number of methods known varies from 5.4 among women with no education to 8.3 among womcn with at least a secondary education. There is a nearly two-method difference between the mean for women who are not working for cash and the women who are working for cash (6.1 methods and 7.9 methods, respectively). 49 4.2 Exposure to Family Planning Information Activities to inform and educate couples about use of contraception are one of the major components of the Egyptian family planning program. The EDHS obtained information on a number of aspects of women's exposure to family planning information, including the first source from which information was obtained, recent exposure to family planning messages broadcast on radio and television and of articles on family planning in newspapers or magazines, and attendance at community meetings in which family plan- ning or Egypt's population problem were discussed. First Source of Family Planning Information The data on the first source of information about family planning is very useful to understand the avenues through which women are initially exposed to the concept of family planning. Table 4.4 shows the distribution of ever-married women by the source from which they first heard about family planning according to residence. Television clearly serves as the primary source of information for the majority of women; 70 percent of women mentioned that they first heard about family planning on television. Friends and relatives (other than the husband) were the tint source for family planning information lor 22 percent ofthe women. Relatively small percentages mentioned other sources, including the radio (1 percent), the raiyda or other family planning outreach workers (2 percent), or public/private health personnel (2 percent). Table 4.4 First source of family p lanning information Percent distribution of ever married women by source from which they first heard atx~ut family p lannmg, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt First Gover- source Urban Rural norates Total Urban Rural Total Urban Rural Total Televxslon 76.4 65.0 78.9 73.7 79.5 71.3 60.3 67.0 57 5 70.3 Radio 1.0 1.2 1.1 1.1 0.6 1.3 1.1 1.2 1 0 1.1 Pnnt media 0.8 0.1 0.8 0.4 0.7 0.2 0.3 0.9 0.0 0.4 Spouse 0.2 0.3 0.2 0.3 0 2 0.3 0.3 0.2 0.3 0.3 Fnends/relativ es 167 26.0 159 19.9 136 22.6 277 22,4 300 21.7 Government doctor/chmc 1 6 1.1 1.2 1.1 1.5 0.9 1.7 2 6 1.4 1.3 Private doctor]clime 0 8 0 2 0.5 0.4 1.0 0 2 0.5 1 0 0.3 0.5 Rmyda]other family planmng worker 1.3 3 4 1.1 2.1 1.1 2 5 3.7 2 1 4 4 2 4 Commumty acuvlty 0.3 0.3 0.1 0.3 0.5 0,2 0.4 0.6 0 3 0,3 Other 0.9 1.7 0.2 0.7 1.4 0 5 2.7 1.9 3.1 1 3 Never heard about family planmng 0.0 0.9 0.0 0 1 0.0 0.2 1,2 0 I 1 7 0 5 Total 100.0 1000 100.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 Number 4596 5268 2357 4067 1210 2857 3440 1029 2411 9864 The preeminence of television as the first source of family planning information is observed in all areas. However, rural women, particularly those living in Upper Egypt were somewhat less likely to hear about family planning for the first time on television and somewhat more likely to hear for the first time from friends or relatives than other women. 50 Sources Influencing Women to Seek Family Planning Information The EDHS collected information about specific sources or events that women perceived as influencing them to seek more information about family planning. Table 4.5 summarizes this information by residence for ever-married women knowing about family planning. Again, TV spots and friends or relatives are the main influences on a woman's decision to seek more information about family planning (51 percent and 44 percent, respectively). Between 10 and 15 percent of women mention private doctors/clinics, government doctors/clinics and raiydas or family planning workers as influencing them to seek information about family planning. Only around 3 percent mentioned community activities (e.g., meetings). Table 4.5 Sources influencing women to seek information about family planning Percentage of ever-married women knowing about family planning who indicated various sources influenced them to seek information about family planning, according to urban-rural residence and place of residence, Egypt 1992 Sources influencing Urban Lower l'gypt Upper Egypt information- Gover- seeking behavior Urban Rural norates Total Urban Rural Total Urban Rural Total TV spots 54.2 48.4 51.9 56.9 60.8 55.2 43.7 51.4 40.4 51.1 Friends/relatives 44.3 44.0 45.3 51.0 49.9 51.5 35.3 35.3 35.3 44.2 Government doctor/clinic 14.2 9.3 18.9 12.1 11.9 12.2 6.0 6.3 5.9 11 6 Private doctor/clinic 18.2 10.2 20.5 14.0 18.0 12.4 9.3 13.1 7.7 13.9 Raiyda/other family planning worker 8.8 11.3 9.2 10.5 9.0 11.2 10.2 7.5 11.4 10.1 Community activity 2.6 2.6 1.9 3.1 3.7 2.8 2.4 2.8 2.3 2.6 Other 31.2 22.8 32.1 26.0 29.4 24.6 23.9 31.3 20.7 26.7 Number of women 4596 5268 2357 4067 1210 2857 3440 11129 2411 9864 Exposure to Messages through Radio and Television Table 4.6 presents the percentage of ever-married women who had heard a messagc about family planning on broadcast media (radio or television) during the month prior to the interview. As might be expected given the wider coverage of television (see Chapter 2), family planning messages broadcast on the television are more successful in reaching an audience than radio messages. Almost three in four women saw a message on television in the month before the survey compared to only one in five women who had listened to a family planning message on the radio. Moreover, virtually all women who had listened to a radio message about family planning also had seen a television message. Around one-quarter of women reported that they had not listened to a radio message nor seen a television message. Recent exposure to family planning messages through broadcast media varies by residence. Rural women are less likely to have seen or listened to a message than urban women (65 percent and 86 percent, respectively). By place of residence, the proportion who had been exposed to a family planning message during the month before the interview varied from a high of 89 percent in the Urban Govemorates to 61 percent in Upper Egypt. Almost half (46 percen0 of the women in rural Upper Egypt had not seen or listened to a family planning message compared to one-quarter of the women in rural Lower Egypt (see Figure 4.2). 51 Table 4,6 Exposure to family planning messages on radio and television Percent distribution of ever-married women by whether they have heard a family planning message on radio or on television in the month preceding the survey, according to selected background characteristxcs, Egypt 1992 Heard family planning message on radio or on television Number Background Radio Television of characteristic Neither only only |]oth Missing Total women Age 15 19 28.9 0.8 53.7 16.5 0.0 100.0 423 20-24 25.5 1.1 53.7 19.7 0.1 100.0 1362 25-29 23.4 0.7 53.0 22.8 0.1 100.0 2013 30-34 23.0 1.1 55.4 20.5 0.1 100.0 1838 35-39 24.8 1.6 53.4 20.2 0.0 100 0 17139 40 44 27.0 0.7 53.7 18.4 13.2 100.0 1411 45-49 28.8 0 8 50.1 20.3 0 0 liX) 0 11118 Urban-rural residence Urban 14.2 13.8 59.3 25 7 0.1 100.0 4596 Rural 34.8 1.2 48.3 15.6 O.l 100.0 5268 Place of residence Urban Govemorates 11.5 0.9 63.0 24.6 0.1) 100.0 2357 Lower Egypt 21.7 1 2 52.3 24.8 () 0 100.0 4067 Urban 13.0 0.5 57.2 29.2 0.0 100.0 1210 Rural 25.4 1.5 50.2 22.9 0.0 100.0 2857 Upper Egypt 38.7 0.9 48.1 12.1 0.2 100.0 3440 Urban 21.6 1.1 53.2 23.8 0.3 100.0 11329 Rural 46.0 0.8 46.(3 7.1 O.l 100.13 2411 Education No education 35.7 1.1 51.6 11.5 0.1 100.0 4771 Some primary 23.6 1.3 53.2 21 8 0.1 100.0 2(378 Primary through secondary 11.6 0.6 59.2 28.6 0.0 I0(1 0 1093 Completed secondary/higher 8.7 0 7 54.7 35.9 0,1 10(h(3 1922 Work status Working for cash 18.1 0.7 53.4 27.8 0.1 100.0 1464 Not working for cash 26.5 1.1 53.4 19.0 0.1 100 0 8401/ Use of contraception Current user 16.2 1.0 58.4 24.3 11 1 100.0 4310 Past user 23.5 1.3 52.7 22.4 0. l I00 0 2064 Never user 37.4 0.8 47.6 14.1 0.1 l(X) O 3490 Total 25.2 1.0 53.4 2(3.3 0.1 11KI.O 9864 52 Figure 4,2 Exposure to Family Planning Broadcasts by Place of Residence Percent 1oo l 8O 60 : 40 :_Ll i L Urban Total Urban Rural Go'~emolales m Total Urban Rural Lower Egypt Upper Egypt EDHS 1992 Exposure to family planning messages varies directly with a woman's educational level. Women who work for cash also were somewhat more likely to report recent exposure to a family planning message than other women. Finally, women who were current users of family planning were more likely to report that they had seen or heard a message about family planning recently than were past users or never users. It is not clear whether the relationship between exposure to family planning messages and user status is causal or not. Because they are practicing family planning, current users may simply be more aware of messages on the topic than other women. Exposure to Mes~ges through Print Media/Community Meetings Women were asked if they had read an article about family planning in a newspaper or magazine during the month before the interview. They also were asked if they had attended a community meeting at which family planning or population problems were discussed during the past year. Responses to these questions are presented in Table 4.7. Few women receive information about family planning through newspapers or magazines. Overall, only about one in twenty women said that they had read an article about family planning; this represents about 14 percent of all women who were literate (data not shown in table). Only a small minority (one in seventeen women) also report attending a community meeting at which family planning or Egypt's population problems were discussed. As expected, women in rural areas, especially in Upper Egypt, were less likely to have read articles on family planning than other women. Exposure to family planning information through community meetings was more common among urban than rural women and rural women in Upper Egypt were the least likely to report attendance at such meetings. 53 Higher educational attainment and work in the cash economy were associated with exposure to family planning messages through newspapers or magazines or at com- munity meetings. There is also a small but definite relationship between exposure to in- formation through print media and communi- ty meetings and experience with the use of family planning methods. 4.3 Attitudinal Indicators After acquiring knowledge, the next step in family planning adoption is to have a positive attitude about the use of contracep- tive methods. Attitudinal data were collected by asking women in the sample whether, in general, they themselves approved of a cou- ple using family planning and what they thought was their husband's opinion on the subject. In addition, respondents were asked about their attitude regarding the use of spe- cific methods including the pill, IUD, con- dom, female sterilization, male sterilization and withdrawal. Attitudes about Use of Family Planning Methods Table 4.8 shows the level of approval of family planning among currently married non-sterilized women who know at least one contraceptive method according to back- ground characteristics. The table also looks at the extent to which these women say their attitude parallels that of their husband. 4 Over 90 percent of non-sterilized married women approve of the use of family plan- ning, and only 5 percent disapprove. Most of the women also believe that their husband approves. Overall, according to the woman, three of four couples approve of the use of family planning. Among couples in which the wife reports differences of opinion, the husband--and not the wife--is more often Table 4.7 Exposure to family planning messages through print media/community meetings Percentage of ever married women who read an artxcle about family planning m a newspaper or magazine during the month before the interview, and the percentage who attended a community meeting at which famJly planning/Egypz's population problem was discussed during the past year. according to selected background characteristics. Egypt 1992 Read article Number Background on family Attended of characterisuc planning meeting women Age 15-19 3 6 4.0 423 20-24 5.3 5.0 1362 25 -29 6.1 7.0 2013 30 34 6.9 8.0 1838 35 -39 5.8 7.0 1709 40-44 5.0 5.t) 141 I 45-49 4.3 5 0 1108 Urban-rural residence Urban 9 1 9.0 4596 Rural 2 6 4.0 5268 Place of residence Urban Govemorates 8.8 10.0 2357 Lower Egypt 5 2 4.0 4067 Urban 10 2 6.0 1210 Rural 3.1 4.0 2857 Upper Egypt 3.9 6.0 3440 Urban 8.6 9.0 1029 Rural 2.0 4.0 2411 Education No education 0.2 3.0 4771 Some primary 2 I 4,0 2078 Primary through secondary 9.1 7.11 1093 Completed secondary/higher 20.8 17.0 1922 Work status Working for cash 17.5 17.0 1464 Not working for cash 3.6 4 0 8400 Contraceptive u~ Current user 7.6 8,0 4310 Past user 5.4 6.0 2064 Never user 3.3 4.0 3490 Total 5.6 6.0 9864 reported to disapprove of family planning. Only 5 percent of women disapprove of family planning use while 13 percent of husbands are perceived by their wives to disapprove. 4See Chapter 13 for a comparison with the husbands' actual attitudes. 54 Table 4.8 Attitudes toward family planning Percent distribution of currently married, non-sterilized women who know of a family planning method by their attitude toward family planning, and their perception of their husband's attitude, according to selected background characteristics, Egypt 1992 Woman approves Woman disapproves Husband Husband's Husband's Number Background Both dis- auitude Husband attitude Both of cbaracteristtc approve approves unknown approves unknown disapprove Other Total women Age 15-19 65.5 6.4 12.4 1.3 1.8 6.5 6.1 1000 408 20-24 72.6 12.0 6.5 1.3 0.6 3.3 3.7 100.0 1319 25-29 76.9 10.8 4.6 1.2 0.6 2.5 3.4 100.0 1948 30-34 77.5 11.1 4.2 1.1 0.4 2.5 3.2 100.0 1730 35-39 79.8 8.6 3.4 1.1 0.4 3.0 3.8 100.0 1552 40-44 79.I 8.6 3.6 1.2 1.0 2.8 3.7 100.0 1192 45-49 73.1 7.7 7.3 1.0 1.1 3.7 6.1 100.0 865 Urban.rural residence Urban 83.3 8.6 3.2 0.8 0.1 1.7 2.2 100.0 4220 Rural 70.1 11.0 6.8 1.4 1.1 4.2 5,3 1000 4794 Place of residence Urban Governorates 85.4 6.8 2.7 1.0 0.0 1.9 2.1 100.0 2168 Lower Egypt 79.9 10.0 5.2 0.9 0.3 1.3 2.4 100.0 3691 Urban 83.0 10.5 3.4 0.2 0.2 0.8 2.1) 100.0 1104 Rural 78.5 9.8 6.0 1.3 0.3 1.5 2.6 lO0.0 2587 Upper Egypt 65.8 11.8 6.6 1.5 1.6 5.8 6.8 100.0 3155 Urban 78.9 10.3 4.0 1.1 0.5 2.5 2.8 100.0 948 Rural 60.2 12.5 7.7 1.6 2.1 7.2 8.6 100.0 2207 Level of education No education 69.9 10.6 7.0 1.2 1.2 4.2 5.9 100.0 4270 Some primary 78.7 9,9 4.7 1.2 0.4 2.4 2.7 1 fgl.0 1892 Primary through secondary 82.5 9.1 2.8 0.5 0.0 2.4 2.6 100.0 994 Completed secondary/higher 85.2 8.5 2.2 1.5 0.1 1.2 1.1 100.0 1858 Work status Working for cash 75.1 10.0 5.5 1.1 0.7 3.3 4.2 100.0 7709 Not working for cash 83.3 9.1 2.4 1.4 0.4 1.1 2.3 100.0 1305 Contraceptive use Current user 89.1 7.4 1.6 0.8 0.0 0.3 0 8 100.0 4207 past user 80.2 105 3.8 1.6 0.2 1.5 2.2 100.0 1815 Never user 55.9 13.0 10.8 1.4 1.9 7.8 9.3 100.0 2992 Total 76.3 9.9 5.1 1.2 0.7 3.0 3.9 100.0 9014 The likelihood that a woman will report that both her husband and she approve of family planning increases with age, reaching a peak of 80 percent among women 35-39 before declining to 73 percent among older women. The level of approval varies between urban and rural areas; 83 percent of couples are reported by the woman to approve of the use of family planning compared to 70 percent in rural areas (see Figure 4.3). Among rural women, there are marked differences by place of residence in the proportion who report that both they and their husbands approve of the use of family planning; 79 percent of women in rural Lower Egypt say both they and their husbands approve compared to only 60 percent among women in rural Upper Egypt (see Figure 4.3). In rural Upper Egypt, women are almost twice as likely to say that their husbands disapprove of family planning as they are to say that they themselves disapprove (20 percent and 11 percent, respectively). 55 Figure 4,3 Couple Approval of Family Planning Use from the Wife's Perspective by Place of Residence Percenl 8O L__ 6O 4O 2O i 0' ~ ~ Urban [oral Urban Rural Total Urban Rural Governo~ates Lower Egypt Upper Egypt EDHS 1992 Approval of family planning is positively related to educational level, and it is somewhat more common among working women than among other women. Significantly, women who have never used family planning are likely to be more conservative in their attitudes than other women. Among never users, only 56 percent report that both they and their husbands approve of family planning compared to 80 percent of women who used in the past and 89 percent of current users. Religion and Use of Family Planning Women also were asked about whether they thought that religion allows or Iorbids the use of family planning. Around three in four women believe that there are no religious prohibitions against family planning, and only 15 percent thought that religion definitely forbids the use of family planning (see Table 4.9). The proportion of women believing that religion allows the use of family planning varies by residence. Women in rural Lower Egypt are the most likely to say religion allows the use of family planning and women in rural Upper Egypt were the least likely to think that family planning use was allowed by religion (80 percent and 69 percent, respectively). 56 Table 4.9 Belief that religion allows or forbids family planning Percent distribution of ever-married women according to whether they believe religion allows or forbids family planning by urban-rural residence and place of residence, Egypt 1992 Urban Lower F, gyp~ Upper Egypt Rehgion's Gover- position Urban Rural notates Total Urban Rural Total Urban Rural Total Allows 78.6 74.9 77.9 79.9 79.9 81).0 71.8 78.6 68.9 76.6 Forbids 15.8 14.7 16.5 14.6 15.6 14.2 15.2 14.7 154 15.2 Don't know 5.6 10.4 5.6 5.5 4.6 5.9 13.1 6.7 15 8 8.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 1000 Number 4596 5268 2357 4067 1210 2857 3440 11129 241 I 9864 Attitudes about Use of Specific Family Planning Methods Currently married women were asked if they agree or disagree with the use of specific family planning methods; the responses to the question are shown in Table 4.10. As expected, the level of approval was highest in the case of the IUD (79 percent), followed by pills (77 percent). The method mix among users in Egypt is still heavily dominated by these two methods. As for other methods, the proportions expressing approval are much lower; condom (22 percent), female sterilization (17 percent), withdrawal (8 percent) and male sterilization (2 percent). Table 4.10 Approval of use of specific family planning methods Percent distribution of currently married women by approval of the use of specific family planning methods, Egypt 1992 Approves of use of method Don't know/ Does Family planning undecided/ not know method Yes No missing method Total Pill 76.9 17.9 4.6 0 6 100.0 IUD 78.7 15.2 5.0 1 I 100.0 Female sterilization 16.8 49.1 4 7 29.4 100.0 Condom 21.6 25.9 7.5 45.0 100.0 Male sterilization 2.2 9.3 1.2 87.2 I00.0 Withdrawal 8.1 16.6 3.7 71 6 1110.0 4.4 Ever Use of Family Planning Methods The 1992 EDHS collected data on the level of ever use of family planning methods. A number of issues relating to method adoption including the first method used and the service provider also were investigated. 57 Levels and Trends in Ever Use The EDHS findings indicate that 65 percent of ever-married women and 67 percent of currently married women have used a family planning method at some time (see Table 4.11). Virtually all women who have ever used a method have experience with modem methods. The pill is the most widely adopted modem method among currently married women (45 percent), followed closely by the IUD (42 percent). Only 8 percent have tried the condom and less than 5 percent have ever used any other modem method (injection, vaginal methods, and female sterilization). The level of ever use of traditional methods is low in Egypt (10 percent). Table 4.11 Ever use of family planning Percentage of ever-married women and of currently married women who have ever used any family planning method, by specif ic method and age, Egypt 1992 Any Dia- Female Ma]e Pen- Proloaged modem phragm/ sterL sten- Any odlc breast- Number Any meth- lnjec- Nor- foam/ lit, a- hza- trad. absu- With- feed- of Age method od Pill IUD tion plant Jelly Condom uon tlon method hence flrawal mg Other women EVER-MARRIED WOMEN 15-19 19.8 18.5 9.7 11.3 0.5 0.0 0.3 1 1 0.0 00 1.4 0.0 0.0 1.3 0.0 423 20-24 43.7 41.6 220 28.2 0.5 0.0 0.4 1 8 0.0 00 4.3 (1.7 1.4 2.4 0.2 1362 25-29 65.6 63.7 38.1 42 8 1.9 0.1 1.7 5.6 0.1 0.0 7.11 2.2 1.6 3.9 0.2 2013 30-34 76.0 74.0 51.9 50.2 3.3 0.3 3.2 7.9 0.7 0.0 102 3.6 2.4 5.5 0.5 1838 35-39 74.7 73.3 54.3 46.7 4.0 0.1 4.3 10.2 1 4 0.0 10 6 4.1) 3.9 5.1 0.2 1709 40-44 70.9 69.2 54.7 40.7 4.8 0.0 7.8 12.0 2.4 0.0 144 5.1 3.7 7.4 1.0 1411 45-49 63.3 62.1 52.2 29.7 3.3 0.4 6.2 9.5 3 2 0.1 14.1 6.5 3 9 6.9 0.9 1108 Total 64.6 62.9 44.0 39.7 2.9 0.1 3.6 7.5 1.1 0.11 9.5 3 4 2.6 4 9 0.4 9864 CURRENTLY MARRIED WOMEN 15-19 20.2 18.8 9.9 11.5 0.5 0.0 0.4 1.2 0.0 0.0 1 4 0.0 0.0 1.4 0.0 415 20-24 44.8 42.6 22.5 29.0 0.6 0.0 0.4 1.8 0.0 0.0 4.4 0.7 1.5 2.5 0.2 1324 25-29 66.7 64.8 38.7 43.8 2.0 0.1 1.7 5.8 0.1 0.0 7 2 2.3 I 7 4.0 0.2 1956 30-34 78.0 76.1 53.1 51.9 3.5 0.3 3.4 8.2 0.8 0.0 111.4 3,7 2 4 5.6 11.5 1743 35-39 77.9 76.4 56.4 49.2 4.2 0.1 4.4 10.8 1.5 0.0 11.1 4.1 40 5.5 0,3 1582 40-44 75.4 73.8 580 44.1 5.3 0.0 8.2 13.5 2.6 0.0 15.7 5.6 42 7.8 1.1 1231 45-49 68.7 67.5 56.5 33~2 3.9 0.5 7.0 11.1 3.6 0.2 15.7 7.5 4.5 7.6 1.1 902 Total 66.9 65.1 45.2 41 7 3.0 0.2 3.7 7.9 1.1 0.0 9.8 3 5 2.7 5.1 0.5 9153 Across age groups, the highest level of ever use is observed for currently married women 30-39 (78 percent) and the lowest level for women 15-19 (20 percent). Women age 30 and older are more likely to have had experience using the pill while, among younger women, experience with the IUD is more common than experience with the pill. Older women also are more likely than younger women to have ever used a tra- ditional method. 58 A comparison of the 1992 EDHS findings with the results of earlier surveys is presented in Table 4.12. The level of ever use among ever-married women increased by around 8 percentage points between the 1980 and 1984 (from 40 percent to 48 percent) and then increased again by almost I0 percentage points between 1984 and 1988. By 1992, the level of ever use had reached 65 percent. Table 4.12 Trends in ever use of family planning methods Percentage of ever-married women 15-49 who have ever used a family planning method by specific methods, Egypt, 1992 EDHS, 1991 EMCHS, 1988 EDHS, 1984 ECPS and 1980 EFS Ever used method Family planning EDHS EMCHS EDHS ECPS EFS method 1992 1991 a 1988 1984 b 1980 c Any metht~l 64.6 63.2 57.4 48.2 39.8 Any modern method 62.9 59.8 55.9 46.7 38.9 Modern method Pill 44.0 44.7 46.0 41.0 35.8 IUD 39.7 32,3 25.6 14.8 8.7 Injection 2.9 2.3 1. I 0.5 Vaginal methods 3.6 5.3 3.9 1.2 Condom 7.5 8.6 3.4 5.0 Female sterilization 1.1 1.5 1.4 0.7 Male sterilization 0.0 0.0 0.0 O. 1 Any traditional method 9.5 11.4 5.3 Safe period 3.4 3.7 1.4 2.7 Withdrawal 2.6 2.4 1.0 2.3 Prolonged breastfeeding 4.9 6.5 3.1 Other traditional methods 0,4 0.8 0.5 Number of women 9864 9073 8911 10013 8788 aAbdeI-Azeem, F. et al., 1993, Table 8.3 bSayed et al., 1989, Tables 5.2 CHallouda et al., 1983, Volume IV, Table 4.3.1-1. By method, the greatest increase was registered for the IUD. In 1992, 40 percent of ever-married women had ever used the IUD, compared to 26 percent in 1988, 15 percent in 1984 and 9 percent in 1980 (see Figure 4.4). In the case of the pill, the level of ever use increased by almost 10 percentage points between 1980 and 1988; however, between 1988 and 1992, there was a small decline (2 percentage points) in the proportion of women who have ever used the pill. These results are consistent with the trend in the method mix among current users over the same period (see Chapter 5). 59 70 60 50 40 30 20 10 0 Pe,cent Figure 4.4 Ever Use of Family P4anning, Egypt 1980-1992 Any method Pqll IUD EDHS1992 Differentials in Ever Use of Family Planning Methods Table 4.13 looks at di ffercnccs among subgroups in the overall proportions of ever-married women who have ever used family planning and in both the distribution of ever use~ by the number of methods ever used and the mean number of methods ever used. The table shows that older women are not only m ore likely to have used a method some time but they also are more likely to have had experience with a greater number of methods than younger women. For example, less than 10 percent of women age 30 and younger report that they have ever used three or more methods compared to around 25 percent of women 40-49. Considering other differentials, a woman is more likely to have used a family phmning method if she lives in urban areas, i f she has at least some primary education, or if she is working for cash. Womcn in these categories also are generally more likely to have experience with more than one method (see Table 4.13). 60 Table 4.13 Ever use of family planning methods by background characteristics Among ever-married women, percentage who have ever used a family planning method and, among ever-users, percent distribution by number of methods used and mean number of methods used, according to selected background characteristics, Egypt 1992 Number of Ever methods ever used Mean Number Background used any number of characteristic method l 2 3+ Total used women Age 15-19 19,8 80.1 16.4 3.5 100.0 1.2 423 20-24 43.7 72.7 23.7 3.6 100.0 1.3 1362 25-29 65.6 61.2 30.4 8.4 100.0 1.5 2013 30-34 76.0 49.2 37.1 13.6 100.0 1.7 1838 35-39 74.7 46.6 36.4 17.0 100.0 1.8 1709 40-44 70.9 41.6 33.5 25.0 100.0 2.0 1411 45-49 63.3 45.2 30.8 24.0 100.0 1.9 1108 Urban-rural residence Urban 76.3 46.8 34.0 19.2 100.0 1.8 4596 Rural 54.5 58.6 31.4 10.0 100.0 1.6 5268 Place of residence Urban Goveraorates 78.0 45.3 35.2 19.5 100.0 1.9 2357 Lower Egypt 70.6 52.9 33.5 13.6 100.0 1.7 4067 Urban 79.2 47.4 34.3 18.2 100.0 1.8 1210 Rural 67.0 55.6 33.1 11.3 100.0 1.6 2857 Upper Egypt 48.4 58.3 29.0 12.7 100.0 1.6 3440 Urban 68.9 49.9 30.3 19.8 100.0 1.8 1029 Rural 39.7 64.6 28.0 7.5 100.0 1.5 2411 Level of education No education 54.8 58.0 31.3 10.7 100.0 1.6 4771 Some primary 71.8 48.5 36.1 15.4 100.0 1.7 2078 Primary through secondary 74.3 43.7 33.2 23.1 100.0 1.9 1093 Completed secondary/higher 75.7 50.0 31.9 18.1 100.0 1.8 1922 Work status Working for cash 74.2 48.1 32.9 19.0 100.0 1.8 1464 Not working for cash 63.0 52.9 32.8 14.3 100.0 1.7 8400 Total 64.6 52.1 32.8 15.1 100.0 1.7 9864 4.5 First Use of Family Planning The Egypt DHS included questions on the first method ever used, the timing of the adoption of the method and the source from which the method was obtained. These data enable an examination of cohort changes in the timing of adoption in order to identify any trend toward earlier adoption of more effective methods. 61 First Method Used Overall, for the majority of Egyptian women, experience with contraception begins with adoption of the pill. Table 4.14 shows that, among ever-users almost 60 percent started family planning by using the pill, while 31 percent chose the IUD for their first method, 5 percent adopted other modem methods and 6 percent began contraception with a traditional method. Younger women (age 15-24) are somewhat more likely to have begun family planning with the IUD. This may reflect the increasing popularity of the IUD in the method mix during the period when younger women first began to use family planning (see Chapter 5). Table 4,14 First method used Percent distribution of ever-users by first method used, according Io selected background characteristics, Egypt 1992 First method used Other Number Background modem Traditional of characteristic Pill IUD method I method 2 Total women Age 15-19 42.4 45.4 5,2 6,9 100.0 84 20-24 43.1 45.1 3,0 8.8 100.0 595 25-29 48.9 38.9 5.2 7.0 100.0 1319 30-34 56.3 33.9 4.0 5.8 100,0 1397 35-39 63.6 26.4 5.6 4.5 100.0 1277 40-44 68.3 20.9 5.9 4.9 100.0 1000 45-49 74.4 15.3 4.7 5.6 100.0 702 Urban-rural residence Urban 57.0 33.5 5.0 4.6 100.0 3505 Rural 60.8 27.0 4.7 7.6 100.0 2869 Place of residence Urban Govemorates 53.4 36.9 5.1 4.6 100.0 1837 Lower Egypt 58.3 30.6 4.2 6,9 100,0 2871 Urban 61.3 30.3 4.7 3,7 100.0 958 Rural 56.9 30.8 3.9 8,5 100.0 1913 Upper Egypt 65.1 23.4 5.8 5.8 100.0 1665 Urban 60,4 28.9 4.9 5.9 100.0 709 Rural 68.5 19.3 6.4 5.8 100.0 956 Education No education 63.5 26.0 4.5 6,0 100,0 2616 Some primary 66,6 24.9 3.9 4,6 100.0 1492 Primary through secondary 60.1 30.6 4.9 4,4 100.0 812 Completed secondary/higher 41.2 44.4 6.4 8.1 100.0 1454 Work status Working for cash 50.3 37,0 6.1 6.6 100.0 1086 Not working for cash 60.4 29.2 4.6 5.8 100.0 5288 Total 58.7 30.5 4.9 5.9 100.0 6374 1Includes injection, vaginal methods (diaphragm/foam/jelly). condom, female sterilization, and male sterilization. 2Includes periodic abstinence, withdrawal, prolonged breastfeeding and other folk methods. 62 Rural users are somewhat more likely than urban users to have started family planning use with the pill (61 percent and 57 percent, respectively) and less likely to have initiated use with IUD (27 percent and 34 percent, respectively). Rural women from Upper Egypt stand out as least likely to have begun family planning use by adopting the IUD; only 19 percent of ever-users in rural Upper Egypt adopted the IUD as their first method compared to 31 percent of ever-users in rural Lower Egypt. A woman's educational level is closely associated with the method selected when family planning use begins. Highly educated women begin use with the IUD more often than other women (see Figure 4.5). Table 4.14 also shows that women in paid employment are somewhat more likely than other women to adopt the IUD as their first method. Percenl Figure 4,5 First Family Planning Method Used by Level of Education 8O 4O ii'ii~ /i '"--"--1 I ~ i 20 i o ~ ~ No education Some primary Pnmary thru secondary Completed secondary/higher EDHS1992 Source for the First Method The 1992 EDHS collected detailed information (name, location and address) of the source from which ever-users first obtained a method. These data are tabulated according to the type of source in Table 4.15. Private sector sources (private hospitals/clinics, private doctors, clinics operated by the Egyptian Family Planning Association (EFPA), the Clinical Services Improvement (CSI) project, and other private voluntary organizations, mosque and church health units, and pharmacies) are clearly the major sources to whom women tum when they first adopt contraception. Two-thirds of ever-users obtained family planning services for the first time from a private sector source, mainly pharmacies. Government health facilities were the source for first methods for one-third of ever-users. 63 Table 4.15 Source of first method used Percent distribution of ever users by source of first method used, according to selected background characteristics, Egypt 1992 First methcxl used Other modem Source Pill IUD method I Total Public ~ctor 23.2 45.0 19.5 30.1 Urban hospital 1.7 10.6 12.6 5.1 Urban health unit 9,2 19.4 3 0 12.2 Rural hospital 1,2 3.6 1.4 2.0 Rural health unit 9.2 6.8 1 3 8.1) Other MOH 0.9 0 5 l).5 0.7 Teaching hospital 0.2 1.4 0.8 t).6 Health insurance organization 0.0 1.t) t).() l).3 Curative care organi/ation 0.7 1.5 0.l) 0.9 Other government 0,1 0.2 0 0 O. 1 Private sector 74 4 54.2 72.4 67.7 Medical private sector 74.0 54.2 72.4 67.5 EFPA 0.4 2.1 0.0 0.9 CSI 0.9 5.4 2.5 2.5 Other PVO 0.5 1.3 0 0 (I.8 Mosque health unit O.1 3.8 00 1.3 Church health unit 0.1 0.2 0.0 O.1 Private hospital/clinic 0,3 3.8 O 8 1.5 Private doctor 2.1 36.5 9.3 13.6 Pharmacy 69 5 1.1 59.8 46.8 Other private sector 0.4 0.0 O.I) 0.3 Other vendor 0.4 0.0 /hO 0 3 Other 1,9 0.7 5.4 1.7 Friends/Relauves 1,3 0.1 2.11 0.9 Other 0.4 0.6 0.5 0.5 Husband bought 0.3 O.II 3.0 0 3 Don't know 0.5 0.11 2.2 0.4 Total 100.0 100.11 100.0 100.0 Number of women 3740 1946 3(/9 5996 MOH = Ministry of Health EFPA = Egyptian Family Planning Association CSI - Clinical Services Improvement project PVO = Private voluntary organization 2Includes injection, vaginal methods (diaphragm/foam/jelly), condom, female steriliTation and male sterilization 64 The source used initially by ever-users varies according to the method selected (see Table 4.15). Ever-users who chose the pill as their first method, generally relied on pharmacies for their supply, followed by public sector providers, especially urban and rural health units (70 percent and 23 percent, respectively). Among women who initiated use with the IUD, 54 percent reported that the IUD was inserted by a private sector provider compared to 45 percent who went to a public sector provider. The small pcrecntage of IUD users who reported obtaining their IUD at a pharmacy probably confused the place of purchase with the place of insertion. Number of Children at First Use of Family Planning Table 4.16 shows the percent distribution of ever-married women by the number of living children at the time of first use of contraception according to selected background characteristics. The results indicate that Egyptian women are adopting family planning fairly early in the family building process although less than 2 percent of ever-users begin using immediately after marriage or before the first birth. Overall, more than one-third of ever-users (24 percent of ever-married women) began using family planning after they had the first child, and almost two-thirds started using after they had one or two children. Table 4.16 Number of children at first use of family planning Percent distribution of ever-married women by number of living children at the time of first use of fazmly planning, according to current age, Egypt 1992 Number of living children at time Never of first use of contraception Number Current used of age contraceptxon 0 1 2 3 4+ Total women Age 15-19 80.2 0.5 14.6 4.5 0.2 0 0 1110 (I 423 20-24 56.3 1.3 25.9 11.5 3.7 1.3 100.0 1362 25-29 34.4 0.9 31.8 16.9 8.8 7.2 100.0 2013 30-34 24.0 1.3 28.2 20.6 11.0 14.9 100.0 1838 35-39 25.3 1.2 23.1 15.0 11.5 24.0 11K).0 1709 40-44 29.1 1.2 18.0 13.5 9.4 28.7 100.0 1411 45-49 36,7 0.7 12.2 11.8 l 1.4 27,3 100.0 1 108 Urban-rural residence Urban 23.7 2.1 35.1 18.5 9.2 11.4 100.0 4596 Rural 45.5 0.2 14.1 11.8 8.8 19.5 100.0 5268 Place of residence Urban Governorates 22.0 2.2 37.2 19.8 9.1 9.7 100.0 2357 Lower Egypt 29.4 0.6 24.9 16.4 10.7 18.0 100.0 4067 Urban 20 8 1.3 38.5 18.5 10,0 10.9 100.0 1210 Rural 33.0 0.3 19.2 15.5 11.1 21.0 100.0 2857 Upper Egypt 51.6 1.0 13.6 9.8 6.8 17.2 100.0 3440 Urban 31.1 2.7 26.4 15.6 8.4 15.9 100.0 1029 Rural 60.3 0.2 8.2 7.4 6.1 17.8 1000 2411 Level of education No education 45.2 0.3 11.1 11,6 9.6 22.2 100.0 4771 Some primary 28.2 0.8 23.6 18.1 11.7 17.5 100.0 2078 Primary through secondary 25.7 1.8 33.5 19.9 9.5 9.6 100.0 1093 Completed secondary/higher 24.3 3.0 50.5 16.8 4.2 1.3 100.0 1922 Work status Working for cash 37.0 0.8 20.9 14.6 9.4 17.2 100.0 8400 Not working for cash 25.8 2.6 40.8 16.7 6.5 7.6 100.0 1464 Total 35.4 1.1 23.9 14.9 9.0 15.7 100.1l 9864 65 There has been a clear downward trend over time in the parity at which women first adopt family planning, with younger users initiating use at lower parities than older women. Among ever-users, the proportion adopting family planning when they had one child increased from 20 percent among women 45-49 to 48 percent among ever-users 25-29. There are differentials in the number of living children at the time of first use of contraception by place of residence, education level, and work status. Urban ever-users begin using at much lower parities than rural ever-users; for example, around 50 percent of urban ever-users initiated family planning use before they had two children, compared with around 25 percent of rural ever-users. Also, as shown in Table 4.16, educated ever-users and ever-users who work for cash are more likely to initiate use at lower parities than other women. Reproductive Intention at First Use The 1992 EDHS also collected information on women's childbearing intentions at the time contraception was first adopted. These data allow an investigation of the extent to which interest in limiting as opposed to spacing births motivates women to begin using family planning. Overall, although there was substantial interest in limiting childbearing, the majority of ever-users (54 percent) began using contraception to delay the next birth. Table 4.17 shows that spacing was clearly the primary motivation among ever-users who initiated family planning use at low parities. At parity 3 or higher, however, the vast majority of ever- users adopted family planning because they wanted to limit births. Table 4.17 Reproductive intentions at time of first use of family planning Percent distribution of ever-users by reproductive intentions at time of first use of family planning, according to number of living children at time of first use, Egypt 1993 Number of children Reproductive retention 0 1 2 3 4+ Total Want child later 95. l 90.6 54.4 28.2 10.0 54.0 Do not want child/ another child 4.7 9.2 45.0 71.8 89.7 45.7 Other 0.3 0.1 0.6 0.0 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 108 2357 1471 884 1554 6374 66 CHAPTER 5 CURRENT USE OF FAMILY PLANNING The level of current use of family planning is one of the indicators most frequently used to asscss the success of family planning program activities. It is also widely used as a measure in the analysis of the determinants of fertility. This chapter focuses on the levels and differentials in family planning use among population subgroups, with a particular emphasis on the method mix among users. Trends in family planning use in Egypt are also described in this chapter. Detailed information on the service providers from which users obtain their methods is presented, and indicators of the accessibility of family planning mcthods are reviewed. 5.1 Levels and Differentials in Current Use of Family Planning The 1992 EDHS results indicate that 47 percent of currently married women are currently using family planning in Egypt (see Table 5.1 and Figure 5.1). Almost all users rely on modem methods; 28 percent of married women are using the IUD, 13 percent rely on pills and 4 percent arc using other modem methods, principally the condom (2 percent) and female sterilization (1 percent). Less than 3 percent are using a traditional method. Table 5.1 Current use of family planning by residence Percent distribution of currently married women by family planning method currently used, according m urban-rural residence and place of residence, Egypt 1992 Method Urban Rural Urban Lower Egypt Upper Egypt Gover- norates Total Urban Rural Total Urban Rural Total Any method 57.0 38.4 59.1 53.5 60.3 50.5 31.4 48.1 243 47.1 Any modern method 54.1 36.6 55.6 51.3 58.5 48.2 29.7 45.4 23.0 44.8 Pill 14.0 11.9 12.5 I5.1 17.3 14.1 10.7 13.8 9.3 12.9 IUD 34.6 22.0 36.8 32.6 36.3 31.0 16,4 27.6 11.6 27.9 Injection 0.5 0.5 0.3 0.5 0.7 0 5 0.6 0.6 0.6 0.5 Diaphragm/foam/jelly 0.5 0.2 0.6 0.2 0.2 0.2 0.3 0.6 0.2 0.4 Condom 3.2 0.9 4.1 1.4 2.4 0.9 1.2 2.1 0.8 2.0 Female sterilization 1.2 1.0 1.4 1.5 1.4 1.5 0.6 0 7 0.5 1 1 Any traditional method 2.9 1.8 3.5 2.2 1.8 2.3 1.7 2.7 1.2 2.3 Periodic abstinence 1 3 0.2 1.6 0 5 1.0 0.2 0.4 1.0 0 1 0.7 Withdrawal 1.1 0.3 1.3 0.5 0.6 0.5 0.5 1.2 0.2 0.7 Prolonged hreastfeeding 0.4 1.2 0.6 1.2 0.2 1.6 0,7 0 5 0,8 0.9 Other methods 0.0 0.1 0.1 0.0 0.0 0.1 0 1 0 0 0.1 0.1 Not currently using 43.0 61.6 40.9 46.5 39.7 49.5 68.6 51.9 75.7 52.9 67 Figure 5.1 Current Use of Family Planning Methods Currently Married Women 15-49 ~UD 28% ~radl~lonal 2% No1 currently using 53% E Ok1',, 1992 Residence Marked differences in the level of family planning use by residence are observed. As Table 5.1 shows, urban women are considerably more likely to be using a method than rural womcn (57 percent and 38 percent, respectively). The IUD is the preferred method among both urban and rural women (35 percent and 22 percent, respectively), followed by the pill (14 percent and 12 percent, respectively). Looking at place of residence, current use is highest in the Urban Govemorates (59 perecnt), followed by Lower Egypt (54 percent). Upper Egypt (31 percent) lags significantly behind thc other two areas. Considering both urban-rural residence and place of residence, a greater proportion of women are currently using a method in urban Lower Egypt (60 percent) than in urban Upper Egypt (48 perccnt). The differentials are even more striking between rural Lower Egypt and rural Upper Egypt; 51 percent of married women in rural areas in Lower Egypt are currently using a contraceptive method compared to 24 percent in rural Upper Egypt (see Figure 5.2). Throughout Egypt the IUD is the most widely used method of contraception. However, there are differentials in IUD use by residence. Uscrs in Upper Egypt are less likely to rely on the IUD than other users (see Figure 5.2). 68 Figure 5,2 Current Use of Family Planning Methods by Place of Residence Percent 7O 60 5O 40 30 2O 10 0 Urban Governorates Tolal Urban Rural Total Urban Lower Egypt Upper Egypt Rural EDHS1992 Background Characteristics Differentials in the level of current use by method according to selected background characteristics are shown in Table 5.2. Current use increases among the five youngest cohorts, reaching its maximum among women in the 35-39 age group, where three in five women are using a method. Women in all age groups prefer the IUD. The proportion using the IUD peaks at 37 percent among women in the 30-34 age group while the proportion using the pill peaks at 18 percent among women age 35-39. As with age, family planning use increases rapidly with the number of living children that a woman has, reaching a peak among women with three children (59 percent). The results confirm that women in Egypt begin adopting contraception after the first child; less than 1 percent of childless women are using contraception. Considering level of education, significant differences in family planning are observed between women who never attended school and women who did attend school, even if they did not complete the primary level. Among women who have attended school, there are only minor differences across educational categories in the level of current use. Overall, the percentage of married women currently using contraception varies from 38 percent among women with no education to 58 percent among women who completed the secondary or higher level. Finally, working women are more likely to practice family planning than women who are not working for cash (58 percent and 45 percent, respectively). 69 Table 5.2 Current use of family p lanning by method Percent disff ibution of currently married women by family planning method currently used, according to selected background chaxacteristics, Egypt 1992 Any modem Background Any meth- characteristic method od Modern method Traditional method Din- Fernale Pert- Prolonged Not phragm/ steri- Any odic With- breast- cur- Injec- Nor- foam/ Con- liza- trad. absti- draw- feed- rently Pdl IUD tion plant jelly dora tion method hence al mg Other using Total Number Age 15-19 13,3 12.7 4.1 8.4 0.0 0.0 0.0 0.2 0.0 06 0.0 0.0 06 0.0 867 100.0 415 20-24 29.7 28.5 6.8 21.2 0.2 0.0 0.0 0 3 0.0 1.2 0.0 0.0 I. I 0.1 70.3 100 0 1324 25-29 46.0 44.2 13,3 29,3 0.2 0,I 0.4 0.9 0.1 1,8 0.2 0.5 1.0 0.0 54.0 100.0 1956 30-34 58.8 56.4 16.2 36.7 0.5 0.0 0.3 2.0 0.8 2.4 0.8 0.4 1.2 0.0 41.2 1(300 1743 35-39 59.6 57.0 18.2 34.0 0.8 0.0 0.4 2.1 1.5 2.6 1.0 0.8 0,7 0 1 40.4 100.0 1582 40~t4 55.5 52.4 14.0 28.9 I I 0.0 08 5.1 2.6 3.1 1 1 I,I 0,8 0 I 44.5 100.0 1231 45~19 34.5 30.3 7 9 14,9 0.5 0.0 0 4 3.0 3.6 4.1 1.8 1,9 0 2 0.2 65 5 ICO.0 902 Numbw of living children 0 0,5 0.5 0.3 0 2 0 0 0.0 0.0 0.0 0.0 0 0 0 0 0.0 0,0 0.0 99.5 100.0 830 l 31.6 30.2 6.7 22,4 0.0 0.0 0.2 0.8 0.1 1 4 0.2 0.6 06 0.0 684 100.0 1175 2 52 5 49.5 12.7 34,3 0.0 0.0 0.1 2.2 0.2 3 0 1.5 0.7 0 8 0.0 47.5 100 0 1585 3 59,3 56.2 17.1 34.8 0.5 0.1 0.5 22 1 1 3 I I 2 0.6 I,I 0.2 407 100.0 1663 4+ 54.3 518 15.8 30,0 1.0 0.0 0.5 26 21 2.5 05 09 1.0 01 457 100.0 3900 Education Noeducadon 37.5 36.0 12.0 20~7 0.5 0.0 02 I 2 1.4 1.5 0.l 0.4 0.9 O0 62.5 1000 4363 Someprtmary 53.5 510 17.6 29,4 05 O0 0.3 22 09 2.5 0.5 06 1.2 03 46.5 ICO.o 1913 Pr n'n m'y tl~ough secondary 56.1 53.0 13 7 34,0 0,6 0.0 0 6 2,6 1.6 3.2 1.7 I 0 0.5 0.0 43.9 ICO.0 1010 Completed sec- ondary/hlgher 58.0 54.5 9.8 400 0.4 0.0 0.6 3.1 0.5 3.5 I 7 1.2 0.6 00 42.0 100.0 1867 Work status Working for cash 58.3 55.1 10.6 39,0 0.6 0.0 0.6 3.4 1.0 3.2 1,6 1.2 04 0.0 41.7 100.0 1317 Not working forc&sh 45.2 430 13.3 26,1 0.5 0.0 0.3 1.7 12 2.2 0.6 0,6 09 0.1 548 1{300 7836 Total 47.1 44 8 12.9 27.9 0.5 0 0 0.4 2.0 I.I 2 3 0.7 0 7 0 9 0 1 52.9 103.0 9153 5.2 Trends in Current Use of Family Planning Family planning use has increased steadily since 1980 (see Table 5.3 and Figure 5.3). Over the 12- year period from 1980 to 1992, current use almost doubled, from 24 percent to 47 percent. The 1992 EDHS results show a somewhat lower level of current use than that reported in the 1991 PAPCHILD survey (47 percent and 48 percent, respectively). Although the apparent plateauing of use rates between 1991 and 1992 is puzzling, the overall trend has clearly been upward. The use rate reported in 1992 EDHS is almost ten percentage points greater than the level reported in 1988 EDHS. The rate of increase in current use has been steady, averaging 25 percent during the periods between the EFS, ECPS, and EDHS surveys. 70 Table 5.3 Trends in current use of family planning Percent distribution of currently married women by the family planning method currently used, Egypt, 1992 EDHS, 1991 EMCHS, 1988 EDHS, 1984 ECPS and 1980 EFS EDHS EMCHS EDHS ECPS EFS Method 1992 1991 a 1988 b 1984 b 1980 b Any method 47.1 47.6 37.8 30.3 24.2 Any modern method 44.8 44.3 35.4 28.7 22.8 Modern method Pill I2.9 15.9 15.3 16.5 16.6 IUD 27.9 24.1 15.7 8.4 4.1 Injection 0.5 0.1 0.3 Vaginal methods 0.4 0.4 0.7 Condom 2.0 2.4 1.3 Female sterilization 1.1 1.5 1.5 M,,de sterilization 0.0 0.0 0.0 Any traditional method 2.3 3.3 2.4 1.6 Safe period 0.7 0.6 0.6 Withdrawal 0.7 0.5 0.3 Prolonged breast feeding 0.9 I. 1 0.6 Other traditional methods 0.1 0.2 0.1 1.4 Not using 52.9 52.4 62.2 69.7 75.8 Total percent 100.0 100.0 100.0 104).0 100.0 Number o[ women 9153 8406 8221 9158 8012 - Not available aAbdel-Azeem, F. et al., 1993, Table 8.7 bSayed et al., 1989, Table 6.1 Table 5.3 shows not only the overall increase in contraceptive use since 1980, but also documents the changes that have been occurring in the method mix. The shift toward greater reliance on the IUD is among the most encouraging findings in the 1992 EDHS. The percentage of married women using the IUD doubled between 1984 and 1988 (from 8 percent to 16 percent), reached 24 percent in early 1991 and 28 percent in late 1992. Over the same period, there was a small decrease in the percentage using the pill (from a peak of 16 percent in 1984 to 13 percent in 1992). As a result, the method mix among users has changed dramatically (see Table 5.4). In 1984, around one in two users relied on the pill, and one in four users had an IUD. By 1988, users were as likely to use the IUD as the pill, and by 1992, almost three in five users employed the IUD while only about one in four relied on the pill (see Figure 5.4). 71 60 Percent Figure 5+3 Current Use of Family Planning Methods, Egypt 1980-1992 50 40 30 20 18 0 1 98O i I i I ] ~ I I 1984 1988 1991 1992 Table 5.4 Trends in the family planning method mix Percent dis~ibution of currently married women using a family planning method by the method used, Egypt, 1992 EDHS, 1988 EDHS and 1984 ECPS EDHS EDHS ECPS Method 1992 1988 a 1984 a Pill 27.4 40.5 54.4 IUD 59.2 41.6 27.7 Condom 4.2 6.3 4.3 Female sterilization 2.3 4.0 5.0 Other modern methods 2.0 1.3 3.3 Traditional methods 4.9 6.3 5.3 Total percent 100.0 100.0 100.0 Number of women 4311 3108 2775 aSayed et al., 1989, Table 6.2 72 Percent IO0 8O 6O 40 2O Figure 5,4 Change in Method Mix, Egypt 1984-1992 1984 1988 1992 5.3 Trends in Current Use of Family Planning by Residence Urban-rural Residence and Place of Residence There have been striking changes in the geographic differentials in current use of family planning (see Table 5.5). Overall, the relative increase in current use between 1984 and 1992 among rural women was greater than the increase among urban women (100 percent and 26 percent, respectively). Much of the change in rural areas occurred during the period between the two DHS surveys; the absolute increase in the rural use rate during the period 1988-92 was fourteen percentage points, almost three times the increase between the 1984 CPS and tbe 1988 DHS (five percentage points). Looking at both urban-rural residence and place of residence, the relative change was greatest in rural Upper Egypt, where the use rate in 1992 was three times the rate in 1984 (8 percent and 24 percent, respectively). In absolute terms, the greatest change has been in rural Lower Egypt, where the use rate rose from 29 percent in 1984 to 51 percent in 1992. The Urban Governorates experienced the slowest growth; the use rate in the Urban Govemorates in 1992 (59 percent) was only nine percentage points higher than the 1984 rate (50 percent). 73 Table 5.5 Trends in current use of family planning by residence Percent of currently married women currently using a family planning method by urban-rural residence and place of residence, Egypt, 1992 EDHS, 1988 EDHS, and 1984 ECPS EDHS EDHS ECPS Residence 1992 1988 a 1984 a Urban-rural residence Urban 57.0 51.8 45.1 Rural 38.4 24 5 19.2 Place of residence Urban Governorates 59.1 56.0 49.6 Lower Egypt 53.5 41.2 34.1 Urban 60.5 54.5 47.6 Rural 50.5 35.6 28.5 Upper Egypl 31.4 22.1 17.3 Urban 48.1 41.5 36.8 Rural 24.3 11.5 7.9 Total 47.1 37.8 30.3 aSayed et al., 1989, Table 6.2 Governnrate-level Use Rates Table 5.6 shows the current use rates in 1988 and 1992 for 21 governorates in Egypt. According to the 1992 EDHS results, current use is higher in the four Urban Governorates than in other govemorates, with the highest level found in Alexandria (62 percent) (see Figure 5.5). Among Lower Egypt governorates, current use falls below 50 percent only in Sharkia and Kafr El-Sheikh govemorates (49 percent and 47 percent, respectively). In Upper Egypt, current use reaches 50 percent only in Giza governorate, it exceeds 30 percent only in Fayoum and Aswan, and it is lowest in Souhag (20 percent). Current use increased between 1988 and 1992 in all govemorates, with the exception of Cairo and Damietta, where use levels were already quite high in 1988. Among the four Urban Govemorates, the absolute increase in current use was greatest in Port Said. Behera governorate registered the largest absolute increase among the 9 govemorates in Lower Egypt and Assuit, the largest increase among the 8 governorates in Upper Egypt. Considering relative increases, changes in use rates among governorates in Upper Egypt are the most striking, largely because the levels of use in 1988 were quite low in these govemorates. Looking at the change in method mix by govemorates, in 1988 the IUD was the predominant method only in 7 of the 21 govemorates (Cairo, Alexandria, Suez, Dakahlia, Kalyubia, Behera, and Giza). By 1992, the IUD had replaced the pill as the predominant method in all but 4 govemorates (Menya, Souhag, Qena, and Aswan). Increases in the use of the IUD were striking even in those governorates where the overall increase in use was below the average. For example, although the use rate in Damietta remained essentially stable between 1988 and 1992, the proportion of women relying on the IUD more than doubled from 14 percent to 29 percent. 74 Table 5.6 Current use of family planning by governorate Percentage of currently married women currently using any method, any modem method, the pill and the IUD, by governorate, Egypt, 1992 EDHS and 1988 EDHS 1992 EDHS 1988 EDIIS Any Any Any modem Any modern Goveraora~e method method Pill IUD triethod method Pill IUD Urban Governorates 59.1 55.6 12.5 36.8 56.0 52.1 16.9 26.8 Cairo 58.1 55.5 13.3 36.4 58.9 54.7 16.7 29.1 Alexandria 62.1 56.9 9.6 39.3 51.6 47.9 16.2 23.8 Port Said 60.5 52.0 17.4 28.2 48.2 46.1 26.8 14.0 Suez 57.3 52.9 12.6 34.2 50.3 48.7 16 1 26.6 Lower Egypt 53.5 51.3 15.1 32,6 41.2 39.1 19.2 16.2 Damietta 53.4 51.1 15.6 29.3 54.1 49.4 27.3 13.9 Dakahlia 52.8 50.8 14.7 32.4 41.3 39.9 18.4 18.8 Shaxkia 49.2 44.1 15.1 25.8 35.2 31.1 17.8 10.6 Kalyubia 57.9 56.8 17.4 35.1 42,3 41.3 16.6 20.8 Kafr El-Sheikh 47.2 45.4 13.9 27.6 41.7 39.9 21.5 13.2 Gharbia 559 55.0 18.5 34.3 50.1 48.0 25.6 17.6 Menoufia 55.7 52.8 13.8 35.5 43.9 41 7 20.2 17.4 Behera 54.7 53.4 11.3 38.4 32.5 31 5 13.3 15.4 lsmailia 50.2 47.7 14.4 27.0 41.0 40.0 27.6 9.5 Upper Egypt 31.4 29.7 10.7 16.4 22.1 20.5 10.(1 7.9 Giza 49.9 47.7 9.9 33.4 45.7 43.2 14.5 22.1 Beni Suef 29.2 29.2 8.8 16.9 15.3 14.2 9.2 4.4 Fayoum 33.3 33.3 10.9 20.1 20.2 16.9 9.7 4.5 Menya 21.9 21.4 12.0 8.2 16.6 16.1 10.3 4.3 Assuit 28.2 24.8 8.0 13.8 12.7 12.2 4.8 5.0 Souhag 19.8 17.2 7.7 6.9 16.2 13.5 7.6 4.9 Qena 24.7 23 1 14.0 7.9 12.2 11.2 10.2 07 Aswan 31.9 28.8 17.5 9.0 18.6 16.2 11.4 2.9 Total 47.1 44.8 12.9 27.9 37.8 33.5 15.3 15.8 75 Figure 5,5 Current Use of Family Planning Methods by Governorate Alexandria Porl Said Ca i rc Suez Kalyub~a Gharb~a Menouha Behera Darn~etta Dakahlla Isma~ha Shark~a Kaf~ EPShelkh i GIZ~ Fayou~ Aswar Benl Suei Assu~l Qena Menya Souha~ ~\~\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~\\\\\\~\\\\\\\\\\~\\~\~\\\\\\\\~\~\\~\~\\\\\\\\\\\\\\\\\\\~ ~\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~\\\\\\\\\\\\\\\\~\~\\\\\\~\\\\\\\\\~\\\\~\\\\~\\\\\\\`~ ~\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~\\\\~\~\\\\\~\\\\\\\\~\~\\\~\\\\\\\\\\\\\~\\\\\~\\\\~ \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~\\\\\\\\\\\~\\\\\\\\\\\~\~\~\\~\\~\~\\~\\~\\\\~\\\\\\~\\\\\\\\\~ \\\\\\\\\\\~\\\\\\\\\\\\\\\\\~\~\\\\\\\\\\\\\~\\\\\\\\\\\\\\~\\\\\~\~\~\\\\\~\~\~\\\\\\\\\\\\\\V`~ \~\\\\\\\\\\\\\\\\~\\\\\\\\\\\\\\\\\\\\~\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~\\\\\\\\\\\\\\\\\\\\\\~ \~\~\\\\\~\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~\~\\\\\\\\~\\\\~\\\1 \\\\\~\\\\\\\\\\\\\\\\~\\\\\\\\~\\\\~\\\\\~\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\~ •\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\•\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\•\\•\q I I ] I ] 10 2O 30 40 50 6O Percent 70 EDHS 1992 5.4 Reasons for Choosing Current Method of Family Planning The masons women give for choosing their current method can provide the family planning program with important insights into the process of adoption of contraception. Table 5.7 summarizes the masons users gave for choosing their current method; it should be noted that more than one response was possible so that the percentages in the table may add to mom than 100 for a method. In the case of the two most popular methods (the pill and IUD), convenience was the primary mason given for choosing these methods; almost 50 percent of both pill and IUD users reported that they chose their method because it was convenient to use. Other masons cited by pill users for choosing the method included the side effects of other methods (28 percent), the ready availability of the pill (19 percent), advice from friends and relatives (16 percent) or from private medical personnel (11 percent) and the cost (11 percent). Side effects of other methods was a frequently cited mason for choosing the 1UD (37 percent) as was the desire to use a permanent (18 percent) or more effective method (14 percent). Significant minorities of IUD users reported that advice from friends and relatives (18 percent) or from private medical personnel (15 percent) was important in their choice of a method. Among users of injection and barrier methods, the side effects of other methods was the most frequently mentioned mason lor choosing their current method; convenience was also frequently cited. Convenience was the mason most often reported for the use of traditional methods. Users of female sterilization reported the desire for a permanent method more often than other reasons, followed by advice from public or private health providers, concerns about the sidc effects of other methods and intcrcst in an effective method. 76 Table 5.7 Reasons for choosing current method of family planning Percentage of family planning users reporting various reasons for deciding to use their current method of family planning, by method, Egypt 1992 Reason for choosing method Family planning method Female sterili- Other Other Tradi- Pill IUD zation clinical I barrier 2 tional Total Advice from government doctor/nurse 5.7 7.9 24.6 29.1 2.5 1.4 7.3 Advice from private doctor/nurse 10.8 15.1 24.4 16.6 12.6 4.6 13.5 Advice from family plan. worker/Raidya 0.8 1.6 0.0 4.6 1.1 0.6 1.3 Advice from relatives/friends 15.7 18.3 3.3 14.5 6.2 12.2 16.3 Side effects of other methods 27.7 37.4 21.0 56.4 59.1 46.6 36.1 Saw TV spot 1.3 2.3 0.2 0.0 2.5 0.5 1.9 Method convenient to use 49.7 48.2 15.3 44.8 41.0 54.7 47.7 Easily available 18.5 4.4 1.2 5.8 12.4 12.4 9.0 Cost 11.0 1.8 0.0 4.5 1.3 0.7 4.2 Wanted permanent method 7.0 17.8 31.7 7.8 1.5 0.7 13.4 Wanted more effective method 6.4 13.6 20.3 14.0 3.4 0.2 10.6 Husband preferred 2.0 0.9 6.8 0.0 7.6 7.5 2.0 Other 2.1 0.6 0.3 0.0 2.8 3.9 1.3 Don't know/Missing 0.6 0. l 0.0 0.0 0.0 0.0 0.2 Number 1181 2555 103 46 212 212 4310 tlneludes injection and Norplant 2Includes condoms and vaginal methods 5.5 Problems with Current Method of Family Planning An understanding of the problems which users experience is important in efforts to improve family planning service delivery in Egypt. Table 5.8 presents information from the EDHS on the main problem current users were experiencing with their methods. Regardless of the method, the majority of users have had no problems with their methods (from 75 percent in the case of pill users to 98 percent of users of traditional methods). Among those users citing problems, most had experienced side effects. The proportion pointing to side effects ranged from 6 percent in the case of the small number of injection users to 20 percent of pill users. With regard to other problems, spotting and bleeding were specifically mentioned by 8 percent of IU D users as a problem, other health concerns were cited by 4 percent of pill users and 5 percent of female sterilization users, and inconvenience was reported by 5 percent of the users relying on barrier methods (diaphragm/foam/jelly and condoms). 77 Table 5.8 Problems with current method of family p lanning Percent distribution of family p lanning users by main problem in using current method of family p lanning, according to specific method, Egypt 1992 Female stenh- Other Other 'rrath Problem with method Pill IUD zadon clinical I bamcr 2 tlonal No problem 74.5 81.6 80.9 90.2 84.5 97.6 Husband disapproves 0.1 0.0 0.0 0.0 1.3 1.5 Side effects 19 6 8 7 11 1 6.4 6 6 0 0 Spotting/bleeding 0.7 7.6 0 2 0.0 0 0 0 0 Period did not come 0.1 0.2 I 5 2.8 0 0 0 0 Other health concerns 4.2 1.6 5.1 0.6 1 5 0.1 Access/availability 0.3 0.0 0.0 0 0 0 0 0 0 Costs too much 0.0 0.1 0.0 0.0 0.0 0.0 Inconvenient to use 0 I 0.2 0.0 0,0 4 9 0.0 Steriliz~l/Want children 0 I 0 0 0.0 0 0 0 0 0.0 Other 0.2 0 1 1.2 0 0 I 2 0 6 Don't know 00 00 00 00 00 0.1 Total 100 0 100 0 100.0 100.0 100.0 100.0 Number 1181 2555 103 46 212 212 Iln¢ludes mjection and Norplant 21ncindes condoms and vaginal methods 5.6 Sources for Modern Family Planning Methods The 1992 EDHS collected more detailed information on sources of family planning services than had been obtained in previous surveys. Current users of modero methods were asked for the name and location of the source from which they had most recently obtained their method. Both the type of source and the address were recorded in the questionnaire and entered in the data file. Type of Source The dominance of private sector sources in the provision of family planning services is evident in the results presented in Table 5.9. Overall, almost two-thirds of current users of modem methods obtain their method from a private sector source (see Figure 5.6), and 35 percent rely on government health facilities. Among users obtaining services from private sector sources, the majority went either to a pharmacy or a private hospitaVclinic or doctor; however, around one in ten users are served by clinics operated by private voluntary organizations (PVOs) or mosques or churches. The source on which family planning users rely for services varies with the method used. Among pill users, 86 percent obtain the method from private sector sources, principally pharmacies, 12 percent rely on public health facilities, and 2 percent get supplies from other sources. Among IUD users, 47 percent rely on public health facilities for their method, and 39 percent obtain the IUD from private hospitals/clinics or doctors. Clinics operated by private voluntary agencies (including the Egypt Family Planning Association (EFPA) and Clinical Services Improvement (CSI) project) or by mosques or churches provide services for 14 percent of lUD users. Users of female sterilization rely mainly on the public sector. 78 Table 5.9 Sources for modem family planning methods Percent distribution of current users of modem family planning methods by most recent source, according to specific methods, Egypt 1992 Modem family planning method Female stenh- Source of method pill IUD Condom zatlon Total t Public sector 11.6 46.9 3.4 65.1 35 0 Urban hospital 0.6 10.9 0.8 51.9 8 5 Urban health unit 2.3 20.4 2 6 0.0 13.7 Rural hospital 0.8 2.5 0.0 2 5 1.9 Rural health unit 7.3 8.2 0.0 0.3 7.3 Other MOIl 0.1 0.7 0.0 0.0 0.4 Teaching hospital 0.2 1.1 0 0 9.0 1.0 HIO 0.0 1.4 0.0 I 5 1.0 CCO 0.2 1.5 0.0 0 0 1.0 Other government 0 1 0 3 0.0 0.0 0 2 Private sector 86 1 52 8 82.6 34.9 63.4 Medical private sector 85.4 52.8 82 6 34.9 63.2 EFPA 0.1 2.0 0.0 0.0 1.3 CSI 0.8 6.5 0.6 0 0 4.6 Other PVO O. 1 1.2 0.0 0.0 0.8 Mosque health unit 0.1 3.6 0.0 0.0 2.3 Church health umt 0.0 0.4 0.0 0 0 0.3 Pnvate hospgal/Clmlc 0.0 3.6 0.0 15 4 2.6 Private doctor 0.6 35.4 0.0 19 5 23 0 Pharmacy 83.6 0.0 82.0 0.0 28.3 Other private sector 0.7 0.0 0.0 0.0 0 2 Other vendor 0.7 0.0 0.0 0.0 0.2 Other 2.1 0.2 7.5 0.0 1.2 llusband bought 0.5 0.0 6.8 0.0 0.5 Friends/Relauves 1.6 0.0 0.7 0.0 0 6 Other 0.0 0.2 0.0 0.0 0.1 Don't know 0 2 0.0 6.5 0.0 0.4 Tclal 100.0 IO0.O lO0.O 100 0 100.0 Number I 181 2555 180 103 4098 MOH = Mlmst~ of Health tiIO = Ilealth Insurance Organization CCO = Curative Care Orgamzauon EI'T'A = Egyptian Family Planning Association CS1 = Chnical Services Improvement project PVO = Private Voluntary Orgamzatlon llncludes users of injection, Norplant and vaginal methods 79 Figure 5.6 Source for Family Planning Methods Current Users of Modern Methods Mosque/church Government facility 35% Pnvate doctc . acy 28% EDHS 1992 Trends in Source Table 5. I 0 compares the distribution of current users by source in the 1992 EDHS with the distri- bution reported in the 1988 EDHS. As mentioned above, in the 1992 EDHS there was increased emphasis on obtaining detailed information, particularly the address of the source. This procedure undoubtedly in- creased the accuracy of the assignment of users to various source categories. Consequently, changes in the distribution of current users by source over the 4-year period must be interpreted with caution since such changes may be at least partially due to the differences in the way that the source information was obtained in the two surveys. The results in Table 5.10 indicate that the percentage of users relying on pharmacies has decreased significantly since 1988; slightly more than half of all users relied on pharmacies in 1988 compared to only one-quarter in 1992. This trend is largely due to the shift that occurred in the method mix toward the IUD. Looking at trends in sources for the IUD, the table shows there has been a small increase in the percentage of users who rely on public health facilities from 43 percent in 1988 to 47 percent in 1992. The substantial increase in the percentage relying on private voluntary organizations for services is partially due to improved procedures for recording source data but it also likely reflects the contribution of the CSI project, which set up a small network of clinics during the period between the 1988 and 1992 surveys. 80 Table 5.10 Trends in the sources of family planning methods Percent distribution of current users of modern family planning methods by source used, according to method, Egypt, 1992 EDHS and 1988 EDHS All methods Pill 1UD t Souse of me~od 1992 1988 1992 1988 1992 1988 Public sector 35,0 23.1 11.6 8.2 46.9 42.6 Private voluntary organization 6.7 0.5 1.0 0.3 9.7 1.3 Other private medical 28.2 a 20.3 0.7 a 0.3 43.0 a 54.3 Pharmacy 28.3 53.4 83.6 87.1 NA NA Other/Not sure 1.8 b 2.6 e 3.0 b 4.0 c 0.2 b 1.7 Total Percent 100.0 100.0 100.0 100.0 100.0 100.0 Number of users 4098 2914 1181 1258 2555 1295 NA = Not applicable tProvider inserting method alncludes private doctors/clinics and mosque and church health units blncludes other private vendor and other sources such as friends/relatives Clncludes home delivery agency Source by Residence Table 5.11 looks at the variation in the type of source by urban-rural residence and place of residence for all methods and for the pill and IUD. In general, the distribution of all users by source does not differ greatly between urban and rural areas or by place of residence. However, there are significant variations in the source distributions by residence for both the pill and the IUD. For example, while the majority of pill users obtain the method from pharmacies, the percentage relying on sources other than pharmacies (largely government health facilities) is greater in rural areas than in urban areas. Among IUD users, there are only minor differences between rural and urban users in the sources used for IUD insertions. However, there are marked differences by place of residence. The percentage of IUD users naming public health facilities as the source for their method varies from 30 percent in urban Upper Egypt to 52 percent in rural Lower Egypt. There is also considerable variation in the percentages relying on private hospitals/clinics and doctors and on PVO clinics. The proportion obtaining the IUD from private hospitals/clinics or doctors is highest among users in urban Upper Egypt (46 percent) and lowest among users from rural Upper Egypt (34 percent). PVO clinics are much more likely to provide IUD users with services in Lower Egypt and Upper Egypt than in the Urban Governorates. Overall, the percentage of IUD users obtaining the method from a PVO facility varies from 5 percent in the Urban Governorates to 17 percent in urban Upper Egypt. 81 Table 5,11 Sources of family p lanning methods by residence Percent distribution of current users of modern family p lanning methods by method and source used, according to urban-rural residence and place of residence, Egypt 1992 Method Urban Rural Urban Lower Egypt Upper Egypt Gover- norates Total Urban Rural Total Urban Rural All methods Public sector 32 3 38.6 37.6 36.7 28 6 40.9 28.5 23.3 32.9 Medical private sector 66.1 59.4 61.0 61.4 69.5 57.2 69.7 75.5 64.8 Private voluntary org. 6.3 7.2 3.4 6.9 8.0 6.3 106 12.0 9.4 Private hospital/clinic or doctor 26.9 24.1 25.3 26.7 28.2 26.0 23.9 29.2 19.4 Mosque/church clinic I 4 0 0 7 5.1 0.9 2 2 0 2 2.7 3.8 1.9 Phanr~cy 28.9 27.4 27.2 26.8 31.1 24.6 32.5 30.6 34.1 Other2/Not sure 1 1 2,0 1.0 1.9 1 8 1.9 1.8 1.2 2.3 Tota] percent 100.0 100.0 11X).O 100.0 100.0 100.0 100.0 100.0 I00.0 Number of users 2315 1783 1224 1921 655 1266 953 435 5J7 Pill Public sector 6.3 17.1 5.6 12.8 4.5 17.2 14.2 10 I 16.8 Medical private sector 91.9 78.7 92.9 82.5 91.9 77.7 84,1 89.7 80.6 Pharmacy 90.2 76.8 91.2 82.0 91.1 77.3 80.2 87.0 75.9 Other 2 1.7 2.0 1.8 0,5 0.8 0.4 3 9 2.6 4.7 Otherl/Not sure 1.9 4.2 1.4 4.6 3.6 5.2 1.8 0 2 2.5 Total percent 1011.0 100.0 100.0 100 11 100.0 I00.0 100.0 100.0 1130.0 Number of users 601 581 274 565 194 371 342 132 210 IUD Public sector 44.0 5/I.9 50.5 48.2 411.3 52.1 38 5 30.0 47.2 Medical private sector 55.7 48.8 49.5 51 5 59.4 47.6 61.11 69 3 52.4 Private voluntary org. 9.1 111.8 4.8 10.4 12.3 9.4 16.1 17.4 14.8 Private hospital/clinic or doctor 40.5 36.9 37.2 39.8 43 7 37.9 39.9 45.7 33.9 Mosque/church chnic 1 6.2 1.1 7.5 1 4 3.5 0.3 5.1 6.2 3.8 Other2/Not sure 0.2 0.4 0.0 0 3 0.4 0.2 0.5 0 7 0.4 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 1190.0 Number of users 1481 1074 809 1221 407 814 525 265 260 llncludes other private vendor and other sources (husband, friends and relatives, etc.) 21ncludes private voluntary orgamzaaon, pnvate hospital/clinic or doctor and mosque/church chmc Rea~ns for Choosing Current Source of Family Planning Methods Family planning users were asked about their reasons for obtaining services from their current source. Table 5.12 shows that the majority of pill users mentioned ease of access to the source as the main reason for choosing the current source (78 percent). Other reasons cited relatively frequently by pill users included the reputation of the source (11 percent) and previous cxpericncc with the source (10 percent). Cost was a factor in the choice of a source for only 6 perecnt of pilI users. 82 Table 5.12 Reasons for choosing current source of family planning methods Percentage of current users of modern family planning methods reporting various reasons for deciding to use their current source of family planning methods, by method, Egypt 1992 Any Reason for choosing modem current source method Pill IUD Advice from government doctor/nurse 2.9 1.5 3.2 Advice from private doctor/nurse 2.9 2.0 3.1 Advice from friends/relatives 19.6 6.9 26.7 Reputation of source 33.4 10.8 45.4 Previous experience 19.3 10.2 24.2 Easy access to source 49.6 78.2 36.9 Cost of services 11.6 5.8 14.5 Other 1.7 2.7 ll.9 Don't know/Missing 2.1 3.0 0.3 Number 4098 1181 2555 Among IUD users, the reputation of the source was the most frequently cited reason for choosing the current provider (45 percent). A substantial percentage of IUD users cited other factors, including ease of access (37 percent), recommendations from friends or relatives (27 percent), and previous experience with the provider (24 percent). Cost was an issue for 15 percent of users. 5.7 Accessibility of Family Planning Methods In order to obtain further information about the accessibility of family planning services, women who knew at least one family planning method were asked about the length of time (in minutes) that was required to reach the source that they named for family planning services. For current users, the source to which the question referred was the last place at which they obtained the method. For nonusers who planned to use in the future, the source was the place which they named as the source for the method that they intended to adopt. For women who knew a method but did not plan to use, the source was simply a place that they knew provided family planning methods. Overall, 58 percent of current users live within 30 minutes of their source, and only 14 percent live an hour or more from the place where they obtained their method (see Table 5.13). The median time required by current users to reach their source is around 16 minutes. Rural users live around twice as far from a source as urban users. Differences between the travel times reported by users and those reported by the two groups of nonusers are not significant. This suggests that physical access to services is not a major barrier to use among Egyptian women. 83 Table 5.13 T ime to source of supply for modern family p lanning methods Percent distribution of currently marr ied women who are current users of modem methods of family planning. who are nonusers of modem methods, and who know a method, by t ime (m minutes) to reach source of supply, according to urban-rural residence. Egypt 1992 Current users Nonusers of Women who of modern methods modern methods km~w a method Time to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 minutes 44,3 21.8 34.5 36.8 14.6 23.2 40.9 17.3 28.4 15-29 nfinutes 23,8 22 8 23.4 21.3 17.6 19,1 22.7 19.6 21.1 30-59 nfinutes 18.5 31 8 24.3 12.6 20.6 17 5 15.8 24.8 20.6 60+ 10,0 20.0 14.4 4.4 11.4 8.7 7.5 14.6 11 3 Don't know time 1,9 2.0 2 0 5.5 3.8 4.5 3.6 3.2 3 3 Relatives/l:nends 1,3 1.6 1.4 3,5 3.8 3.7 2,3 3 11 2.7 Don't know source 0.0 0.0 0.0 15.2 27.4 22.7 6 8 16.9 12.2 Not stated 0,1 0.0 0.1 0.7 0.7 0.7 0 4 0.5 0.4 Total percentage I(X) O 100.0 100.0 10(I.0 1 (X).O 100.0 101).0 100.0 1000 Number 2315 1783 4098 1966 3089 5055 4273 4844 9117 Median 15,2 30.1 15 8 15.0 25.8 15.7 15.1 3/I.I 15 7 84 CHAPTER 6 USE OF THE PILL AND IUD The majority of contraceptive users in Egypt rely on either the pill or the IUD. The EDHS included a number of special questions relating to the adoption and use of these two methods. In presenting these data, this chapter addresses a number of important issues, including the quality of use of the pill and the cost of family planning services for both pill and IUD users. Information was obtained from pill and IUD users on a number of key service delivery issues that are assumed to influence both the acceptance and use of these methods, including the waiting time for services, the sex of the provider, the information given to users at the time of acceptance and any follow-up by the provider. 6.1 Pill Use Around one-third of all women currently using family planning in Egypt are pill users. In the EDHS, there were a number of questions designed to investigate the quality of pill use. Information was obtained from current users on the brand of pills used in order to assess the extent to which the brand promoted in Egypt's contraceptive social marketing program was being used. Current users also were asked several questions relating to the cost of services. In addition, information was obtained from both current users and past users on their interaction with service providers. This information largely relates to pharmacies, which are the principal source for the pill in Egypt. However, pill users who consulted another medical provider prior to obtaining the pill from a pharmacy also were asked a series of questions about their last visit to that provider. Quality of Pill Use Table 6.1 and Figu re 6.1 include a number of indicators of the extent to which women who reported that they were current pill users may not be taking the pill properly. Clearly, the fact that nearly one in four pill users was unable to show a pill packet to the interviewer is of major concern. When asked the reasons for not having the packet available, 48 percent had misplaced the packet, 19 percent said they did not need to take the pill because they were having their menstrual period, 15 percent had forgotten to buy the packet, 5 percent were "resting," and 3 percent said that their husband was away (table not shown). Users claiming to have misplaced the packet may simply have wanted to avoid taking the time to find the packet for the interviewer, and users reporting that they did not have a packet because they were having a period may have been planning to obtain a packet following the interview. However, other reasons given for not showing a packet ("forgot to buy," "resting," or "husband away") indicate that at least one in five pill users may not be systematically taking the pill although they regard themselves as current users. Among pill users able to show a packet, there also was evidence that not all users are taking the pill systematically. EDHS interviewcrs examined the pill packets to determine if pills were taken in the proper sequence. Overall, 23 percent of all pill users showed the interviewers packets in which pills had apparently been taken out of order (Table 6.1). Table 6.1 also shows that 22 percent of users reported that they had interrupted use for one or more days during the previous month. Among those interrupting use, two-thirds had stopped use because they forgot the pill, misplaced the packet, or run out of supplies (table not shown). Other reasons suggest that use often is interrupted because of concerns about side effects; 14 percent of pill users who missed taking the pill at least once in the month prior to the interview cited menstrual irregularity, spotting or bleeding, other side effects or illness as the reason for not taking the pill. Other reasons for interrupting use included the belief 85 Table 6.1 QuMityofpil l use Percentage of current users of the pill who were unable to show a pill packet, who had taken pills out of sequence, or who had missed taking the pill one or more days during the month before the survey, by select background characteristics, Egypt 1992 Pills Unable taken Missed Number Background to show out of taking of characteristic packet sequence pill women Age 15-19 10.3 10.3 20.9 17 20-24 22.6 17.0 19.0 90 25-29 21.5 21.7 23.9 260 30-34 17.5 27,1 24.9 282 35-39 24.6 23.5 21.0 288 40-44 32.6 20.9 22.3 172 45-49 29.3 28.9 19.6 72 Urban-rural residence Urban 23.6 24,4 23.8 601 Rural 23.0 22. l 21.2 581 Place of residence Urban Govemorates 22.7 32.0 29.6 274 Lower Egypt 25.7 24.0 20.8 565 Urban 27.2 20.1 20.1 194 Rural 24.9 26.1 21.1 371 Upper Egypt 19.8 14.9 19.7 342 Urban 20.0 14.9 17,3 132 Rural 19.6 14.9 21.2 210 Education No education 23.9 25.4 22.7 522 Some primary 22.8 24.8 21.5 338 Primary through secondary 17.9 19.7 25.5 138 Completed secondary/higher 26.6 16,9 21.4 184 Total 23.3 23.2 22.5 1181 that there was no need to take the pill if the husband was away or the couple was not having intercourse (l 1 percent). Looking at the differentials presented in Table 6.1, there is no unilorm relationship between background characteristics such as age, residence and educational level and the indicators of pill use compliance. Further investigation is needed to determine what factors relate to compliance. 86 Percent 4O 30 20 10 0 Unable to Pills taken show pill oul o[ pack sequence Figure 6.1 Quality of Pill Use among Current Pill Users IL M~ssed one or more days during month EDHS 1992 Finally, forgetting to take the pill increases the risk of an unplanned pregnancy for the user. Table 6.2 looks at the action current users report they would take if they missed taking the pill. Almost two-thirds of current users respond that they would take extra pills on the following day or use another method, both of which are appropriate responses to the situation. However, around 20 percent report that they would continue as usual taking only one pill on the day if they forgot. Use of Social Marketing Brands Contraceptive social marketing (CSM) programs distribute, promote and sell contraceptives through commercial outlets. During the period prior to the EDHS, Egypt had an active CSM program, the Family of the Future, which distributed the Norminest brand of pills through a network of pharmacies. To obtain information on the number of users purchasing the Norminest brand, the EDHS interviewers asked to see the packet of pills for each user. If the user bad the packet available, the interviewer recorded the brand. If not, the interviewer asked the user which Table 6.2 Action taken if forgot to take the pill Percent distribution of current users of the pill by action that they would take if they forgot to take two or more pills, Egypt 1992 Action taken Total Start again as usual 18.8 Take extra pills 61.9 Use another method 0.2 Extra pills plus another method 1.7 Other 1.6 Never forgot 15.8 Total 100.0 Number of women 1181 brand she was currently using. Overall, 15 percent of current users were using the Norminest brand. In terms of market share among users, Norminest was in third place behind Microvlar (22 percent) and Nordette (18 percent), but was more widely used than Anovlar (11 percent) or Primovlar (11 percent) (see Figure 6.2). 87 Figure 6,2 Pill Brands Used by Current Pill Users Nofdette 18% Norm~nest 1 5% Anovlar 1 Pnrnovlar ~ 1 Tnovlar 8% <nown 14% EDHS 1992 Table 6.3 shows that the proportion using Norminest varies only slightly by residence; it is highest among users in urban areas in Lower Egypt (18 percent) and lowest among users from Upper Egypt (12 percent). Cost of a Pill Cycle and Willingness to Pay Table 6.4 looks at the information provided by current users about the amount that they paid lor the most recent packet of pills. Virtua/ly all users paid something lo obtain the pill although the amounts paid for a packet were not large; eight in ten users paid 50 piastres or less for a packet, and 20 percent paid 10 piastres or less. The Egyptian family planning program is confronted with the need to consider ways in which it can increase the proportion of the cost of the services that it recovers from program users in order to enhance the program's sustainability. To investigate whether the program might charge higher prices for pill cycles, all current users of the pill were asked about whether they would be willing to pay specific amounts for each pill cycle. The suggesled amounts ranged Table 6.3 Use of social marketing brand pill Percentage of current users of the pill who are using a social marketing brand (Norminest), by urban-rural residence and place of residence, Egypt 1992 Residence Total Urban-rural residence Urban 15.8 Rural 13.8 Place of residence Urban Govemorates 16.5 Lower Egypt 15.7 Urban 17.6 Rural 14.8 Upper Egypt 12.0 Urban 12.0 Rural 12.0 Total 14.8 Number of women 1181 88 from 50 piastres to more than 5 pounds. Table 6.5, which shows the proportion of users will ing to pay specific amounts, suggests that many users would be willing to pay considerably more for a cycle of pills than they currently do. The vast majority of current users indicate that they would be willing to pay 50 piastres for each pill cycle, and more than three in four current users would be willing to pay 1 pound per cycle. The proportion willing to pay a specific amount continues to decrease directly with the suggested price per cycle, from 54 percent who express a willingness to pay 2 pounds per cycle to only 22 percent who are willing to pay more than 5 pounds. Table 6.4 Cost of method for pill users Percent distribution of current users of the pill by cost of a cycle of pills (in piastres), Egypt 1992 Cost of one cycle Total Free 0.3 1-10 piastres 19.9 11-30 piastres 5.1 31-50 piastres 56.4 51-75 piastres 2.8 76-100 piastres 1.8 More than 100 piastres 9.4 Don't know/Missing 4.2 Total percentage 100.0 Number of women 1181 Median 35.8 Mean 38.9 Table 6.5 Amount willing to pay for pills Percentage of current users of the pill indicating willingness to pay various amounts for a cycle of pills, Egypt 1992 Amount Total 50 piastres 95.5 1 pound 78.7 2 pounds 54.2 3 pounds 39 0 4 pounds 32.1 5 pounds 29.4 > 5 pounds 21.9 Number of women 1181 Cost of Consultat ion In addition to paying for pill cycles, two in five current users of the pill reported that they had consulted a doctor or other health provider at the time that they be- gan using the pill. Table 6.6 shows the distribution of pill users reporting such consultations according to the cost of the consultation and the type of provider. Typically pill users consulting a public sector provider said the consultation was free of charge (29 percent) or cost less than 3 pounds (58 percent). Pill users who consult private providers generally paid more for services, with 45 per- cent saying that the consultation charge was between three and five pounds and 29 percent paying a fee of six pounds or more. Table 6.6 Cost of consultation for pill users Percent distribution of current users of the pill who con.suited a doctor/clinic before begirming to use the pill by the cost that they paid for the consultation, according to the type of provider, Egypt 1992 Service provider Cost of Private/ consultation Public Other Total Free 29.3 7.7 13.6 0-2 pounds 58.2 12.4 25.0 3-5 pounds 7 5 44.6 34.4 6-10 pounds 1.1 23.7 17.5 11-20 pounds 0.8 3.6 2.9 21+ pounds 0.6 2.0 1.6 Don't know/Missing 2.4 5.9 5.0 Total 100.0 100.0 100.0 Number of women 131 347 479 Median 0.7 5.4 4.0 Mean 1.1 5.9 4.6 89 Service Delivery Indicators Pharmacies The EDHS investigated a number of aspects of the interaction between the sources of pill services and users of the services. Questions were included about the pharmacy from which users purchased pill cycles and about the serv- ices received from medical providers that the user consulted. The questions were addressed to both current and past users of the pill and, for both groups, referred to the provider from which they had last obtained services. The information ob- tained from both groups of users is subject to recall error, with the level of error likely to vary directly with the length of time since the user adopted the method. Table 6.7 summarizes the information obtained for pill users who reported that they had visited a pharmacy to obtain supplies during the current or most recent episode of pill use. Overall, only 66 percent of ever users of the pill re- ported that they themselves had obtained pill supplies at a pharmacy. Among those saying that they had never visited a pharmacy to obtain the pill, the majority (around two- thirds) indicated that their husband obtained the pill packets, with the remainder saying friends or relatives, including their children obtained the supplies (table not shown). Table 6.7 Information received at pharmacies about the pill Percent distribution of ever users of the ptll who report ever obtaining the pill themselves from a pharmacy by type of information provided at the pharmacy where supplies were obtained for the current/most recent segment of use, according to user status, Egypt 1992 Information Current Past All received users users users To ld about other methods Yes 5.4 11.4 9.8 No 94.3 88.6 90.1 Shown how to use pill Yes 10.7 23.2 20.0 No 89.3 76.8 80.0 S ideef fec ts descr ibed Yes 3.2 6.1 5.3 No 96.8 93.9 94.6 Total 99.9 100.0 100.0 Number of women 753 2] 29 2882 According to the results presented in Table 6.7, there is relatively little interaction between pill users and the staff at the pharmacy from which they obtain their pills. Only around one in ten were told about other methods, only one in five users were shown how to use the pill by pharmacy staff, and only one in twenty received any description of the possible side effects of the pill. Past users were about twice as likely as current users to report getting basic information from the pharmacy staff. To some degree, the limited nature of the information provided to pill users by the pharmacy staff may reflect both the fact that many pill users consult medical providers before obtaining the supplies at the pharmacy and the fact that many pill users have had previous experience with the method. Such users may not address questions to the pharmacy staff nor be perceived by the pharmacy staff as needing any advice. Nevertheless, the results in Table 6.7 suggest that staff of pharmacies might play a greater role in providing information about the pill. The targets of this IE&C effort should include husbands and other persons obtaining pill cycles as well as women who visit the pharmacy themselves. Medical Providers The EDHS resulL~ indicate that two in five ever users of the pill consulted a doctor or clinic prior to adopting the method. Table 6.8 shows that the majority of users (83 percent) had no complaints about the time that they had to wait for services. Ninety-four percent also reported that the consultation included a physical examination; only 6 percent said they were not examined. Regarding the sex of the provider, pill users are more likely to report having been examined by a male than a female doctor. However, consultations with a female doctor were more common than with a male doctor for pill users obtaining services at a public sector provider. 90 Table 6.8 shows the majority of pill users who consulted a health provider before beginning use of the pill were told about how to use the method (90 percent) and about possible side effects of the method (60 percent). A significant proportion (47 percent) also were told about other methods. Two in five pill users also reported returning to the provider for additional consultation or follow-up. There are only slight differences in these measures between current and past users and between users obtaining services from public sector providers and those consulting private sector providers. .Table 6.8 Service delivery indicators for pill users Percent distribution of ever users of the pill who report that they consulted a medical provider when they began using during the current/most recent segment of use by service delivery indicators, according to user status and type of provider, Egypt 1992 Current users Past users All users Service delivery Private/ Private/ Private/ indicator Public Other Total Public Other Total Public Other Total Waiting time too long Yes 10.9 18.9 16.7 20.6 15.6 17.3 18.3 16.6 17.1 No 89.1 81.1 83.3 79.4 84.4 82.7 81.7 83.4 82.9 Had physical examination By male doctor 38.8 59.0 53.5 38.2 64.9 56.0 38.3 63.2 55.3 By female doctor 47.5 38.9 41.3 50.8 31.3 37.8 50.0 33.5 38.7 Not examined 12.5 2.1 5.0 11.1 3.8 6.2 11.4 3.3 5.9 Told about other methods Yes 43.8 53.2 50.6 46.0 44.8 45.2 45.5 47.2 46.7 No 56.2 46.8 49.4 54.0 55.2 54.8 54.5 52.8 53.3 Shown how to use pill Yes 84.5 94.2 91.6 86.4 91.0 89.5 86.0 92.0 90.1 No 15.5 5.8 8.4 13.6 8.9 10.4 14.0 8.0 9.9 Side effects described Yes 60.4 57.6 58.4 56.0 63.5 61.0 57.0 61.8 60.3 No 39.6 42.4 41.6 44.0 36.5 39.0 43.0 38.2 39.7 Returned for follow-up Yes 34.4 35.9 35.5 35.1 44.0 41.1 35.0 41.7 39.6 No 65.6 64.1 64.5 64.9 56.0 58.9 65.0 58.3 60.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 131 347 479 426 852 1278 557 1199 1756 Again, caution should be used in interpreting the findings since the results are subject to recall error. The advice provided to a user at the visit in question may vary according to the experience that the user has with the pill or other methods and the number of times that the user has visited the provider. Nevertheless, the findings suggest there may be need for providers to increase both the information that they provide to clients on methods and side effects and to encourage users to return for follow-up. 91 6.2 IUD Use Three in five women currently using family planning in Egypt are IUD users. As was the case with the pill, the EDHS collected information both on the actual cost of obtaining the method and on the amounts that IUD users indicate they would be willing to pay to get the method. In addition, information was obtained from both current users and past users on basic service delivery measures. Cost of the IUD and Willingness to Pay Table 6.9 looks at the information provided by current users about the amount that they paid for the IUD services. Virtually all IUD users paid something to obtain the method; only 4 percent said that they had obtained the method free of any charge. Among those paying to obtain the IUD, the majority paid 10 pounds or less. The median cost of an IUD from a public sector provider was 4 pounds, compared to 9 pounds for an IUD from a provider operated by a private voluntary or religious organization and 21 pounds for an IUD from a private doctor or clinic. Table 6.9 Cost of method for IUD users Percent distribution of current users of the IUD by cost of the method, according to the type of provider, Egypt 1992 Private Mosque Private voluntary or Public hospital/ organi- church Cost of health chnic/ zation chnic/ method facility doctor clinic Other Total Free 3.9 4.0 1.8 0.0 3.6 < 6 pounds 74.6 5.3 37.8 17.9 41.6 6-10 pounds 12.7 11.3 17.7 38.8 13.8 l 1-15 pounds 5.2 16.2 33.9 26.6 13.2 16-20pounds 1.0 15.9 5 2 11 1 7.7 21-30 pounds 0.8 18.4 1 8 3.2 7.9 31-50 pounds 0.4 14.3 0.9 0.0 5.8 51 pounds or more 0.1 9.4 (1.5 1.2 3 8 Don't know/Missing 1.3 5.2 0.3 1.2 2.7 To tal percentage 100.(1 100.0 100.0 100.0 100.0 Number of women 1199 996 250 109 2555 Median 3 5 20.6 9.2 10.5 7.6 Mean 4.5 22 1 8.9 11 0 12.1 To investigate whether higher prices might bc charged for IUD services, all current users of the IUD were asked about whether they would be willing to pay various amounts for the method. The sug- gested amounts ranged from 5 to more than 200 pounds. Table 6.10, which shows the proportion willing to pay various amounts, indicates that many IUD users would be willing to pay considerably more for the method than they currently do. The vast majority of current users would be willing to pay 5 pounds, and eight in ten would be willing to pay 10 pounds. The proportion willing to pay a specific amount con- tinues to decrease directly with the suggested amount, from 50 percent who express a willingness to pay 25 pounds to only 7 percent who are willing to pay more than 200 pounds. Table 6.10 Amount willing to pay for IUD insertion Percentage of current users of the IUD indicating willingness to pay various amounts to have the IUD inserted, Egypt 1992 Amount Total 5 pounds 95.4 10 pounds 80.7 25 pounds 511.3 50 pounds 26.0 100 pounds 13.7 150 pounds 9.4 200 pounds 8.6 > 200 pounds 6.7 Number of women 2555 92 Service Delivery Indicators Again, as with the pill, the EDHS investigated a number of aspects of the interaction between the providers of IUD services and users of those services. The questions were addressed to both current and past users and referred to experience in the most recent episode of use. The responses are subject to recall error, which is assumed to increase with the length of time since the user visited the provider. The results presented in Table 6. I 1 and Figure 6.3 show that only one in five IUD users complained about having to wait too long for services. Virtually all IUD users reported having a physical examination at the time they obtained the method, and the majority (60 percent) said that a female doctor had examined them. IUD users obtaining services from a public sector provider were somewhat more likely to report that they had seen a female doctor than users who got services from a private sector provider (68 percent and 53 percent, respectively). Table 6,11 Service delivery indicators for IUD users Percent dislxibution of ever users of the IUD by service delivery indicators, according to user status and type of provider, Epypt 1992 Current users Past users All users Service Private/ Private/ Private/ measure Public Other Total Public Other Total Public Other Total Waiting time t~) long Yes 19.3 17.6 18.4 16.5 18.9 17.8 18.4 18.1 18.2 No 80.6 82.4 81.5 83.5 81.1 82.2 81.5 81.9 81.8 Had physical examination By male doctor 27.3 43.9 36.1 35.6 50.6 44,l 30.0 46.3 38.9 By female doctor 71.4 55.8 63.1 62.1 48.6 54.4 68.4 53.2 60.1 Not examined 1.1 0.3 0.7 2.3 0.8 1.4 1.5 0.5 1.0 Told about other methods Yes 27.0 35.9 31.7 27.5 39.6 34.4 27.2 37.2 32.6 No 72.9 64.1 68.2 72.4 60.4 65.6 72.8 62.8 67.3 Shown how to check IUD In place Yes 87.8 89.4 88.7 88.7 90.4 89.7 88.1 89.8 89.0 No 12.0 10.6 11.3 11.3 9.6 10.3 11.8 10.2 10.9 Told about side effects Yes 59.9 70.6 65.6 57.2 62.6 60.2 59.0 67.7 63.7 No 39.9 29.4 34.4 42.8 37.4 39.7 40.9 32.3 36.2 Returned for follow-up Yes 45.2 57.1 51,5 49.6 62.4 56.9 46.7 59.1 53.4 No 54.7 42.9 48.4 50,4 37.6 43.1 53.2 40.9 46.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1199 1355 2554 586 771 1357 1785 2126 3911 93 Looking at the other indicators of service delivery presented in Table 6.11, only one-third of IUD users reported that they were told about other methods at the time that they obtained their IUD. Most (89 percent) were given advice about how to check that the IUD was in place and 64 percent received information on the side effects that they might experience. Slightly more than half of all IUD users indicated that they had returned to the provider for additional consultation or follow-up. In general, IUD users who obtain services from private providers are somewhat more likely than users who obtain services from public providers to report receiving information about other methods and potential side effects and to say that they had returned for follow-up. As was the case with the information from pill users, caution should be used in interpreting the findings. However, the results again suggest that both private and public sector providers offering family planning services need to improve the information that is given to clients and to encourage users to return for follow-up. Percent 100 80 60 40 20 0 Had physical exam Note Ind~calors are for most recent segment of use Figure 6,3 Service Delivery Indicators among Ever Users of the IUD Told abOul Shown how I0 Told about Relurned fo{ other methods check lUO side effects Iollow-up EDF~S1992 94 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE This chapter focuses on women who are not using family planning and presents information on the following topics: levels of family planning discontinuation, masons for discontinuation, reasons for nonuse, intention to use in the future, timing of future use, and the methods preferred by potential users. The information presented in the chapter is important in evaluating the prospects for family planning acceptance among women who aN not currently using a family planning method. 7.1 Discontinuation Rates A key concern for family planning programs is the rate at which users discontinue use of contraception and the reasons for such discontinuation. Life table contraceptive discontinuation rates based on information collected in the calendar in the EDHS questionnaire aN presented in Table 7.1. All episodes of contraceptive use between January 1987 and the date of interview were recorded in the calendar, along with the main reason for any discontinuation of use during this period. In addition, in order to obtain the duration of the first episode of use occurring in the calendar period, any woman using in January 1987 was asked about the date that she had started that period of use. These women enter the life table at their duration of use as of January 1987. Thus, the discontinuation rates presented in Table 7.1 refer to all episodes of use in the period of time covered by the calendar, not just those episodes that began during the calendar period. Specifically, the rates are based upon episodes of use during the 60-month period 3-63 months prior to the EDHS. In calculating the rates, the month of interview and the two preceding months are ignored in order to avoid the bias that might be introduced by an unrecognized pregnancy. Table 7.1 Contraceptive discontinuation rates One-year contraceptive discontinuation rates due to method failure, desire for pregnancy, health reasons, or other reasons, according to specific methods, Egypt 1992 Reason for discontinuation Side To effects/ All Method become health other All Method failure pregnant concerns reasons reasons Pill 8.7 5.0 19.5 8.9 42.1 IUD 1.5 2.3 7.6 1.1 12.5 Condom 4.4 6.3 10.3 26.5 47.5 Periodic abstinence (19.3) (5.9) (2.1) (13.3) (40.5) Prolonged breastfeeding 10.3 1.4 0.1 13.2 25.1 Total 5.7 3.6 12.5 7.2 29.0 Note: Figures are based on life-table calculations. Values in parentheses are based on fewer than 125 person-months of exposure. The rates presented in Table 7.1 are cumulative one-year discontinuation rates and represent the proportion of users discontinuing by 12 months after the start of use. The rates are calculated by dividing the number of discontinuations at each duration of use in single months by the number of months of exposure at that duration. The single-month rates arc then cumulated to produce a one-year rate. In calculating the rates, the reasons for discontinuation are trcated as competing risks (net rates). For purposes of the table, the 95 reasons are classified into four main categories: method failure, desire to become pregnant, side effects/health reasons, and all other reasons. The results in Table 7.1 indicate that almost three in ten users in Egypt stop using within 12 months of starting use; 6 percent stop using due to method failure, 4 percent because they want to become pregnant, 13 percent as a result of side effects or health concerns, and 7 percent for other reasons. The one-year discontinuation rates vary by method. The rate for the pill is considerably higher than for the IUD (42 percent and 13 percent, respectively). Rates for the condom (48 percent) and periodic abstinence (41 percent) are higher than that for prolonged breastfeeding (25 percent). Looking at the reasons for discontinuation of the pill, 20 percent of users discontinue during the first year of use because of side effects and health concerns, 9 percent due to method failure, 5 percent as a result of the desire to become pregnant, and 9 percent for all other reasons. IUD users are most likely to discontinue during the first 12 months because they experience side effects or have health concerns(8 percent); only 2 percent report stopping because they became pregnant. Although significant proportions of condom users discontinue due to method failure (4 percent), the desire to become pregnant (6 percent), and side effects or health concerns (10 percent), other reasons (27 percent) are more important, particularly those relating to the convenience and perceived efficacy of the method. Method failure is clearly an issue for users relying on traditional methods; 19 percent of periodic abstinence users and 10 percent of users relying on prolonged breastfeeding stop use because they become pregnant. 7.2 Reasons for Discontinuing Use of Family Planning Table 7.2 and Figure 7.1 present information on the reasons women give for discontinuing use of a family planning method. The table is based on all discontinuations occurring during the five years preceding Table 7.2 Reasons for discontining use of family planning Percent distribution of discontinuations of family planning methods In the last five years by main reason for discontinuation, according to specific method, Egypt 1992 Periodic Prolonged Main reason for absti- breast discontinuafon Pill IUD Condom hence feeding Total Became pregnant 22.5 8.8 18.7 50.0 29.4 18 7 To become pregnant 16.0 26.0 16.6 22.0 8.5 18.8 Husband disapproved 0.9 0.4 4.8 3.7 0.0 1 2 Side effects 32.7 38.0 11.8 1.2 1.3 30.4 Health concerns 10.9 11.7 6. l I).0 3 5 10.2 IUD expelled 0.0 1.0 0.4 0.0 0.0 0.4 IUD expired 0.0 1.3 0.1 0.0 0.0 0.4 Switch method/rest 0.8 3.3 4.3 0.0 0.1 1.8 More effective method 1.6 0.2 15.3 11.5 19.7 3.3 Inconvenient to use 1.0 0.6 7.9 2.1 7.6 1.8 Access/availability 0.2 0.1 0 5 0.0 0.0 0.3 Cost 0.0 0.0 0.0 0.0 0.0 0.0 Doctor's advice 0.0 0.3 0.0 0.0 0.1 0.2 Breasffeeding eods/penod returns 0.l 0.0 1 5 0.0 26.8 1.5 Infrequent sex 9.5 4.1 8.3 7.1 0.3 7.1 Marital dissolution 0.6 2 6 1.2 (1.3 0.0 1.3 Menopause 1.5 0.9 2.2 1.3 0.0 1.2 Fatalistic 0.3 0 2 0. l 0.2 0.9 0.3 Other 1.2 0.6 0.3 0.6 1.9 1.1 Don't know 0.1 0.1 0.0 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 2414 1616 269 112 258 4925 96 Figure 71 Reasons for Discontinuing Use of Family Planning Methods To become pregnanl 19% came pregnant 19% S~de effects 30% Other 12% Health concerns 10% Other melhod related 10% NoTe Figures are for dlSCOntlnuatlons during the bye year period preceding the survey EDHS1992 the survey, regardless of whether they occurred during the first 12 months of use or not. Taking into account all methods, side effects (30 percent) is the reason given most frequently for discontinuation, followed by the desire to get pregnant, and becoming pregnant while using (19 percent each). Looking at the pattems for specific methods, discontinuation due to method failure is high for all methods except the IUD, peaking at 50 percent for periodic abstinence. The desire to become pregnant is mentioned somewhat more often as the reason for discontinuing use of the IUD and periodic abstinence than of other methods. Not surprisingly, side effects and health concerns are less frequently mentioned as masons for discontinuation of traditional methods than they are in the case of the pill (44 percent) and the IUD (50 percent). A significant proportion of condom users and users of both periodic abstinence and prolonged breastfeeding discontinue use because they want a more effective method. Around one-quarter of all discontinuations by users of prolonged breastfeeding are due to the fact that the woman's menstrual period retums or the child is weaned. 7.3 Future Use of Family Planning To obtain information about potential demand for family planning services, all currently married women who were not using contraception at the time of the survey were asked about their interest in adopting family planning in the future. Table 7.3 presents the distribution of currently married women who were not using family planning by their intention to use in the future, according to the number of living children. Forty-six percent of nonusers said that they intended to use family planning in the future, 29 percent within the next 12 months. The proportion intending to use peaks at 53 percent among nonusers with two children. The timing of the intention to use also varies with the number of living children; nonusers with no children 97 Table 7.3 Future use of family planning Percent distribution of currently married women who are not using a family planning method by past experience with family planning and intention to use in the future, according to number of living children, Egypt 1992 Past experience with family planning and future intentions Number of living children 1 0 1 2 3 4+ Total Never used family planning Intend to use in next 12 months 1.5 21.0 18.5 12.7 10.9 13.1 Intend to use later 23.0 14.5 4.3 5.0 3.7 8.2 Unsure as to timing 6.0 6.0 2.4 1.6 1.9 3.2 Unsure as to intention 14.7 10.2 4.7 4.6 2.3 5.9 Do not intend to use 53.3 32,9 28.7 27 3 29.0 32.2 Previously used family planning Intend to use in next 12 months 0.3 3.2 20.4 24.0 211.5 15.6 Intend to use later 0.0 3.7 4.9 2.7 2.9 3.0 Unsure as to timing 0.0 1.5 2.4 3.8 3.0 2.4 Unsure as to intention 0.0 1,2 3.4 3.7 2.9 2 5 Do not intend to use 1.1 5.9 10.1 14.6 22.9 14.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 All currently married nonusers Intend to use in next 12 months 1.7 24.2 38.9 36.7 31.4 28.7 Intend to use later 23.0 18.1 9.2 7.7 6.6 11.2 Unsure as to timing 6.1 7.6 4.8 5.4 4.9 5,6 Unsure as to intention 14.7 11.3 8.2 8.3 5 2 8.3 Do not intend to use 54.5 38.8 38.8 41.9 51 9 46.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 575 844 809 720 1895 4843 1Includes current pregnancy or only one child are much less likely than nonusers with two or more children to express an intention to use within the next 12 months. Looking at the relationship between previous use of family planning and intention to use in the future, those who intend to use in the future are somewhat more likely to have never used than to have used in the past. This is due in part to the fact that the nonuser group includes more never-users than past-users. Considering never-users as a group by themselves, they are much less likely than past-users to express a desire to use in the future; three in five never-users do not plan to use in the future or are unsure about their intentions compared to around two in five past-users. 98 7.4 Reasons for Nonuse of Family Planning The reasons given by women who do not use family planning are of particular interest to the family planning program in Egypt. Table 7.4 presents the distribution of currently married non- users who do not intend to use in the future by the main reason for not using. The primary reason for not using is the desire to become pregnant; 27 percent of nonusers said that they were not using because they wanted more children. Concem about possible difficulty in becoming pregnant (24 percent) was the next most common reason for nonuse. Other often-mentioned reasons in- cluded a fatalistic aUitude (9 percent), health concems (8 percent), husband's disapproval (3 percent), and a lack of need for contraception because the woman was menopausal or had had a hysterectomy (13 percent) or the couple had sex infrequently (7 percent). Only 1 percent men- tioned religion as a reason for nonuse. There are significant differences in the answers given by women under age 30 and those 30 and over. Nonusers under age 30 are more likely than older nonusers to mention the desire Table 7.4 Reasons for not using family planning Percent distribution of currently married nonusers who do nol intend to use in the future by main reason for not using, according to age, Egypt 1992 Age Main reason for not using family planning 15-29 30 49 Total Want children 58.6 13 5 26.9 Lack of knowledge 0.2 0.4 0.3 Side effects 4.5 2.3 2.9 Health concerns 3.9 9.8 8.1 Hard to get methods 0.2 0.0 0.1 Costs too much 0.1 0.1 0.1 Inconvenient 0.3 0.5 0.4 Religion 2.4 0.5 1.0 Opposed to family planning 0.3 0.3 0.3 Husband opposed 7.1 1.8 3.4 Other people opposed 0.8 0.1 0.3 Fatalistic 5.1 11.2 9.4 Infrequent sex 4.1 8.3 7.1 Difficult to be pregnant 8.6 30.2 23.7 Menopausal/Had hysterectomy 0 2 18 0 12.7 Other 1.3 2.0 1.8 Don't know 2.5 1.0 1.4 Total 100.0 100.0 I00.0 Number of women 665 1573 2239 to have more children (59 percent and 14 percent, respectively), while concern about possible difficulty in becoming pregnant is mentioned by more older nonusers than younger nonusers (30 percent and 9 percent, respectively). As might be expected, lack of need for contraception because the woman was menopausal or had had a hysterectomy was a reason given almost exclusively by older nonuser. Infrequent sex, a fatalistic attitude, and health concerns also were reasons mentioned more often by nonuscrs age 30 and ovcr than by those undcr age 30. 7.5 Preferred Methods of Family Planning among Nonusers Method preferences among currently married women who were not using a family planning method at the time of the survey but who intended to use a method in the future are shown in Table 7.5. The IUD and pill are the most popular methods among users in Egypt. Therefore, it is not surprising that over 40 percent of nonusers who intend to adopt a family planning method mention the IUD as the preferred method and 20 percent express a preference for the pill (see Figure 7.2). The only other modem method preferred by more than one percent of nonusers is injection (4 percent). A significant proportion of nonusers also mention prolonged breastfeeding as the method that they intend to use (14 percent). There is little variation in method preferences according the timing of future use. Nonusers intending to use within the next 12 months are somewhat more likely to express a preference for the IUD (47 percent) than nonusers planning to use after 12 months (34 percent) or are uncertain about when they will begin using (38 percent). The proportion expressing a preference for prolonged breastfeeding also varies somewhat with the timing of future use. 99 Figure 7,2 Preferred Method among Nonusers Who Intend to Use in the Future IUD 48 J rllecLRu[ i ¢¢~ Prolonged breastfeedmg 14% ~ethod 3% Unsure aboul method 16% The popularity of the IUD and pill among nonusers intending to use in the future raises a number of challenges for the Egyptian family planning program. Providers trained to insert the IUD must be available to meet the increased demand in both the public and private sector. Efforts must also be directed toward improved counseling for new users of both methods to reduce discontinuation. Table 7.5 Preferred method of famdy planning for future use Percent distribution of currently married women who are not using a family planning method but who intend to use in the future by preferred method, according to whether they mtend to use in the next 12 months or later, Egypt 1992 Intend to use In next After Unsure Preferred method 12 12 as to of family planning months months timing Total Pill 19.8 22.0 20.4 20.4 IUD 47.3 33.6 37.5 42.7 Injection 4.7 4.8 2.2 4.4 Norplant 0.4 0.5 0.7 0.5 Diaphragm/foam/jelly 0.2 0.0 0.7 0.2 Condom 0.8 0.1 0.1 0.5 Female sterilization 1.1 0.5 0.9 1.0 Periodic abstinence 0.4 0.1 0.6 0.3 Withdrawal 0.3 0.1 0.0 0.2 Prolonged breastfeeding 12.1 19.5 16.2 14.4 Other 0.1 0.0 0.0 0.1 Not sure 12.8 18,8 20.6 15.2 Total 100.0 100.0 100.0 100.0 Number of women 1388 541 269 2199 100 CHAPTER 8 FERTILITY PREFERENCES The Egypt DHS included a number of questions to ascertain fertility preferences. The value of the responses to these questions for predicting the future childbearing behavior of individual women is questionable. Women's attitudes toward childbearing change over time. Moreover, women may not be able to act on their preferences due to societal pressures or the desires of other family members, particularly the husband. Overall, however, the data on fertility preferences provides an indicator of the direction that future fertility will take, as well as an assessment of the need for family planning and the extent of unwanted fertility. 8.1 Des i re fo r More Ch i ld ren In order to obtain information on future childbearing intentions, currcntly married respondents were asked: "Would you like to have another child or would you prefer not to have any more children?" I f they did indeed want another child, they were asked: "How long would you like to wait from now before the birth of another child?" I f the woman had not yet had any children, these questions were appropriately phrased, and i f the woman was pregnant, she was asked about her desire for more children after the baby she was expecting. The small number of respondents who reported current use of female sterilization or male sterilization were not asked about their future childbearing desires; they are classi fled as wanting no children in the tabulations on childbearing intentions. Almost two-thirds of married women do no want any more children (see Table 8.1 and Figure 8.1). Among women who express a desire for another child, the majority want to delay the next birth two or more years; only 12 percent of married women want another child within two years. Not surprisingly, the desire to have a child soon is most prevalent among women who have not yet begun childbearing; 86 percent of women with no children want a birth soon. Among women with one child, the majority (62 percent) want to delay the next birth. The desire to cease childbearing rises dramatically among women with more than one Table 8.1 Fertility preferences by number of living children Percent distribution of currently married women by desire for more children, according to number of living children, Egypt 1992 Number of living children I Desire for more children 0 1 2 3 4 5 6+ Total Have another soon 2 85.7 24.4 10.3 4.5 2.2 1.5 1.0 12.0 Have another later 3 5.2 62.1 24.5 9.7 4.4 2.5 I. l 15.9 Have another, undecided when 1.8 2.0 0.7 0.7 0.1 0.4 0.0 0.7 Undecided 0.8 1.5 3.8 2.5 2.5 1.2 2.0 2.2 Want no more 1.9 8.7 58.8 79.5 87.5 88.5 90.6 65.6 Sterilized 0.0 0.1 0.2 1.0 1.4 2.2 2.5 1.1 Declared infecund 4.6 1.2 1.7 2.1 2.0 3.6 2.8 2.3 Total lO0.O 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 578 1215 1641 1705 1425 1053 1535 9153 1Includes current pregnancy ~Want next birth within 2 years Want to delay next birth for 2 or more years 101 Figure 8,1 Fertility Preferences Currently Married Women 15-49 Want no more 66"% Uncertain 3% Stenhzed/ Infecund 3,% Have another chdd soon (<2 yrs) 12% ,re another child ar (_>2 years) 16% EDHS 1992 child; the proportion wanting no more children increases from almost 60 percent of women with two children to over 90 percent of women with six or more children. Table 8.2 shows the distribution of currently married women by desire for more children, according to age. The desire to space births is concentrated among young women (under age 25). Interest in limiting childbearing increases rapidly with age, from around 10 percent among women 15-19 to over 80 percent among women 40-49. Table 8.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Egypt 1992 Desire for Age of woman more children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another SOon t 36.5 20.1 14.5 10.8 7 5 5 5 2.9 12 0 Have another late~ 48.4 43.0 23.9 9.0 3.3 0.8 0.4 15.9 Have another, undecided when 2.1 1.3 0.7 0.6 0.6 0.1 0.4 0.7 Undecided 2.0 2.9 3.0 1.8 3.0 1.3 0.5 2.2 Want no more 10.7 32.6 57.6 76.3 82.5 84.7 80.4 65.6 Sterilized 0.0 0.0 0.1 0.8 1.5 2.6 3.6 1.1 Declared infecund 0.3 0.2 0.1 0.7 1.7 5.1 11.8 2.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 415 1324 1956 1743 1582 1231 902 9153 1Want next birth within 2 yeats 2Want to delay next birth for 2 or more years 102 Table 8.3 looks at the variation in the proportion of women wanting no more children with the number of living children for various subgroups. The results suggest that urban women begin to want to limit family size at lower parities than rural women. For example, nearly 70 percent of urban women with two children say that they do not want another child compared to less than 50 percent of rural women. Urban- rural differentials narrow but remain evident as the number of living children increases. Table 8,3 Desire to limit childbearing Percentage of currently married women who want no more children, by number of living children and selected background characteristics, Egypt 1992 Number of living children t Background characteristic 0 l 2 3 4 5 6+ Total Urban-rural residence Urban 2.7 13.3 68.3 88.4 94.4 94.6 94.1 70.2 Rural 1.2 4.3 47.2 71.6 83.6 88.2 92.7 63.7 Place of residence Urban Govemorates 1.0 16.0 69.0 87.6 94.5 93.4 94.8 70.1 Lower Egypt 2,1 7.7 63.0 87.2 92.0 93.7 94.5 70.9 Urban 2,7 12.4 69.9 91,7 95.3 94,9 92.5 71,4 Rural 1,8 5.4 59.1 84,7 90.4 93,3 94.9 70.6 Upper Egypt 2.4 5.2 43.7 63.9 81.1 85,8 91.3 59.6 Urban (8.1) 8.9 64,6 85.6 93.2 96.7 94.3 69.0 Rural 0.7 3.1 30.8 54.6 74.9 81.7 90.5 55.7 Education No education 2.1 7.2 51.2 74.0 87.1 88.2 92.4 69.2 Some primary 0.2 12.5 57.5 84.4 89.4 92.7 94.7 74.2 Primary through secondary 4.0 12.0 65.6 83,2 92.6 97.6 98.1 67.3 Completed secondary/higber 2.0 7.7 64,9 86.0 91.4 95.8 (77.7) 53.1 Work status Working for cash 2.2 13.4 71.8 89.3 92.7 87.5 96.8 68.5 Not working for cash 1.9 S.0 55.4 78.4 88.4 91.0 92.9 66.5 Total 1,9 8.8 59.0 80,5 88.9 90.7 93.1 66.8 Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 25 to 49 women. llncludes current pregnancy Considering the differentials by place of residence, the proportion wanting no more children among married women living in rural Upper Egypt is only 56 percent compared to around 70 among women living in the other areas. However, as Figure 8.2 shows, this proportion represents a very substantial increase over the proportion of married women from rural Upper Egypt reported as wanting no more children in the 1988 Egypt DHS (44 percent). The marked change in fertility preferences parallels the sharp increase in contra- ceptive practice in rural Upper Egypt discussed earlier. 103 Figure 8,2 Percentage of Currently Married Women Who Want No More Children by Place of Residence, 1988 and 1992 Percent 80 60 40 2O o Urban Governorales Total Urban Rural Coral Urbar Lower Egypt Upper Egypl Rural EDHS 1992 The absence of a definite association between educational level and the proportion wanting no more children among all women is at least partially a result of the concentration of more educated women at lower parities, where women are more likely to express a desire for more children. Among married women with two or more children, a positive association between the number of living children and educational level is clearly evident. Women working for cash are more likely than other women to want no more children, with the relationship being particularly strong among women with two to four living children. 8.2 Need for Family Planning Services Information on fertility preferences alone is not sufficient to assess the need for family planning services. Many women who do not want to have another child or who want to space the next birth are already using contraception or are not exposed to the risk of pregnancy because they are menopausal or infecund. The estimates of unmet need and of met need lor family planning services, and of the total demand services presented in Table 8.4 take into account these as well other factors. Specifically, unmet need for family planning (shown in columns I-3 of Table 8.4) is defined as including: a) women who are pregnant or amenorrbeic and whose last birth was mistimed and b) women who are neither pregnant nor amenorrhcic and who want no more children or want to space the next birth, but are not using contraception. Menopausal and infecund women are excluded from the unmet need category as are pregnant or amenorrheic women who became pregnant while using a method (these women are in need of better contraception). Met need for family planning (shown in columns 4-6) includes women who are currently using contraception. Total demand for family planning (shown in columns 7-9) represents the sum of unmet need and met need and, in addition, includes pregnant and amenorrheic women who became pregnant while using a family planning method. The percentage of the total demand that is satisfied is shown in the last column of Table 8.4. 104 Table 8.4 Need for family planning services Percentage of currently married women with unmet need for family planning, met need for family planning, and the total demand for family planning services, by selected background characteristics, Egypt 1992 Met need for Unmet need for family planning Total demand for Percentage family planning I (currently using) 2 family planning 3 of demand Number Background For For For For For For saris- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fled women Age 15-19 21.6 2.2 23.8 10.8 2.4 13.3 33.8 4.9 38.7 38.6 415 20-24 16.2 6.7 22.9 17.1 12.6 29.7 34.4 20.3 54.7 58.1 1324 25-29 9.9 12.8 22.7 13.2 32.7 46.0 24.1 46.7 70.8 67.9 1956 30-34 3.6 16.1 19.8 7.2 51.6 58.8 11.3 70.2 81.5 75.8 1743 35-39 3.1 18.0 21.0 3.1 56.5 59.6 6.3 76.0 82.3 74.5 1582 40-44 0.8 16.4 17.2 0.7 54.9 55.5 1.4 72.2 73.6 76.7 1231 45-49 0.3 11.0 11.3 o. 1 34.3 34.5 0.5 45.4 45.8 75.2 902 Urban-rural residence Urbatt 4.5 10.7 15.2 9.8 47.2 57.0 14.8 58.8 73.7 79 3 4281 Rural 8.8 15.5 24.3 6.1 32.3 38.4 15.4 49.4 64.8 62.5 4873 Place of residence Urban Governorates 4.1 9.3 13.4 10.2 48.9 59.1 15.2 59.1 74.3 82.0 2201 Lower Egypt 5.8 11 9 17.7 8.4 45.1 53.5 14.5 58.5 73.1 75.8 3746 Urban 3.9 10.7 14.6 10.3 50.1 60.3 14.2 61.7 75.9 80.8 1120 Rural 6.6 12.4 19.0 7.6 42.9 50.5 14.7 57.2 71.8 73.6 2626 Upper Egypt 9.8 17.7 27.5 5.5 25.9 31.4 15.8 447 60.5 54.6 3207 Urban 6.2 14.2 20.3 8.3 39.8 48.1 14.8 54.9 69.7 70.9 960 Rural 11.4 19.2 30.5 4.3 19.9 24.3 16.3 40.3 56.6 46.0 2247 Education No education 7.3 I7.2 24.6 3.7 33.8 37.5 11.5 52 3 63.8 61.5 4363 Some primary 5.2 134 18.7 5.7 47.8 53.5 11.3 63.1 74.4 74.9 1913 Primary through seconda.,T 7.0 11.3 18.3 9.9 46.3 56.1 17.7 58.4 76.1 75.9 1010 Completed second- ary/higher 7.1 4.9 12.0 184 39.6 58.0 26.2 45.4 71.6 83.3 1867 Work s~alus Working for cash 4.7 10.1 14.8 11.0 47.2 58.3 16.1 58.4 74.5 80.1 1317 Not working for cash 7.1 138 21.0 7.3 37.9 45.2 15.0 53.0 68.0 69.2 7836 Total 6.8 13.3 20.1 7 8 39.3 47.1 15.1 53.8 69.0 70.9 9153 IUnmet need for spacing includes pregnant women whose pregnancy was misumed, amenorrhelc women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of farmly planning and say they want to wait 2 or more years for their next hirth. Also included in unraet need for spacing ale women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for hmittng refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted and women who are neither pregnant nor amenorrheic and who are not using any method oF family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrheic women who became pregnant while using a method (these women are in need of better contraception). Also excluded are menopausal or infecund women. 2Using for spacing is defined as women who aw using some method of farmly planning and say they want to have another child or are undecided whether to have another. Using for hmJtlng is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3Total demand includes pregnant or amenorrheic women who became pregnant while using a method (method failure). 105 According to Table 8.4, one in five married women in Egypt is in need of family planning services. Combined with the 47 percent of married women who are currently using a contraceptive method, the total demand for family planning comprises almost 70 percent of married women in Egypt. Presently, 71 percent of the total demand for family planning in Egypt is met (last column). Significantly, only 52 percent of the potential demand for services to space births is being met compared to 73 percent of the demand for limiting. As is evident in the first column of Table 8.4, interest in spacing births is largely concentrated among young women (under age 25), and greater efforts are obviously required to meet the needs of these women, Unmet need is greater among rural than urban women (24 percent and 15 percent, respectively). Considering place of residence, unmet need varies from 13 percent in the Urban Governorates to 31 percent in rural Upper Egypt. Unmet need varies inversely with educational level, from a high of 25 percent among women who never attended school to only 12 percent among women with a secondary education. This is due to the fact that a much higher proportion of educated women are using family planning, leading to a larger proportion of their demand being satisfied. Finally, unmet need is less among women who work than among other women (15 percent and 21 percent, respectively). 8.3 Ideal and Actual Number of Children Table 8.5 shows the distribution of ever-married women by ideal family size, according to number of living children. In responding to the question on ideal family size, a woman was required to perform the difficult task of considering, abstractly and independently of her family size, the number of children that she would choose if she could start again. The results in Table 8.5 indicate that many women found it hard to respond to this question. Overall, 19 percent of ever-married women were unable to give a numeric response. Table 8.5 Ideal number of children Percent distribution of ever-married women by ideal number of children and mean ideal number of chddren for ever-married women and for currently married women, according to number of living children, Egypt 1992 Number of living children 1 Ideal number of children 0 1 2 3 4 5 6+ Total 0 0.0 0.2 0.3 0.3 0.3 0.7 0.3 0.3 1 7.9 4.4 2.5 3.2 1.4 0.7 0.8 2.6 2 52.0 52.8 52.1 33.2 32.8 24.5 18.0 36.9 3 14.1 21.4 21.4 35.5 16.2 21.3 21.2 22.6 4 7.3 7.2 9.1 10.0 24.8 13.9 19.9 13.7 5 1.8 0.8 1.1 1.6 1,8 7.0 3.1 2~3 6+ 1.5 1.1 1.2 1.7 1.8 3.5 6.3 2.5 Non-numeric response 15.3 12.2 12.3 14.5 21.0 28.4 30.3 19.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 670 1339 1755 1810 1529 1127 1634 9864 Mean ideal number 2.4 2.5 2.5 2.8 3.0 3.2 3.5 2.9 Number of ever-married women 568 1176 1539 1548 1208 807 1139 7985 Mean for currently married women 2.4 2.4 2.5 2.8 3.0 3.2 3.5 2.8 Number of currently married women 499 1083 1447 1458 1136 754 1070 7447 Note: The mean excludes women who gave non-numeric responses. tlncludes current pregnancy 106 Childless women were somewhat more likely than women with one or two children to give a non-numeric answer; otherwise, the proportion giving non-numeric answers increased significantly with the number of children that a woman already had. In considering the findings in Table 8.5, it is also important to remember that the actual and ideal number of children tend to be related. There are several reasons for the relationship. First, to the extent that women implement their preferences, those who want larger families will tend to achieve larger families. Second, women may adjust upwards their ideal size of family, as the actual number of children increases (i.e., rationalization). It is also possible that women with large families, being on average older than women with small families, have larger ideal sizes, because of attitudes that they acquired 20 to 30 years ago. Despite the likelihood that some rationalization occurs, it is common to find that respondents state ideal sizes lower than their actual number of surviving children. Table 8.5 shows that most women want small families. More than one-third of ever-married women prefer a two-child family, and another fifth consider a three-child family ideal. Less than 5 percent want five or more children. Among women giving numeric answers, the mean ideal family size is 2.9 children. As expected, higher parity women show a preference for more children; the mean ideal family size increases from 2.4 children among childless women to 3.5 among women with six or more living children. Many women in Egypt have had more children than they would now prefer. Overall, two in five women who gave a numeric answer to the ideal family size question expressed a preference for fewer children than they actually have. As expected, the disparity between the ideal and actual number of children tends to increase with the actual number of children; among women giving numeric answers, the proportion preferring a smaller family than they actually have increases from less than 2 percent of women with two or fewer children to more than 90 percent of women with six or more children. Table 8.6 takes age into account in examining the variation in the mean ideal family size among various subgroups. The mean ideal family size increases directly with age, from 2.5 children among ever- married women 15-19 to 3.2 children among women 45-49. Other differentials in Table 8.6 parallel the differentials observed in actual fertility levels; the mean ideal family size is greater among rural women, women from Upper Egypt, women never attending school, and women who are not working for cash than among other women. The largest mean ideal family size--3.5 childmrv--is found among women in rural Upper Egypt. Nevertheless, comparing this figure with the total fertility rate for rural Upper Egypt--for the three-year period before the survey--5.97 births per woman--indicates that, at current fertility levels, the average rural woman in Upper Egypt is having more than two children more than shc would prefer. 107 Table 8.6 Mean ideal number of children by background characteristics Mean ideal number of children for ever-married women, by age and selected background characteristics, Egypt 1992 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Urban-rural residence Urban 2.3 2.5 2.5 2.6 2.8 2.7 2.9 2.6 Rural 2.6 2.7 2.9 3.2 3.3 3.4 3.7 3.1 Place of residence Urban Governorates (2.4) 2.4 2.4 2.6 2.7 2.8 2.9 2.6 Lower Egypt 2.2 2.4 2.6 2.7 2.9 2.9 3.2 2.7 Urban * 2.3 2.5 2.5 2.8 2.6 2.8 2.6 Rural 2.3 2.4 2.6 2.8 3.0 3.0 3.3 2.8 Upper Egypt 2.8 3.0 3.0 3.4 3.4 3.5 3.9 3.3 Urban (2.6) 2.7 2.6 2.9 3.0 2.7 3.3 2 8 Rural 2.8 3.1 3.3 3.7 3.7 4.0 4.3 3.5 Education No education 2.5 2.8 2.9 3 1 3.2 3.2 3.5 3.1 Some primary 2.6 2.6 2.7 3.0 3.0 3.0 3.1 2.9 Primary through secondary 2.5 2.4 2.6 2.5 2.7 2.7 2.7 2.6 Completed secondary/higher * 2 5 2.4 2.5 2.6 2.5 3.0 2.5 Work status Working for cash * 2.5 2.4 2.6 2.6 2.6 2.8 2.6 Not working for cash 2.5 2.6 2.7 2.9 3.1 3.1 3.3 2.9 Total 2.5 2.6 2.7 2.9 3.0 3.0 3.2 2.9 Note: Figures in parentheses are based on 25 to 49 women, while an asterisk means the figure is based on fewer than 25 women and has been suppressed. 8.4 Fertility Planning There are two approaches to measuring the level of unwanted fertility using EDHS data. The first approach is based on the responses to a question as to whether each birth was planned (wanted then), unplanned (wanted later), or not wanted at all. Measures based on these data are likely to underestimate unwanted fertility because women may rationalize mistimed or unwanted pregnancies and declare them as wanted once the children are born. Table 8.7 shows the percent distribution of births in the five yea~ before the survey by whether the birth was wanted then, wanted later, or not wanted. Overall, more than one-third of the births in the five-year period can be considered as unplanned; 26 percent were not wanted at the time that they were conceived, and 9 percent were reported as mistimed (wanted later). The proportion of unplanned births increases directly withthebirthorderofthechild. Half of all fourth and highcr ordcr births were unwanted. Similarly, alarge proportion of births to older women are unwanted--nearly 60 percent of the births to women 35-39 and 70 percent or more of the births to women age 40 and older. At current fertility levels, almost one in six births 108 Table 8.7 Fertility planning status Percent distribution of births in the five years preceding the survey by fertility planning status, according to birth order and mother's age, Egypt 1992 Planning status of birth Birth order Number and mother's Wanted Wanted Not of age then later wanted Missing Total births Birth order 1 95.5 3.8 0.7 0.0 100.0 2085 2 75.8 19.6 4.6 0.0 100.0 1826 3 67.2 11.3 21.3 0.2 100.0 1568 4+ 44.2 6.1 49.6 0.0 100.0 4159 Age at birth <20 87.8 8.8 3.4 0.0 100.0 1043 20-24 77.0 12.5 10.5 0.0 100.0 2943 25 29 64.7 10.3 24.9 0.1 100.0 2741 30-34 51.7 5.5 42.8 0.0 100.0 1697 35-39 38.8 3.4 57.7 0.0 100.0 90(1 40-44 28.3 1.2 70.5 0.0 100.0 302 45-49 25.2 0.0 74.8 0.0 100.0 12 Total 65.11 9.0 25.9 0.0 100.0 9638 Note: Birth order includes current pregnancy. occur to women in these age groups, indicating the significant impact that the avoidance of unwanted births among older women might have on fertility levels. Childbearing among older women and high-parity mothers also involves increased mortality and morbidity risks for the mothers and their children, providing another reason for greater effort to help these mothers prevent unwanted pregnancies. The second approach to measuring unwanted fertility is to calculate what the fcnility rate would be if all unwanted births were avoided. The wanted fertility rate is calculated in the samc manner as the total fertility rate, but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as those which exceed the number considered ideal by the respondent. (Women who do not report a numeric ideal family size are assumed to want all their births). Thesc rates may be underestimated to the extent that women are unwilling to report an ideal family size lower than their actual family size. Table 8.8 presents the total wanted fertility rate and the total fertility rate for the three-year period before the survey by selected background characteristics. A comparison of the two rates suggests the potential demographic impact of the elimination of unwanted births. The wanted fertility rate for Egypt as a whole is 2.7 births per woman, 1.2 children less than the actual total fertility rate. This implies that the total fertility rate is 30 percent higher than it would be if unwanted births were avoided. The gap between the wanted and actual fertility rates is greatest among rural women, women from Upper Egypt (particularly those from rural areas), womcn who never attended school or have less than a primary education, and women who are not working for cash. It is notable that the wanted fertility rate for the Urban Govemorates and for urban areas in Lower Egypt is less than 2 births, suggesting that fertility in these areas would be at the replacement levcl if unwanted births were prevented. 109 Table 8,8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Egypt 1992 Total wanted Total Background fertility fertility characteristic rate rate Urban-rural residence Urban 2.0 2.9 Rural 3.4 4.9 Place of residence Urban Govemorates 1.8 2.7 Lower Egypt 2.5 3.7 Urban 1.9 2.8 Rural 2.7 4.1 Upper Egypt 3.7 5.2 Urban 2.4 3.6 Rural 4.3 6.0 Education No education 3.5 5.0 Some primary 2.5 4.0 Primary through secondary 2.0 3.0 Completed secondary/higher 2.3 2.9 Work status Working for cash 2.1 2.9 Not working for cash 2.8 4.1 Total 2.7 3.9 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 3.2. 110 CHAPTER 9 PROXIMATE DETERMINANTS OF FERTILITY This chapter addresses the principal factors, other than contraception, which affect a woman's chances of becoming pregnant: nuptiality, postpartum amenorrhea and abstinence from .sexual relations, and secondary infertility. Marriage is a primary indicator of exposure of women to the risk of pregnancy, and is, therefore, important for the understanding of fertility patterns. Populations in which the age at marriage is low tend to be populations with early childbearing and high fertility. Trends in the age at which women marry can help explain trends in fertility levels. The chapter also looks at other measures of the level of exposure to pregnancy, including breastfeeding, postpartum amenorrhea and postpartum abstinence that result in insusceptibility to the risk of pregnancy during the early months after a birth. The chapter concludes with an examination of two indicators of decreasing exposure 10 the risk of pregnancy with age: menopause and terminal infertility. In the EDHS, only women 15-49 who had ever been married were interviewed with the individual questionnaire. However, a number of the tables presented in this chapter arc based on all women, i.e., on both ever-married and never-married women. In constructing these tables, the number of ever-married women interviewed in the survey is multiplied by an inflation factor that is equal to the ratio of all women to ever- married women as reported in the household questionnaire. This procedure expands the denominators in the tables so that they represent all women. The inflation factors are calculated by single years of age and, where the results are presented by background characteristics, single-year inflation factors are calculated separately for each category of the characteristic. 9.1 Current Marital Status Current marital status is shown in Table 9.1 for all women 15-49. Overall, 65 percent are currently married, 4 percent are widowed, 1 percent are divorced, and 30 percent are never married. The proportion ever married increases rapidly with age, from 14 percent among teenagers to 57 percent among women in their early 20s. The virtual universality of marriage for women is evident from the fact that, among women age 30 and over, more than 95 pcrccnt arc, or have been married. Table 9.1 Current marital status Percent distribution of women by current marital status, according to age, Egypt 1992 Marital status Number Never of Age married Married Widowed Divorced Total women 15-19 86.1 13.7 0.1 0.2 100.0 3(/37 20-24 43.4 55.0 0.4 1.2 100.0 2405 25-29 13.4 84.1 0.7 1.7 100 0 2324 30-34 4.9 90.2 3.0 1.9 100.0 1933 35-39 2.5 90.2 5.0 2.2 100.0 1754 40-44 2.3 85.3 10.4 2.0 100.0 1444 45-49 0.9 80.7 16.6 1.8 100.0 1119 Total 29.6 65.3 3.6 1.4 100.0 14015 l l l Most disruption of marital unions appears to be due to the death of the husband. The proportion divorced varies between 1 and 2 percent across age groups. The proportion widowed rises from less than 1 percent among women age 30 and younger to 17 percent among women 45-49. 9.2 Marital Exposure Marital exposure is looked at in greater detail in Table 9.2. The table is based on information collected in the calendar and shows the percentage of months in the five years before the survey spent in a marital union. The percentage of months married incorporates the effects of age at first marriage, marital dissolution through divorce or widowhood, and remarriage. Overall, Egyptian women in the reproductive ages were in current marital unions around 60 percent of the time during the five-year period prior to the survey. As expected, the percentage of months married increases rapidly among younger women before peaking at 91 percent among women 35-39 and falling off to 83 percent among women 45-49. The pattern reflects the pace of entry into marriage among young women, which is most rapid in the 20-29 age cohorts, as well as the increasing incidence of widowhood among women age 40 and above. Table 9.2 Marital exposure Percentage of months spent in marital union in the five years preceding the survey, by age and selected background characteristics, Egypt 1992 Age at time of survey Background characteristic 15-19 20-24 25 29 30-34 35-39 40 44 45 49 Total Urban.rural residence Urban 2.5 25.5 67.2 86.4 91.9 87.3 84.5 57.5 Rural 8.6 52.9 86.5 91.6 89.8 87 2 80.4 62.9 Place of residence Urban Governorates 2.5 20.5 66.7 85.7 92.4 88 4 85.8 59.1 Lower Egypt 4.4 38.1 78.6 91.5 89.5 85 8 81.9 58.5 Urban 2.3 25.4 67.6 88 7 90.3 85.8 87.2 57.0 Rural 5.1 43.8 83.2 92.9 89.1 85.8 79.4 59.2 Upper Egypt 10.0 55.7 83,0 88 9 91 7 88.4 80.4 63.8 Urban 2.9 37.0 66.8 85 9 92.8 86.3 78.1 56.0 Rural 13.5 64.8 91.2 90.3 91 1 89 5 81.5 67.8 Education No education 13.8 64.0 88.7 91 4 90.4 86.1 81.4 74.9 Some primary 8.8 57. I 80.0 90.9 90 7 87 8 84.5 73.0 Primary through secondary 2.8 38.4 80.0 87.6 91.3 88.5 80.5 32.8 Completed secondary/higher 1.2 15.2 58.4 84.0 92 2 91.0 89.3 47.4 Work status Working for cash 2.2 17.6 57.3 80 6 86.9 79.9 78.1 63.1 Not working for cash 6.0 42.6 80.9 91.3 92.2 88,8 83.2 59.6 Total 5.8 39.5 77.1 89.0 91.0 87,3 82.7 60.1 112 There are signi ficant differentials in marital exposure by residence, educational level and work status. These differentials tend to be quite large among younger women, reflecting the effect of differences in the propensity to delay marriage among the various subgroups. For example, urban women in the 20-24 age cohort spent only 26 percent of the months in the five years prior to the survey married, compared to 53 percent among rural women 20-24. In the same age group, women from the Urban Governorates and Lower Egypt spent a considerably smaller proportion of the time in the five years before the survey married than women from Upper Egypt (21 percent, 38 percent and 56 percent, respectively). Large differentials in the proportion of months spent married by younger women are observed by level of education and work status. For example, the percentage of months spent married by women 20-24 varies from 64 percent among those with no education to 15 percent among those with at least a secondary education. Moreover, working women in the 20-24 age group only spent 18 percent of the 60 months prior to the survey married, compared to 43 percent for women in the same age cohort who were not working. Reflecting both the near universality of marriage and the increasing prevalence of widowhood, the differentials in the percentage of months married shown in Table 9.2 narrow and, in some cases, reverse direction for older cohorts. 9.3 Age at First Marriage The pereentagc of women ever married by select exact ages and the median age at first marriage, according to current age, is shown in Tablc 9.3. The table confirms that there has been a steady increase over the past 25 years in the age at which Egyptian women first marry. Overall, the median age at marriage has increased from 18.3 years in the oldest age cohort to 19.9 years among women 25-29. There has been a particularly sharp decline in the proportion of women marrying in their early teens; the percentage marrying by exact age 18 has fallen from 47 percent among women 45-49 to 27 percent among women 20-24. Table 9.3 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to curcent age, Egypt 1992 Current age 15 Percentage of women who were Percentage Median first married by exact age: who had Number age at never of first 18 20 22 25 married women marriage 15 19 2.7 NA NA NA NA 86.1 3037 20-24 7.2 26.7 41.3 NA NA 43.4 2405 25-29 9.9 35.0 50.8 65.9 80.1 13.4 2324 30-34 11.7 39.1 55.4 69.4 82.9 4.9 1933 35-39 10.2 37.6 57.8 69.9 83.4 2 5 1754 40-44 14.3 41.3 59.0 71.2 83.5 2.3 1444 45-49 18.2 47.3 63.6 78.2 89.0 0.9 1119 2049 11.1 36.4 53.0 66.1 77.3 14.0 10978 25-49 12.2 39.1 56.3 70.0 83.1 5.8 8573 NA -- Not applicable aomitted because less than 50 percent of the women in the age group x to x+4 were first mm'ried by age x a a 19.9 19.3 19.3 18.9 18.3 19.6 19.2 113 Substantial residential differentials in the age at first marriage are observed in Table 9.4. The median age at first marriage among urban women 25-49 is 20.9 years, three years greater than the median among rural women. Considering the trends across age cohorts, it is clear that the age at marriage has increased more rapidly among urban than rural women. Consequently, the difference in the age at marriage between urban and rural women has nearly doubled, increasing from 1.7 years among women 45-49 to 3.6 years among women 25-29. The median age at first marriage among women 25-49 in the Urban Govemorates is two years higher than that in Lower Egypt and more than three years higher than that in Upper Egypt (see Figure 9.1). There is only a small difference in the median age at first marriage between women from urban Lower Egypt and urban Upper Egypt (20.8 years and 20.5 years, respectively). However, the median age at marriage is much higher in rural Lower Egypt (18.5 years) than in rural Upper Egypt (17.2 years). The increases in age at marriage that are observed across age cohorts confirm the long-term nature of the upward trend in age at marriage in all areas. Median Age Figure 9,1 Median Age at First Marriage All Women 25-49 7( Urban Total Urban Rural Total Urban Rural Governorates Lower Egypt Upper Egypt EDHS1992 Large differences in age at first marriage by educational level are cvident in Table 9.4. There is an almost seven year difference in the median age at first marriage between women who never attended school and women who completed at least the secondary level. Within each education category, increases in the age at marriage across cohorts are comparatively small. This suggests that the upward trend in the age at first marriage over time is primarily a consequence of increasing educational attainment among younger women. A woman's current work status is associated with delayed marriage. The median age at marriage for women who were working for cash at the time of the survey was 23.5 years, nearly five years higher than the median for women who were not involved in paid employment. The change in age at marriage across age cohorts also is greater for women working for cash than for other women. 114 Table 9.4 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background characteristics, Egypt 1992 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40 44 45-49 20-49 25-49 Urban-rural residence Urban a 22.0 21.1 20.9 20.4 19.3 a 20.9 Rural 19.0 18.4 17.7 18.0 17.6 17.6 18.2 17.9 Place of residence Urban Governorates a 22.0 21.8 21.2 20.7 19.5 a 21.1 Lower Egypt a 19.9 19.1 19.2 18.7 18.2 19,5 19.1 Urban a 22.4 20.4 21.2 19.9 19.3 a 20.8 Rural a 19.1 18.3 18.5 18.3 17.9 18.8 18.5 Upper Egypt 18.7 18.3 17.8 18.3 17.6 17.5 18.1 17.9 Urban a 21,6 20,6 19,9 20.6 18,7 a 20.5 Rural 17,5 17.4 17.1 17.5 16.5 17.1 17.2 17.2 Education No education 17.9 17.5 17.3 18.0 17.7 17.6 17.7 17.6 Some primary 18.6 19.0 18.2 19.0 18.7 17.7 18.6 18.6 Primary through secondary a 19.7 19.9 19.7 20.3 19.9 a 19.9 Completed secondary/higher a 23.8 24.1 25.0 24.8 24.3 a 24.3 Work status Working for cash a 23.6 23.6 23.7 24.2 21.7 Not working for cash a 19.2 18.4 18.6 18.4 18.0 Total a 19.9 19.3 19.3 18.9 18.3 a 23.5 19.0 18.6 19.6 19.2 Note: Media.as are not shown for women 15-19 because tess than 50 percent have married by age 15 in all subgroups shown in the table. aOmitted because less than 50 percent of the women in the age group were first married by age 20. 9.4 Marriage between Relatives Marriages between relatives (consanguineous marriages) are common in Egypt. According to the EDHS data presented in Table 9.5, 40 percent of ever-married women report that their current or, in the case of widowed or divorced women, their most recent husband was a relative. Six in ten consanguineous marriages involve first cousins. The percentage of marriages involving relatives generally increases with the current age of the woman. A strong inverse relationship between the percentage of marriages involving relatives and age at first marriage is evident for women who have been married only once. The proportion of women who married a relative decreases from over 50 percent among those who married before age 15 to less than 25 percent among those who married at age 24 or above. Only about one4ifth of the women who have married more than once report their current or most recent husband was a relative. 115 Table 9.5 Consanguinity Percent distribution of ever-married women by relationship to their husbands, according to background characteristics, Egypt 1992 Don't Number Rackground First Other No know/ of characteristic cousin relative relation missing women Age 15-19 27.7 22.2 5(1 I 0.0 423 20-24 25.7 16.6 57.7 0.0 1362 25-29 25.2 16.2 58.5 0.1 2013 30-34 25.3 14.4 60.2 0.1 1838 35-39 21.9 14.8 63.4 0 0 1709 40-44 26.0 15.4 58.6 0.0 1411 45-49 21.6 15.1 63.3 0.0 11/)8 Age at first marriage <15 35.6 18.7 45.6 0.1 1142 15 34.0 19.1 46.9 1).0 794 16-17 28.5 17.3 54.2 0.0 2070 18-19 25 6 15.7 58.8 0.0 1822 20-21 22.5 14.7 62.8 0.0 1377 22-23 18.0 14.9 67.1 0.0 853 24+ 12.6 11.5 75.8 0.0 1269 Married more than once 11.4 11.8 76 5 0.3 537 Urban-rural residence Urban 18.7 13.1 68.2 0.0 4596 Rural 29.5 18.0 52.4 0.1 5268 Place of residence Urban Govemorates 17.8 13.1 69.1 0.0 2357 Lower Egypt 21.2 12.7 66.0 0.1 4067 Urban 15.5 10.2 74 3 /1.0 1211/ Rural 23.7 13.8 62.5 0.1 2857 Upper Egypt 33.0 21.0 46 0 0.0 3440 Urban 24.7 16.4 58.9 0 0 1029 Rural 36.5 23.0 40.5 11.11 2411 Education No education 30.0 16.5 53.4 0.0 4771 Some primary 22.2 17.8 59.9 0.1 2078 Primary through secondary 21.6 14.0 64.3 0.0 1093 Completed secondary/higher 15.0 12.2 72.8 0.0 1922 Total 24.5 15.7 59 8 0,0 9864 As expected, consanguineous marriages are more common in rural than urban areas. Nevertheless, nearly one-third of marriages in urban areas involve relatives. Place of residence is also related to the prevalence of marriage between relatives. The percentage of women reporting contracting such marriages is considerably greater in Upper Egypt (54 percent) than in Lower Egypt (34 percent) and the Urban Govemorates (31 percent). The highest level of consanguineous marriage is found in rural Upper Egypt, 116 where six in ten marriages are between relatives. Level of education also influences the likelihood of marriage to a relative. The percentage of marriages involving relatives decreases from 47 percent among women never attending school to 27 percent among women who completed the secondary level or higher. 9.5 Postpartum Amenorrhea, Abstinence and Insusceptibility The risk of pregnancy following a birth is influenced by two factors: breastfeeding and sexual abstinence. Postpartum protection from conception can be prolonged by breastfeeding through its effect on the length of amenorrhea (the period prior to the return of menses). Protection can a l~ be prolonged by delaying the resumption of sexual relations. Women are defined as insusceptible if they are not exposed to the risk of pregnancy, either because they are amenorrbeic or abstaining following a birth. The percentage of births whose mothers are postpartum amenorrheic, abstaining and postpartum insusceptible is shown in Table 9.6 by the number of months since the birth. These distributions are based on current status data, i.e., on the proportion of births occurring x months before the survey for which mothers are still amenorrheic, abstaining or insusceptible. The median and mean duration estimates shown in Table 9.6 and Table 9.7 are calculated from the current status proportions at each time period. The data are grouped in two-month intervals to minimize fluctuations in the estimates. Table 9.6 Postpartum amenorrhea, abstinence and insusceptibility Percentage of births whose mothers are postpartum amenon'heic, abstaining and insusceptible, by number of months since birth, and median and mean durations, Egypt 1992 Number Months Amenor- Insus- of since birth rheic Abstaining ceptible births < 2 97.0 82.5 97.0 201 2-3 67.2 13.7 71.1 308 4-5 53.8 6.6 55.0 265 6-7 44.6 4.0 46.9 273 8-9 37.9 7.0 41.3 243 10 11 23.2 4.1 26.6 239 12-13 20.4 4.0 21.9 285 I4-15 14.8 1.4 15.3 300 16-17 10.7 1.3 11.5 289 18-19 10.0 1.9 11.5 263 20-21 5.2 0.9 6.1 264 22-23 5.2 1.8 7.0 287 24-25 2.7 1.3 3.9 317 26-27 1.3 0.6 1.9 329 28-29 0.5 1.2 1.7 242 30-31 0.7 1.3 2.0 266 32-33 0.5 0.6 1.0 244 34-35 0.0 0.4 0.4 294 Total 20.8 6.3 22.2 Median 5.6 1.8 6.l Mean 8.2 3.0 8.7 Prevalence/Incidence mean 7.4 2.2 7.9 4908 117 The period of postpartum amenorrhea is considerably longer than the period of postpartum abstinence and is the major determinant of the length of the period of postpartum insusceptibility to pregnancy for Egyptian women (see Figure 9.2). The percentage of births for which the mothers are amenorrheic decreases from 97 percent immediately following the delivery to 67 percent 2-3 months after birth. By 6-7 months following birth, fewer than half of women are still amenorrheic and, by 12-13 months after birth, only one- fifth have not resumed their menstrual period. In Egypt, as in other Islamic countries, many couples observe a period of sexual abstinence after birth, which traditionally last 40 days. Reflecting the effect of this tradition, the percentage of mothers who are abstaining from sexual relations decreases rapidly following birth. At 2-3 months following birth, only 14 percent are still abstaining and, by 12-13 months, less than 5 percent have not yet resumed sexual relations. Percenl 1001 Figure 9,2 Percentage of Births Whose Mothers Are Amenorrheic or Abstaining 60 40 2O C- O 2 4 6 8 10 12 14 16 16 20 22 24 26 26 Months Sinc~ Bkqb 30 32 34 EDHS1992 Overall, around one-half of all Egyptian women are risk of pregnancy by 6 months following a birth un/ess they have begun to use contraception. The mean duration of the period of postpartum insusceptibility is almost 9 months. Median durations of postpartum amenorrhea, abstinence and insusceptibility by various background characteristics are presented in Table 9.7. Average durations of postpartum abstinence do not vary greatly among population subgroups. However, there are marked differentials in the duration of postpartum amenorrhea. Median durations are longest for rural women, women living in Upper Egypt and women with less than a primary education. The differentials in the median durations of postpartum insusceptibility reflect the combined effects of amenorrhea and abstinence. On average, women over 30 are insusceptible for more than 7 months, almost two months longer than younger women. A similar although slightly greater differ- ential is observed between the median durations for urban and rural women. 118 Table 9.7 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Egypt 1992 Postpartum Number Background Postpartum Postpartum irususcep- of characteristic amenorrhea abstinence tibility births Age <30 5.1 1.8 5.5 3049 30+ (6.9) 1.8 (7.3) 1859 Urban-rural residence Urban 4.2 1.8 4.7 1803 Rural 6.9 1.8 7.3 3105 Place of residence Urban Governorates (4.1) (1.8) (4.5) 851 Lower Egypt 5.2 1.8 5.5 1944 Urban * * * 460 Rural (5.9) 1.8 (6.1) 1484 Upper Egypt 7.3 1.8 8.0 2113 Urban * * * 493 Rural (8.2) 1.8 8.8 1620 Education No education 8.3 1.8 (8.7) 2500 Some primary (5.5) (1.7) * 918 Primary through secondary * * * 464 Completed secondary/higher (3.8) (1.9) (4.1) 1027 Total 5.6 1.8 6.1 4908 Note: Medians are based on current status. Figures in parentheses are 49 cases, while an asterisk indicates that the figure is based on fewer and has been suppressed. based on 25 to than 25 cases 9.6 Termination of Exposure to Pregnancy The risk of pregnancy declines with age, particularly after age 30, as increasing proportions of women become infecund. While the onset of infecundity is difficult to determine, there are ways of estimating its effects for a population. Table 9.8 presents two indicators of decreasing exposure to the risk of pregnancy for married women age 30 years and older: menopause and terminal infertility. A woman is considered to be menopausal if she declared herself as menopausal or if she is non-pregnant, non-amenorrheic and did not have a menstrual period for six or more months before the survey. A woman falls into the terminal infertility category if she was continuously married, did not give birth, and did not use any contraceptive method during the five-year period preceding the survey and she is not currently pregnant. 119 As expected, the proportion menopausal rises rapidly with age, particularly among women age 40 and older. It peaks at 48 percent among women 45-49. Terminal infertility exhibits a similar direct relationship with age, increasing from 28 percent among women 30-34 to 99 percent among women 48-49. Table 9.8 Temlinatlon of exposure to the risk of preklnancy Indicators of menopause and terminal infertility among currently married women age 30 49, by age, Egypt 1992 Menopause I Terminal infernhty 2 Age Percent Number Percent Number 30-34 1.8 1375 28,4 q74 3509 2.7 1375 42.7 387 40 41 5.8 551) 61/,2 177 42-43 7.8 415 72,1 142 44-45 17.8 533 83.5 223 46-47 31.1 307 92 5 155 48-49 48,3 249 98 6 147 Total 9.1 481)4 59.5 1604 1Percentage of non-pregnant, non-amenorrhem currently married women whose last menstrual period occurred snx or more months preceding the survey or who report that they are menopausM. 2Percentage of currently married women in thmr first union cff five or more years who have never used contraception and who did not have a birth In the five years preceding the survey and who are not pregnant. 120 CHAPTER 10 INFANT AND CHILD MORTALITY This chapter presents information on levels, trends and differentials in neonatal, postneonatal, infant and child mortality and on the prevalence of high-risk fertility behavior. This information is central to an assessment oftbe demographic situation in Egypt. It is also important in efforts to improve child survival programs in Egypt and in identifying those segments of the child population that are at increased risk. 10.I Assessment of Data Quality The mortality estimates are calculated from information that was collected in the birth history section of the individual questionnaire. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live in the household, who live elsewhere, and who died). These questions were followed by a retrospective birth history in which data were obtained on sex, date of birth, survivorship status, and current age or age at death of each of the respondents' live births. This information is used to directly estimate mortality rates. In this report, infant and child mortality are measured using five rates: Neonatal mortality: the probability of dying within the first month of life; Postneonatal mortallty: the difference between infant and neonatal mortality; Infant mortality: the probability of dying before the first birthday; Child mortality: the probability of dying between the first and fifth birthday; Under-five mortality: the probability of dying before the fifth birthday. The reliability of the mortality estimates from retrospective birth histories depends upon the completeness with which deaths of children are reported and the extent to which birth dates and ages at death are accurately reported and recorded. Omission of births and deaths directly affects mortality estimates, displacement of dates has an impact on mortality trends, and misreporting of the age at death may distort the age pattern of mortality. The quality of the birth history data is examined in detail in Appcndix D. Table D.5 looks at evidence of underreporting of deaths, particularly of those deaths which occur in very early in infancy. If early neonatal deaths arc selectively underreported, the result would be an abnormally low ratio of deaths under seven days to all neonatal deaths. The ratio of deaths in the first six days to all neonatal deaths presented in Table D.5 is high, indicating that early infant deaths have not been severely underreported in the EDHS. However, the ratio is higher for the period 0-4 years prior to the survey than for earlier periods, suggesting that some early infant deaths were not reported by older women. The quality of the reporting of age at death for children who had died is also important. Misreportiog of age at death will bias estimates of the age pattern of mortality if the net result of the misreporting is transference of deaths between age segments for which rates are calculated; for example, an overestimate of child mortality relative to infant mortality may result if children who died during the first year of life are reported as having died at age one year or older. In an effort to minimize error in the reporting of age at death, EDHS interviewers were instructed to record deaths under one month in days, and under 2 years of age in months. They were specifically asked to probe for deaths reported at one year of age to ensure that 121 they had actually occurred at 12 months. Nevertheless, there is evidence of heaping in the reporting of age at death (see Table D.6). With regard to the issue of date displacement, there was evidence of possible misreporting of birth dates for children born in the five-year period immediately prior to the survey. The distribution of all children by calendar year of birth showed a slight deficit of births in calendar year 1987 and an excess of births in calendar year 1986 (see Table D.4). The apparent transference of births out of 1987 was greater for dead than surviving children. This pattern has been noted in other DHS surveys; it is believed to be the result of transference of births by interviewers out of the period for which the health and calendar data were collected (January 1987 through the date of the survey). Interviewers are thought to be motivated both by a desire to reduce their workload and to avoid asking detailed questions about children who died. This brief review of the assessment of the quality of the EDHS mortality data indicates that there are some problems with the data, particularly date displacement and heaping on certain ages at death. However, several analyses carried out by the DHS program suggest that the effect on the mortality estimates of errors in reporting of the magnitude observed in the 1992 EDHS would not be large (Sullivan et al., 1990). Moreover, an analysis of the pattern of heaping on age at death observed in the 1992 EDHS indicated that this heaping would have resulted in a downward bias in the childhood mortality of no more than 5 percent. Thus, the results in this report are unadjusted for misreporting. 10.2 Levels and Trends in Infant and Child Mortality Neonatal, posmeonatal, infant, child and under-five mortality rates are shown in Table 10.1 for five-year periods in the 25 years preceding the survey. Under-five mortality for the most recent period (0-4 years preceding the survey) is 85 deaths per 1,000 births. This means that about one in twelve children bom in Egypt die before they reach their fifth birthday. Roughly, three in four under-five deaths occur in the first year; infant mortality is 62 deaths per 1,000 births and child mortality is 25 deaths per 1,000 births. During infancy the risk of neonatal death (33 per 1,000) is nearly the same as the risk of posmeonatal death (29 per 1,000). The estimates in Table 10.1 indicate that mortality levels have declined rapidly in Egypt since the late 1970s. The current under-five mortality rate represents an "almost 50 percent decrease from the level of 157 deaths per 1,000 births which prevailed during the period 10-14 years before the survey (approximately 1978-1982). An cxamination of the trend in the other mortality indicators suggests the pace Table 10.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey, Egypt 1992 years Neonatal Posmeonatal Infant Child Under-flve preceding mortality mortality mortality mortality rnortallty survey (NN) (PNN) (lq0l (aql) (sq0) 0-4 32.8 28.7 61.5 24.8 84.8 5-9 51.4 46.1 97.4 36.1 130.1 10-14 48.3 59.8 108.1 55.3 157.4 15-19 53.3 75.9 129.2 90.9 208.4 20-24 48.5 85.4 133.9 110.3 229.5 122 of decline was somewhat faster in the case of child mortality than infant mortality; child mor- tality decreased by 55 percent, from a level of 55 per 1,000 births 10-14 years before the sur- vey while infant mortality declined by 43 per- cent, from a level of 108 per 1,000 births at the same point in time. Using estimates from 1980 Egypt Fertility Survey, the 1988 Egypt Demographic and Health Survey, the 1991 Egypt Maternal and Child Health Survey, as well as the 1992 EDHS, the downward trend in infant mortality in Egypt since the early 1950s is shown in Ta- ble 10.2 and Figure 10.1. During the more than 40-year period, infant mortality declined by 67 percent, from 191 deaths per 1,000 births in 1950-1954 to 62 in 1988-1992. Table 10.2 Trend in infant mortality~ 1950-1992 Trend in infant mortality in Egypt, 1950-1992 EFS EDHS EMCHS EDHS Period 1980 1988 1991 1992 1950-1954 1955-1959 1960-1964 1965-1969 1970-1974 1975-1979 1977-1981 1978-1982 1979-1983 1982-1986 1983-1987 1984-1988 1987-1991 1988-1992 191 166 151 141 146 132 119 73 105 94 59 Sources: Sayed et al., 1989, Table 8.5 Abdel-Azeem et al., 1993, Table 10.4 108 97 62 250 200 Deaths per 1,000 births Figure 10,1 Infant Mortality, Egypt 1950-1992 15o lOO 5o o 1950 i i i i i I i 1962 1972 1982 1992 Note Rales are from vanous surveys covering the period 123 10.3 Socioeconomic Differentials in Mortality Differentials in the various mortality rates by selected background characteristics are presented in Table 10.3. The table focuses largely on basic socioeconomic characteristics including urban-rural residence, place of residence, mother's educational level and work status, but also examines the issue of whether mortality varies according to the maternity care received by the mother prior to the child's birth. A ten-year period is used to calculate the mortality estimates in order 1o have a sufficient number of cases in each category. Table 10.3 Infant and child mortality by background characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected background characteristics, Egypt 1992 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortahty mortality characteristic (NN) (PNN) (tq0) (4q0 (sq0) Urban-rural residence Urban 31.5 23.0 54.4 17.6 71.1 Rural 49.3 46.9 96.2 39.1 131.6 Place of residence Urban Govemorates 31.5 23.0 54.5 14.4 68 1 Lower Egypt 37.2 28.4 65.7 23.6 87 7 Urban 25.7 18.1 43.7 12.4 55.6 Rural 41.1 31.9 73.0 27.6 98.5 Upper Egypt 52 4 53.4 105.8 45.7 146.7 Urban 37.3 27.8 65.0 29.6 92.7 Rural 57.3 61.8 119.1 51.5 164.4 Education No education 51.0 46.7 97 8 38.9 132.8 Some primary 36.3 38.4 74.7 27.6 100.3 Primary through secondary 40.5 22.0 62.4 23.5 84.4 Completed secondary/higher 22.4 13.4 35.8 6,2 41.8 Work status Working for cash 36 4 25.4 61.8 17. I 77.9 Not working for cash 43.3 39.4 82.7 32.4 112.4 Medical maternity care No antenatal/delivery care 30.9 38.3 69.1 29.8 96.9 Either antenatal or delivery 39.1 26.6 65.6 17.3 81,8 Both antenatal and delivery 28.9 20.8 49.7 10 2 59 3 Total 42.4 37.6 79.9 30.3 1ll7.8 124 Urban-rural differences are large at all ages. For example, the under-five mortality in urban areas is 71 per 1,000 births, 46 percent lower than the rural level (131 per 1,000 births). There is also considerable variation in mortality by place of residence (see Figure 10.2). Mortality for all age groups is highest in rural Upper Egypt, where infant mortality is 119 per 1,000 births and under-five mortality is 164 per 1,000 births. These levels are around 60 percent higher than the mortality observed in rural Lower Egypt (73 per 1,000 births and 99 per 1,000 births, respectively). Of interest also is the fact that mortality rates for urban Lower Egypt are somewhat lower than the rates observed for the Urban Govemorates. Differences by education are very large. For example, under-five mortality for children of mothers who have completed the secondary level or higher is 42 per 1,000 births, less than one-third of the level among child ren whose mothers have never attended school. The educational differential becomes larger with increasing age o f the child. Children of women who work for cash have lower mortality at all ages than children of other women. Use of basic maternity care services is generally associated with lower mortality. The one exception is in the case of neonatal mortality levels, where the level of neonatal mortality for children whose mothers had no antenatal care or medical assistance at delivery is lower than the level among children whose mothers had either antenatal care or medical assistance at delivery and only slightly higher than the level among children whose mothers had both antenatal care and medical assistance at delivery. Deaths per 1000 births Figure 10,2 Infant Mortality by Place of Residence 140 120 100 80 60 40 20 0 Urban Governorates / / Total Urban Lower Egypl ,/ Rural Total Urban Rural Upper Egypt EDHS1992 10.4 Demographic Differentials in Mortality Table 10.4 presents mortality differentials according to demographic characteristics of the child and the mother that often have been shown to be related to mortality levels, including the sex of the child, mother's age at the birth, birth order, lcngth of the previous birth interval, and the mother's perception concerning the size of the child at birth. 125 Table 10.4 Infant and child mortality by demographic characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected demographic characteristics, Egypt 1992 Demographic characteristic Neonatal Posmeonatal Infant Child Under-five mortality mortality mortality mortality mortality (NN) (PNN) (tqe) (4qi) (sqo) Sex of child Male 48.4 36.0 84.4 24.6 107.0 Female 36.1 39.2 75.3 36.1 108.6 Age of mother at birth < 20 55.8 61,8 117.6 37.4 150.6 20-29 38.2 35.0 73.2 29.0 100.1 30-39 45.7 32,4 78.1 29.4 105.2 40-49 (29.6) (22.1) (51.7) * (79.1) Birth order 1 37.4 32.0 69.4 18 2 86.3 2-3 37.2 35.6 72.7 26 7 97.5 4-6 43.0 35.6 78.6 37.9 113.6 7+ 60.9 54.6 115.4 40.5 151.3 Prevhins birth Interval < 2 yrs 66.9 61.7 128.6 52.1 174.0 2-3 yrs 32.2 30.5 62.7 26.8 87.8 4 yrs + 25.3 14.3 39.6 13.1 52.2 Size at birth l Very small * * * * * Smaller than average 44.9 35.8 80.8 23.6 1(/2.5 Average or larger 30.0 28.0 58.0 19.6 76.4 Note: Rates based on 250-499 cases are enclosed in parentheses. Those based on fewer than 250 cases (exposed children) are suppressed and marked with an asterisk tRates for the five-year period preceding the survey As expected, neonatal mortality is higher among males than females. Postneonatal mortality varies only slightly with the sex of the child, but child mortality is more than 40 percent higher among females than males (36 per 1,000 births and 25 per 1,000 births, respectively). Since mortality is typically lower among females than males, this pattern suggests that there may be gender-related difference in child- rearing practices or in the recourse to health care services during childhood that favor boys over girls. The effect of a young maternal age at birth is clear in Table 10.4. Both infant and child mortality is substantially higher among children of mothers who were less than age 20 at the time of the child's birth. Somewhat surprisingly, the mortality of children born to mothers age 40 and over is lower than that for all other matemal categories. This may be due to the small number of births to older mothcrs since the relationship between mortality and maternal age is typically a U-shaped curvc, with peaks for children of youngest and oldest mothers. 126 Mortality according to birth order shows the expected pattem of higher mortality associated with higher birth order. Also as expected, the length of the birth interval is strongly associated with higher mortality. For example, the level of under-five mortality found among children born less than two years after a previous birth (174 per 1,000 births) is more than three times the level found among children born four or more years after a previous birth (52 per 1,000 births). The effect of short birth intervals on mortality is clearly evident at all ages. These findings support the importance of child spacing for child survival. Children who are smaller than average at birth, as perceived by their mothers, experience higher mortality rates than children perceived to be average, larger than average, or very large. Since low birth weight is known to have a strong effect on early morbidity, it is not surprising that the most pronounced effect occurs during the neonatal period and diminishes with increasing age of the child. 10.5 High-Risk Fertility Behavior Previous research has shown that strong relationships exist between matemal fertility patterns and children's survival chances. Typically, infants and children have a greater probability of dying if they are bom to mothers who are too young or too old, if they are born after a short birth interval, or if they are of high parity. For purposes of the analysis which follows, a mother is classified as "too young" if she is less than 18 years of age, and "too old" if she is over 34 years of age at the time of delivery. A "short birth interval" is defined by a birth occurring less than 24 months after the previous birth, and a child is of "high birth order" if the mother had previously given birth to three or more living children (i.e., if the child is of birth order 4 or higher). Table 10.5 presents the distribution of children born in the five years preceding the survey and of currently married women according to these risk factors. The table also examines the relative risk of mortality for children by comparing the proportion dead in each high-risk category with the proportion dead among children not in any high-risk category. First births, although often at increased risk, are not included in this analysis because they arc not considered an avoidable risk. The data presented in the first two columns of Table 10.5 address the issue of high-risk fertility behavior by looking at the actual prevalence of high-risk births during the five-year period before the survey and its implications with respect to the mortality of those births. As Column 1 in Table 1(I.5 shows, more than 60 percent of children born in the five year period before the survey are in at least one of the elevated risk categories. A third (22 percent) of all births at elevated risk had been subject to multiple risk characteristics. A short birth interval and high birth order were the most common high-risk factors. The risk ratios shown in Column 2 of Table 10.5 illustrate the relationship between the risk factors and mortality levels. The risk ratios for children in the single high-risk categories are generally lower than the risk ratios for children in multiple high-risk categories. The lowest risk ratio (1.0) is found for births to mothers over age 34 and the highest (3.2) for the category combining three of the four high-risk factors (short interval, higher birth order, and old matemal age). The data presented in the final column of Table 10.5 looks to the future, addressing the question: how many married women have the potential for having a high-risk birth? The results were obtained by simulating the distribution of currently married women by the risk category into which a currently conceived birth would fall. A woman's current age, time elapsed since last birth, and parity were used to determine into which risk category the next birth would fall, if the woman were to conceive at the time of the survey. For example, if a woman age 37, who has five children, and had hcr last birth three ycars ago were to become pregnant, she would fall into the multiple high-risk category of being too old (35 or older) and at too high a parity (4 or more children). 127 Overall, 79 percent of women have the potential to give birth to a child with an elevated risk of mortality. A greater proportion of married women exhibit the potential for having a birth in a multiple high-risk category than in single high-risk category (33 percent and 46 percent, respectively). In terms of the risk categories themselves, the potential is greatest for births at elevated risk due to high birth order (18 percent) and old maternal age and high birth order (33 percent). Table 10.5 High-risk fertility behavior Percent distribution of children bern in the five years preceding the survey who are at elevated risk of mortality, and the percent distribution of currently married women at risk of conceiving a child with an elevated risk of mortality, by category of increased risk, Egypt 1992 Births in the 5 years preceding the survey Percentage of currently Risk Percentage Risk married category of births rauo women a Not in any high-risk category 39.0 1 .I) 21.3 Single high-risk category Mother's age < 18 3.1 1.5 0.7 Mother's age > 34 1.1 1 0 5.4 Birth interval < 24 12.1 1.5 8.6 Birth order > 3 23.1 1.1 18 4 Subtotal 39.4 1.2 33.2 Multiple high-risk category Age <18 & birth interval <24 c 1.0 3.0 I).l Age >34 & birth interval<24 0.3 2.3 1).2 Age >34 & birth order>3 9.3 1.1 33.1 Age >34 & birth interval <24 & birth order >3 2.0 3.2 3.11 Birth interval <24 & birth order >3 9.6 2 3 9.0 Subtotal 21.6 1.9 45.5 In any high-risk category 61.0 1.5 78.7 Total 100.0 NA 100 0 Number 8626 NA 9153 Note: Risk ratio is the ratio of the proportion dead of births m a specific high- risk category to the proportion dead of births not in any high-risk category. NA = Not applicable aWomen were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 months ago, and latest birth of ~rder 3 or ~igher. Includes sterdlzed women Clncludes the combined categories age <18 and birth order >3 128 CHAPTER 11 MATERNAL AND CHILD HEALTH Improving the health status of mothers and young children is a primary focus of the Egyptian government's health care policy and programs in Egypt. This chapter presents findings from four areas of importance to the health of Egyptian children and their mothers, which can be used in efforts to plan and monitor the outcome of maternal and child health care initiatives. The topics covered include antenatal care, delivery characteristics, immunization, and childhood illnesses and treatment. I L l Antenatal Care One of the priorities of the Egyptian government's maternal and child health program is to provide medical care during pregnancy to ensure the survival of both mother and child. To obtain information on the utilization of antenatal care services, the EDHS included several questions relating to the source of antenatal care, number and timing of visits, and tetanus toxoid vaccinations. This section discusses these antenatal care issues. Source of Antenatal Care Table 11.1 shows the distribution of births in the five years preceding the survey by source of antenatal care received by the mother during pregnancy. A birth is considered to have received antenatal care if the mother visited a provider for such care at least oncc during her pregnancy. If the mother consulted more than one type of provider, only the most qualified source is recorded in the table. The survey results indicate that many mothers do not seek antenatal care. Among births in the five years before the EDHS, only 53 percent received antenatal care from a trained medical provider. In virtually all cases, the mother received antenatal care from a doctor. Antenatal care was more likely to be sought from a private sector provider than at a government health facility; mothers reported that they went to a private provider in the case of 77 percent of the births in which antenatal care was received (table not shown). The data show that there are marked differentials in antenatal care coverage among subgroups. Antenatal care from a trained provider is much more common for urban births (69 percent) than rural births (43 percent). The proportion of births whose mothers received antenatal care from a trained provider is highest in the Urban Governorates (74 percent), followed by urban areas in Lower Egypt (68 percent) and Upper Egypt (62 percent) (see Figure 1 l. 1). The mothers of more than half the live births in rural areas in both Lower Egypt and Upper Egypt did not receive any antenatal care during pregnancy. With regard to the other background characteristics in Table 11.1, antenatal care is most likely to have been received for births of low birth order, births to mothers who have at least a secondary education and births to mothers who work for cash. A mother's age makes little difference in the likelihood that antenatal care will have been received prior to a birth. 129 Table 11.1 Antenatal care Percent distlibution of births in the five years preceding the survey, by source of antenatal care during pregnancy, according to selected background characteristics, Egypt 1992 Antenatal care provider ~ Traditional Trained birth Number Background nurse/ attendant/ No one/ of characteristic Doctor midwife Other 2 Missing Total births Mother's age at birth < 20 50.9 0.0 0.0 49.1 100.0 945 20-34 53.1 0,1 0.1 46.7 I00.0 6595 35+ 52.3 0.0 0.0 47.7 100.0 1086 Birth order l 69.7 0.0 0.0 30.3 100.0 1806 2-3 53.4 0.1 0.0 46.4 100.0 3037 4-5 46.8 0.1 0.1 53 0 100.0 1882 6+ 41.7 0.1 0.1 58.1 100.0 1900 Urban-rural residence Urban 68.8 0.1 0.0 31.1 100.0 3237 Rural 43.2 0.1 0.1 56.7 I00.0 5389 Place of residence Urban Govemorates 73.4 0.1 0.0 26.5 100.0 1557 Lower Egypt 49.1 0.1 0.1 50.8 100.0 3408 Urban 67.5 0.0 0.0 32.5 100.0 820 Rural 43.3 0.1 0.1 56.5 100.0 2588 Upper Egypt 47.4 0.1 0.1 52.4 100.0 3661 Urban 6I .8 0.2 0.0 38.0 100.0 860 Rural 43.0 0.0 0.1 56.8 100.0 2801 Mother's education No education 39.6 0.0 0.1 60.2 100.0 4427 Some primary 51.8 0.2 0.1 47.9 100.0 1735 Primary through secondary 68.8 0.0 0.0 31.2 100.0 806 Completed secondary/higher 81.2 0.1 0.0 18.7 100.0 1657 Work status Working for cash 66.1 0.0 0.2 33.7 100.0 1087 Not working for cash 50.9 0.1 0.0 49.0 100.0 7539 All births 52.8 0.1 0.1 47.1 100.0 8626 Note: Figures are for births in the period 1-59 months preceding the survey. A birth is considered to have received antenatal care if there was at least one antenatal care consultation during the pregnancy. ~If the respondent mentioned more than one provider, only the most qualified provider is considered. 2Includes "Don't know" 130 100 Percent Figure 11,1 Antenatal Care Indicators by Place of Residence 80 60 40 20 0 Urban Total Urban Rural Governorales Lower Egypt TT = Telanus toxo~d r']seen by doctor[~Had Total Urban Rural Upper Egypt TT inleclion rl EDHS 1992 Number and Timing of Antenatal Care Visits Both the number and timing of antenatal care visits are con- sidered to be of great importance with respect to pregnancy outcome. Antenatal care can be more effective when it is sought early in the pregnancy and is received regularly throughout the pregnancy. As shown in Table 11.2, if an Egyptian mother seeks antenatal carc, she is likely to make more than one visit. However, even among mothers who seek care, the median number of visits is only 3.5. Among mothers who obtained antenatal care, the majority report the first pregnancy check occurred at or before thc fifth month of pregnancy. The median time at which mothers started antenatal visits is 3.2 months. Tetanus Toxoid Vaccinations Neonatal tetanus is one of the major causes of death in young infants. To fully protect against neonatal tetanus, it is recommended that mothers receive two tetanus toxoid injections during pregnancy. However, if a woman has been vaccinated during a previous preg- nancy, she may only require a booster dose for a current pregnancy, and five doses of tetanus toxoid are considered to provide lifetime protection. In order to estimate the extent of tetanus toxoid coverage during pregnancy, the EDHS collected data on whether the women received tetanus toxoid vaccinations for each pregnancy in the five Table 11.2 Number ofanLenatal care visits and stage of pregnancy Percent d~stnbut]on ol Nrtfis m the live years preceding ale survey by number of antenatal care (ANC) visits, and by the stage of pregnancy at the lame of file first visit, Egypt 1992 Antenatal visits/ Stage of pregnancy All al firsl visit thrths Number or AN(" ~isits 0 47 1 I 12.3 23 174 4+ 22 5 [)oa't kilt)w, rqlSslng 0 7 Total 100.0 Median no. of vlsxls 3.5 Number of months pregnant at the t ime of first ANC visit No antenatal care 47.1 <= 5 months 459 6-7 months 4 3 8+ months 2.3 Don't know, mxssmg 0,4 Total I ao 0 Median number of months pregnant at first visit 3.2 Number ol live births 8626 Note: lqgures are lot b~rths m the period 1-59 months preceding the survey. 131 years preceding the survey and if so, the number of injections. These results are presented in Table 11.3. For more than two-fifths oftbe births (43 percent), mothers did not receive a tetanus toxoid vaccination; for 17 percent, the mothers received one dose, and, for 41 percent, the mothers received two or more doses. The current level of tetanus toxoid coverage is five times higher than the level reported in the 1988 EDHS when mothers reported receiving a tetanus toxoid vaccinations for only 11 percent of births (Sayed et al., 1989). The marked increase is most likely a response to a public campaign to improve tetanus toxoid coverage that was conducted during the period between the two DHS surveys. Table 11.3 Tetanus toxoid vaccination Percent distribution of births in the fwe years preceding the survey, by number of tetanus toxoid injections given to the mother dunng pregnancy, according to selected background characteristics, Egypt 1992 Number of tetanus toxoid injections Two Number Background One doses Don't know/ of characteristic None dose or more Missing Total births Mother's age at birth < 20 36.3 14.5 49.1 0.1) 100.0 945 20 34 42.3 16.9 40.6 0.2 100.0 6595 35+ 49.6 16.0 34.3 0.2 100.0 1086 Birth order 1 33.2 11.7 54.9 I).2 100.0 181)6 2-3 39.0 20.3 40.5 0.2 100.0 3037 4-5 46.5 16.1 37.2 0.2 100.0 1882 6+ 53.2 15.5 31.3 0.I I00.0 1900 Urban-rural residence Urban 42.9 16.9 40.0 0.2 100.0 3237 Rural 42.3 16.3 41.2 0.1 100.0 5389 Place of residence Urban Govemorates 47.8 14.9 37.1 0 3 100.0 1557 Lower Egypt 35.8 18.7 45.3 0.2 100 0 3408 Urban 32.0 18.4 49.4 0.2 11XI l) 820 Rural 37.0 18.7 44.0 0.2 100.0 2588 Upper Egypt 46.6 15.2 38.1 0.1 100.0 3661 Urban 44.6 19.0 36.3 0.2 100.0 860 Rural 47.2 14.1 38.7 0.0 1 ll(I.0 2801 Mother's education No education 46.4 15.4 38.0 0.2 100.0 4427 Some primary 42.7 18.0 39.2 0.1 100.0 1735 Primary through secondary 35.9 16.9 47.2 0.0 101).0 806 Completed secondary/higher 35.3 17.6 46.8 0.2 100.0 1657 Work status 39.9 18.6 41.4 0.0 100.0 1087 Working for cash 42 9 16.2 40.7 0.2 1/)0.0 7539 Not working for cash All births 42.6 16.5 40.8 0.2 100.0 8626 Note: Figures are for births in the period 1-59 months preceding the survey. 132 Differentials in tetanus toxoid coverage also are shown in Table 11.3. The younger a mother is, the more likely it is that a tetanus toxoid vaccination was received during pregnancy. Vaccination coverage decreases directly with the birth order of the child. Coverage levels are the same in urban and rural areas. Surprisingly, Upper Egypt is achieving coverage similar to that in the Urban Goveroorates while Lower Egypt is doing better than both (see Figure 11.1). Births to mothers who completed at least prim ary education are somewhat more likely to be protected against neonatal tetanus than births to mothers with less education. On the other hand, the fact that a mother works for cash makes only a slight difference in the probability that a birth was protected against neonatal tetanus. 11.2 Nature of Delivery Another crucial element in reducing health risks for mothers and children is increasing the proportion of babies that are delivered in health facilities. Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for either the mother or the baby. This section discusses three topics related to delivery: place of delivery, type of assistance during delivery, and dclivcry characteristics. Place of Delivery Table 11.4 presents the distribution of births in the five years preceding the survey by the place of delivery. Almost three-quarters of all deliveries take place at home. Although the proportion of home deliveries is high, more births are occurring in health facilities (27 percent) now compared to the 1988 EDHS results, where 22 percent of births were reported to have been delivered at a health facility (Sayed et al., 1989). Among births in health facilities, more than 60 percent take place in government hospitals or health units. Although the majority of births occur at home, there are striking differences by age of the mother and birth order of the child. Deliveries at home decrease with mother's age and increase with birth order. There also are significant differences by residence. In urban areas, the probability that a birth was delivered at home or in a health facility is almost equal. In contrast, more than eight in ten rural deliveries take place at home. Even greater differences are evident according to the place of residence. For example, in the Urban Govemorates, almost six in ten deliveries occur at health facilities while, in rural Upper Egypt, almost nine in ten deliveries take place at home (see Figure 11.2). Education clearly is positively related to the percentage of deliveries at a health facility. Also, births to women working for cash are twice as likely as births to women not working for cash to occur at a health facility. Finally, the number of antenatal care visits is related to the likelihood that a birth occurred at a health facility. The percentage delivered at a health facility was 13 percent among births in which no antenatal care was received compared to 25 percent among births in which the mother reported 1-3 antenatal care visits and 58 percent among births in which there were 4 or more antenatal visits. 133 Table 11.4 Place of deliverf Percent distribution of births in the five years preceding the survey, by place of delivery, accord- ing to selected background characteristics, Egypt 1992 Public Private Number Background health health At of characteristic facility facilty home Other Total births Mother 's age at birth < 20 13.6 5.3 81.1 0.0 100.0 945 20-34 16.7 10.5 72.7 0.1 100.0 6595 35+ 21.3 12.0 66.5 0.1 100.0 1086 Birth order 1 26.4 17.0 56.5 0.1 100.0 1806 2-3 15.8 10.9 73.2 0.1 1130.0 3037 4-5 12.8 7.3 79.8 0.1 100.0 1882 6+ 14 I 5 0 80.9 0.0 100.0 1900 Urban-rural residence Urban 30.4 17.5 52.0 0.1 100.0 3237 Rural 8.9 5.7 85.3 0.1 100.11 5389 Place of residence Urban Governorates 38.2 18.0 43.7 0 1 100.0 1557 Lower Egypt 13.4 10.3 76.2 0.0 100.0 3408 Urban 24.5 20.0 55.4 0.1 100.0 820 Rural 9.9 7.3 82.8 0.11 11X).1) 2588 Upper Egypt 11.2 6.6 82.1 0.1 100.0 3661 Urban 21.8 14.3 63.8 0.0 1011.0 860 Rural 8.0 4.2 87.7 0 2 100 0 28111 Mother 's education No education 11.2 3.9 84.8 0.0 100.0 4427 Some primary 17.5 7.2 75.3 0.0 100.0 1735 Primary through secondary 22.0 12.9 64.8 0.3 100.0 806 Completed secondary/higher 29.3 28.4 42.1 0.3 100.0 1657 Work status Working for cash 28.3 19.8 51 4 0.4 100 0 1087 Not working for cash 15.3 8.7 75.9 0.0 100.0 7539 Antenatal care visits None 10.1 3.1 86.8 0.0 100.0 4061 1-3 17.5 7.8 74.7 0.1 100.0 2560 4 or more 30.6 27.9 41.2 0.3 100.0 1945 Don't know/Missing 22.3 5.0 72.1 0.0 100.0 59 All births 17.0 10.1 72.8 0.1 100.0 8626 Note: Figures are for births in the period 1-59 months preceding the survey. 134 60 50 40 30 20 10 Percent Figure 11,2 Delivery at Health Facility by Place of Residence 0 Urban Tolal Urban Rural Total Urban Rural Governorates Lower Egypt Upper Egypt EDHS1992 Assistance during Delivery Table 11.5 shows the percent distribution of live births in the five years preceding the survey by type of personnel assisting during delivery. If the mother was assisted by more than one type of provider, only the most qualified person is recorded in the table. Very few births (2 percent) are delivered without assistance. Traditional birth attendants (dayas) provided assistance in delivering somewhat more than half of aU births and relatives or friends assisted with 5 percent of the deliveries. Doctors (34 percent) or trained nurse-midwives (7 percent) assisted around 40 percent of births. The proportion of deliveries assisted by trained medical providers increases with mother's age and decreases with birth order of the child. Medical personnel assisted more than six in ten urban births but were present at only one in four rural deliveries. Even more pronounced differences are observed by place of residence. The percentage of births assisted by trained personnel ranges from a high of 68 percent in the Urban Governorates to a low of 23 percent in rural Upper Egypt. As expected, more educated women more frequently receive assistance at birth from medical personnel than less educated women; the proportion receiving medical assistance ranges from around one- quarter of births to mothers with no education to three-quarters of births to mothers with at least a secondary education. Working for cash is also associated with a greater likelihood of receiving medical assistance; almost two-thirds of births of working women were assisted by trained medical providers compared to around one-third of births to women who were not working for cash. 135 Table 11.5 Assistance during delivery Percent distribution of births in the five years preceding the survey by type of assistance during delivery, according to selected background characteristics, Egypt 1992 Attendant assisting during delivery I Trained Traditional Number Background nurse/ birth Relative/ of characteristic Doctor Midwife attendant 2 Other No one Total births Mother's age at birth < 20 27.3 6.1 60.6 5.3 0.7 100.0 945 20-34 33.4 7.6 52.8 4.5 1.7 100.0 6595 35+ 39.5 5.9 46.8 5.2 2.7 100.O 1086 Birth order 1 51.0 6.7 39.0 2.7 0 5 100.0 1806 2-3 33.5 8.5 52.0 4.6 1.3 100.0 3037 4-5 25.3 8.0 60.1 4.5 2.1 100.0 1882 6* 24.7 4.7 60.5 7.0 3.1 100.0 190(I Urban-rural residence Urban 52.6 9.9 33.4 3.2 0.8 100.0 3237 Rural 22.0 5.5 64.6 5 6 2.3 100.0 5389 Place of residence Urban Govemorates 60.2 8.1 28.1 3.3 0.4 100.0 1557 Lower Egypt 32.0 7.7 56.5 2.9 0.9 100.0 3408 Urban 50.5 12.4 35.7 1.1 0.3 100.0 820 Rural 26.2 6.3 63.0 3.4 1.1 100.0 2588 Upper Egypt 23.4 6.3 60.2 7.0 3.0 100.0 3661 Urban 40.9 10.9 41.0 5.1 2.2 100.0 860 Rural 18.1 4.9 66.1 7.6 3.3 100.0 2801 Mother's education No education 19.3 4.8 66.6 6.8 2.5 1011.0 4427 Some primary 32.8 7.0 54.5 4.4 1.3 100 0 1735 Primary through secondary 45.I 12.9 38.7 2.1 1.2 100 0 806 Completed secondary/higher 66.3 10.8 21.6 0.8 0.4 100.0 1657 Work status Working for cash 56.5 9.0 30.7 3.4 0.5 100.0 1087 Not working for cash 30.1 6.9 56.1 4.9 1.9 100.0 7539 Antenatal care visits None 17.5 5.9 67.3 6.6 2.7 I00,0 4061 1-3 33,4 8.3 52.9 4.3 1.2 100.0 2560 4 or more 66.8 8.1 23.3 1.5 0.3 100.0 1945 Don't know/Missing 39.1 16.5 40.9 2.9 0.0 100.0 59 Total 33.5 7.2 52.9 4.7 1.7 100.0 8626 Note: Figures are for births in the period 1-59 months prior to the survey. Ilf the respondent mentioned more than one attendant, only the most qualified attendant is considered. 21ncludes both txained and untrained traditional birth attendants 136 Delivery Characteristics The EDHS collected information on several other aspects relating to the delivery of births, including the extent of caesarean section and premature deliveries. Questions on birth weight and the size of the baby at birth were included to estimate the proportion of low birth weight infants. Table 11.6 summarizes the data on these delivery characteristics for births in the five years before the sur- vey. The results indicate that only 5 percent of deliveries were by caesarean section and, according to the respondents, only 3 percent of the births were delivered prematurely. Birth weight are not avail- able for 92 percent of the births. Among the small number of births for which mothers were able to provide birth weights, 11 percent weighed less than 2.5 kilograms and, thus, can be classified as low birth weight infants. According to the respondents' own assessment of their infant's size, about 15 percent of the births were smaller than average or very small in size and 7 percent were larger than average or very large. 11.3 Immunization of Children An essential part of improving child survival is increasing the percentage of children immunized against the major prevent- able childhood diseases. The worldwide Expanded Program on Im- munization (EPI) t has established guidelines on childhood immunizations. The guidelines call for all children to receive: a BCG vaccination against tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertussis, and tetanus; three doses of polio vaccine; and a measles vaccination. 2 Children should receive all of these vaccinations by the time that they are 12 months of age. Levels of Vaccination Coverage In the EDHS, information on childhood vaccinations was collected for all children born during the five years preceding the Table 11.6 Characteristics of delivery Percent distribution of births in the five years preceding the survey by whether the delivery was by caesarean section, whether premature, birth weight and the mother's estimate of baby's size at birth, Egypt 1992 Delivery Percent characteristic of births Caesarean Yes 4.6 No 95,3 Don't know/Missmg 0,1 Total 100.0 Premature blr ~,h Yes 2.9 No 97.0 Don't know/Missing 0.2 Total 100.0 Birth weight Less than 2.5 kg 0.9 2.5 kg or more 7.1 Don't know/Missing 92.0 Total 100.0 Size at birth Very small 0.7 Smaller than average 14.6 Average 77.9 Larger than average 6.2 Very large 0.6 Don't know/missing 0.1 Total 100.0 Number of births 8626 Note: Figures are for births in the period 1-59 months preceding the survey. survey. In Egypt, immunizations are recorded on a child's birth certificate. For each child born during the five-year period before the survey, mothers were asked whether they had the birth certificate for the child and, if so, to show the certificate to the interviewer. When the mother was able to show the certificate, the dates of vaccinations were copied from the record to the questionnaire. In cases where the vaccination record on the certificate was incomplete, the mother was asked a further question about whether the child had received any other vaccinations. If the vaccination record was not available for the child, the mother was asked specific questions about whether the child had received each vaccine. 1The Egyptian EPI program is managed by the Communicable Disease Department of the Ministry of Health and receives assistance from USAID and UNICEF. 2The Egyptian government recently added the hepatitis vaccine to its child immunization program. The EDHS included hepatitis in the list of vaccines for which information was collected. However, because the hepatitis immunization component was launched only a short time before the survey fieldwork, only a few children were reported as having received the vaccine, and it is not included in the immunization tables in this report. 137 Table 11.7 summarizes vaccination coverage for children age 12 to 23 months. The first indicator shows the proportion of the children who had been vaccinated at any age up to their age at the time of the survey. These results are presented according to the source of the information used to determine coverage, i.e., vaccination record or mother's report. The second indicator shows the proportion of children who had been vaccinated by age 12 months, the age at which vaccination coverage should be complete. According to information from both the vaccination records and mother's recall, 90 percent of children age 12-23 months have received a BCG vaccination. Coverage for the first dose of DPT is somewhat higher (93 percent), and it is also higher for the first dose of polio (95 percent). Coverage declines for subsequent doses of the vaccines. Only 76 percent of the children received the third dose of DPT and 79 percent, the third dose of polio; the dropout rates 3 between the first and third doses of DPT and of polio are 18 and 17 percent, respectively. The coverage rate for measles vaccine (82 percent) is only slightly higher than that for the third dose of DPT or polio. Overall, 67 percent of the children were fully vaccinated, while 4 percent had not received any vaccination. As mentioned earlier, it is recommended that children complete the schedule of immunizations during their first year of life, i.e., by 12 months of age. Table 11.7 shows that, among children aged 12-23 months at the time of interview, 57 percent had been fully vaccinated before their first year of life. This represents 85 percent of all of the children 12-23 months who had ever received the full schedule of immunizations. With regard to specific vaccines, children were least likely to have received the measles vaccine by age 12 months. Seventy percent of all children had received the measles vaccine by age 12 months. Table 11.7 Vaccinadons by source of information Percentage of children 12-23 months who had received specific vaccines at any time before the survey and the percentage vaccinated by 12 nk, nths of age, by whether the information wa.s from a vaccination record or from the mother, Egypt 1992 Percentage of children who received: DPT Poho Number Source of of information ItCG 1 2 3+ 1 2 3+ Measles All I None chddren Vaccinaled at any l ime before the survey Vaccmauon record 51 9 53.5 52 0 47.6 53.7 52 1 47.9 47 3 43.1 0.8 880 Mother's report 37.5 39,3 35.8 28.8 40 8 37.9 31.0 34 2 24.3 3.0 714 Either source 89 5 92.8 87.8 76.4 94.5 90.1 78.9 81.5 67 4 3.8 1594 Vaccinated by 12 months of age 88.8 92.2 86.4 72.7 93.8 88.6 75 0 70.3 57 2 4.8 1594 Note: For children whose information was based on the mother's report, the proporUon of vaccinations given during the first year of life was assumed to be the same as for childlen with a written record of vaccination IChildren who are fully vaccinated (t.e. those who have received BCG, measles, and three doses of DPT and polio vaccines). 3Dropout rate = (Dose 1 - Dose 3) * 100/Dose 1 138 Vaccination Coverage during the First Year of Life Table 11.8 is based on children 12 to 59 months of age and shows the percentage of children who have a vaccination record, as well as the percentage who have received each vaccine during the first year of life, according to information from birth certificates and mothers' reports. For children whose information was based on the mother's recall, the distribution of vaccinations during the first year of life was assumed to be the same as that for children for whom a vaccination record was available. The first row in Table 11.8 shows the proportion of children age 12-59 months for whom a vaccination record was seen by the interviewer. Overall, records were seen for slightly less than half of all of the children. The percentage of children for whom a vaccination record was seen decreases with age, from 55 percent among children 12-23 months to 42 percent among those age 48-59 months. This decline probably reflects a greater tendency for mothers to have misplaced the vaccination records for older children. Table 11.8 Vaccinations in the first ~'ear of life Percentage of children one to four years of age for whom a vaccination record was seen by the interviewer and the percentage vaccinated for BCG, DPT, polio, and measles during the first year of life, by current age of the child, Egypt 1992 Current age of child in months All children Vaccination 12-59 status 12-23 24-35 36-47 48-59 months Vaccination record seen by interviewer 55.2 50.3 45.9 42.3 48.3 Percent vaccinated at O-ll months a BCG 88.8 86.8 87.8 83.6 86.7 DPT 1 92.2 90.6 89.6 88.0 90.0 DPT 2 86.4 86.7 85.9 82.3 85.2 DPT 3 72.7 75.4 76 7 75.1 75.0 Polio 1 93.8 91.8 91.3 89.4 91 5 Polio 2 88.6 88.0 88.0 83.9 87 (i Polio 3 75.0 78.2 78.4 77.1 77 2 Measles 70.3 69 3 71.4 69.6 7/I.1 All vaccinations b 57.2 57.3 61.5 61.11 59.3 No vaccinations 4.8 6.1 6 2 8.6 6.5 Number of children 1594 1583 1628 1788 6593 alnformation was obtained either from a vaccination record or from the mother if there was no written record. For children whose information was based on the mother's report, the proportion of vaccinatiorts given during the first year of Life was assumed to be the same as that for children with a written vaccination record. bchildren who have received BCG, measles, and three doses of DPT and polxo vaccines. 139 No clearcut trend over time is evident in the patterns of vaccination coverage by the child's age. Older children (age 36-59 months) are somewhat more likely to have been fully immunized during the first year of life than younger children. However, the proportion of children with no vaccinations in the first year of life appears to have decreased slightly over time, declining from 9 percent among children age 48-59 months to 5 percent among children 12-23 months. Differentials in Vaccination Coverage Table 11.9 looks at vaccination coverage among children age 12 to 23 months by selected back- ground characteristics, including the child's sex and birth order, urban-rural residence, place of residence, and the mother's educational level and working status. The figures in the table refer to the percentage of children receiving the vaccinations at any time up to the date of the survey, and they are based both on information from vaccination records and mothers' reports. The table includes information on the proportion of children for whom a vaccination record was seen. Table 11.9 Vaccinations by background characteristics Percentage of children 12 23 months who had received specific vaccines by the time of the survey (according to the vaccination card or the mother's report) and the percentage with a vaccination record, by selected background characteristics, Egypt 1992 Percentage of children who received: Percentage with a DPT Polio vaccl- Number Background nation of characteristic BCG 1 2 3+ 1 2 3+ Measles All I None record children Sex Male 89.0 92 7 87.8 77.6 94.7 90.1 80.1 81 7 68.9 3.5 55.6 850 Female 89.9 92 8 87 8 75.0 94.4 90.0 77.6 81 2 65 7 4 2 54.8 743 Birth order 1 94.7 96.4 92.8 83.5 97.8 94.4 85.2 87.4 75 1 1 4 58.4 369 2-3 91.6 94.1 88.4 76.4 95.5 90.5 79.2 85.1 69 9 2 5 56.1 557 4-5 88.1 92.1 88.1 77.8 94.3 90.6 79.3 79.4 66 1 4.0 53.8 359 6+ 80.8 86.9 80.3 66.3 89.1 83.5 70.4 70.4 55 2 8.8 51.4 308 Urban-rural residence Urban 94.0 95 6 92 8 83 9 96.5 95.0 87.4 87 7 77.1 2 5 57.3 592 Rural 867 91 1 84.9 72.0 934 872 740 77.9 61 7 4.6 54.0 11)02 Place of residence Urban Governorates 95 9 96.0 94.2 87.3 96.8 96.1 89.6 90.9 81.7 2 3 59 3 278 Lower Egypt 93.4 95.0 90.9 82.3 96.6 91.9 83.3 87.3 74 4 2 5 56 1 642 Urban 96.4 96.4 96.4 90.6 97.3 97.3 93.4 89 9 83.4 1 8 62 6 148 Rural 92.5 94 5 89 2 79.8 96.4 90.3 80.3 86 6 71.7 2 7 54.2 493 Upper Egypt 83.0 89 3 82.2 66.3 91.6 85.9 70.4 72.1 54.8 5 7 52.7 674 Urban 88.8 94 2 87.1 72.1 95 3 91 2 78.2 80.2 63.6 3 4 49.1 165 Rural 81.2 87.8 80 6 64 4 90.5 84.1 67.8 69.4 52 0 6 4 53.9 509 Mother's education No education 85.0 89.4 82.3 69.4 92.5 85.2 71.4 74 9 59.6 5 6 53.7 780 Some primary 88 3 94 3 91.2 79.6 94.6 92.6 83.3 82.5 66.7 3 4 58 7 332 Primary through secondary 96 8 95 4 93.3 79.4 95.8 93.4 81.7 89,7 75.0 2 0 61 7 152 Completed secondary/higher 97.7 98 1 94.8 88.5 98.8 97.6 91.11 92.4 83.1 0 6 52 2 329 Work status Wortang for cash 95.7 97.8 93.0 87 5 98,4 96.3 90,3 89.5 79 8 1.1 42.3 186 Not working for cash 88 6 92.1 87.1 75 0 94.0 89.3 77.4 80.4 65 8 4.2 56.9 1407 All children 89.5 92.8 87.8 76.4 94.5 911.1 78.9 81 5 67 4 3 8 55.2 1594 1Children who are fully vaccinated (i .e, those who have received BCG, measles, and three doses of DIYl ' and polio vaccines). 140 Males have a slight advantage over females in vaccination coverage; 69 percent of males have received all vaccinations compared to only 66 percent among females. The discrepancies between sexes are greatest in the case of the third doses of polio and of DPT. Vaccination coverage levels decrease with the child's birth order. Striking differentials are apparent by residence, as shown in Figure 11.3. Urban children are more likely to be fully vaccinated than rural children (77 percent and 62 percent, respectively). The largest differences again occur for the third doses of DPT and polio. By place of residence, coverage levels vary from 82 percent in Urban Govemorates to 74 percent in Lower Egypt and 55 percent in Upper Egypt. Coverage levels are higher in rural Lower Egypt than in urban Upper Egypt, and levels are lowest in rural Upper Egypt, where only 52 percent of children have received all vaccinations. As expected, the percentage of children that have received all vaccines increases with education of mother. It is also higher among children whose mothers work for cash than among children of women not working for cash. Figure 11.3 Percentage of Children 12-23 Months Who Are Fully Vaccinated, by Place of Residence Percent 100 80 6O 49 2O 0 Urban Governora[es /-.-- / Total Urban Lower Egypt Rural Total Urban Rural Upper Egypl EDHS 1992 11.4 Childhood Illness and Treatment Two main illnesses, as well as their treatment, are discussed in this section due to their importance for infant and child survival. They are acute respiratory infection and diarrhea. 141 Table 11.10 Prevalence and treatment of acute respiratory infection Percentage o f chi ldren under five years who were ill with a cough accompanied by short, rapid breathing dur ing the two weeks preceding the survey, and the percentage of ill chi ldren who were treated with specific remedies, by selected background characteristics, Egypt 1992 Among children with cough and short, rap=d breathing Percentage taken to a health Percentage lacflxty or provider, of chd- by type of facility dren with cough and Public Background short, rapid and Anu- characteristic breathing Pubhc I Private 2 Private biotic Pt:rccnlage treated with Injec- Cough tion syrup Other Unknown Number pdl/ pdl/ Itome of syrup ~yrup remedy Other None chddren Child's age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Fern',de Birth order 1 2-3 4-5 6+ Urban- rura l residence Urban Rural Place of residence Urban Governorates Lower Egypt Urban Rural Upper Egypt U~rban Rural Mother's education No education Some primary Primary through secondary Completed second- ary/higher Wock status Working for cash Not working for cash All children 8.8 17.3 27.4 2.4 20 1 13 2 41 9 6.6 10.9 0 5 6 5 37 9 688 11 7 16.5 47.7 0.2 21.2 22.4 78 9 16 8 16 4 1,6 1.3 12,0 737 11.3 20,4 47.9 1.0 25.3 28.4 61.8 23.9 21 9 I 4 I I 18 8 1594 7,8 194 36.4 0.0 21.1 21.8 67,7 162 176 (12 O.(I 150 1583 60 16,5 28.8 1.5 27.3 138 5(14 2(12 169 00 1 (1 3(12 1628 6.2 16.7 37.6 2.3 29.2 225 65.3 17.3 16,4 22 () I 19 ~ 1788 8.8 15.6 435 20 285 23,6 65,3 18.8 202 7.6 21.4 34.1 0.1 195 196 58,5 17.7 14.6 12 14 168 4144 (1.8 1 1 25 5 3874 92 11.8 49.1 0.3 28.2 17.9 693 148 26.1 ] 0 (I.2 16.8 17(XI 7.9 18,6 39.6 0.1 26.9 20.9 64 9 16 9 11 9 I I 11.8 21 5 2835 6.6 22.1 39.6 0.0 22.4 21.2 63.7 19,1 198 21 33 169 1761 9.5 20.9 29.1 4.3 19.0 27,3 5(18 22 9 16 1 (12 1.3 26 1 1722 8.0 18.4 435 2.6 349 199 678 151 172 1 I 03 151 3(187 8.4 18.1 367 (13 18.3 22.9 589 2(12 180 I 0 I 8 2411 4931 7.0 281 37.5 6.2 42.1 196 674 164 15(I 1,6 (17 18[) 1484 8.4 151 46.4 0.4 23.8 23.6 692 182 21.1 0.7 11.3 t74 3208 8.8 15.4 58.2 0.0 30.8 252 67,9 15.6 194 I10 l).() 162 789 8.2 15.0 42.4 0.5 21.4 23.0 69.6 19 I 21 7 0.9 0.4 17 9 2419 8.6 17.5 33.2 0.0 18.8 21.0 53.9 19 0 15.5 I I 2 3 24 8 3326 9.13 7.6 384 (/.0 28.5 15.3 684 129 /8 1 1 3 (/(/ 1(/2 813 8.5 20.9 31.4 0.0 15.4 22.9 489 21 2 146 I 1 3 I 298 2512 8.2 20.1 29.9 1 3 17.9 22.7 57 7 18.3 14 4 1.6 1.7 25.9 4(154 9.0 24.0 37.2 2.0 265 249 6(I,7 21.6 19.4 00 I 4 179 1619 8.6 12.5 56.0 0 0 29 4 20,2 73 0 10 7 20 9 0 5 (I (I 14 8 756 7.4 87 59.1 0.3 378 164 71 (I 18 t 23(1 8.6 19.7 44 1 1 5 32 6 20.5 63.3 16.U 17 8 8.2 18.0 385 1 1 232 220 621 186 177 8.2 18.2 39.3 1 I 24.5 21.8 622 183 177 Note: Figures are for children born m the period 1 59 months preceding the survey 1Includes government hospitals and health units 21ncludes private hospltals/cbmcs and private doctors 0 (13 1t I 1589 t 02 134 1(/2(I [) 1 4 21 8 6998 1,0 I 2 21) 7 8018 142 Acute Respiratory Infection Acute respiratory infection (ARI) is a common cause of morbidity and death among children under five years of age in Egypt. A large proportion of the deaths caused by pneumonia can be prevented by early diagnosis and treatment of ARI with antibiotics. ARI prevalence was estimated in the EDHS by asking mothers if their children under age five had been ill with coughing accompanied by short, rapid breathing, a during the two weeks preceding the survey. Mothers whose children experienced these symptoms were asked about what they had done to treat the illness. Information on the prevalence of ARI and treatment practices are presented in Table 11.10. The EDHS results indicate that the prevalence of cough with rapid breathing in the two weeks prior to the survey is 8 percent among children under five years of age. Advice or treatment was sought from a health facility in the case of 59 percent of children with ARI symptoms. Mothers who reported that a health facility was consulted were twice as likely to have consulted a private sector facility as a public sector facility. The most common treatment is cough syrup (62 percent) followed by antibiotics (25 percent) and injection (22 percent). One in five children with cough and short, rapid breathing were not given anything to treat the illness. Table 11.10 also looks at differentials in the prevalence of ARI symptoms and treatment practices for children suffering from these symptoms by selected characteristics of the child and the mother. The prevalence differentials are generally small. Thc largest differences are by the child's age, with children 6-23 months being somewhat more likely to have had cough and short, rapid breathing than younger or older children. Treatment practices are more variable across subgroups. Health facilities arc morn likely to have been consulted and treatments given (especially cough syrup and antibiotics) Ior male children, urban children (particularly those from thc Urban Govemorates and urban Lower Egypt), and children of educated mothers or of mothers who are working for cash than for other children. It also is evident that mothers are less likely to treat cough and short, rapid breathing in young children (under 6 months of age). Diarrhea Dehydration brought on by severe diarrhea remains a major cause of child death in Egypt. This section discusses thc prevalence of diarrhea as well as treatment practiccs. Of particular interest is thc knowledge and use of oral rehydration therapy (ORT), which has been widely promoted in Egypt. ORT solution (used in oral rehydration therapy) may bc prepared from commercially produced packets of oral rehydration salts (ORS) or a homemadc mixture usually prepared with sugar, salt and water. Table 11.11 summarizes the prevalence of diarrhea in children under five years of age and treatment practices. Thirteen percent of children had diarrhea at some time in the two weeks preceding the survey, including 1 percent with bloody diarrhea. Six percent were still having an episode of diarrhea at the time of the survey (i.e within the last 24 hours). Children age 6-23 months are more likely to have experienced diarrhea, including bloody diarrhea than children in other age groups. Differentials in the prevalence of diarrhea by the other background aCough and short, rapid breathing are signs and symptoms of pncumonm. The EDHS estimate ol ARI prevalence thus corresponds to an estimate of the prevalence of children who need treatment for presumed pneumonia and does not include other ARl-related conditions (coughs and colds, wheezing, ear infection, and streptococcal sore throat) covered under the WHO guidelines for ARI case management. 143 characteristics in Table 11.11 are not marked; however, levels tend to be highest for male children, fi rst-bom children and children of sixth or higher birth order, children living in Upper Egypt (especially urban areas), childrenofmothers at intermediate educational levels and of mothers who arc not working for cash than other children. Table 11.11 Prevalence of diarrhea Percentage of children under five years who had diarrhea and dtarrhea w)th blood in the two weeks preceding the survey, and the percentage of children who had diarrhea in the preceding 24 hours, by selected background characteristics, Egypt 1992 I)larrhea m the All preceding 2 weeks I diarrhea in the Number Background All Diarrhea precedinl~, of characteristic diarrhea wllh bhx)d 24 hottls g Chl[drc[i Child's age < b months 19 0 0.3 9 9 688 6-11 Months 27 8 1.2 120 737 12-23 Months 21 7 1.2 9 4 1594 24-35 Months 12.5 0.8 4 9 1583 36-47 Months 6.8 0.8 2 3 1628 48 59 Months 4 7 0.3 1 5 1788 Sex Male 14.4 08 64 4144 Female 12.3 O 7 4 7 3874 Birth order 1 15.1 0,7 6.1 17OO 2-3 12.9 (I.7 5 1 2835 45 11 1 06 54 1761 6+ 14,9 El 59 1722 Urban-rural residence Urban 13.4 0.5 5 3 3087 Rural 13.4 0 9 5 8 493 I Place or r~sidcncc Urban Governorates 12.0 1) 4 4.4 1484 Lower Egypt 12.1 O 6 4 9 3208 Urban 12.1 O 5 4 6 789 Rural 12 1 O 7 50 2419 Upper Egypt 15.3 1 I 6 7 3326 Urban 17 3 0 8 7 4 813 Rural 14.6 1.2 6 5 2512 Mother's education No educataon 13.3 0.8 5 9 4054 Some primary 14.1 09 5 7 1619 Primary through secondary 14 8 I I 5 2 756 Completed secondary/lugher 12 1 0.4 4 7 1589 Work status Working for cash 11 1 0 5 4 4 1(1211 Not working for cash 13 7 O,S 5 7 6998 All chddren 13 4 O S 5 6 80 [ S Note Figures are for chddren born m tile |xzrtod 1 59 month~ preceding tile survey. llncludes diarrhea m the past 24 hours 2Includes diarrhea wath blo(xl 144 The Egyptian diarrheal disease control program has placed considerable emphasis on the use of oral rehydration therapy in cases of childhood diarrhea. Table 11.12 looks at over- all levels of knowledge and ever use of ORS packets among women who have given birth in the five years prior to the survey. It is clear that knowledge is virtually universal; 99 percent of mothers know about ORS packets. Ever use levels are also high at 70 percent among all mothers. Ever use generally increases with the age of the respondent. Rural mothers, less edu- cated mothers, and mothers not working for cash are more inclined to use ORS packets as compared to other women. This may be due to the greater availability of other treatments among urban, educated mothers, and those mothers working for cash. Treatment practices for diarrhea are further assessed in Table 11.13, which looks at the extent to which advice or treatment was sought from medical providers and also details the percentage of children with recent bouts of diarrhea who were given various treatments, including ORT. Forty-five percent of children under five years of age who had diarrhea in the two weeks preceding the survey were taken for treatment to a medical provider. Mothers were twice as likely to have sought treatment from a private provider than from a public health facility. The percentage seeking medical advice or treatment was higher for young children under two years of age than for older children, peaking at 60 percent among children age 6-11 months. No significant differences in the ten- dency to seek advice or treatment are observed by the sex of the child, but mothers are more inclined to take their first order children to a health facility than children of any other birth order. Mothers in Upper Egypt are less likely to take children for treatment to a health facili- Table 11.12 Knowledge and use of ORS packets Percentage of mothers with births in the five years preceding the survey who know about and have ever used ORS packets, by selected background characteristics, Egypt 1992 Know Have ever Number Background about ORS used ORS of characteristic packets packets mothers Age 15-19 98.2 50,4 227 20-24 98.9 65.7 1081 25-29 98.4 73.5 1672 30-34 99.5 73,3 1286 35+ 98.4 70.8 1410 Urban-rural residence Urban 99.3 66 3 2309 Rural 98.3 73.2 3367 Place of residence Urban Govemorates 99.3 65.0 1126 Lower Egypt 99.2 71.2 2317 Urban 99.4 62.5 608 Rural 99.1 74.3 1709 Upper Egypt 98.0 72.2 2233 Urban 99.4 72.8 575 Rural 97.5 72.0 1658 Education No education 98.1 71.8 2767 Some primary 99.1 75.2 1163 Primary through secondary 99.1 70.1 579 Completed secxmdary/higher 99.5 62.4 1167 Work status Working for cash 99.1 67.5 748 Not working for cash 98.7 70.8 4928 All mothers 98.7 70.4 5676 Note: Figures include mothers who have given ORS for diarrhea during the preceding two weeks, although they were not asked about knowledge of ORS packets. ty than mothers in either the Urban Govemorates or Lower Egypt. The probability of taking the child for treatment increases with mother's education and is higher when the mother is working for cash than when she is not. Table 11.13 also considers the types of treatments that mothers reported. Overall, only 29 percent of mothers had done nothing to treat thc diarrhea. Mothers of children under 6 months of age and those age 3 years and above were more likely to report doing nothing to treat the diarrhea than mothers of children in the other age groups. Marked differences in the propensity to treat the diarrhea are observed by place of 145 Table 11.13 Treatment of diarrhea Percentage of children under five years who had diarrhea in the two weeks preceding the survey who were taken for treatment to a health facility or provider, the percentage who received oral rehdyration therapy fORT), the percentage who received increased fluids, the percentage who received neither ORT nor increased fluids, and the percentage receiving other treatmenks, according to selected background characteristics, Egypt 1992 Background characteristic Percentage taken to a health percent- facility or provider, Oral rehydraUon Per- age re- by type of facdity the*apy fORT) centage ceJvmg Percentage receiving other treatments: recelv- neither Pubhc mg In- ORT not In- Other Children and ORS creased increased Anti- jec- pill/ Intra- Florae with f)ubhc I Prtvate 2 private packet Rill: flutds flutds btottcs tLon syrup venous remedy Other None diarrhea Child's age < 6 months 14.0 34 9 0.0 23 6 2.2 14.0 65.3 12.8 5.2 31,9 0.9 3 0 0.0 37.7 f31 6-1 l months 18 7 40.8 0 0 42.3 5 4 16.1 51 0 28.3 7 0 32.3 1 5 2.9 1.2 24.9 205 12-23 months 13 8 34.9 l.O 32.4 7.1 20.9 50 8 24.0 5.6 40.0 1 I 0.8 0.8 22.9 345 24-35 months 13 6 26.9 0,0 24.9 4.6 20 4 57.7 23 3 3AI 32.0 1 +7 I 9 0~7 26 3 f97 36-47 months 6.9 17 0 0.0 f4 2 3.3 f9 f 68.1 f8,2 4.f 32.2 1 4 1.2 0 2 40 7 I fl 48-59 months IO.O 17 2 0 0 20 3 13.5 f6, f 64.2 20.1 4 9 19,6 0 2 0.0 0 0 42 I 84 Sex Male f2.7 33 6 0,6 30 5 4.7 17.7 57.4 23.8 6.5 32 4 0.8 1.9 0.9 29.4 598 Female 15 1 28.5 l) 0 27.1 7 2 19.6 55 8 20 7 3 4 35.3 f 7 f.3 0,3 28.6 476 Blfr th order 9.1 41 9 (13 27 0 3,2 f 8 8 60.1 24 5 5.6 38 0 0.8 2 1 1.0 27 6 257 2-3 f3.8 31 8 (1,3 27 3 5.3 17 8 58.4 23.4 3.6 33.9 2.0 2 1 0 1 27.9 365 4-5 f2.3 290 0.0 282 8.5 199 57.4 248 55 330 09 22 05 28.9 f96 6+ 19.4 2f 7 0 6 34 2 7.2 18 I 50.3 17+2 6.5 29.4 0 7 0 I f 2 32.3 256 Urban-rural residence Urban 12.0 35 I 0.6 23 5 3.5 17.9 62 0 24 0 3.7 37.1 1.2 2.4 l.l 28.7 414 Rural 14 8 28.9 0 I 32.5 7 3 18.9 53.4 21 5 6.0 31 5 1.2 I 2 0.3 29 3 659 Place of residence Urban Govemorates 16.5 34 3 0 8 27.3 2 4 f 3.4 61.5 26.9 4. I 33.0 1.8 3,5 0 7 27.4 178 Lower Egypt 11.4 39 8 0.5 35 3 8.7 26 2 45. f 24 5 6 9 38.2 2 2 I 4 0 4 20,8 387 Urban 5.9 47 8 I 1 27 1 7 I 32,6 48 0 26.1 5 6 44.0 I 8 3 8 I 6 18.7 95 Rural 13.2 37 2 0.3 38 0 9.2 24.1 44 2 24.0 7 4 36.2 2 4 0 6 0 0 21.5 291 Upper Egypt 14.5 23,8 0 0 24.8 4 9 14.4 63 9 19.3 4 1 30 5 0,2 1 2 0.8 35.9 509 Urban 105 27.6 00 16.2 25 13.5 72.1 188 2.0 376 00 02 1 3 37.1 141 Rural 16.0 223 00 28.(I 58 14.8 607 19.5 4.9 27.8 03 16 0,6 354 368 Mother's education No education 16 6 26.9 0+4 32.7 6.3 17 4 54.8 19 0 6.3 30.0 0.8 I 1 I 0 31.7 54f Some primary 9,0 25 5 0.0 24 3 5.7 f3 9 64.4 21.2 5.2 32.2 1.9 1 6 0 6 34.0 228 Pnmary through secondary 14.3 31 3 II 9 25.8 8.3 15 3 59.9 27 4 0.8 33 6 1.8 2 6 If 0 26.5 112 Completed second- ary/higher fO 8 50 6 O 0 26 0 3.3 29 0 51.3 30.6 4.1 45 8 I 1 2 8 0 0 17.4 193 Work status Working for cash 106 39.0 0.0 30.8 2.7 279 48.1 25.2 4.7 46.3 3.1 19 0.2 19f fl3 Not workmg for cash 141 30.4 03 28.8 6.2 f74 57.7 221 5.2 32.2 10 16 07 302 96f All children 13,7 31 3 0.3 29 0 5.8 18.5 56.7 22.4 5 1 33.7 1.2 I 6 0.6 29 I 1074 Note: Figures are for chddren born in the period 1-59 months preceding the survey Oral rehydratton therapy fORT) includes sohiUon prepared from ORS packets, and recommended home fluids (RIIF), c g, sugar-salt-water solutton Increased finds includes increased frequency of brea~tfeedmg. Ilncludes government hospttals and health untts :Zlnchides private hospltals/chnics and private doctors 146 residence. Children from Lower Egypt have a better chance of receiving some type of treatment than those from the Urban Gover- norates or Upper Egypt. The percentage not receiving treatment clearly decreases with mother's education and is lower for mothers who work for cash than those who are not working. An oral rehydration salt (ORS) packet was used to treat diarrhea in 29 percent of the cases, 6 percent were given recom- mended home fluid (RHF), and 19 percent were given increased fluids. If oral rehydration therapy is defined broadly to include ORS, recommended home fluids, and increased fluids, then 43 per- cent of children with diarrhea received some form of oral rehydra- tion therapy. Antibiotics (22 percent) and other pills or syrups (34 percent) also were commonly used to treat children with diarrhea. The EDHS also directly investigated the extent to which mothers made changes in the amount of fluids that a child received during a diarrheal episode. To obtain these data, mothers who re- ported that they were still breastfeeding a child who had diarrhea during the two-week period were asked whether they increased the number of breastfeeds, reduced them, or made no change at the time the child had diarrhea. All mothers who had a child with diar- rhea also were asked whether they had changed the amount that the child was given to drink during the diarrheal episode. Table 11.14 shows that, among those children who were breastfed, although the majority (84 percent) continued to be breastfed as usual or were given additional feedings, 14 percent were given fewer feedings and breastfeeding was stopped for 2 percent. Among children re- ceiving fluids other than breast milk, the majority (63 percent) con- tinued as usual or increased the amount of fluids during the diar- rhea episode. However, more than one-quarter of mothers reduced the amount of fluid supplements. These results suggest that further education is needed to ensure that children receive enough fluids during a diarrheal episode. Table 11.14 Feeding practices during diarrhea Percent distribuuon of children under five years who had diarrhea in the two weeks preceding the survey, by feeding practices during diarrhea, Egypt 1992 Feeding practices Percent during diarrhea of chddren Breastfeeding frequency 1 Same as usual 76.6 Increased 7.5 Reduced 13.6 Stopped 1.5 Don't know/missing 0.7 Total 100.0 Number of children 9118 Amount of fluids given Same as usual 46.7 More 16 1 Less 26.5 Breast milk only 8.6 Don't know/mLssmg 2. I Total 100.0 Number of children with diarrhea a 1074 IApplies only to children who are still breast fed. 2Children born in the period 1 59 months preceding the survey. 147 CHAPTER 12 INFANT FEEDING AND MATERNAL AND CHILD NUTRITION This chapter focuses on several aspects related to the nutritional status of mothers and children under age five. The EDHS data allow an assessment of infant feeding practices (including breastfeeding practices, introduction of supplementary weaning foods, and use of feeding bottles), nutritional status of children (based on height and weight measurements of the respondents' children under the age of five years) and nutritional status of mothers. 12.1 Breastfeeding and Supplementation Infant feeding has an impact on both the child and the mother. Feeding practices arc an important determinant of the child's nutritional status, which influences the child's growth and development. Poor nutritional status is related to increased risk of morbidity and mortality for the child. In addition to the direct effects on the child, feeding practices have an indirect effect on the postpartum fertility of the mother. More frequent breastfeeding for longer durations as well delays in the age at which supplementary foods are introduced are associated with longer durations of postpartum amenorrhea and, thus, longer birth intervals and lower fertility. Prevalence of Breast feeding The data presented in Table 12.1 indicate that almost all Egyptian children (94 percent) are breastfed for some period of time. Diffcrentials in the proportion of children breastfed are quite small, with at least 92 percent of children in every subgroup reported as having been breastfed. The timing of initiation of breastfceding for the last-born child also is examined in Table 12.1. Early initiation of breastfeeding is important for both the mother and the child. From the mother's perspective, early suckling stimulates the release of a hormone that helps the uterus achieve a contracted state. From the child's perspective, the first breast milk (colostrum) is important since it is very rich in antibodies. One- quarter of children were put to the breast within an hour of birth and 64 percent within the first day. The most striking differential in the timing of initiation of breast feeding is observed for rural Upper Egypt; only 53 of children from rural Upper Egypt were brcastfed during the first day following birth compared to around 70 percent of children living in other areas. Introduction of Supplements Mothers were asked about the current breastfeeding status of all last-bom children under age five and, if the child was being breastfed, whether various types of liquids or solid foods bad been given to the child "yesterday" or "last night." This information is used to derive the percentages of children breastfeeding and exclusively breastfeeding that are shown in Table 12.2 and Figure 12.1. Children who are exclusively breastfed receive breast milk only. Children who are fully breastfed includes those who are exclusively breastfed and those who receive only plain water in addition to breast milk. Exclusive breastfeeding is recommended for the first 4-6 months of a child's life because it limits exposure to disease agents and because breast milk is the optimal source of nutrients for infants in this age group. 149 Table 12.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and the percentage of last-born children who started breastfeeding within one hour of birth and within one day of birth, by selected background characteristics, Egypt 1992 Among all children: Among last-born chddren, percentage who started bre~tfeeding: Percentage Number Within Within Number Background ever of 1 hour 1 day of ehm'acteristic breastfed children of birth of birth chddren Sex Male 93.7 4502 23.9 64.6 3031 Female 94.5 4195 25.4 63.0 2721 Urban-rural residence Urban 93.2 3255 25.3 68.6 2344 Rural 94.6 5442 24.2 60.6 3408 Place of residence Urban Govemorates 92.2 1564 25.0 68.5 1142 Lower Egypt 95,0 3438 27.7 69.0 2347 Urban 93.6 825 26.2 70.7 616 Rural 95.4 2612 28.2 68.4 1731 Upper Egypt 94.0 3695 21.3 56.2 2263 Urban 94.8 866 24.9 66.5 586 Rural 93.8 2829 20.1 52.6 1677 Mother 's education No education 94.6 4470 23.4 59.2 2800 Some primary 94.0 1745 26.0 65.7 1182 Primary through secondary 92.9 813 27.1 74.9 584 Completed secondary/higher 93.3 1668 25.0 67.5 1185 Work status Working for cash 94.2 1093 24.0 63.4 764 Not working for cash 94.1 7604 24.7 63.9 4988 Ass/stance at delivery Medically trained person 92.7 3536 22.6 64.4 2555 Traditional birth attendant 94.9 4601 26.9 63.8 2858 Other or none 96.2 560 20.3 60.4 339 Place of delivery Health facility 91.8 2356 19.6 61.7 1709 At home]Other 94.9 6333 26.8 64.8 4040 All children 94.1 8697 24.6 63.9 5752 Note: Figures are based on all children born in the fwe years preceding the survey, whether living or dead at the time of the interview. 150 Table 12.2 Breastfeeding status Percent distribution of living children by breastfeeding status, according to child's age in months, Egypt I992 Percentage of living children who are: Breastfed and given: Number Not Exclusively Plain of breast- breast- water Supple- living Age in months fed fed only ments Total children <2 1.8 59.5 0.6 38.0 100.0 204 2-3 3.9 49.7 1.7 44.7 100.0 306 4-5 4.2 28.6 6.8 60.4 I00.0 249 6-7 6.4 15.0 11.2 67.4 100.0 266 8-9 14.0 3.9 4.5 77.6 100.0 238 10-11 14.1 3.7 5.5 76.7 100.0 233 12-13 20.2 4.4 3.9 71.5 100.0 265 14-15 28.2 1.8 4.2 65.8 100.0 290 16-17 31.2 0.4 6.1 62.3 100.0 280 18-19 42.2 2.1 2.1 53.6 100.0 244 20-21 52.7 0.0 0.9 46.4 100.0 244 22-23 72.2 0.0 0.8 27,1 100.0 271 24-25 84.5 0.4 0.0 15.1 100.0 302 26-27 89.9 0.0 1.3 8.8 100.0 305 28-29 93.6 0.0 0.0 6.4 100.0 228 30-31 92.9 0.5 0.0 6.6 100.0 247 32-33 94.7 0.0 0.0 5.3 100.0 229 34-35 95.2 0.0 0.8 4.0 I00.0 272 Note: Breastfeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no supplements. Figure 12,1 Distribution of Children by Breastfeeding Status According to Age Pe[cent 1 O0 80 60 40 20 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 Age *n Months i I "Exclusive BF mBF + Water r"IBF + Supplements IANot BF I m 34 EDHS 1992 151 Exclusive breastfceding is common but not universal among children under four months of age in Egypt. The results in Table 12.2 indicate that 60 percent of children who were less than two months of age and 50 percent of children age 2-3 months receive only breast milk. The percentage exclusively breastfed then drops rapidly to 29 percent among children 4-5 months of age and 15 percent among children 6-7 months of age. The percentage of children who receive breast milk and water only increases from less than I percent among those less than two months of age to a peak of 11 percent among children 6-7 months of age. Supplements other than plain water are given to many children at an early age. Among children less than two months of age, 38 percent are given supplements other than plain water, and the proportion receiving such supplementation increases rapidly to nearly 70 percent among children 6-7 months of age. Table 12.3 looks in more detail at the type of supplements received by breastfed children. Infant formula is given to children, particularly to those over three months of age, but children are more likely to receive fresh milk or other liquids than formula. Solid or mushy food begins to be introduced into the diet at ages 4-5 and 6-7 months. By 8-9 months of age, more than 70 percent of children receive solid or mushy food along with breast milk or are fully weaned. Table 12.3 also indicates the extent to which bottles are used to feed young children. Bottle feeding increases the risk that a young child will develop diarrhea or other diseases since it is difficult to properly sterilize the nipple. The use of a bottle also contributes to sborteningofthe period of postpartum amenorrhea for mothers since it is associated with a lessening of the intensity of breastfeeding. The majority of young children are not fed with a bottle in Egypt. However, nearly one-fifth of breastfed children less than eight months of age were given a bottle with a nipple on the day before the interview. Table 12.3 Breastfeeding and supplementation by age Percentage of breastfeeding children who are receiving specific types of food supplementation, and the percentage who are using a bottle with a nipple, by age in months, Egypt 1992 Age in months Percentage of breast feeding children who are: Receiving supplement Using a bottle Number Infant Other Other Solid/ with a of formula milk liquid Mushy nipple children '~2 1.6 12.8 32.7 0.1 16.1 200 2-3 7.6 14.8 34.6 3.9 21.3 294 4-5 17.0 27.0 33.4 33.7 21.0 239 6-7 18.5 30.6 43.3 45.8 16.6 249 8-9 18.8 39.7 48.1 72.1 9 3 205 I0-11 14.8 40.4 49.3 75.1 9.1 200 12-13 18.6 34.4 52.5 73.5 7.5 211 14-15 15.1 36.9 47.4 85.2 3.1 208 16-17 13.3 34.4 53.5 80.9 7.4 193 18-19 17.0 46.7 58.0 86.9 4.0 141 20-21 10.7 43.5 54.7 88.7 4.8 I 15 22-23 16.5 50.2 67.5 93.1 5.6 75 24-25 (11.7) (42.2) (65.4) (90.0) (0.0) 47 Note: Breastfeeding status refers to preceding 24 hours. Percents by type of supplement among breastfeeding children may sum to more than 100 percent, as children may have received more than one type of supplement. Figures in parentheses are based on 25-49 cases. 152 Duration and Frequency of Breastfeedlng The duration and frequency of breastfeeding are described in Table 12.4. The estimates of mean and median durations presented for subgroups in this table generally are based on current status data. The prevalence/incidence mean is provided for the total population in order to allow for comparison with the results of earlier surveys in Egypt. The median duration of breastfeeding is 19.1 months. The early introduction of supplements is reflected in the short duration of exclusive breastfeeding (1.8 months). Few children who are supplemented receive only plain water in addition to breast milk and thus, the median duration of full breastfeeding (2.0 months) also is quite short. Differentials in the duration of breast feeding also are shown in Table 12.4. There is little difference in the median duration between male and female children, suggesting that the breastfeeding practices of mothers in Egypt are not influenced by the child's gender. Rural children are breastfed for a somewhat longer period than urban children (19.7 months and 18.2 months, respectively). By place of residence, median breastfeeding durations vary from a low of 17.3 months in urban Lower Egypt to 20.2 months in rural Upper Egypt (see Figure 12.2). Better educated mothers wean their babies sooner than less educated mothers; nevertheless, the median duration of breast feeding among mothers who have completed the primary level or higher is fairly long (16.8 months). There is little variation in the duration of breastfeeding by work status of the mother. Children whose mothers had medical assistance at the time of delivery are breastfed for a somewhat shorter duration than children whose mothers were attended by a daya (traditional birth attendant). As noted above, the duration of the period of postpartum amenorrhea for a mother is related not only to the duration of breastfeeding but also to the frequency of breastfeeding. Around nine in ten children under the age of six months were breastfed at least six times in the 24 hours preceding the interview. There are only small differences among subgroups in this indicator. 12.2 Nutritional Status of Children Nutritional status is a major determinant of children's susceptibility to disease and, thus, of the risk of dying. A child's nutritional status in influenced by feeding practices as well as by infections. To assess nutritional status, all children of women interviewed in the EDHS who had been bom since January 1987 were weighed t and their height 2 measured. These data as well as information on the child's age in months obtained from the birth history was used to constmct the following indices: • height-for-age • weight-for-height • weight-for-age The nutritional status of children in the EDHS is evaluated by calculating the extent to which these three anthropometric indices deviate from measurements for a standard population of healthy, well-fed children. As recommended by the World Health Organization (WHO), the international reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by the U.S. Centers for Disease Control (CDC) is used as the reference population. The use of this reference population is based on ~For the measurement of weight a digital scale with accuracy of + 100 grams was used. 2Although the term "height" is used throughout this analysis, children younger than 24 months were measured lying on a measuring beard (recumbent length) while standing height was measured for older children. 153 Table 12.4 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and full breastfeeding, and the percentage of children under six months of age who were breastfed six or more times in the 24 hours preceding the survey, by selected background characteristics, Egypt 1992 Median duration in months Number Percentage of <6 months Number Any Exclusive Full children breastfed of Background breast- breast- breast- <3 years 6+ times in children characteristic feeding feeding feeding I of age last 24 hours <6 months Sex Ma3e 19.2 1.7 1.9 2608 88.5 388 Female 18.9 1.8 2.2 2365 89.9 371 Urban.rural residence Urban 18.2 0.7 0.8 1826 88 1 272 Rural 19.7 2.5 3.0 3147 89.8 487 Place of residence Urban Governorates 18.5 0.6 0.6 861 90.9 130 Lower Egypt 18.9 1.8 2.0 1970 90.1 312 Urban 17.3 0.6 0.7 465 85.4 76 Rural 19.1 2.4 2.6 1504 91.6 237 Upper Egypt 19.6 2.6 3.4 2143 87.6 317 Urban 17.9 2.4 2.7 500 85.6 66 Rural 20.2 2.7 3.8 1643 88.1 251 Mother's education No educanon 19.6 2.1 2.6 2530 90.3 395 Some primary 20 3 2.9 3 6 937 90.5 123 Primary through secondary 16.8 2.0 2.2 469 91.8 70 Completed secondary/higher 16.8 1 1 1.1 1037 84.6 171 Work status Working for cash 18.8 0.7 0.7 613 83.1 100 Not working for cash 19.1 2.0 2.4 4360 90.1 659 Assistance at delivery Medically trained person 18.1 1.4 1.6 2141 88.9 340 Traditional birth attendant 19.7 2.1 2.6 2530 88.6 374 Other or none 19.8 2.6 2.9 303 (95.8) 45 All children 19.1 1.8 2.0 4974 89.2 759 Mean 18.4 3.8 4.7 94.8 NA NA Prevalence/Incidence mean 17.6 3.1 4.0 NA NA NA Note: Medians and means are based on current status. Figures in parentheses are based on 25-49 cases. NA = Not applicable ~Either exclusively breastfed or recewed plain water only in addition to breastfeeding, 154 Figure 12.2 Median Duration of Breastfeeding, by Place of Residence Median number of monlhs Urban Govemorates Total Urban Rural To~al Urban Rural Lower Egypt Upper Egypt EDHS1992 the finding that well-nourished young children of all population groups (for which data exist) follow very similar growth patterns (see MartoreU and Habicht, 1986). Although there are inherent variations in height and weight, these variations approximate a normal distribution when the population is large. Each of the standard indices provides somewhat different information about the nutritional status of a population of children. The height-for-age index is an indicator of linear growth retardation. Children whose height-for-age is below minus two standard deviations (-2 SD) from the median of the reference population are considered "stunted" (i.e., they are short for their age) and children who are below minus three standard deviations (-3 SD) from the median of the reference population are considered severely stunted. Stunting is an outcome of a failure to receive adequate nutrition over a long period of time, and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of undernutrition in a population and does not vary appreciably according to the season of data collection. The weight-for-height index measures body mass in relation to body length, and describes current nutritional status. Children who are below minus two standard deviations (-2 SD) from the median of the reference population are considered "wasted" (or thin) and children whose weight- for-height is below minus three standard deviations from the median of the reference population are considered severely wasted. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent episodes of illness, causing loss of weight and the onset of undemutrition. Wasting may also reflect acute food shortage. Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic undernutrition; however, it does not distinguish between a child who is underweight 155 because of stunting and one who is underweight because of wasting. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as "underweight," and children whose weight-for-height is below minus three standard deviations (-3 SD) from the median of the reference population are considered to be severely underweight. Weighl-for-age is commonly used in clinical settings for continuous assessment of nutritional progress and growth. In a healthy well-fed population of children, it is expected that only 2.3 percent of children will fall below minus two (-2 SD) from the median of the reference population for each of the three indices. Less than one percent of children are expected to be below minus three standard deviations. Information on the three indices is presented in Table 12.5 by age and other demographic characteristics of the child and in Table 12.6 by socioeconomic characteristics of the child's mother. The two tables are based on information from 7,279 children under five years of age. These children represent 90 percent ofalleligible children. Six percent ofeligiblechildren were excluded from the analysis of these data Table 12.5 Nutritional status by demographic characteristics Percentage of children under five years who are classified as undernourished according to three anthropometric indices of nutritional status: height for-age, weight-for-height, and weight-for-age, by selected demographic characteristics, Egypt 1992 Demographic characteristic Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SI) 1 -3 SD -2 SD 1 -3 SD 2 SI) I children Age Under 6 months 2.5 5 7 0.3 2.0 0.0 2.1 577 6-11 months 7.3 16.9 1.4 5.3 2.1 10.7 685 12-23 months 12.4 35.8 1.3 4.8 2.8 14.9 1448 24-35 months 12.1 28.4 0.6 3.2 2.7 12.0 1460 36-47 months 9.9 24.2 0.4 2.8 1.3 6,4 1473 48-59 months 6.0 20.6 0.5 2.1 0 5 6 0 1636 S~rx Male 9.1 24.4 0 9 3.2 1.6 9.1 3761 Female 9.1 24.4 0.6 3,3 1.7 9.3 3519 Birth order 1 7.7 22.1 0.8 3.3 1.2 8.4 1525 2-3 9.0 23.0 0.5 2.9 1.6 8.4 2586 4-5 7.7 25.0 0.9 3.5 1.4 8.5 1607 6+ 12.3 28.3 1.0 3.7 2.6 12.0 1562 Birth interval First birth 7.7 22.1 0.8 3.3 1.2 8.4 1538 < 24 months 11.7 28.1 0.9 3.2 2.1 10,4 1703 24-47 months 9.7 25.9 0.6 3.3 1.9 10.4 2909 48+ months 5.8 18.2 0.7 3.3 0,9 5 6 1129 All children 9.1 24.4 0.7 3.3 1.7 9.2 7279 Note: Figures are for children born in the period 1-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished if their z-scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the median of the reference population. tlncludes children who are below -3 SD 156 Table 12.6 Nutritional status by socioeconomic characteristics Percentage of children under five years who are classified as undernourished according to three anthropometric indices of nutritional status: beight-for-age, weight-for-height and weight-for-age, by selected socioeconomic characteristics, Egypt 1992 Socioeconomic characteristic Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD 1 -3 SD -2 SD 1 -3 SD -2 SD I children Urban-rural residence Urban 6,7 18.8 0.7 3.3 1,1 6.8 2743 Rural 10.6 27.8 0.8 3,2 2.0 10,6 4537 Place of residence Urban Governorates 5.7 16.1 0.9 4.3 1,4 7.4 1240 Lower Egypt 9,4 25,6 0,6 2.5 1.3 7.7 3002 Urban 6.3 19.5 0.2 2.3 0.4 4.4 752 Rural 10.5 27.6 0,7 2.5 1.6 8.8 2250 Upper Egypt 10.3 26.7 0.8 3.7 2.2 11.4 3037 Urban 8,8 22.7 0,8 2.9 1.3 8.3 751 Rural 10,7 28,0 0,8 3.9 2.4 12 4 2287 Mother's education No education 11,0 28,2 0,9 3.8 2.2 10.6 3713 Some primary 9.8 27.0 0.7 2,8 1,6 10.5 1478 Primary through secondary 6.9 18.7 0.7 3.6 1,0 6.3 677 Completed secondary/higher 4.7 14.4 0,3 2,2 0.7 5.5 1412 Work status Working for cash 8.3 I9,1 0.8 1.9 2.1 6.8 910 Not working for cash 9.3 25.2 0,7 3,5 1.6 9.5 6369 All children 9,1 24,4 0,7 3.3 1.7 9.2 7279 Note: Figures are for children born in the period 1-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished if their z-scores are below minus two or minus [hree standard deviations (-2 SD or -3 SD) from the median of the reference population. Includes children who are below -3 SD because information on one or both measurements was not available. The most common reason for nonmeasurement was that the child was not at home when the interviewer visited the household. Also excluded from the analysis are children with grossly improbable weight or height measurements due to recording error or age misreporting (4 percent) and children whose month and year of birth were not reported by the mother (less than 0.5 percent). Height-for-age. Children whose height-for-age is below minus two standard deviations (-2SD) from the median of the reference population are stunted or short for their age. As discussed above, stunting is the result of a state of chronic undemutrition over a long period of time. Overall, 24 percent o f Egyptian children under five years of age can be classified as stunted, and 9 percent are considered to be severely stunted. A child's age is significantly correlated with the prevalence of stunting. Stunting increases rapidly during the first year of life, peaking in the second year of life, where 36 percent of children are stunted. Although the level of stunting declines among older children, one in five children age 48-59 months still is considered to be stunted. There is no difference in the level of stunting between male and female children. Stunting increases with birth order, and it occurs more frequently among children born after a short birth interval (less than 24 months) than those bom after a long interval (48 months or longer) (28 percent and 18 percent, respectively). 157 Rural areas had higher levels of stunting than urban areas (28 percent and 19 percent, respectively). Stunting is less prevalent in the Urban Govemorates (16 percent) than in Lower Egypt (26 percent) and Upper Egypt (27 percent). Educational differences in stunting are pronounced; stunting was twice as common among children of mothers who never attended school as among children of mothers who had completed at least the secondary level. Stunting is less evident among children of mothers who work for cash than among children of mothers not employed in an occupation for which they receive a cash income. Weight-for-height. Children wbose weight- for-height is below minus two standard deviations (-2SD) from the median of the reference population are wasted (or thin). As discussed above, wasting is the result of a state of acute undernutrition over a short period of time. Overall, 3 percent of children under five years of age are moderately wasted and around 1 percent are severely wasted. The level of wasting peaks at 5 percent among children in the age categories 6-11 and 12-23 months. Weight-for-age. Children whose weight-for-age is below minus two standard deviations (-2SD) from the median of the reference population are considered underweight. Weight-for-age provides an index of the joint effect of chronic and acute undernutrition. Overall, 9 percent of Egyptian children under five years of age are underweight, with 2 percent classified as severely underweight. By age, the percentage underweight exceeds 10 percent of children 6-35 months of age, peaking at 15 percent among children age 12-23 months. Virtually no difference is observed in the percentage underweight between boys and girls. Variations by birth order and birth interval show no definite pattern although the percentage underweight is highest for children of birth order six or higher and lowest for children born 48 months or more after a preceding birth. Considering socioeconomic differentials, urban children are less likely than rural children to be underweight and the percentage underweight varies by place of residence from a low of 4 percent among children from urban Lower Egypt to 12 percent among children from rural Upper Egypt. The percentage underweight among children whose mothers completed at least primary school is 6 percent compared to 11 percent among children of mothers who never attended school or did not complete the primary level. The small differential by work status favors children of mothers who work in the cash economy. 12.3 Nutritional Status of Mothers All mothers of children born since January 1987 were eligible to be weighed and measured 3 in the EDHS. In reviewing the results of the matemal anthropometric data collection, it is important to note that information is presented only for women who had a live birth during the live-year period before the survey and is not representative of the entire EDHS sample. In particular, older women tend to be underrepresented in the group for which the height and weight measures are available. Table 12.7 shows the distribution of mothers by height, weight, and body mass index, along with the means and standard deviations for each of these measures. Height and weight measures are missing from Table 12.7 for about 5 percent of eligible women, who were not available at the time that the measurer visited the household. In addition, women who were pregnant at the time of the survey or who had delivered within the two months preceding the survey were excluded from the calculation of the weight and body mass measures. Maternal height is useful for identifying mothers at nutritional risk and also provides a good indicator of the socioeconomic status ofthe mother. In addition, height is used to predict the risk of difficult delivery, since short stature is associated with small pelvic size. The risk of low birth weight also is higher for children r'fhe measuring boards and scales used for adult anthropometry were the same as those used to collect anthropometric measurements of children; as with older children, standing height was obtained for adulLs using a specially designed extension for the measuring board. 158 of short women. Although the cutoff point, i.e., the height below which a mother can be considered to be at nutritional risk, varies between populations, it is likely to be in the range of 140-150 centimeters. The mean height of mothers measured in the EDHS was 157 centi- meters. Less than 2 percent were shorter than 145 centi- meters and 9 percent were in the 145-150 centimeter range. Low prepregnancy weight generally is associ- ated with unfavorable pregnancy outcomcs, although maternal height also must be taken into account. Exclud- ing women who were pregnant or had had a recent birth, the mean weight of motbers is 66 kilograms. Only 9 per- cent of the mothers weighed less than 50 kilograms, while one-third weighed 70 kilograms or more. Indices of body mass are uscd to assess thinness or obesity. The most commonly used indcx is the body mass index (BMI), which is defined as the weight in kilograms divided by the square height in meters. For the BMI, a cut-off point of 18.5 has been recommended for defining chronic energy deficiency. Obesity has not been clearly defined. The mean BMI for Egyptian moth- ers who were not pregnant and had not given birth with- in two months prior to the survey was 26.9, and only 2 percent had a BMI below 18.5. Table 12.8 shows the variation in the maternal nutrition status indicators according to basic demo- graphic and socioeconomic characteristics. In general, there is little variation in cither the mean height of moth- ers or the percentage with height below 145 centimeters. However, the differences in height show a consistent pattern: the shortest mothers were those from rural Up- per Egypt and those without education. Somewhat great- cr variation is observed in the BMI figures although the differences arc still not very large. The percentage of mothers with a BMI below 18.5 rc:lchcs 4 percent only among women in the 15-19 agc group and those living in rural Upper Egypt. Table 12.7 Anthropomelric indicators of maternal nutritional status Percent distribution and mean and standard deviation for women who had a birth in the five years preceding the survey by selected anthropomemc indicators (height. weight, and body mass index (BMI)). Egypt 1992 Dxstribution mcluding Indicator Total missing Height (cm) < 140 0.1 0.1 140-144 1.2 1.2 145-149 8.9 8.5 150-159 60.7 57.9 160-169 27.7 26.5 171)-179 1 1 1.1 > 180 0.2 0.2 ~lissing 4.6 Total 100 0 100.0 N umber of women 5417 5676 Mean 157.0 Standard deviation 5.8 Weight (kg) < 40 0.3 0.2 40 49 9.1 8.7 50-59 27.8 26.4 60-69 29.0 27.5 >70 33,9 32.3 ~hssmg 4.9 Total 100.0 100.0 Number of women I 4627 4864 Mean 66 3 Standard devlataon 14 0 BMI < 16.0 02 0.2 16.0-18 4 1.3 1.2 18.5-19.9 3.8 3.6 20.0-22.9 19.5 18 5 23.0-25.9 26.5 25.2 26./I-28 9 20.11 19.0 >29 0 28.8 27.4 ~,4Lssmg 4.9 Total 100.0 100.0 Number of women I 4624 4864 Mean 26.9 Standard devlabon 5 4 IExcludes pregnant women and those who gave birth in the two months preceding the survey 159 Table 12.8 Differentials in maternal anthropometric indicators Mean height and percentage of women shorter than 145 centimeters, mean Ix~dy mass index (BMI) , and the percentage of women whose BMI is less than 18.5, according to selected background characteristics, Egypt 1992 l leight BMI Background Percent Percent characteristic Mean <145 cm Number Mean <18 5 Number Age 15-19 156.6 0.8 218 23.9 4 2 173 20-24 157.5 1.3 1047 25.0 2 1 798 25-29 157.2 09 1594 26.3 1.8 1351 30-34 157.0 2.0 1221 27.6 1 I 1065 35-39 156.6 (1.9 828 28.1 1.3 745 40-44 156.2 2 4 407 2q.2 1.2 391 45-49 155.7 1 4 11)2 28.0 0 9 101 Urban-rura l residence Urban 157.3 1 6 2165 28.6 1 1 1912 Rural 156.8 1.2 3253 25.6 2 0 271 ] Place of residence Urban Governorates 157.4 1 6 1011 29.0 1.4 892 Lower Egypt 157 7 0.7 2252 27.5 0 5 1960 Urban 1576 1.1 599 29.2 0.3 541 Rural 157.7 0.6 1653 26 8 0 6 1419 Upper Egypt 156 1 I 9 2154 25.1 3.0 1771 Urban 1567 1 9 555 27.1 1.4 479 Rural 155.9 1.9 1600 24 3 3 5 1292 Educat ion No education 156.6 1.3 2654 25 7 2 3 2198 Some primary 156 5 1.7 1116 27.8 1.3 999 Primary through secondary 157 4 1.3 547 28 0 0. I 479 Completed secondary/higher 158 2 1.1 1099 28,0 1.0 948 Work status Working for cash 157 7 1.0 709 28 1 1 1 625 Not working for cash 156 9 1.4 4708 26 7 1.7 3999 Chi ldren ever born 1 157 4 1.5 9114 25 7 I 7 695 2-3 157.3 1.0 1917 26 7 1.8 1639 4-5 157.1 1.7 1288 27.3 1.8 1114 6+ 156.3 1.4 13118 27.3 I.I 1175 Total 157.11 1.3 5417 26.9 1 6 4624 160 CHAPTER 13 HUSBANDS' SURVEY The Egypt DHS interviewed a sub- sample of husbands of eligible women in order to obtain insights into the role that men play in the fertility and family planning decision-mak- ing processes. This chapter presents basic in- formation obtained from the husband's survey relating to a number of topics including family planning knowledge, practice and attitudes and fertility preferences. 13.1 Husbands' Sample A systematic sample of one of every three households in the women's survey was chosen for inclusion in the husbands' sample. All husbands of eligible currently married women in these households were eligible for the husbands' survey, even if the woman her- self was not interviewed. As noted in Chapter 1, response rates for the husbands' survey were lower than for the women's survey. Overall, 2,466 husbands--82 percent of those eligible for the husbands' survey--were successfully interviewed. Since this chapter focuses on comparison of the attitudes of husbands with those of their wives, results are presented only for the 2,406 husbands whose wives also wcre interviewed in the survey. 13.2 Background Characteristics of Husbands General Characteristics Table 13.1 presents selected back- ground characteristics of husbands, including age, residence, place of residence, and educa- tional status. The age distribution is skewed toward older ages; nearly one-half of the hus- bands interviewed were age 40 and over, more than one-third were in their thirties and only 15 percent were under age 30. This pattern re fleets the tendency for men to marry later than women. Table 13.1 Husbands' background characteristics Percent distribution of husbands by selected background characteristics, Egypt 1992 Number of husbands Background Weighted Un- characteristic percent Weighted weighted Age <25 3.5 85 78 25-29 11.7 281 290 30-34 17.8 429 424 35-39 17.7 427 420 40-44 16.8 405 405 45-49 13.5 324 319 50-54 9.3 224 227 55+ 9.7 233 243 Urban-rural residence Urban 45.4 1093 1159 Rural 54.6 1313 1247 Place of residence Urban Govemorates 23.8 573 655 Lower Egypt 41.0 986 925 Urban 11.4 274 281 Rural 29.6 711 644 Upper Egypt 35.2 847 826 Urban 10.2 245 223 Rural 25 0 602 603 Education No education 28.7 690 670 Some primary 24.9 599 586 Primary through secondary 17.2 415 412 Completed secondary/higher 29.2 702 738 Husband's occupation Technical/professional 11 9 286 293 Administrative (2.0) (49) 46 Clerical 8.6 208 213 Sales 6.8 164 163 Services 7.7 185 182 Agriculture 28 8 694 680 Production 28.4 683 695 Other 3.2 77 76 Missing 2.6 62 58 All husbands 100.0 2406 2406 Note: Figures in parentheses we based on 25 to 49 cases. 161 With regard to the husbands' educational attainment, more than one-quarter have received no formal education. Another quarter attended school but did not complete the primary level, 17 percent completed the primary but not the secondary level, and 29 percent completed at least the secondary level. The distribution of occupations shows that more than one-quarter of husbands are agricultural workers and around another quartcr are production workers. The percentages working in the clerical, sales, and services sectors are similar (7-9 percent), 12 percent work in professional/technical occupations, and 2 percent in administrative positions. The "other" category (3 percent) includes husbands who reported that they were retired, were students, were not working, or were in the military. Differentials in Education Table 13.2 presents the distribution of husbands by education according to selected characteristics. The proportion of husbands who are not educated exhibits a U-shaped curve with age. The lower educational Table 13,2 Husbands' level of exlucation Percent distribution of husbands by htghest level of education attended, according to selected background characteristics, Egypt 1992 Level of education Primary Completed Number Background Some through secondary/ of ch~actenstlc None primary secondary higher Total husbands Age <25 34.1/ 21 6 22.8 21.5 100.0 85 25-29 22.4 30.1/ 16.3 31.3 100.0 281 30-34 15.7 28.6 17.5 38.1 100.0 429 35 39 21.6 22.2 19.8 36.3 100.0 427 40-44 30.2 20.1 17.3 32.4 100.0 405 45-49 34 9 21.1 18.7 25.3 100.0 324 50-54 41 g 25.4 16.2 16.6 100.0 224 55+ 47.4 30.9 10.0 11.7 100.0 233 Urban-rural residence Urban 17 2 21.2 20 3 41.2 100.0 1093 Rural 38.2 27.9 14 7 19.2 100,0 1313 Place of residence Urban Govemorates 12.8 20.2 21 0 46.0 100.0 573 Lower Egypt 29.0 28.9 18.3 23.8 100.0 986 Urban 18 0 25.9 22.3 33.9 10O.0 274 Rural 33.3 30 1 16.8 19.9 100.0 711 Upper Egypt 39 1 23 4 13.4 24.1 100.0 847 Urban 26.8 18 4 16 6 38.2 100.0 245 Rural 44.1 25,4 12 1 18.4 1 (X).(I 602 Husband's occupation Technical/professional 2 7 2.3 2.2 92.9 100.0 286 Administrative (2.2) (4.4) (5.3) (88.1) 100.0 49 Clerical 1.6 5.6 17.1 75.7 100.0 208 Sales 28 3 25.7 23.5 22.5 100.0 164 Servxces 29 9 39.7 21.8 8.7 100.0 185 Agriculture 54.7 28.2 9.9 7.2 100.0 694 Production 24.2 34.4 27.9 13.4 100.0 683 Other 13 7 16.9 33.9 35.4 100.0 77 Missing 34 3 31.7 10.0 23.9 100.0 62 Total 28.7 24.9 17.2 29.2 100.0 2406 Note: Figures in parentheses arc based on 25 to 49 cases, 162 attainment among husbands under age 30 than among older husbands is related to the fact that men who marry earlier are likely to be less educated than those who delay marriage. Urban husbands are clearly better educated than those in rural areas. As seen in Table 13.2, urban husbands are more than twice as likely to have attended school as mral husbands and, among those who have attended school, urban husbands are more likely to attain the higher levels of education than rural husbands. By place of residence, the proportion of husbands without any education is only 1 in 8 in the Urban Govemorates compared to almost 1 in 6 husbands in urban Lower Egypt and more than 1 in 4 husbands in urban Upper Egypt (Figure 13.1). Within rural areas, only 33 perccnt of husbands in Lower Egypt have had no education compared to almost 44 percent in Upper Egypt. Figure 13.1 Percentage of Husbands Who Have No Education, by Place of Residence Percent 5O 40 30 2O 10 0 Urban Governo~ates 1 Total Urban Rural TotaJ Urban Rural Lower Egypt Upper Fgypt EDHS 1992 Not surprisingly, educational attainment is highest among husbands in professional/technical, administrative or clerical occupations. Three-quarters or more o f husbands in thesc occupations have at least a secondary education. Husbands working in agriculture arc the least educated; more than half have never attended school. Exposure to Mass Media The information on media exposure of husbands shown in Table 13.3 is useful for targeting media messages on health and family planning to men. Almost half of all husbands read a newspaper at least once a week, 87 watch television daily, and 80 percent listen to radio everyday. 163 Table 13.3 Husbands' access to mass media by background characteristics Percentage of husbands who usually read a newspaper once a week, watch television daily, or listen to radio daily, by selected background characteristics, Egypt 1992 Read Watch Listen to Number Background newspaper television radio of characteristic weekly daily daily husbands Age <25 25.5 91.9 78.1 85 25-29 42.7 88.8 78.8 281 30-34 55.0 88.7 82.4 429 35-39 54.2 89.6 80.8 427 40 -44 51. ] 85.1 80. ] 405 45-49 48.6 86.6 79.8 324 50 54 35.7 85.9 75 6 224 55+ 33.7 76 5 78.5 233 Urban-rural residence Urban 62.8 94.3 86 0 1093 Rural 33.9 80 3 74.6 1313 Place of residence Urban Governorates 68.0 95.0 89.1 573 Lower Egypt 43.6 90.4 84.2 986 Urban 58.3 95.5 84.4 274 Rural 37.9 88.4 84.2 711 Upper Egypt 36.8 76.7 68.3 847 Urban 55.6 91.2 8(I.6 245 Rural 29.2 70.8 63.3 602 Education No education 6.5 73,3 66.4 690 Some primary 29.7 85.6 78 5 599 Primary through secondary 65.9 93.2 85.4 415 Completed secondary/higher 90.5 96.8 90.7 702 Total 47.0 86.7 79.8 2406 The relationship between age and the media exposure indicators is not uniform. For example, the percentage of husbands reading a newspaper weekly increases with age, reaching a peak among men in the 30-34 age group and then generally declines among older men. Exposure to radio on a daily basis exhibits a similar relationship with age, while there is a small but steady decrease in exposure to television as age increases. Exposure to mass mcdia clearly is greater among husbands in urban areas compared to rural areas. By place of residence, media exposure is greatest in the Urban Govemorates and least common in rural Upper Egypt. The differences tend to be greater in the case of exposure to print media, which is probably due to the lower educational attainment of husbands in rural Egypt. As expected, educational attainment is positively related to all of the media exposure indicators. The educational effect is strongest in the casc of newspaper reading. 164 13.3 Comparison between Characteristics of Husbands and Wives This section includes a comparison of the age and education distributions of husbands and wives. These comparisons are presented for two reasons: first, to gain some insight into the couple's characteristics rather than those of each spouse separately and, second, to provide a background for the discussion later in this chapter of the couple's practices and attitudes towards contraception, their fertility desires, and their perceptions concerning women's roles in the household. As shown in Table 13.4, husbands generally are older than their wives. In only about I in 20 couples, the wife is older than the husband. In the case of 31 percent of the couples, the husband is less than five years older than the wife, for 38 percent, there is a 5-9 year difference, and for 26 percent, the difference is ten years or more. The mean difference between the couple's ages is 7.5 years. Table 13.4 Couples' age difference Percent distribution of couples by age difference between spouses and mean age difference between spouses, according to wife's age, Egypt 1992 Husband's age - wife's age (in years) Number Wife Mean of Wife's age older 0-4 5-9 10-14 15+ Total difference husbands 15-19 0.0 23.0 41.0 27.5 8.5 100.0 8.6 113 20-24 1.6 28.2 41.3 19.1 9.8 100.0 8.2 331 25-29 3.3 34.9 39.4 14.0 8.4 100,0 7.2 481 30-34 8.4 31.7 36.0 17.8 6,1 100.0 6.8 448 35-39 6.7 33.6 40.2 9.8 9.7 100.0 7.0 412 40-44 8.5 25.2 33.1 18.8 14.3 100.0 7.9 376 45-49 3.6 31.6 34.4 17.5 12.9 100.0 7.7 242 Total 5.3 30.7 37.8 16.4 9.8 100.0 7.5 2406 Regarding educational differences between husbands and wives, the EDHS results indicate that around half of all couples attained the same educational level. As shown in Table 13.5 and Figure 13.2, among more than one-fifth of couples, both the husband and wife never attended school, among one-tenth, the husband and wife had similar intermediate levels of education, and among slightly less than one-fifth of the couples, both had at least a secondary education. When there is a difference in the level of educational attainment between spouses, the difference gencrally is due to the higher educational level of the husband. Overall, the husband had attained a higher level of education than his wife in the case of almost 2 in 5 couples while the wife attained a higher level in the case of only around 1 in 10 couples. 165 Table 13.5 Couples' level of education Percent distribution of couples by highest level of education attended, according to selected background characteristics, Egypt 1992 Wife's educational level Primary Completed Number Husband's Some through secondary/ of educational level None primary secondary higher Total couples No education 22.6 4.9 1.0 0.1 28.7 690 Some primary 15.1 7.6 1.9 0.3 24.9 599 Primary through secondary 7.5 5.1 2.8 1.8 17.2 415 Completed secondary/higher 3.6 2.9 4.3 18.4 29.2 702 Total 48.8 20.6 9.9 20 7 100.0 2406 Number 1173 496 239 497 2406 2406 Figure 13,2 Comparison of Levels of Education of Husbands and Wives W~fe and husband same 51% Wile has higher level 10! Husband has higher level 39% EDHS1992 166 13.4 Knowledge of Family Planning Level of Knowledge Knowledge o f at least one family planning meth- od is almost universal among husbands, as shown in Ta- ble 13.6. However, knowledge varies greatly by specific method. Ninety-five percent or more of husbands know about the pill and IUD. Between 60 and 70 percent of husbands are aware of the condom, injection, and female sterilization, and 30 to 40 percent report knowing about Norplant and vaginal methods. Vasectomy is the least widely recognized modem method, with only 25 percent of husbands saying that they are aware of the method. Three times as many husbands know at least one tradi- tional method. The most widely known traditional meth- ods are prolonged breastfeeding and withdrawal, known by 59 and 47 percent of husbands, respectively. Most husbands are not only knowledgeable about family planning methods but they also know a place where they can obtain a method. Knowledge of a source for any method is 92 percent among husbands. Around 9 in 10 husbands who know about the pill, IUD, condom and female sterilization are able to name a source for these methods. With regard to the other modem methods, only in the case of Norplant and injection, does the proportion of husbands knowing the method who also know a source fall below 8 in 10. Table 13.6 Husbands' knowledge of family planning methods and source for methods Percentage of husbands knowing any family planning method and knowing a source (for information or services), by specific method, Egypt 1992 Know Know Method method source Any method 96.7 92.3 Any modern method 96.7 92.1 Modern method Pill 96.2 88.2 IUD 94.8 83.7 Injection 65.8 49.5 Norplant 34.7 24.9 Diaphragm/foam/jelly 30.0 25.2 Condom 69.0 63.1 Female sterilization 64. l 56.7 Male sterilization 25.1 20.4 Any traditional method 75.2 23.9 Periodic abstinence 38.0 23.9 Withdrawal 47.4 0.0 Prolonged breastfeeding 59.2 0.0 Other I. 1 0.0 Number of husbands 2406 2406 Sources of Family Planning Information Husbands knowing about family planning were asked a number of questions concerning the sources from which they had received family planning information including the first source from which they had obtained information and sources to which they may have been exposed recently. In addition, they were asked their opinion as to the acceptability of radio and television broadcasts of family planning messages. As noted in Chapter 4, there is an on-going mass media program in Egypt designed to increase awareness about family planning. The EDHS data on sources of family planning information provide insight into the extent to which the public media campaigns reach men (as well as women) and on male acceptance of such awareness-raising activities. Table 13.7 discusses the first source of family planning information named by husbands who knew at least one contraceptive method. Television is the most frequently cited source for family planning information (75 percent), followed by relatives (other than the wife) or friends (15 percent). Family planning providers were named by very few husbands as the first source. There are some interesting differences by residence in the percentages of husbands citing both television and relatives and friends as the first source. For example, the importance of television decreases and that of relatives and friends increases slightly among rural husbands compared to urban husbands. By place of residence, the percentage reporting relatives (other than the wife) and friends is highest among 167 Table 13.7 Husbands' first source of family planning information Percent distxibution of husbands knowing about family plmming by source from which they first heard about family planning, according to urban-rural residence and place of residence. Egypt 1992 Source Urban Rural Urban Lower Egypt Upper Egypt Gover- notates Total Urban Rural Total Urban Rural Total Television 79.7 71.1 78.9 75.6 82.0 73.0 71.8 79.11 68 8 75.1 Radio 2.2 2.8 2.0 3.3 2.1 3.7 1.9 2.8 1.5 2.5 Pnnt media 3.6 1.4 3.8 2.0 2.3 1.9 1.9 4.6 0 7 2.4 Spouse 0.7 0.5 0.6 0.6 0.5 0.7 0.7 1.4 0.4 0.6 O diet relat~ yes/friends 10.9 19.3 11.8 14.3 9.7 16.2 19.3 10.3 23.1 15.4 Government doctor/clinic 0.4 0.8 0.3 0.7 0.5 0.8 0.8 0.5 1.0 0.6 Private doctor/clinic 0.3 0,2 0 2 0.3 0.7 0.1 0 2 0.0 (1.2 0.2 Raiyda/other FP worker 0 3 2.5 0 3 1.7 0.0 2 4 2.0 0 8 2.6 1 5 Community meeting 0.2 0.3 0.3 0.3 0.3 0.3 0.1 0.0 0.2 0,3 Other 1.5 1.2 1.7 1.2 1.9 0 9 1.3 0.8 1.5 I 3 Total 100.0 100.0 100.0 lfX) 0 100.0 100.0 100.0 1 (}(}.0 100.0 100.0 Number of husbands 1076 1250 569 969 273 696 787 234 553 2326 husbands from rural Upper Egypt, and the percentage citing television as the first source is the lowest. Thus, although television remains the initial source of family planning information for the majority of husbands in all geographic areas, peers and relatives are important in transmitting family planning knowledge in rural areas, particularly in Upper Egypt. The family planning information and education program in Egypt includes messages transmitted through the mass media (television, radio, and newspapers and magazines) and at community meetings. The level of recent exposure of husbands to messages about family planning through these sources is described in Table 13.8. Among husbands knowing about family planning, 6 in 10 have seen a family planning message on television during the month preceding the survey. Radio reaches about one-third of knowledge- able husbands. The sources of family planning information with the lowest coverage are community meetings and articles on family planning in newspapers or magazines; only 12 percent of husbands attended a community meeting on family planning in the year preceding the survey, and only 10 percent reported reading a family planning article in a newspaper or magazine during the month before the survey. Differentials in exposure to messages about family planning by selected background characteristics also are highlighted in Table 13.8. The most striking differences are observed by urban-rural residence, place of residence, and education. Urban husbands are somewhat more likely than rural husbands to receive information through all of the sources except radio, with the urban-rural difference being greatest in the case of television. In general, husbands from Upper Egypt, particularly the rural areas, are less likely than husbands from other areas to have been exposed to family planning messages. There clearly is a positive relationship between husband's education and exposure to messages. With regard to community meetings, urban husbands and husbands with a secondary or higher education are slightly more likely to have attended a meeting than other husbands. 168 Table 13.8 Husbands' exposure to media messages about family planning Among husbands knowing about family planning, the percentage who have heard a message about family planning on the radio or on the TV in the last month, who have read an article about family planning in a newspaper or magazine in the last month, who have attended a community meeting about family planning in the past year, and the percentage who consider it acceptable to broadcast family planning messages on the radio or TV, according to selected background characteristics, Egypt 1992 Family Source of message planning message on Number Background Saw tleard on Read Attended radio/TV of characteristic on TV radio article meeting acceptable husbands Age <25 66. I 33.9 2.2 8.0 92.9 80 25-29 58.1 32.2 5.1 9.5 90.4 265 30-34 59.1 36.9 10.6 12.7 86.5 422 35-39 68.4 35.1 11.4 14.9 87.2 418 40-44 61.8 31.6 11.8 10.6 85.3 395 45-49 63.4 36.0 11.3 12.5 85.8 313 50-54 54.3 34.3 7.8 12.8 83.3 215 55+ 54.2 33,7 7.1 9.9 77.1 217 Urban-rural residence Urban 68.5 31.5 12.2 13.3 86.7 1076 Rural 54.6 36.9 7.2 10.8 85.1 1250 Place of residence Urban Governorates 74.2 25.5 14.3 16.2 85 I 569 Lower Egypt 57.3 48.0 9.2 9.8 89.8 969 Urban 59.4 53.1 10.7 9.5 91.2 273 Rural 56.4 45.9 8.7 9.9 89.3 696 Upper Egypt 56.1 24.1 6.5 11.5 81.4 787 Urban 65.3 21.0 9.0 10.8 85.4 234 Rural 52.3 25.4 5.4 11.8 79.8 553 Education No education 51.7 31.4 3.9 9.6 84.0 I 112 Some primary 61.7 37.1 6.9 8.8 87.2 484 Primary through secondary 70.5 37.5 14.3 8.2 89.7 236 Completed secondary/higher 76.8 37.0 22.6 22.1 86.7 494 Total 61 0 34.4 9.5 11.9 85.8 2326 Husbands were asked whether it is acceptable for family planning messages to be provided on radio or television. Table 13.8 shows that 86 percent of the husbands knowing about family planning find it acceptable to have media broadcasts on family planning. Differences in the acceptability of media broadcasts by age, residence, and education are minimal. By place of residence, urban Lower Egypt and rural Upper Egypt represent the extremes with regard to the acceptability of broadcast messages on family planning (91 percent and 80 percent, respectively). 13.5 Use of Fami ly P lanning Levels of Ever Use and Current Use The pattem of ever use and current use of family planning reported by husbands is shown in Table 13.9. Two-thirds of husbands reported that they or their wives had used a family planning method at some time. The most widely used method is the pill (44 percent) closely followed by the IUD (41 percent). Only 169 9 percent of husbands reported that they had ever used a condom. The level of ever use of periodic abstinence and withdrawal, which also require active male participation, is even lower, and no husband has bad a vasectomy. With regard to the level of current use, almost 50 percent of husbands reported that they (as a couple) were using a method of family planning at the time of the interview. The majority of current users ,17 percent of all husbands---were using modem methods. The IUD was the most common method (30 percent), followed by the pill (14 percent) and condom (2 percent). Consistency in the Reporting of Use of Family Planning by Husbands and Wives The consistency in reporting of ever use and cur- rent use of family planning methods is examined in Ta- bles 13.10 and 13.11, respectively. More than 90 percent of couples gave consistent responses about ever use of family planning, 65 percent agreeing that they had used a method and 29 percent agreeing that they never used a method. Thus, the proportion of couples for which there is a discrepancy between the husband's and wife's re- sponses is only 6 percent (5 percent for modem methods, 11 percent for traditional methods). Table 13.9 Husbands' use of family planning methods Percentage of husbands who have ever used a family planning method, and the percentage who are currently using a method, by specific methods, Egypt 1992 Ever Currently Method used using Any method 66,8 49.8 Any modern method 64.7 47.1 Modern method Pill 44.4 13.8 IUD 41.2 29.6 Injection 2.5 0.5 Norplam 0.1 0.0 Diaphragm/foam/jelly 2.7 0.3 Condom 8.7 2.3 Female sterilization 0,8 0.7 Male sterihzatinn 0.0 0 0 Any traditional method 12.4 2.7 Periodic abstinence 5.7 0.9 Withdrawal 4.0 0.9 Prolonged breast feeding 5.8 0.9 Other 0.1 0.0 Not currently using 50.2 Number of husbands 2406 2406 Table 13.10 Ever use of family planning among couples Percent distribution of couples by husband's and wife's reported ever use of family planning, according to specific methods, Egypt 1992 Ever use of family planning Husband Both only Method used used Wife Both Number only never of used used Total couples Any method 64.8 2.0 Any modern method 63.1 1.6 Pill 42.2 2.2 IUD 40.2 1.0 Injection 2.0 0.4 Norplant 0.0 0.1 Diaphragm/foam/jelly 2.0 0.7 Condom 6.2 2.5 Female sterilization 0.7 I).l Male sterilization 0.0 0.0 Any traditional method 6.3 6.1 Periodic abstinence 2.9 2.8 Withdrawal 1.7 2.3 Prolonged breastfeeding 2.2 3.6 Other 0.0 0.1 4 0 29.2 100.0 2406 3 3 32.0 100.0 2406 3.9 51.7 100.0 2406 2.1 56.6 100.0 2406 0.9 96.6 100.0 2406 0.0 99,9 100.0 2406 1.8 95.5 100.0 2406 2.5 88.8 100.0 2406 0.0 99.2 100.0 2406 0.0 100.0 100.0 2406 4.8 82.7 100 0 2406 1.8 92.6 100,0 2406 1.3 94.7 100,0 2406 3.0 91.1 100.0 2406 0.5 99.4 100.0 2406 170 Table 13.11 Current use of family planning among couples Percent distribution of couples by husband's and wife's reported current use of family planning, according to specific methods. Egypt 1992 Current use of family planning Husband Wife Both Number Both only only not of Method using using using using Total couples Any method 47.2 3.0 3.2 46.6 100,0 2406 Any modern method 44.3 2.8 2.2 50,7 100,0 2406 Pill 12.2 1.5 0,9 85.3 100,0 2406 IUD 28.1 1.6 1.4 69.0 100.0 2406 Injection 0.4 0.0 0.0 99.5 100,0 2406 Norplant 0.0 0.0 0.0 100.0 100.0 2406 Diaphragm/foam/jelly 0.3 0.1 0.1 99.6 100.0 2406 Condom 1.8 0.5 0.5 97.3 100.0 2406 Female sterilization 0.6 0.1 0.1 99.2 100.0 2406 Any traditional method 1.7 0.9 1.4 95.9 100,0 2406 Periodic abstinence 0.5 0.4 0.5 98.6 100,0 2406 Withdrawal 0.7 0.2 0.5 98,6 100.0 2406 Prolonged breastfeeding 0.5 0.3 0.3 98.8 100.0 2406 Other 0 0 0.0 0.1 99.9 100.0 2406 The level of disagreement in the responses regarding current use also is small. Overall, there is agreement about current use among 94 percent of all couples, with 47 percent saying that they are currently using and the same percentage reporting no current use (see Table 3.11). The small proportion of couples among whom there is a discrepancy in the responses concerning current use of contraception are evenly divided between those couples in which the husband reported use and the wife did not (3 percent) and those couples in which the wife reported current use and the husband did not (3 percent). When use of specific methods is considered, the percentage of couples among whom there is disagreement in the responses of the husband and wife about current use is highest for the IUD (3 percent). 13.6 Dif ferent ia ls in Knowledge and Use of Fami ly P lann ing Table 13.12 highlights differences in knowledge and use of methods and knowledge of sources by selected background characteristics of the husbands, including age, urban-rural residence, place of residence, and education. Knowledge of any method or any modem method and knowledge of a source for a modem method is fairly uniform across age groups, peaking in the 30-39 age group. The age pattern is similar for both ever use and current use of family planning; use levels increase with age through the 40-44 age group, before declining among older men. Knowledge of family planning methods is almost as high among rural husbands as urban husbands; however, rural husbands are less likely to know where to get a method than their urban counterparts. The gap between urban and rural areas is even greater with regard to use of family planning. The likelihood that a husband is a current user of modem methods is nearly 1.5 times greater in urban than in rural areas. Differences in the level of knowledge of any method or any modem method among husbands from the five regions in Egypt do not exceed 8 percent. Regarding knowledge of a source, however, the differences increase to almost 20 percent; 99 percent of husbands in urban Lower Egypt know of a source for modem methods compared to only 80 percent in rural Upper Egypt. Differences among regions become more striking when use is considered. Rural Upper Egypt has thc lowest prevalence of current use among husbands, almost half the rate for urban Lower Egypt, which has the highest use rate. 171 Table 13.12 Husbands' knowledge and use of family planning methods by background characteristics Percentage of husbands knowing may family planning method and knowing a source for a modem method, and the percentage who have ever used and are currently using any method and any modem method, by selected background characteristics, Egypt 1992 Know Ever Ever Currently Currently Know Know source for used used using using Number Background any modem modem any modem any modem of characteristic method method method method method method method husbands Age <25 93.9 93.9 86.9 19.3 16.6 11.4 11.4 85 25-29 94.6 94.6 90.8 41.2 39.9 28.1 26.8 281 30-34 98.5 98.5 94.9 69.5 66.1 52.9 49.9 429 35-39 98.1 98.1 95.0 70.9 68.5 54.1 51.7 427 40-44 97.4 97.4 93.4 76.9 75.6 62.5 60.6 405 45-49 96.6 96.6 91.5 76.3 74.6 57.0 53.6 324 50-54 96.3 96.3 90.1 72.8 70.7 52 4 46.7 224 55+ 93.4 93.4 85.8 65.7 64.2 41.3 38.9 233 Urban-rural residence Urban 98.5 98.5 96.7 78.2 76.2 60.4 56.9 1093 Rural 95.2 95.2 88.3 57.3 55.2 41.0 39.0 I313 Place of residence Urban Govemorates 99.3 99.3 98.4 80.3 78.5 63.4 59.3 573 Lower Egypt 98.3 98.3 96.5 75.5 72.8 56.8 53.9 986 Urban 99.4 99.4 99.3 87.3 85.1 65.2 62.6 274 Rural 97.9 97.9 95.4 70.9 68.1 53.5 50.5 711 Upper Egypt 93.0 93.0 82.8 47.5 46.0 32.4 31.0 847 Urban 95.5 95.5 89.6 63.1 61.0 47.9 44.8 245 Rural 91.9 91.9 80.0 41.1 39.9 26.1 25.4 602 Education No education 94.7 94.7 87.8 57.3 55.3 39.7 37.6 1173 Some primary 97.6 97.6 94.8 72.1 70.4 54.9 53.0 496 Primary through secondary 98.4 98.4 94.9 79.7 78.1 63.0 60.8 239 Completed secondary/higher 99.4 99.4 98.3 77.6 74.9 62.1 57.1 497 Total 96.7 96.7 92.1 66.8 64.7 49.8 47.1 2406 The educational differentials show the expected pattem: knowledge and use of family planning generally increase with the husband's level of education. However, the greatest differences are observed between husbands with no education and those who have ever attended school. Among educated husbands, knowledge and use levels tend to increase with the level of education but the pattem is not uniform and the differences between educational categories are frequently small. 13.7 Intention to Use Family Planning Husbands who knew about family planning but were not currently using any method were asked about their intention to use family planning in the future. As shown in Table 13.13, more than one-third of all husbands expressed an intention to use in the future. A somewhat greater percentage (43 percent) said they did not intend to use a method, and the remainder either were uncertain about use or they did not know any method. Rural husbands were almost as likely to say that they intended to use as urban husbands (38 percent and 39 percent, respectively) and, surprisingly, somewhat less likely to say that they would not use family planning in the future. This is largely due to the fact that husbands in the Urban Govemorates were much more likely to say that they did not intend to use than husbands from other areas. By place of 172 Table 13.13 Husbands' future use of family planning Percent distribution of husbands who ate not currently using any family planning method by intention to use in the future and preferred method, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper F.gypt Intention to use Gover- family planning Urban Rural notates Total Urban Rural Total Urban Rural Total Intend to use 39.0 38.0 36.5 41.9 44.9 41.1 36.3 38 5 35.7 38 3 Unsure about use 9.4 13.6 9.2 13.7 9.3 15.0 12.0 9.9 12.6 12.1 Do not intend to use 47.7 40.2 52.2 40.5 44.2 39.4 41.3 42.9 40.8 42.9 Do not know method 3.9 8.2 2.0 3.9 1.7 4.5 10.4 8.6 10 9 6.6 Total 100.0 100.0 1000 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of husbands 433 775 210 426 95 331 572 128 445 1209 residence, the proportion of husbands intending to use in the future was as high or higher in urban Upper Egypt (39 percent) and in rural Upper Egypt (36 percent) as in the Urban Governorates (37 percent). In turn, both urban and rural Lower Egypt had higher proportions intcnding to use (45 percent and 41 percent, respectively) than the other areas. The EDHS also investigated the reasons husbands had for not intending to use at any time in the future. The main reason was the desire to have children (27 percent), followed by fatalism (18 percent), the wife being menopausal (17 percent) and the wife be- ing considered as unable to get pregnant (14 percent) (see Table 13.14). Only 5 percent mentioned that religion was the main reason for not using, which is very low in comparison with Pakistan, where 18 percent of husbands who did not intend 1o use in the fu- ture cited religion as the reason for not using (National Institute of Population Studies and IRD/Macro International Inc., 1992, Table 12.8). 13.8 Attitudes about Family Planning Husbands were asked about their approval, in general, of the use of family planning by couples and their perception of their wife's attitude. Similar information was collected in the women's questionnaire (see Chapter 8). These data are used not only to look at the extent to which husbands support the use of family planning, but also to look at how accurate are the perceptions of both hus- bands and wives regarding their spouse's attitude toward family planning. In addition in this section, the husband's opinion as to whether religion forbids or allows family planning is considered. Finally, other attitudinal information collected from husbands, in- cluding their opinions about the use of specific family planning Table 13,14 Husbands' reasons for nonuse Percent distribmion of husbands who are not currently using any family planning method and who intend not to use at any time in the future by reasons for nonuse, Egypt 1992 Reason for nonuse Total Want children 26.7 Lack of knowledge 0.3 Costs too much 0.2 Side effects 0.9 Health concerns 5.8 Hard to get methods 0.3 Inconvenient 2.0 Religion 5.1 Opposed to family planning 3.1 Partner opposed 0.1 Other people opposed 0.2 Fatalistic 17.6 Infrequent sex 3.0 Wife can't get pregnant 13.8 Wife menopausal/ had hysterectomy 16.5 Other 2,2 Don't know 2.0 Total IO0.0 Number of husbands 518 methods, perceptions about problems in using specific methods and preferences regarding the sex of the doctor providing family planning services to their wives, are summarized. 173 Husbands' Attitudes about Use of Family Planning In general, the majority of husbands (84 percent) approve of family planning, and only 1 in 10 disapproves (see Table 13.15). The likelihood that husbands disapprove of family planning is somewhat greater in rural than in urban areas (12 percent and 9 percent, respectively). By place of residence, the differentials are even more marked (see Figure 13.31. The likelihood that the husband disapproves varies from a high of 19 percent in rural Upper Egypt to a low of 6 percent in rural Lower Egypt. This pattem indicates the need for quite different motivational campaigns to encourage adoption of family planning in roral areas in the two regions. Table 13.15 Husbands' approval of famil, t, plarming Percent distribution of husbands by their approval of the use of family planning, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt Approval of Gover- farmly planning Urban Rural notates Total Urban Rural Total Urban Rural Total Approve 88.2 80.0 89.7 90.1 91.3 89.7 72 2 81 5 68.5 83.7 Disapprove 8.7 11.7 9.0 6 1 7 0 5.7 16.2 10 0 18.8 10.3 Don't know]Undecided]Missing 1.5 3.5 0.6 2 I 1,1 2.5 4.5 3 9 4.7 2.6 Do not know method 1.5 4.8 0.7 1.7 0.6 2.1 7.{) 4.5 8.1 3.3 Total I00.0 I00.0 I00.0 I00.0 100.0 100.0 1000 100.0 I(X).O 100.0 Number of husbands 1093 1313 573 986 274 711 847 245 6(12 2406 Figure 13,3 Percentage of Husbands Who Disapprove of the Use of Family Planning by Place of Residence Percent 20 15 10 5 0 Urban Total Urban Rural Total Urban Governorales Lower Egypt Upper Egypt Rural EDHS 1992 174 Wives' Perceptions of Husbands' Attitudes The EDHS women questionnaire included a question about the wife's perception conceming her husband's attitude about the use of family planning, and the husband questionnaire included a similar question about the husband's perception of his wife's attitude. Perceptions about a spouse's attitude toward family planning use are clearly important in shaping a couple's decision to use family planning. As shown in Table 13.16, 81 percent of wives believe that their husbands approve of the use of family planning, 12 percent believe that their husbands disapprove of family planning and 7 percent are uncertain. In three-quarters of the cases, the wife was accurate in her perceptions. In those cases in which the wife was wrong about the husband's attitude, 52 percent believed that the husband disapproved of or was unsure about the use of family planning when the husband actually approved. Table 13.16 Wives' perceptions of husband's approval of family planning Percent distribution of couples by wife's perception of husband's approval or disapproval of family planning and husband's actual attitude, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt Wife's perception and Gover- husband's attitude Urban Rural notates Toral Urban Rural Total Urban Rural Total Wife: Husband approves 86.8 75 3 87.8 83.9 87.3 82 6 71.6 84 0 66.6 81).5 llusband approves 79.3 65 5 81.7 77.4 80.7 76 I 58.5 72,2 52.9 71,7 llusband disapproves 5.2 5.0 5.2 3.6 4.8 3.1 6.7 5.6 7.2 5 1 nusband unsure/Don't know 2.3 4.8 1.0 2.9 1.7 3.4 6 4 6.2 6.5 3.7 Wife: Husband disapproves 8.6 15.6 7.0 9.8 9.2 10.0 19.1 11.5 22.2 12 4 Ilusband approves 5.6 8.6 4.1 7.8 7.5 7.9 8.8 7.2 9.5 7.3 llusband disapproves 2.5 5.2 2.9 1.8 1.7 1.8 7.3 2.4 9.3 4 0 llusband unsure/Don't know 0.5 1.8 0.1 0.3 0.0 0.4 3.0 1.9 3.4 1.2 Wife: Husband unsure 4.6 9.1 5.2 6.3 35 7.4 9.2 4.5 I1.1 7 I 1 lusband approves 3.3 5.8 3.9 4.9 3.0 5.7 4.9 2.2 6.1 4.7 llusband disapproves 1.1 1.5 1,0 0.7 0.5 0.8 2.2 2.1 2.2 1.3 l lusband unsure/Don'l know 0.2 1.8 03 0.6 0.0 0.9 2.1 0.2 2.8 1.1 Total 100.0 100.0 100.0 100.0 100,0 100.0 100.0 100.1) I(X).0 100.0 Number of couples 1093 1313 573 986 274 711 847 245 602 2406 Husbands were somewhat more likely to accurately predict their wife's attitude. According to Table 13.17, 85 percent of the husbands believed that their wives approved of the use of family planning, 7 percent thought that the wife disapproved, and 8 percent reported that their wife was uncertain about her attitude toward the use of family planning. Husbands were correct in their perceptions in 83 percent of the cases. Among those who did not accurately predict the wife's attitude, almost 8 in 10 believed that their wife disapproved or was uncertain about family planning when the wife actually approved of family planning. The residential patterns follow expected pattems. Husbands and wives from rural Upper Egypt were more likely than husbands or wives from the other areas to be wrong in their perceptions concerning their spouse's attitude. Among couples from rural Upper Egypt, one-third of wives and 29 percent of husbands were wrong in their perception of their spouse's attitude. 175 Table 13.17 Husbands' perceptions of wife 's approval of family planning Percent distribution of couples by husband's perception of wife's approval or d~sat,proval of family phmning and wife's actual attitude, according to urban-rural residence and place of residence, Egypt 1992 Urban l.owcr Egypt Upper Egypt Husband's perception Gover- and wife's attitude Urban Rural notates Total Urban Rural Total Urban Rural Total Husband: Wi fe approves 89.6 81.7 92.5 89.7 91.2 89.1 75.2 81.0 72.8 85.3 Wife approves 86.2 75.0 88.5 86.{) 89.6 84.6 67.5 77.1 63.7 80.1 Wife disapproves 1.7 4.0 2.1 2.1 0A 2 7 4.5 2.1 5.4 2.9 Wife unsure/Don't know 1.7 2.7 1.9 1 6 I 3 1 8 3 2 1.8 3 7 2.2 Husband: Wife disapproves 5.5 8 0 3 7 4.6 4 8 4 5 11,7 10.5 12.2 6.9 Wife approves 4.2 5.2 2.9 3.7 3 3 3 9 7 1 8.1 6 7 4 7 Wife disapproves 1.1 2 0 0 7 0.6 0 7 (I 5 3.4 2.4 3.8 1.6 Wife unsure,q)on't know 0.2 0.8 0.0 0.3 0 8 0 1 1 2 0 0 1 7 0.5 Husband: Wife unsure 4.9 10.3 3.8 5.7 40 64 13 I 85 15.0 7.9 Wife approves 3.8 6.8 3.1 4.7 3.4 5.2 7.9 6 I 8.7 5.4 Wife disapproves 0 3 1 7 0 0 0.4 0 0 (I 5 2.6 1 2 3.2 1 1 Wife unsure/Don't know {).8 1.8 0.8 0.7 0 6 (I 7 2 6 1 2 3.2 1.4 Total 100.1) I00.0 100.0 100.0 10(10 I()() 0 l()00 1000 I00.0 I00.0 Number of couples 1093 1313 573 986 274 71 I 847 245 602 2406 Religion Table 13.18 examines the husband's opinion on whcther religion allows family planning or not. Seventy-one percent of husbands believe that religion allows family planning, and only 19 percent say it does not. The proportion of husbands who think that religion forbids the usc of family planning is similar in urban and rural areas (19 percent and 20 percent, respectivcly). By place of residence, the percentage of husbands holding the opinion that religion forbids family planning use varies from 16 percent in rural Lower Egypt to a high of 24 percent in rural Upper Egypt. Table 13.18 Husbands' belief that rel igion allows or forbids fmluly planmn,q Percent distribution of husbands by their opinion as to whelher rel igion allow~ or h~rbtd ~, the use of family planning, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt Religion's Govcr- position Urban Rural norates Total tJrb, m Rural "l~t,d Urban Rural Total Allows 74.7 68.5 76.1 77.3 77 4 77 3 61 1 68.6 58.1 71.3 Forbids 18.8 19.7 18.2 16.7 18 9 15 9 23.0 20.2 24 2 19.3 Don't know/Missing 4.9 7.0 5.0 4 3 3 1 4.8 8 8 6 7 9 7 6 1 Do not know method 1.5 4.8 0.7 I 7 0 6 2 I 7.[) 4.5 8 1 3 3 Total I00.0 I00,0 100.0 100.0 lO0 0 10(30 n)(l f) Ioo o 1oo o IO1) o Number of husbands 1093 1313 573 986 274 711 847 245 602 2406 176 Attitudes about the Use of Specific Methods As shown in Table 13.19, fewer than 1 in 5 husbands express disapproval of the use of the pill (19 percent) and IUD (14 percent). However, the likelihood of disapproval increases dramatically for male methods such as the condom (41 percent) and withdrawal (33 percent). Disapproval levels also are high for both female sterilization (48 percent) and male sterilization (21 percent). Table 13.19 Husbands' approval of use of specific methods of family planning Percent distribution of husbands by approval of the use of specific methods of family planning, Egypt 1992 Husband approves of method Don't know/Does not undecided/ know Method Yes No missmg method Total Pill 73.0 18.8 4.4 3.8 100.0 IUD 75.8 14.0 5.1 5.2 100.0 Female sterilization 11.9 48.2 4.0 35.9 100.0 Condom 21.0 41.3 6.8 31.0 100.0 Male sterilization 2.6 20.8 1.7 74.9 100.0 Withdrawal 9.7 33.0 4.6 52.6 100.0 Husbands who knew about family planning were further asked about their opinion on the main problem regarding the use of specific contraceptive methods. Table 13.20 summarizes the problems that husbands reported by method. With regard to use of the pill, although the majority of husbands (55 percent) said that there are no problems, almost 1 in 4 husbands are concerned about the pill's side effects. A similar pattern is exhibited for the IUD. For both condoms and withdrawal, inconvenience is the most frequently cited problem, with about 1 in 4 husbands giving this response in the case of each of these methods. A significant proportion of husbands (around 10 percent) also see condoms and withdrawal as ineffective. Finally, religious objections are the most often cited problem for both female sterilization and male sterilization. Attitude about Male Providers The husband was further asked whether he objects or does not object to his wife seeing a male doctor for family planning. In general, the majority of husbands have no problem with male providers. However, 3 in 10 husbands do object to their wives obtaining family planning services from a male doctor, as shown in Table 13.21. The likelihood that a husband would object is higher in rural areas, especially in rural Upper Egypt (36 percent), as compared to urban areas. In urban areas, the proportion of husbands objecting to a male provider is lowest in urban Lower Egypt (23 percent) and highest in the Urban Govemorates (see Figure 13.4). 177 Table 13.20 Husbands' problems with specific methods of family planning Percent distribution of husbands who know about family planning by the main problem identified with the method, according to specific methods, Egypt 1992 Female Male sterili- sterili- With- Problem Pill IUD zation Condom zatinn drawal None 54.6 57.0 14.2 20.6 9.5 19.9 Spouse disapproves 1.0 1.5 5.0 3.7 6.9 3.1 Community disapprove 0.0 0.0 1.6 0.7 5.7 2.2 Religion disapproves 2.7 2.3 48.0 3.0 45.4 9.4 Side effects 27.4 19.0 3.1 7.0 1.8 4.9 Access/availability 0.1 0.1 0.3 0.0 0.2 1.3 Costs too much 0.1 0.2 0.8 0.4 0.9 0.0 Inconvenient to use 4.4 3.9 5.5 25.5 7.1 28.9 Not effective 1.7 3.1 0.4 9.2 0.3 11.4 Permanent/irreversible 0.1 0.0 7.3 0.0 8.0 0 1 Other 0.6 0.9 1.3 2.3 0.6 2.0 Don't know 7.5 11.9 12.4 27 6 13.5 16 8 Toml 100.0 100.0 100.0 100.0 100.0 1{}0.0 Numberofhusbands 2315 2281 1542 1660 603 1140 Figure 1 3.4 Percentage of Husbands Who Would Object if Wife Visited a Male Doctor for Family Planning, by Place of Residence Petcen[ 5O 4O 3O 2O 10 0 Urban Governorates /- Total Urban Lower Egypt Rural Total Urban Rural Upper Egypt EDHS 1992 178 Table 13.21 Husbands' objection to wife seeing male doctor Percentage of husbands who know about family planning by attitude toward wife obtaining family planning services from a male doctor, according to urban-rural residence and place of residence, Egypt 1992 Husband's attitude Would Number Background Would not Don't know/ of characteristic object object missing Total husbands Urban-rural residence Urban 27.8 71.5 0.8 100.0 1076 Rural 33.8 65.2 0,9 100.0 1250 Place of residence Urban Governorates 31,0 68.3 0,7 100,0 569 Lower Egypt 29.8 69.4 0.8 100.0 969 Urban 23.0 76,8 0.1 100.0 273 Rural 32.5 66,5 1.0 100.0 696 Upper Egypt 32.6 66.4 1.0 100.0 787 Urban 25.5 72.9 1.6 100.0 234 Rural 35.6 63.7 0.8 100.0 553 Education No education 36.1 63.2 0.7 100.0 642 Some primary 29.6 70.1 0.3 100.0 579 Primary through secondary 34.3 64.0 1.7 100.0 407 Secondary + 25.6 73,5 0.9 100.0 698 Total 31.0 68.1 0.8 100.0 2326 13.9 Fertility Desires A number of questions were included in the Egypt DHS to obtain information on various aspects of the fertility preferences of husbands, including the desire for another child and the ideal number of children. In addition, there were questions addressed both to women and husbands as to who had the main influence on childbearing decisions. The results of these questions are described in this section. Desire for Children In the 1992 EDHS, husbands were asked about their desire for additional children. The results reveal that six in ten husbands do not want any more children (,see Figure 13.5). The proportion desiring an additional child decreases with the number of living childrcn that the husband has, ranging from 98 percent among husbands with no children to only 8 percent among husbands with 7 or more children (see Table 13.22). 179 Figure 13,5 Fertility Preferences of Husbands Want anolher child 33% Uncertain 6% Want no more ch~Ldfer- ~DHS1992 Table 13.22 Husbands' desire for more children Percent distribution of husbands by desire for more children, according to the number of living children, Egypt 1992 Number of living children Desire for future children 0 l 2 3 4 5 6 7+ Total Want another child 95.7 87.7 39.1 20.2 14.7 10.8 11.2 7.5 33,0 Want no more/none 3.5 10.4 50.7 73.6 76.0 85.3 81.2 86.9 60.8 Undecided/Don't know 0.9 1.9 10.2 6.2 9.3 3.9 7.6 5.6 6. l Total 100.0 100.0 100.0 100 0 100.0 100.0 100.0 100.0 lIFO.0 Number of husbands 193 279 401 408 332 3(16 210 277 2406 Son Preference The issue of whether son preference influences the desire for children is examined in Table 13.23, which shows the variation in the proportion wanting no more children according to the number of living sons and daughters. At each parity, the proportion of husbands desiring to limit childbearing increases with the number of living sons. For example, among husbands with two children, those who have two sons are much more likely to say that they want no more children than those husbands with two daughters (53 percent and 36 percent, respectively). 180 Table 13.23 Husbands who want no more children Percentage of husbands who want no more children, by number of living sons and daughters, Egypt 1992 Number of living daughters Number of living sons 0 1 2 3+ Total 0 3.5 9.2 36.0 57,9 17.8 1 11 5 54.8 67.9 77.0 53.3 2 53.ll 81.0 80.2 81.5 75.6 3+ 70.1 86.8 85.5 86.8 84.3 Total 27.11 60.7 71.9 80.4 60,8 Ideal Number of Children As mentioned above, husbands also were asked about the ideal number of children they would like to have. The results in Table 13.24 show the distribution of husbands by their ideal number of children according to the actual numbcr of children that they have. Overall, there was a clear preference among husbands for either a two child (28 pcrccnt) or three child (21 percent) family. An additional 20 percent considered four or more children as idcal. The table also indicates that a substantial proportion of husbands (28 percent) were unable to spccify the number of children that they considered ideal. Among those giving numeric reposes, the mean ideal family size was 3.3. This avcrage generally increases with the number of children that a man already has, peaking at 4.7 among men with 7 or more children. Table 13,24 Husbands' ideal number of children Percent distribution of husbands by 1deal number of children and mean ideal number of children, according to number of living children, Egypt 1992 Number of living children Ideal number of children 0 1 2 3 4 5 6 7+ Total 0 1) 11 0.(/ 0.2 0.3 0.1 1.9 0.7 0.0 0.4 1 6.3 2.7 1.0 0.9 1.5 0.6 1.3 1.2 1.7 2 44.4 46.7 43.4 24 6 21.2 16.1 15.0 11.1 27.9 3 18.5 20,7 23.3 38.4 14.1 17.6 15.8 12.1 21.2 4 6 1 6 9 9 5 8.9 28.0 12 5 9.9 14.5 12.4 5+ 6.4 3.8 3.5 4.2 6.6 14.7 14.6 13.8 7.9 Non-numeric answers lS 2 19.3 19.2 22.6 28.6 36.5 42.6 47.3 28.5 Total 10l).0 1110.11 100.0 1000 100.0 100.0 100.0 100.0 100.0 Number 193 279 401 4118 332 306 210 277 2406 Mean 2 9 2 6 2 8 3.l) 3.6 4.2 4.3 4.7 3,3 Note: The mean excludes husbands who gave non-numeric resl~mses. 181 Main Influence on Decision to Have Another Child Table 13.25 and Figure 13.6 consider the opinions of husbands and wives as to the person who should have the main influence on the decision to have another child. The results indicate that around half of all husbands believe that both the husband and wife should have an equal say in the decision to have a child, and 40 percent feel that the husband should have the main influence. Only a small proportion of husbands believe that the wife should have the main influence on childbearing decisions; husbands are in fact somewhat more likely to say that other individuals (e.g., relatives or medical personnel) should have the main influence than they are to accord the wife the main decision-making role (6 percent and 4 percent, respectively). Table 13.25 Husbands' and wives' perceptions of main influence on decision to have another child Percent distribution of couples by husband's and wife's perceptions as to the person who has the main inf luence on the decision to have another child, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypz Upper Egypl Husband's perception Gover- and wife's attitude Urban Rural notates Total Urban Rural Total Urban Rural Total Husband: Husband main 36.5 43.0 37.0 38.2 38.6 38.1 44.2 33.2 48.7 40 1 Wife: husband main 14.0 22 8 13.5 18.9 18.0 19.3 22.3 10.7 27 1 18.8 Wife: wife main 3 5 2.7 5.2 1.9 2,2 1.8 3.0 1.2 3.7 3.1 Wife: both equal 18.3 16 1 17.4 16.3 18.5 15.5 17.8 20.3 16 8 17,1 Wife: other 0.7 1.4 0,9 1.1 0.0 1.5 I. I 0.c~ 1.2 1 1 Husband: Wife main 3.4 3.9 4.3 2.9 1.7 3.4 4.2 3 0 4.6 3.7 Wife: husband main 1.0 1.9 1.3 1.3 0.5 1.6 1.8 1.1 2.1 1.5 Wife: wife main 0.6 0.6 0.7 0.8 0.6 0.8 0.4 0 1 0.5 0.6 Wife: both equal 1.5 1.3 1.9 0.8 0.6 1).9 1 8 1.8 1.8 1.4 Wife: other 0.2 0.1 0.4 0.0 0.0 0.1 0.2 0.0 0 2 0.2 Husband: Both equal 55.8 46.2 55.9 52.6 53.5 52.3 44.5 58.3 38 9 50.6 Wife: husband main 8.0 14.0 5.8 15.3 10.6 17.1 10.4 10.4 10.4 11 3 Wife: wife main 3.6 2.1 4.1 2 2 2.4 2 1 2.6 3.9 2.0 2 8 Wife: both equal 42.6 28.2 44.4 33.6 40.4 31.0 29.5 40.9 24.9 34 7 Wife: Other 1.6 1 9 1.6 1.6 0 1 2,2 2.0 3.1 1 6 1.8 Husband: Other 4.3 6.9 2.9 6.2 6.1 6.2 7.1 5.5 7 7 5 7 Wife: husband main 2.0 2.9 1.5 2.7 2.8 2.7 2.8 2.3 3.0 2 5 Wife: wife main 0.1 0.3 0.2 0.2 0.0 0.2 0.3 0. I 0 3 0.2 Wife: both equal 1.8 2.3 0.9 2.2 2.7 2.0 2.7 2.7 2 6 2.1 Wife: other 0.4 1 5 0.2 1.1 0.6 1.3 1 3 0.4 1.7 1.0 Total 1130.0 100.0 1130.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of couples 1093 1313 573 986 274 711 847 245 602 2406 The marked differences among couples in their opinions as to the role husbands and wives should have in childbearing decisions also are highlighted in Table 13.25. Overall, there is agreement on this topic in the case of only 55 percent of the couples interviewed in the EDHS. Of particular interest is the fact that fewer than half of the wives of men who believe that the husband should have the main influence on childbearing decisions agree with their husbands. Looking at residential pattems, husbands from rural Upper Egypt are considerably more likely than husbands from other areas to believe that the husband should have the main influence on childbearing decisions and less likely to believe that these decisions should be made jointly. As in the other areas, husbands and wives in rural Upper Egypt do not always share the same view of the fertility decision-making process. For example, 45 percent of the wives of men who say that the husband has the main influence on 182 Figure 13,6 Opinions of Husbands and Wives as to Person with Main Influence on Decision to Have Another Child W~le 4~ Husband 40% Other 6% Wife - " Husband 34% Other 4% Both 51% Both 55% Husbands Wives EDHS 1992 the decision to have a child disagree with their husbands; the majority of wives who disagree see childbearing as a joint decision. 13.10 Wife's Status in the Family The 1992 EDHS collected information in both the women's and husbands' surveys on a number of indicators of the wife's position in the family. One series of questions focused on the freedom wives are given to go out alone, express disagreement with the husband in family discussions and to work. The results presented in Table 13.26 indicate that wives are more likely than husbands to say that a wife should be able to go out alone or with children to buy household items or to visit relatives (85 percent and 78 percent, respectively). Wives also are much more likely than their husbands to accord a woman the right to work (74 percent and 49 percent, respectively). Husbands are, however, somewhat more likely than their wives to accord the wife the right to express disagreement with the husband in family (67 percent and 57 percent, respectively). Residential differentials in the responses to these questions indicate that both husbands and wives are more conservative in their attitudes in rural areas, especially in Upper Egypt, than in urban areas. Perceptions conceming husband-wife roles in making various household decisions are shown in Table 13.27. The majority of husbands and wives believe that the husband should have the final word on decisions regarding visiting relatives/friends, the household budget, and the wife's employment. With regard to children's education and marriage plans, husbands and wives tend to be more evenly divided between the opinion that the husband has the final say and the belief that the decision should be made jointly. Interestingly, more than half of both husbands and wives believe that the decision to have another child or to use family planning should be made jointly. 183 Table 13.26 Husbands' and wives' perceptions of wife's posi6on in family Among husbands and wives, the percentage saying that the wife can go out alone, that the wife should express an opinion when she disagrees with her husband, and that a woman should be able to work, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt Indicator of Gover- wife's position Urban Rural notates Total Urban Rural Total Urban Rural Total Wife can go out alone Husband 84.3 73.0 89.2 81.3 76.0 83.3 67.0 82.2 60.8 78.1 Wife 88.6 81.6 89.9 89.7 87.2 90.7 75.6 87.2 70.8 84.8 Wife should express opinion Husband 78.7 57.2 80.8 68.5 78.8 64.5 55.8 73.6 48.5 66.9 Wife 74.1 42.5 81.0 55.0 70.4 49.0 42.7 62.2 34.8 56.8 Wire should be able to work ttusband 50.5 47.8 49.4 52.6 53.2 52.4 44.6 50.1 42.3 49.0 Wife 75.9 72.4 74.0 78.7 81.0 77.8 68.4 74.5 65.9 74.0 Number of couples 1093 1313 573 986 274 7II 847 245 602 2406 Table 13.27 Husbands" and wives' opinions as to who should have the last word on household decisions Percent distribution of couples by husbands' and wives' opinions as to who should have the last word in various household decisions, Egypt 1992 Husband's opinion as to Wife's opinion as to who has last word who has last word Number Household of decision Husband Wife Both Other Total Itusband Wife Both Other Total couples Visit friendsArelatives 61.1 2.7 35.8 0.4 100.0 59.9 3.0 36.6 0.5 100.0 2406 Household budget 68.1 9.6 20.4 1.9 100.0 60.2 11.9 25.1 2 8 100.0 2406 Having another child 41.1 3.1 52.2 3.6 100.0 37.4 4.8 55.6 2.2 100.0 2406 Children's education 47.3 1.6 48.3 2.8 100.0 41.4 2.2 53.1 3 2 100.0 2406 Children's marriage 47.0 1.4 40.1 11.5 100.0 44.8 1.0 43.9 10.3 100.0 2406 Use of family planning methods 37.2 6.7 54.7 1.3 100.0 33.6 8 0 57.0 1.4 100.0 24(36 Wife's employment 77.6 3.5 18.8 0.2 100.0 71.1 4 9 23.8 0.3 100.0 2406 The proportions of husbands and wives saying that husbands should have the last word in important household decisions are shown in Table 13.28 by residence. The proportions of both husbands and wives saying that the husband should have the final say are generally more similar among rural than urban couples. Among urban couples, the greatest disagreement is observed with regard to decisions about the household budget, children's education, use of family planning, and the wife's employment. In all cases, rural couples, especially those from rural Upper Egypt are more likely than urban couples to see the husband as having the final say in family decisions. 184 Table 13.28 Husbands' and wives' belief that husband should have last word on household decisions r according to residence Among husbands and wives, the percentage saying that the husband should have the last word on important household decisions, according to urban-rural residence and place of residence, Egypt 1992 Urban Lower Egypt Upper Egypt Household Gover- decision Urban Rural notates Total Urban Rural Total Urban Rural Total Visit friends/relaUves Husband 50.2 70.2 46.1 62.7 55.1 65.6 69.5 54.4 75.6 61.1 Wife 47.7 70.0 39.5 65.7 57.2 69.0 66.9 56,4 71.1 59.9 Household budget Husband 58.4 76.2 52.0 69.7 65.4 71.4 77.2 65.7 81.8 68.1 Wife 47.1 71.1 40.2 65.8 57.4 69.0 67.1 51.6 73.5 60.2 Having another child Husband 32.7 48.1 28.1 36.9 32.4 38.6 54.9 43.8 59.4 41.1 Wife 28.0 45.3 25.6 35.8 29.2 38.4 47.3 32.3 53.4 37.4 Children's education Husband 34.6 58.0 27.2 45.7 38.0 48.7 62.9 48.0 68.9 47.3 Wife 24.6 55.4 20.8 41.2 27.3 46.5 55.6 30.6 65.8 41.4 Children's marriage Husband 34.3 57.6 29.2 47.4 37.2 51.3 58.7 43.1 65.1 47.0 Wife 28.4 58.4 22.6 45.9 34.0 50.5 58.5 35.8 67.7 44.8 Use of family planning methods Husband 27.5 45.3 21.3 34.0 31.2 35.0 51.7 37.7 57.4 37.2 Wife 20.1 44.9 16.1 32.3 I9.3 37.3 47.0 30.1 53.9 33.6 Wife's employment Husband 71.2 82.9 69.2 81.1 78.3 82.2 79.0 67.6 83.6 77.6 Wife 60.1 80.2 56.3 74.6 64.0 78.7 76.9 64.5 81.9 71.1 Number of couples 1093 1313 573 986 274 711 847 245 602 2406 13.11 Typical Family Expenditure and Wife's Contribution to the Household Budget In the 1992 EDHS, the husband was asked about what he thought that a typical family in the same situation as his family spent in a month. The distribution of husbands according to the estimated typical monthly expenditure and the median typical family expenditure is shown in Table 13.29. Overall, the median expenditure for a typical family in Egypt is 252 pounds. Thirty percent of families are estimated to spend less than 200 pounds and 19 percent are seen as spending 400 or more pounds. Looking at the variation in the typical family expenditure by selected background characteristics, the median expenditure increases with the husband's age, peaking at slightly over 300 pounds among those age 40 and over. Considering residential differentials, the median typical family expenditure is around 100 pounds greater among urban families than rural families (305 pounds and 204 pounds, respectively). The median expenditure by a typical family exceeds 300 pounds only in the Urban Govemorates and urban areas in Lower Egypt. 185 Table 13.29 Husbands' opinions as to the typical family expenditure Percent distribution of husbands by opinion as to the total monthly expenditure of a family similar to his, according to selected background characteristics, Egypt 1992 Total monthly expenditure Unsure/ Number Background 1OO- 200- 300- 400- 500- Don't of characteristic <100 199 299 399 499 599 600+ know Total Medlarl husbands Age <25 16.5 40.5 17.7 12.0 25-29 8.6 36.1 26.8 15.7 30-34 5.9 28.7 29.2 20.6 35-39 2.6 21.0 28.3 28.2 40-44 3.1 20.8 24.3 25.0 45-49 2.4 19.9 23.2 22.2 50-54 2.3 19.1 21.9 25.2 55+ 5.8 21.6 17.7 26.7 Urban-rural residence Urban 1.6 13.4 22.4 29.1 Rural 7.3 33.8 27.0 18.0 Place of residence Urban Governorates 0.6 6.0 21.0 31 4 Lower Egypt 6.4 30.1 27.3 22.4 Urban 3.6 22.1 22.5 31.3 Rural 7.5 33.2 29.1 19.0 Upper Egypt 5.5 30.5 24.8 18.1 Urban 2.0 20.9 25 7 21.1 Rural 7.0 34.4 24.5 16.9 Education No education 7.1 34.6 25.4 18.0 Some primary 5.4 30.3 26.5 19 8 Primary through secondary 5.5 18.9 24.0 30.5 Completed secondary/higher 1.2 12.9 23.6 26.4 Husband's occupation Techalcal/professional 1.5 12.2 26.0 24.0 Administrative 0.0 5.3 10.7 22.8 Clerical 0.9 16.0 29.5 26.8 Sales 3.9 25 0 21.0 23 9 Services 3 2 27.5 29.1 23.9 Agriculture 9.8 35.7 25.9 16.2 Production 3.6 22.0 24.4 27.4 Other 2.5 6.6 17.2 26.3 Missing]Not specified 0.6 39.3 17 8 26.1 0.0 1.3 2.5 9 5 100.0 155.4 85 3.9 3.0 1.5 4.4 100.0 201.4 281 7.5 3.3 2.11 2.7 100.0 207 9 429 8.7 6.0 2.3 2.8 100.0 256.3 427 8.0 10.5 7.11 1.4 100.0 300.5 405 12 3 8,0 7.7 4.4 100.0 301.3 324 11.7 8.2 7.3 4.3 100.0 302.2 224 8.0 10.3 6.3 3.8 100.0 301.3 233 12.1 10.6 8 1 2.7 100.0 304.6 1093 5 11 3.4 l 6 4.0 100.0 203.4 1313 15.8 13.5 10.1 1.7 100.0 308.5 573 5.7 4.7 1.4 2.0 100.0 206.1 986 7.9 7.9 3.8 0 9 100.0 300.5 274 4.8 3.4 0.5 2.5 1000 203.5 711 6.0 4.4 4.4 6.2 1000 206.3 847 8.0 6.8 8.1 7 3 100.0 257.8 245 5.2 3.3 2 9 5.8 100.0 203 2 602 3 6 3.6 2.4 5.3 100.0 202.9 690 5.9 5 6 2.3 4.0 100 0 206.5 599 10.5 50 3.6 2.1 1000 300.2 415 13.3 11.5 9.1 1 9 100.0 305.5 702 10.2 15.1 103 0.6 100.0 305.4 286 10.9 6 9 31.3 12.1 100.0 404.7 49 17.2 4.6 3.0 1.9 100.0 301.2 208 6.4 9.6 6.3 3.9 100.0 257.1 164 6.8 5 8 1,8 2 1 1000 209.0 185 2.9 2.5 I 6 5.5 1000 2009 694 10.7 6.9 3.1 1.8 100.0 258.6 683 9.1 17.7 13 2 7.5 100.0 307.8 77 6 4 11.3 2 5 6.9 100.0 204.1 62 All husbands 4.7 24.5 24.9 23.0 8 2 6.7 4 5 3.4 100.0 251.6 2406 As expected, typical family expenditures increase with the husband's educational level. With regard to occupation, husbands working in technical, professional and administrative jobs report higher typical family expenditures than husbands in other occupations. The median expenditure for these occupations exceeds 300 pounds, and husbands in administrative occupations report that the median expenditure among households in situations similar to their own is more than 400 pounds. Agricuhural workers report the lowest typical expenditure at just over 200 pounds. Husbands also were asked if their wife made any contribution to the household budget. In general, nearly 6 in 10 husbands reported that the wife made some contribution to the household budget. The proportion reporting that the wife made a contribution generally increases with the typical family expenditure, 186 as shown in Table 13.30. The proportion also generally increases with the husband's age, peaking at 65 percent in the 45-49 age group. Variations by urban-rural residence, and place of residence are not especially marked. However, the proportion of wives making some contribution to the households budget is significantly higher among husbands with a secondary or higher education than among husbands with less education. Similarly, husbands involved in professional and administrative jobs are more likely to report that their wives contribute to the household budget than agricultural or production workers. Table 13.30 Wives' contributions to the househhold budget Percentage of husbands whose wives contribute to the household budget, by selected background characteristics, Egypt 1992 Number Background Wife of characteristic contributes husbands Monthly expenditure <100 59.2 114 100-199 54.4 590 200-299 57.1 600 300-399 59.8 554 400-499 65.3 197 500-599 68.5 160 600+ 66.1 109 Not sure/Don't know 44.8 82 Age <25 49.4 85 25-29 51.2 281 30-34 54.4 429 35-39 62.9 427 40-44 59.8 405 45-49 65.2 324 50-54 58.5 224 55+ 59.3 233 Urban-rural residence Urban 57.4 1093 Rural 59.6 1313 Place of residence Urban Govemorates 58.5 573 Lower Egypt 60.5 986 Urban 57.4 274 Rural 61.7 711 Upper Egypt 56.5 847 Urban 54.9 245 Rural 57.1 602 Education No education 52.5 690 Some primary 58.1 599 Primary through secondary 52.5 415 Completed secondary/higher 68.6 702 Husband's occupation Technical/professional 74.4 286 Administrative 75. l 49 Clerical 63.6 208 Sales 46.7 164 Services 52.0 185 Agriculture 58.1 694 Production 54.8 683 Other 60.6 77 Missing/Not specified 51.7 62 All husbands 58.6 2406 187 REFERENCES Abdel-Azeem, F., Farid, S.M., and Khalifa, A.M. 1993. Egypt Maternal and Child Health Survey. Cairo: Central Agency for Public Mobilization and Statistics [Arab Republic of Egypt] and Pan Arab Program for Child Development [League of Arab States]. Bucht, B. and EI-Badry, M.A. 1986. Reflections on Recent Levels and Trends of Fertility and Mortality in Egypt. Population Studies 400): 101-114. Central Agency for Public Mobilization and Statistics (CAPMAS) [Arab Republic of Egypt]. 1989. 1986 Population and Housing Census. Cairo: Central Agency for Public Mobilization and Statistics. Central Agency for Public Mobilization and Statistics (CAPMAS) [Arab Republic of Egypt]. 1993a. EstimateofPopulationSize,ArabRepublicofEgypton 1-7-93 [in Arabic]. Cairo: Central Agency for Public Mobilization and Statistics. Central Agency for Public Mobilization and Statistics (CAPMAS) [Arab Republic of Egypt]. 1993b. Statistical Year Book June 1993. Cairo: Central Agency for Public Mobilization and Statistics. CentralBankofEgypt [Arab RepublicofEgypt]. 1993. AnnualReport1991/92. Cairo: Central Bank Press. Hallouda, A. M., Amin, S. Z., and Farid, S., editors. 1983. The Egyptian Fertility Survey. 4 vols. Cairo: Central Agency for Public Mobilization and Statistics. Khalifa, A. M., Sayed, A. A. H., E1-Khorazaty, M. N. and Way, A. A. 1982. Family Planning in Rural Egypt 1980: A Report on the Results of the Egypt Contraceptive Prevalence Survey. Columbia, Maryland: Population and Family Planning Board and Westinghouse Health Systems. Martorell, Reynaldo and Jean-Pierre Habicht. 1986. Growth in Early Childhood in Developing Countries. In: Human Growth: A Comprehensive Treaty. ed. by Frank Falkner and J.M. Tanner, Vol. 3, 241-262. New York: Plenum Press. Mauldin, W.P. and Ross, J.A. 1991. Family Planning Programs: Efforts and Results: 1982-89. Studies in Family Planning, 22 (6):350-367. National Institute of Population Studies (NIPS) and IRD/Macro International Inc. (IRD). 1992. Pakistan Demographic and Health Survey 1990/91. Columbia, Maryland: NIPS and IRD. National Population Council. 1991. National Strategy, 1992-2007 [in Arabic]. Cairo: National Population Council. Sayed, A. A. H., E1-Khorazaty, M. N., and Way, A. A. 1985. Fertility and Family Planning in Egypt. Columbia, Maryland: Egypt National Population Council and Westinghouse Public Applied Systems. Sayed, A. A. H., Osman, M., EI-Z~aty, F. and Way, A.A. 1989. Egypt Demographic and Health Survey 1988. Columbia, Maryland: National Population Council and Institute for Resource Development/Macro Systems, Inc. 189 Sullivan, J., Bicego, G.T. and Rutstein, S.O. 1990. Assessment of the Quality of Data Used for the Direct Estimation oflnfant and Child Mortality in the Demographic and Health Surveys. In An Assessment of DHS-I Data Quality. DHS Methodological Reports, No. 1. Columbia, Maryland: Institute for Resource Development/Macro Systems, Inc. United Nations (UN). 1991. World Population Prospects. Population Studies, No. 120. United Nations Development Program (UNDP). 1991. Human Development Report 1991. New York: Oxford University Press. World Bank. 1993. World Development Report. New York: Oxford University Press. 190 APPENDIX A SURVEY STAFF APPENDIX A SURVEY STAFF: 1992 EGYPT DEMOGRAPHIC AND HEALTH SURVEY Technical and Administrative Staff Technical Director Dr. Fatma Hassan EL-Zanaty Consultants Dr. Hussein Abdel-Aziz Sayed, Senior Consultant Dr. Medany M. Dessouki, Sampling Consultant Senior Technical Staff Dr. Hassan H.M. Zaky, Assistant Director Dr. Gihan Shawky, Associate Director For Data Processing Dr. Enas Mansour, Associate Director For Sampling Senior Field Staff Mr. Abdel-Hakim M. Abdel-Hakim, Field Coordinator Mr. Gamal A. Eleish, Assistant Senior Data Processing Staff Dr. Rashad Hamed, Data Processing Coordinator Mr. Manal E1-Fiki, Assistant Anthropometric Consultants Dr. Effat Fakher El-Din Dr. Abdel Monem Darwesh Macro International Staff Dr. Ann Way, Country Monitor Dr. Alfredo Aliaga, Sampling Specialist Mr. Trevor Croft, Data Processing Specialist Dr. Sidney Moore, Editor Ms. Kaye Mitchell, Document Production Specialist Mr. Jonathan Dammons, Graphics Specialist Office Staff Mr. Mohamed A. Ismail, Supervisor Mr. Hosney Atteya Hassan, Topographer Ahmed Mohamed Hassan Alaa Badr Mosad Emad Badr Mosad Galal Tawfik Ahmed Maha Ahmed Omar Mahmoud El-Said Mahmoud Saber Mohamed Hussein Safaa Ahmed Shaker Sahar Hassan Mohamed Sherif Saleh Aly Tahra Hamouda Hussein Tarek Hamdy Hassan Yasmin Kamal Ezzat, Research Assistant Mary Tawfik Youssef, Secretary Administrative and Financial Sabry Soliman Farag 193 Supervisors Abdel-Aziz Mahmoud Adel Sayed Hussein Fayez Amin Khalil Galal Mohamed Abdel-Hakim Ibrahim Sayed Hussein lhab Ismail Refai Khaled Mohamed Abdel-Dayem Mohamed Abdel-Samie Mohamed Counters Abdel-Rahim Arafat Mahmoud Abdel-Raouf Mahmoud Mohamed Abdel-Shafy Abdel-Mone~ Ahmed Afifi Sanad Afifi Ahmed Mugahed Abdel-Samad Akram Badr El-Din Alaa Badr Mosad Aly EI-Sayed Abdel-Wanis Amin Ezzat Amin Ashraf Gaber Abdel-Aziz Ayman Atteya Atteya Ayman Gaber Mohamed Basiouny Aly Mohamed Farouk Geyouchy Hassanein Hassan Imam Marzouk Hisham El-Sayed Hisham Hisham Habib EI-Husseini Hisham Mohamed Abdel-Razck Hussein Abdel-Gawad Imam Counters Alaa Badr Mosad Aly E1-Sayed Abdel-Wanis Amin Ezzat Amin Ayman Atteya Atteya Hisham Habib El-Husseini lhab Ismail Refai Khaled Ahmed Mohamed Khaled Mohamed Abdel-Dayem Mohamed Darwish Omar Field Staff Quick Count Staff: Initial Phase Mohamed Mohamed Darwish Omar Mohamed Mostafa Sayed Mohamed Ezzat Abdel-Salam Mostafa Kamal lsmail Osama Radwan Mohamed Sherif Ahmed EI-Sebaei Tohamy Sayed Abdcl-Rahman lhab Mostafa Younes Khaled Ahmed Mohamed Khaled Hemdan Abdel-Ghany Mahmoud Amin lbrahim Mohamed Ahmed EI-Sayed Mohamed Amin Hamed Mohamed Farag-Alla Zoghby Mohamed Hassan Mohamed Mohamed lbrahim El-Said Mostafa Kamal lsmail Nazih EI-Sayed Hassan Osama Hussein Ahmcd Sameh Said Amin Samir EI-Sayed Soliman Shcdf Mohamcd lbrahim Tohamy Sayed Abdel-Rahman Wahid Mohamcd EI-Dessouki Walid Helmy Hassan EI-Shaer Quick Count Staff: Quality Control Phase Mohamed Ezzat Abdel-Salam Mohamed Farag-Alla Zoghby Mohamed Mostafa Sayed Mostafa Kamal Ismail Nazih EI-Sayed Hussein Osama Radwan Mohamed Sameh Said Amin Sherif Ahmcd EI-Sebaci 194 Supervisors Alaa Badr Mosad Aly EI-Sayed Abdel-Wanis Ayman Atteya Atteya Galal Mohamed Abdel-Hakim Hisham Habib EI-Husseini Khaled Mohamed Abdel-Dayem Listers Abdel-Gaw~td Mohamed Abdel-Gaw~td Abdel-Rahim Arafat Mahmoud Abdel-Raouf Mohamed Abdel-Shafy Abdel-Monem Ahmed Ashraf Abdel-Sattar Eleish Basiouny Aly Mohamed Gamal Mohamed Abdel-Zaher Gamal Shawki Ragab Hany Mohamed Abdel-Wahab Haisam Mohamed Farouk Khaled Ahmed Mohamed Listers Ahmed Mohamed Hassan Ashraf Abdel-Sattar Eleish Maher Farouk Abdo Supervisors Abdel-Azim Abdel-Razek Abdel-Aziz Mahmoud Mohamed Fakhry Ahmed Hegazy Fayez Amin Khalil Galal Mohamed Abdel-Hakim Samy lssa Assistant Supervisors Abdel-Latif Abdel-Aty Ahmed Abdel-Monsef Adham Ibrahim Emad Badr Mosad Khaled Mohamed Abdel-Dayem Mahmoud Abdel-Rahman Abdo Listing Staff: Initial Phase Mohamcd Darwish Omar Mohamed Farg-Alla Zoghby Mostafa Kamal Ismail Osama Radwan Mohamed Tohamy Sayed Abdel-Rahman Khalcd Hamdan Abdel-Ghany Maher Farouk Abdo Mohamed Ahmed EI-Sebaei Mohamed Abdcl-Rahman Abdo Mohamcd Ahmcd EI-Saycd Mohamed Abdel-Hamid Mohamed Mohamed EI-Sayed EI-Husseini Mostafa Abdel-Samie Nazih EI-Sayed Hassan Samir EI-Saycd Soliman Shcrif Mohamcd Ibrahim Listing Staff: Quality Control Phase Aly EI-Sayed Abdel-Wanis Hosney Atteya Hassan Osama Radwan Mohamed Interviewing Staff Kamel Sayed lbrahim Mahmoud Metwally Mohamed Moetemed Khalil Sherif Ahmed E1-Sabaei Ahmed Abdel-Wahab Wagih Hassanein Omar Mohamed Abdel-Fattah Osama Radwan Mohamed Reda Hassan Mohamed Said Mohamed Mostafa Tohamy Sayed Abdel-Rahman Yousrey Ramadan 195 Field Editors Areal Taha Abdel-Magid Fatma Abdel-Rasoul Fatma Mohamed Aly Hanan Abdel-Latif Hayam Hassan Abdel-Halim Laila Gad Abdel-Motaal Interviewers Abir Mohamed Abo EI-EIa Am~tl Abdel-Wahed Hassan Areal Gamal Zaky Amal E1-Sayed Abdel-Magid AmAI Mohamed Ahmed Am/d Mohamed Kasem Am/tl Mostafa Mohamed Doaa Ramadan Mohamed EI-Sayeda Mahmoud Hassan Fatma Ahmed Aly Fatma Ibrahim Omar Fatma Ismail Sayed Fatma Mounir Mohamed Fawzia Hassan Ibrahim Ganet Wasfi Nagib Gihan Mohamed Mahmoud Hanaa Ahmed Hassan Hanan Eid Hoaida Adel Shehata Hoda Ahmed Mohamed Hoda Salem lnas Fakhry Inas Said Labib Laila Hassan Akl Magda Ahmed Hussein Magda Mahmoud Omar Supervisors Ahmed Abdel-Wahab Mahmoud Emad Badr Mosad Gamal Abdel-Sattar Eleish Hosney Atteya Kamel Sayed lbrahim Khaled Mohamed Abdel-Dayem Mahmoud Abdel-Rahman Abdo Reintervie wing Staff Maha Mohamady Manal Amr Mahmoud Nermin Mohamed E1-Sayed Sahar Ahmed Farghaly Seham Mohamed lsmail Soheir E1-Badry Atef Manal Mahrous Manal Mohamed E1-Hady Manal Mohamed Mokhtar Mervat Ismail Senousy Mervat Mostafa Mervat Shafik Mona Ahmed Hassan Mona Ahmed Radwan Mona Kamal Mahmoud Mona Mohamed Abdel-Khalek Monira Abdalla EI-Sayed Nagat Hassan Aly Nahed Saycd Salem Nora Refai Omeima Mostafa Pakinam Kamal Safaa Abdel-Halim Safeya Anwar Kaldas Sahar Abdel-Monem MetwaUy Sahar Ahmed Abdel-Fattah Sahar Ahmed Abdel-Moety Samar Yassin Mohamed Sherin Sobhy Saleh Taghrid Sabry Zcinab Fathy EI-Sayed Mahmoud lbrahim Metwally Medhat Mahrous Zakhary Mohamed Farag-Alla Zoghby Osama Radwan Mohamed Tohamy Saycd Abdel-Rahman Wagih Hassanein lbrahim 196 Interviewers Am~tl Mohamed Ahmed Am~tl Mohmed Kasem Doaa Ramadan Mohamed Fatma Ahmed Aly Fatma Ibrahim Omar Fatma Mounir Mohamed Hanaa Ahmed Hussein Hanan Mohamed Abdel-Lati f Hoaida Adel Shehata Hoda Mohamed Ahmed Hoda Salem Abdel-Maksoud lnas Said Labib Laila Gad Abdel-Motaal Magda Ahmed Hussein Maha Ahmed Omar, Field Secretary Office Editing Staff Editors Alyaa Roushdy Zahran Am~tl Mohamed Kasem Amany Hassan Aly Farina Abdel-Rasoul Farina Ahmed Aly Fatma Ibr~im Omar Hanan Mohamed Abdel-Latif Hayam Hassan Abdel-Halim Hoaida Adel Shehata Coders Amany Hassan Aly Hashem Abdel-Ghany Data Processing Staff Abdel-Fattah Sayed Ahmed Mohamed Hassan Ayman Mohamed Abdel-Monem Azza Kamal Mohamed Hashem Abdel-Ghany Hazem Sayed lhab Helmy Marwa Hassan Mary Tawfik Youssef Office Staff Maha Mohamady Mohamed Manal Amr Mohamed Manal Mohamed E1-Hady Mervat Mostafa Mohamed Mona Ahmed Hassan Nahed Sayed Salem Pakinam Kamal Safeya Anwar Kaldas Sahar Abdel-Moety Sahar Ahmed Abdel-Fattah Samar Yassin Mohamed Scham Mohamed Ismail Zeinab Fathy El-Sayed Laila Gad Abdel-Motal Nahed Sayed Salem Safaa Ahmed Shaker Sahar Abdel-Moety Sahar Ahmed Farghaly Sahar Hassan Mohamed Sherin Sobhy Saleh Tahra Hamouda Hussein Mohamed Abdel-Sattar Yasmin Kamal Ezzat Mohamed Marzouk Amin Mohamed Abdel-Monem Fahmy Mohamed Youssef Ezz-EI-Din Nagwa Metwally Fahmy Nefiessa Mohamcd Rania Zakaria Hussein Saber Mohamed Hassan Yahya Zakaria Hussein 197 APPENDIX B SAMPLE DESIGN APPENDIX B SAMPLE DESIGN The major objective of the Egypt Demographic and Health Survey sample design was to provide estimates with acceptable precision for important population characteristics such as fertility, infant and child mortality, contraceptive prevalence, and maternal and child health indicators. These estimates were required at the national level, for urban and rural areas and for five major residential subgroups (Urban Governorates, Lower Egypt (urban and rural) and Upper Egypt (urban and rural)). In addition, estimates of contraceptive prevalence and the basic health indicators were required for each of 21 governorates. To achieve these objectives, a three-stage probability sample was adopted. The following is a detailed description of the 1992 EDHS sample design. A description of the field activities involved in the implementation of the sample design is included in Chapter 1 of this report. B.I Sample Coverage Administratively, Egypt is divided into 26 goveroorates. The 1992 EDHS sample covered 21 of these 26 govemorates. Only the Frontier governorates were excluded from the sample frame because of the disproportionate resources required to survey the population in these govemorates; the net effect on national estimates of excluding these govemorates is negligible because they include only about 1 percent of Egypt's population. B.2 Sample Design The main concern in developing the sample design for the 1992 EDHS was to secure a sufficient number of cases in each domain in order to increase the precision of estimates and reduce sampling error. Sampling error has two components, one corresponding to variation between primary sampling units (PSUs) and the other to variation within PSUs; the major component is usually the variation between PSUs. Thus, the total number of PSUs is an important factor in controlling the size of the sampling error since the variation between PSUs depends on this number. The DHS sampling policy recommends a minimum of 1000 women per domain. Moreover, with an optimal sample take of about 25 cases per PSU, it is recommended that a minimum of 40 PSUs be selected per domain. This recommendation reflects a balancing of the desire to increase the "spread" of the sample (i.e, to increase the number of PSUs) and the interest in avoiding oversampling, which can result in unnecessarily high costs and increased problems in controlling the quality of the interview process. The standard DHS approach had to be modified in the design of the Egypt DHS sample because estimates were required for each govemorate. The main variables for which govemorate-level estimates were needed involved proportions rather than rates (e.g., contraceptive prevalence). Thus, a smaller sample could be selected from each govemorate than would have been needed for the calculation of fertility or mortality measures. The EDHS sample design called for a minimum of 450 women in each govemorate, and a minimum of 25 clusters per govemorate. The target sample was fixed at 10,000 interviews with ever-married women age 15-49. Using information from the 1988 EDHS on the number of eligible women per household and response rates, it was estimated that 12,030 households had to be selected in order to yield the desired number of interviews. The EDHS design called for these households to be selected from a total of 378 primary sampling units (209 201 villages and 169 shiakhas/towns). Table B.I presents the distribution of the PSUs and the target sample by govemorate. Table B.I Distribution of target sample and number of primary sampling uniLs (PSUs) by governorate and sector (urban-rural) Urban Rural Overall Sample sampling Governorate size Sample Segment PSUs Sample Segment PSUs fraction Urban Governorates Cairo 1400 1400 70 35 1/1390 Alexandria 600 600 30 15 1/1220 Port Said 560 560 28 14 1/200 Suez 590 590 30 15 1/ 160 Lower Egypt Damietta 540 135 10 5 405 14 14 t /330 Dakahlia 550 143 l0 5 407 14 14 1/1460 Shaxkia 500 115 8 4 385 13 13 1/1530 Kalyubia 500 220 14 7 280 9 9 1/1280 Kafr El-Sheikh 500 115 8 4 385 13 13 1/760 Gharbia 510 168 12 6 342 11 11 1/1280 Menoufia 500 100 6 3 4110 13 13 1/1030 Behera 500 115 8 4 385 13 13 1/1390 Ismailia 560 274 18 9 286 10 10 1/250 Upper Egypt Giza 550 314 20 10 236 8 8 1/1810 Beni Suef 500 125 8 4 375 13 13 1/650 Fayoum 500 115 8 4 385 13 13 1/690 Menya 500 105 8 4 395 13 13 1/1250 Assiut 500 140 10 5 360 12 12 1/1000 Souhag 570 125 8 4 445 15 15 1/920 Qena 500 115 8 4 385 13 13 1/1050 Aswan 60tl 240 16 8 360 12 12 l/31111 Total 12030 5814 338 169 6216 209 209 B.3 Sample F rame For each govemorate, a list of shiakhas/towns constituted the initial primary sample frame for urban areas, and a list of villages constituted the frame for the rural area. The Central Agency for Public Mobilization and Statistics provided updated population information for each of the administrative units in the frame. For the second stage selection, a frame was required for the selected PSUs only. Before carrying out the second stage selection, detailed maps were obtained for each PSU. B.4 Sample Selection First Stage In this stage, a total of 377 ~ PSUs were selected from 21 govemorates (169 urban, 208 rural). A list of PSUs allocated according to govemorate and residential sector (urban/rural) is shown in Table B.2. Figures B. 1.1-B. 1.3 show the geographical distribution of the 377 sampling selected in the 1992 E DHS. t One of the rural primary sampling units (EI-Sebaiaa village in Aswan) had become a town and was excluded from the sample. 202 Table B.2 Primary sampling units by govemorate, Egypt DHS 1992 URBAN GOVERNORATES EI-Barad Sherif E1-Ezab Mahmasha Masaken EI-Zawia EI-Hamma EI-Amiria EI-Zatoun EI-Keblia Masaken EI-Amiria EI-Shamalia EI-Ezab Arab Abo-Tawila EI-Zahraa And Masaken EI-Helmia Tolumbate Ain Shams EI-Salam El Sharkia Kafr EI-Shorafaa EI-Bostan EI-Abasia El keblia Hadayek El Koba Masaken EL-Amiria El Ganoubia EI-Bitash Gharb Zawiat E1-Kabania EI-Hadma Kebly Ezbat Saad EI-Kassee Kebly Dana EI-Gadida And Ezbat EI-Wastania San Estifano El- Seouf Kebly EL-Galaa EI-Saraye EI-Manaakh AboEI-Hassan MontazahSaad El-Arab Fisal (City) EI-Ganaen (City) Kism Talent Cairo Alexandria Port Said Suez LOWER EGYPT EI-Teraa EI-Boulakia Roud EI-Famg EI-Balad EI-Sabtia EI-Sakayeen EI-Birkadar Nasser Nasr EI-Keblia EI-Kadria EI-Baghalaa Abo-EI-Seoud And EI-Madabegh EI-Manial EI-Gharbi EI-Basatin El Gharbia Dar EI-Salam EI-Hagaraa EI-Massara EI-Balad Helwaen EI-Balad 15 'j' Mayou (Town) EI-Mandarah Kebly Sidi Beshr Kebly Mergham Embrouzo and Moharam Beck EI-Mesalah Gharb and Sherif Basha Ghent EL-Enab Gharb EI-Wardiaan Shark lbrahim Hassanin Port Fouad(Town) Gazirat Pohairnt EI-Manzalah EI-Kabouti Kism Rabm Sheikha Owlaa Sheikha Taniaa Urban KismAwal KismTani KismRabia Damietta Faraskour (Town) EI-Zarkaa (Town) 203 Rural EI-Mohamdia (Monshet Farouk) Kafr EI-Morabian EI-Sharkia Kafr El-Wastany EI-Sawalem EI-Sananiah Shat EI-Khayata Shat El-Sheikh Dorgham Urban Sherbine (Town) Manzalaa (City) Kism Awal Meet Talkha Rural EI-Satamouni EI-Dahria EI-Bousraat EI-Azzazna EI-Salam Taranis EI-Bahre EI-Tawela Urban Fakouse (Town) Urban Sherbine (Town) Manzalaa (City) Kism Awal Meet Talkha Rural EI-Satamouni EI-Dahria EI-Ron~raat Elnahal Rural Shenbaraa Mankelaa Manshat Ebn-EI-Aas EI-Monagaa AI-Kobra Aki~ad EI-Keblyia Dawamah Manshat EI-Manesterli EI-Nakhase Urban Kafr Manaker EI-Kanater EI-Khayria (Town) Bahtim Rural Kafr Sharaf EI-Deen Kafr EI-Gazzar EI-Shoubak Nobe Taha Dandana Urban Baltim (Town) Fouah (Town) Dakahlia Sharkia Kalyubia Kafr El-Sheikh Shat Ezbet-EI-Lahm Shat Mouheb and EI-Sayale EI-Barashia EI-Tarha Sharabas Dakahla Kafr Turky Kafr EI-Berdmaase Aggaa (Town) Kafr Demlraa EI-Gadida Kafr EI-Kordi Berkin Manshat Helal Kafr Derabe Baktaress Olilah Kafr Meet EI-Azz Youssef Beck Kafr EI-Berdmaase Aggaa (Town) Kafr Demlraa EI-Gadida Kafr EI-Kordi Rt~rkin Belbeese (City) Kafr Ab~ah Kafr El-Sheikh EI-Zawahn EI-Horria Shoubra EI-Nakhlaa EI-Naahamna Meet Bashaar Mostorod Bigam Abo AI-Ghitc Kafr AI-Shorafam EI-Gharbi Meet Halfaa Saryakouse Desouk (City) Awade EI-Zawawi Rural EI-Komision Shark Abo Ghenima Koume EI-Dahab (Zobaida EI-Bahari) EI-Rasif EI-Sahel EI-Bahari (Dabloosh) Kafr EI-Garaydah Ketah EI-Hamoul Urban Katoure (Town) Naser Habibe Youssef AI-Sengawy Rural Ketamet EI-Ghabaa Shoubra Baloulah EI-Sakhaweya Bashbishe Mahalet Abo Ali AI-Kantarah Kafr AI-Azyzia Sandbaste Urban Hassan Hassan Amer EI-Kammash Menouf (City) Rural Kafr Betebs Toukh Tanbasha Shoubra Bakhoume Meet Abo Shiha Dakma Meet Affiah Kafr EI-Shabaa Urban Kafr EI-Daware (City) Edko (City) Rural Ezzab Dafashou EI-Meadya Fisha Balakhah Botorus Zawyt sakr Abaadiat Damanhoure Ezbet AI-Sarwe Urban EI-Kantarah Shark (Town) Haye El-Sheikh Zayed EI-Temsah EI-Arayshah EI-Gadidah Gharbia Menoufia Behera IsmaUia 205 AI-Khadimia Sandalaa EI-Safiaa And Meet EI-Hamide Shabase EI-Shohadaa Manshat Zahlouk EI-Manshaa EI-Kobra El-Santa (Town) Waboure EI-Noure Ali Aghaa EI-Bandarah Monshat Abo Abd Allah Shabshir EI-Hessah Maneil EI-Howishat Kolaibe Abyaare Ashmoune (City) Sedoude Abo Senita Kafr Shoubra Zengi Derouah Shanshoure and Hessetha Manial Arouse Houshe Issa (City) Kartassaa Abo Yehya EI-Oyoune Nakla EI-Enab lbrahim Mehana Kherbcta EI-Azzimah Monshat EI-Shohadaa EI-Haikre El-Tale EI-Kabire (Town) Rural A1-Akharsa Abo Khalifa Abo Sowaire EI-Mahatah El- sabaa Abaare EI-Gharbia Eine Ghosine Urban EI-Moun~a Gezirat Embabah GeziratMeetOkbah EI-Dokki Zenine Rural Bortos Oum Dinaar Kerdasah Warak El-Arab Urban Nasser (Town) AI-Mermah and EI-Ezab Rural Aboyate Gazirat EI-Masadah Maydoume Gazirat Abo Saleh Bani Hani Mayyanah Baroute Urban Abshwaye (Town) Taamiah (Town) Rural Abo Kassah EI-Moshar'ak Senrou EI-Bahriah Kasr Bayade Terssa Matar Tarres EI-Mazatly Urban Mataye (Town) Kism Talet UPPER EGYPT Giza Beni Suef Fayoum Menya 206 Nafisha EI-Manayef Saraabiume EI-Kassassin EI-Gadida EI-Kassassin EI-Kadima EI-Omraniah EI-Gharbia Harah Oulaa EI-Mounibe Monshat EI-Bakari EI-Saff (Town) Tamouah Mazghouna Kafr Turkey and Kafr Tourkhan EI-Beremble Beba (Town) EI-Feshne (Town) Damoushia Beni Kasem Konboshe EI-Hammra Dashashah EI-Gafadunc Shenery Kism Tam Kism Rabia Masaret Sawi EI-Mandarah Amiriet EI-Fayoum (EI-Masloub) Abo Sire Defnou EI-Menya Kalmashah EI-Fckriah (Town) Dalrc Mouase (Town) Rural Beni Warkaan Dahroute Atou El-Waker Masaret Hagag lbrahim Dafash EI-Bergayah Urban Manfaloute (City) Shiakha Oulaa Shiakha EI-Hamraa Rural Kharka Nazlet Sarakna Tanagha A1-Mandara Kebly AI-Hamaame Koum EI-Mansourah Urban Tamma (Town) Gohinah (Town) Rural EI-Aghanna Fao Gharb Bengga EI-Nazzah EI-Bahariah EI-Samarnah Fazarra BelKariah EI-Hamadiah Tounes Urban Nagaa Hamadi (Town) Kism Tani Rural AI-Awsate Samhoude AI-Beharzah Koum AI-Begga AI-Gharbi Bahgoum Houah Fao Bahari EI-Daire AI-Hogayrate Urban Edfou (Town) Koum Ombo (City) Drawe (Town) Rural EI-Bousaylia EI-Wasta EI-Hagze Bahari EI-Redissia Bahari AI-Kalh Gharbe AI-Alaki Aklite Assuit Souhag Qena Aswan 207 Saft EI-Khmaar Sharkiah Atlidem Mantoute AI-Rairamoon Sengerg Beni Omraan El Naseria (Town) EI-Badari (Town) Drenka AI-Akrade Nazlet EI-Assara EI-Nekhila EI-Dawir EI-Nawawrah Shiakha EI-Kabshc EI-Monshaa (Town) EI-Hawawishe EI-Horayzate EI-Gharbia Aoulad Salama AI-Masayde EI-Balabishe Bahari Aoulad Yehya Bahari El-Sheikh Marzouk Luxor (City) Armante (City) Dandara AI-Kharanka Hegazzah Bahari EI-Baghdadi EI-Rouzaykate Shiakha Oulaa Shiakha Tania Shiakha Talla AI-Abbassia Almansouriah Fares Nemra Sabaa Bahari EI-Akkabc Figure B.I.I Distribution of Sampling Points, Urban Governorates, Egypt Demographic and Health Survey, 1992 ALEXANDRIA ~ - I / CAIRO / , i t ~ / I ! / I "c" / I ~//,\ SUEZ'~" ~ / 208 bO ~D Figure B.1.2 Distribution of Sampling Points, Lower Egypt, Egypt Demographic and Health Survey, 1992 ",, ,+,+. • ' % '-% + J./ J. k •A / A & -~* ; ~ Boundary of Governorate . . . . . Urban Rural • Agricultural Boundary Urban Governorate Figure B.I.3 Distribution of Sampling Points, Upper Egypt, Egypt Demographic and Health Survey, 1992 ~if. A ~ • Boundary of Governorate . Agricultural Boundary Urban ~- Rural * Urban Governorate 210 Within each govemorate and residential sector (urban/rural), the list of first-stage units was arranged in serpentine order, beginning from the northwest comer of the govemorate, using the map of each govemorate. The sample of PSUs was selected systematically with probabilities proportional to 1986 Census population using the equation; Pn=aMos J~= Mos I where a = the total number of PSUs to be selected from the residential sector in the govemorate, Mos i the measure of size for the PSU, which was obtained by dividing the total population in the PSU by 5000 for urban units or 1500 for rural units and rounding the result to the nearest integer, and E~14os, = the sum of the Mos, values for all PSUs in the govemorate-residential sector. Second Stage The second stage of selection involved several steps. First, detailed maps were obtained for each shiakha and for villages with populations over 20,000. These maps were divided into a number of pans (with equal size). One part was then selected from each PSU. In both urban and rural PSUs, a quick-count operation was carried out in the field to provide information about the number of dwelling units (see Chapter 1 for a description of the quick-count operation). These counts were used to divide the selected parts (or the entire village in the case of rural PSUs with less than 20,000 population) into a number of roughly equal size segments. Two segments from urban areas and one segment from rural areas were then selected systematically from each PSU with probability proportional to size using the following equations: for 14rba~ fo r rural where M,j = the estimated housing units assigned to the j-th segment in the i-th PSU, 211 the estimated number of housing units in the selected pan in the PSU, and the number of parts in the PSU. = = Third Stage A list of all the households living within the selected segments was prepared for third stage selection (see Chapter 1 for a description of the household listing operation). Using the household lists, a systematic sample of households was selected with the selection interval, I= PItP~ I, where Pt, and P2j = as calculated above, and f, = the overall sampling fraction for each govemorate based on estimated 1992 population for the govemorate (see Table B. 1 ). A systematic subsample of one-third of the household sample was selected for the husband survey. B.5 Results of Sample Implementation Results of the sample implementation are presented for the women's survey in Table B.3.1. The results indicate that of the 11,304 households selected, the EDHS field teams successfully interviewed 10,761. The household response rate was 98 percent. In the interviewed households, 9,978 eligible women were found, of whom 99 percent were interviewed. Response rates for the husband's survey were somewhat lower than for the women's survey. Table B.3.2 shows that 3,027 eligible husbands were found, of which 82 percent were interviewed. 212 Table B.3.1 Sampie implementation: Women Percent distribution of households and eligible women by results of the interview, and household response rates, eligible woman response rates, and overall response rates, according to sample domain and urban-rural residence, Egypt 1992 Result Urban Rural Urban Lower Egypt Upper Egypt Gover ~ notates Total Urban Rural Total Urban Rural Total Selected households Completed (C) 94.1 96.4 93.7 96.5 95.5 97.1 95.0 93.6 95.7 95.2 llousehold present but no competent respondent at home (P) 2.1 0.7 2.5 1.1 1.5 0.9 0.9 1.8 0.5 1.5 Postponed 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 Refused (R) 0.3 0.0 0.3 0.1 0.1 0.0 0.2 0.4 0.0 0.2 Dwelling not found (DNF) 0.0 0.0 0,0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 Household absent (IIA) 1.9 1.5 2.0 1.0 1.4 0.8 2.1 1.9 2.2 1.7 Dwelling vacant/address not a dwelhng (DV) 1.3 1 2 1.0 1.1 1.3 1.0 1.6 1.9 1.4 1.3 Dwelling destroyed (DD) 0.2 0.1 0.2 II. 1 0.2 0.0 0.2 0.2 0.2 0.1 Other(O) 0.1 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 6082 5222 3243 4215 1551 2664 3846 1288 2558 11304 Household response rate (HRR) t 97.5 99.2 97 0 98.7 98.3 98.9 98.8 97.6 99.5 98.3 Eligible women Completed (EWC) 98 9 98 8 98.8 98.7 98.8 98.6 99.1 99.3 99.0 98.9 Not at home (EWNII) 0.8 0.8 0.8 1.0 0.8 1,1 0.6 0.6 0.6 0.8 Refused (EWR) 0.2 0.1 0.2 0.1 0.2 0,1 0.1 0.0 0.2 0.2 Par tiy completed (E WPC) 0.0 0.1 0.0 0.1 0.2 0.0 0.1 0.0 0.1 0.1 Other (EWe) 0.1 02 0.2 0.2 0.1 0.2 0.1 0.1 0.1 0.1 Total Percent 100.0 100.0 100.0 100.0 1190.0 100.0 100.0 100.0 100.0 100.0 Number 4725 5253 2517 3864 1215 2649 3597 993 2604 9978 Eligible woman response rate (EWRR) 2 98.9 98.8 98.8 98.7 98.8 98.6 99.1 99.3 99.0 98.9 Overall response rate (eRR) 3 96 4 98.0 95.9 97.4 97.1 97.5 98.0 96.9 98.5 97.1 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, dwelling not found and household absent. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed and "other." The overall response rate is the product of the household and woman response rates. l . . . . . Us ng the number of households falhng in o specific response ca egones, the household response ra e (HRR) is calculated ~: C C+I IP+P+R +DNF 2Using the number of ehgible women falling rote specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC EWC + EWNII + EWP + EWR + EWPC + Ewe SThe overall response rate (eRR) is calculated ~s: eRR = HRR * EWRR 213 Table B.3.2 Sample implementation: Husbands Percent disla'ibution of households and eligible husbands by results of the interview, and household response rates, eligible husband response rates, and overall resporme rates, according to sample domain and urban-rural residence, Egypt 1992 Urban Lower Egypt Upper Egypt nover- Result Urban Rural norates Total Urban Rural Total Urban Rural Total Selected households Completed (C) 94.5 96.5 94.8 96.7 95.1 97.7 94.5 93.1 95.2 95.4 Household present but no competent respondent at home (P) 1.5 0.8 1.5 0.9 1.4 0.7 1.3 1.8 0.9 1 2 Refused(R) 0.2 0.0 0.3 0.0 0.0 00 0.1 0.2 0.0 0.1 Household absent (HA) 1.7 1.5 1.6 1.1 1.4 1.0 2.2 2.5 2.0 1.6 Dwelling vacantladdress not a dwelling (DV) 1.8 1.1 1.4 1.1 2.1 0.6 2.0 2.3 1.8 1 5 Dwelling destroyed (DD) 0.1 0 1 0.2 0.1 0.0 0.1 0.1 0.0 0.1 0.1 Other (O) 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0 0 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 10(I.0 Number 2026 1748 1079 1415 514 901 1280 433 847 3774 Household response rate (HRR) 1 98.2 99.2 98.2 99.1 98.6 99.3 98.6 97 8 99.0 98.7 Eligible husbands Completed (EttC) 83.9 79.3 85.9 80.6 81.9 80 0 79.2 80.9 78.6 81.5 Not at home (EHNtl) 15.1 19 2 12.9 17.5 16 4 18.0 20.1 19.1 20.5 17 3 Postponed (EHP) 0.2 0 6 0.3 0.9 0.3 1.1 0.0 0.0 0.0 (1.4 Refused (EIIR) 0.4 0 5 0.6 0.3 0.3 0.2 0 6 0.0 0.8 (I.5 Other (EtlO) 0.5 0 3 0.3 0.8 1.1 (I 6 0.1 0.0 0 1 (1.4 Total percent 1130.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 0 Number 1426 1601 773 1175 360 815 1079 293 786 3027 Eligible husband r~ponse rate (EHRR) 2 83.9 79.3 85 9 80.6 81.9 80.0 79.2 80.9 78.6 81.5 Overall re spon~ rate (ORR) 82.4 78.7 84.3 79.8 80.8 79.5 78.1 79.1 77.9 8(I.4 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, dwelling not found and household absent. The eligible husband response rate is calculated for completed interviews ~ a proportion of completed, not at home, postponed, refused, partially completed and "other." The overall response rate is the product of the household and man response rates. Using the number of households falling into spec tic response categories, the household response rate (ItRR) is calculated as C C+t IP+P+R+DNF 2Using the number of eligible men falling into spemfic response categories, the ehgible man response rate (EWRR) is calculated as: EIIC EIIC + EItNII +EIIP+ EIIR + EIIPC+ EHO ~The overall response rate (ORR) is calculated as" ORR = IlRR * EIIRR 214 APPENDIX C ESTIMATES OF SAMPLING ERRORS APPENDIX C ESTIMATES OF SAMPLING ERRORS The results from sample surveys are affected by two types of errors, nonsampling error and sampling error. Nonsampling error is due to mistakes made in carrying out field activities, such as failure to locate and interview the correct household, errors in the way the questions are asked, misunderstanding on the part of either the interviewer or the respondent, data entry errors, etc. Although efforts were made during the design and implementation of the EDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be measured statistically. The sample of women selected in the EDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each one would have yielded results that differed somewhat from the actual sample selected. The sampling error is a measure of the variability between all possible samples; although it is not known exactly, it can be estimated from the survey results. Sampling error is usually measured in terms of s tandard error of a particular statistic (mean, per- centage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which, apart from nonsampling errors, the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that same statistic as measured in 95 percent of all possible samples with the same design (and expected size) will fall within a range of plus or minus two times the standard error of that statistic. If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the EDHS sample design depended on stratification, stages and clusters. Consequently, it was necessary to utilize more complex formulas. The computer package CLUSTERS, developed for the World Fertility Survey program by the International Statistical Institute, was used to assist in computing the sampling errors with the proper statistical methodology. The CLUSTERS program treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: t,t~ 2 ] vat(r) = 1- f ,~[ mh x--., 2 Zh in which zm = ym-r .x~, and z h -- Yh - r .xh where h mh Yh, represents the stratum which varies from 1 to H, is the total number of EAs selected in the h th stratum, is the sum of the values of variable y in EA i in the h th stratum, 217 Xhi f is the sum of the number of cases (women) in EA i in the h ~ stratum, and is the overall sampling fraction, which is so small that CLUSTERS ignores it. In addition to the standard errors, CLUSTERS computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. CLUSTERS also computes the relative error and confidence limits for the estimates. In addition to the standard errors, CLUSTERS program also computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample; a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. Sampling errors are presented in Tables C.2-C.11 for variables considered to be of major interest. Results are presented for the whole country, for urban and mral areas separately, and for the Urban Govemorates, Lower Egypt (total/urban/rural) and Upper Egypt (total/urban/mral). For each variable, the type of statistic (mean or proportion) and the base population are given in Table C.I. For each variable, Tables C.2-C. 11 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted cases (WN), the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R:t:2SE). The confidence limits have the following interpretation. For the proportion of currently married women currently using a contraceptive method (CUSE), the overall average from the sample is .471 and its standard error is 0.009. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., .471 + (2 x 0.009), which means that there is a high probability (95 percent) that the true proportion currently using is between .453 and .489. The relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The magnitude of the error increases as estimates for subpopulations such as geographical areas are considered. For the variable CUSE, for instance, the relative standard error (as a percentage of the estimated proportion) for the whole country and for urban and rural areas is 1.9 percent, 1.9 percent, and 3 percent, respectively. 218 Table C.1 List of selected variables for sampling errors~ Egypt 1992 Variable Variable name Estimate Base population URBRUR SECOND CUWORK AGEM20 EVBORN EVB40 SURVIV KMETHO KSRCE EVUSE CUSE CUMODE CUPILL CUIUD PSOURC NOMORE DELAY IDEAL ANTCAR NTETAN MEDELI VACREC BCG DPT3 POL3 MEASLE FULLIM RESPIR DIARR2 DIARR1 ORSTRE MEDTRE Urban Proportion With secondary education or higher Proportion Currently working Proportion Married before age 20 Proportion Children ever bom Mean Children ever born to women 40-49 Mean Children surviving Mean Knowing any contraceptive method Proportion Know source for any method Proportion Ever used any contraceptive method Proportion Currently using any contraceptive method Proportion Currently using a modern method Proportion Currently using pill Proportion Currently using IUD Proportion Using public sector source Proportion Want no more children Proportion Want to delay 2 or more years Proportion Ideal number of children Mean Had antenatal checkup Mother received tetanus injection Received medical care at delivery Vaccination record seen Received BCG vaccination Received third BCG dose Received third DPT dose Received measles vaccination Fully immunized Had cough and difficulty breathing Had diarrhea in last 2 weeks Had diarrhea in last 24 hours Treated with ORS packets Consulted a medical facility Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Proportion Ever-married women Ever-married women Ever-married women Ever-married women Currently married women Currently married women aged 40-49 Currently married women Currently married women Currently married women Currently married women Currently married women Currently married women Currently married women Currently married women Current users of modern methods Currently married women Currently married women Currently married women giving numeric response Births m last five years Births in last five years Births in last five years Children under five Children under five Chddran 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children under five in last 2 weeks Children under five Children under five Children under 5 with diarrhea in last 2 weeks Children under 5 with diarrhea in last 2 weeks 219 Table C.2 Sampling errors - Entire sampl% Egypt 1992 Number of cases Variable Standard Design Relative Confidence limits Value error Unweighted Weighted effect error (R) (SE) (N) (WN) (DEFY) (SE/R) R-2SE R+2SE URBRUR .466 .017 9864 9864 3.447 .037 .431 .501 SECOND .259 .012 9864 9864 2.726 .046 ,235 .283 CUWORK .148 .008 9864 9864 2.360 .057 .131 .165 AGEM20 .617 .011 9427 9441 2.185 .018 .595 .639 EVBORN 3.882 .043 9148 9153 1.495 .011 3,797 3.968 EVB40 6.007 .101 2122 2134 1.574 .017 5.805 6 210 SURVIV 3.3111 .034 9148 9153 1.491 .010 3,242 3.378 KMETHO .996 .000 9148 9153 NAC .000 .996 996 KSRCE .929 .005 9148 9153 1 939 .0116 .919 ,939 EVUSE .669 .009 9148 9153 1.797 .1113 ,651 687 CUSE .471 .009 9148 9153 1.740 .019 .453 .489 CUMODE .448 .009 9148 9153 1,735 .11211 .4311 .466 CUPILL .129 .005 9148 9153 1.397 .038 .119 139 CU1UD .279 .007 9148 9153 1.526 .026 .265 293 CUCOND .020 .002 9148 9153 1 253 .(}93 .016 ,023 PSOURC .350 .012 3985 4098 1.620 .035 .326 375 NOMORE .656 .006 9148 9153 1.302 .010 .643 .669 DELAY .159 .005 9148 9153 1.236 .030 .1511 .169 IDEAL 2.850 .1123 7416 7447 1.419 .008 2.8114 2.895 ANTCAR .529 .011 8692 8626 1.746 021 .506 .551 NTETAN .426 .009 8692 8626 1.399 021 .4118 .443 MEDELI .406 .015 8692 8626 2.248 1136 .377 .436 VACREC .552 .017 1563 1594 1.365 .031 .518 .587 BCG .895 .010 1563 1594 1.235 .011 .875 .914 DPT3 764 .016 1563 1594 1.473 .021 .733 .796 POL3 .789 .015 1563 1594 1.462 .019 .759 .820 MEASLE 815 .014 1563 1594 1.432 .017 .787 .843 FULLIM .674 .017 1563 1594 1.408 .025 .641 .707 RESPIR 1/82 .003 8067 81118 1.0611 .042 .1175 .1189 DIARR2 .134 .006 8067 81118 1.384 042 .123 .145 DIARR1 .056 .0(13 8067 81118 1.279 1161 .049 .062 ORSTRE 2911 018 1119 11174 1.214 .1/60 .255 .325 MEDTRE .453 .018 1119 1074 1.152 .041 .416 .4911 NAC = Not able to compute 220 Table C.3 Sampling errors - Urban r Egypt 1992 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (8E) (N) (WN) (DEFT) (8E/R) R-2SE R+2SE URBRUR 1.000 .000 SECOND .408 .019 CUWORK .206 .015 AGEM20 .478 .015 EVBORN 3.378 .058 EVB40 4.910 .132 SURVIV 3.004 .046 KMETHO .998 .000 KSRCE .979 .004 EVUSE .782 .011 CUSE .570 .01 l CUMODE .541 .011 CUPILL .140 .006 CUIUD .346 .010 CUCOND .032 .003 PSOURC .323 .019 NOMORE .690 .009 DELAY .146 .007 IDEAL 2.638 .025 ANTCAR .689 .018 NTETAN .429 ,013 MEDELI .625 .024 VACREC .573 .023 BCG .940 .013 DPT3 .839 .019 POL3 .874 .015 MEASLE .877 .018 FULLIM .771 .024 RESPIR .080 .006 DIARR2 .134 .011 DIARR1 .053 .006 ORSTRE .235 .031 MEDTRE .478 .034 4673 4596 NAC .(300 1.000 1.000 4673 4596 2.660 .047 .370 .446 4673 4596 2.511 .072 .176 .235 4585 4516 2.079 .032 .447 .509 4352 4281 1.610 .017 3.262 3.493 1151 1127 1.723 .027 4.645 5.174 4352 4281 1.569 .015 2.911 3.096 4352 4281 NAC .000 .998 .998 4352 4281 1.649 .004 .972 .986 4352 4281 1.679 .013 .761 .803 4352 4281 1.467 .019 .548 .592 4352 4281 1.475 .021 .518 .563 4352 4281 1.127 .042 .128 .152 4352 4281 1.417 .030 .326 .367 4352 4281 1.285 .107 ,025 .039 2299 2315 1.932 .058 .286 .361 4352 4281 1.237 .013 .672 .707 4352 4281 1.361 .050 .131 .160 3824 3783 1.246 .009 2.589 2.688 3358 3237 1.849 .026 .654 .725 3358 3237 1.308 .030 .403 .455 3358 3237 2.332 .038 .577 .673 582 592 1.108 .039 .527 .618 582 592 1.350 .014 .914 .967 582 592 1.296 .023 .800 .878 582 592 1.121 .017 .843 .904 582 592 1.354 .021 .840 .913 582 592 1.390 .1131 .723 .818 3191 3087 1.163 .076 .068 .092 3191 3087 1.640 .080 .113 .156 3191 3087 1.421 .113 .041 .064 449 414 1.455 .132 .173 .297 449 414 1.310 .070 .411 .545 NAC = Not able to compute 221 Table C.4 Sampling errors - Rural, Egypt 1992 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R 2SE R+2SE URBRUR 000 .(300 SECOND .129 .009 CUWORK .098 .007 AGEM20 .744 (110 EVBORN 4.325 .047 EVB40 7.237 .113 SURVIV 3.579 .040 KMETHO .994 .001 KMDMET .993 .001 KSRCE .885 .008 EVUSE 570 .01 I CUSE .384 .011 CUMODE .366 01 I CUPILL .119 .008 CUIUD .220 .(X)7 CUCOND .009 .(X) l PSOURC 386 .1115 NOMORE .627 .009 DELAY .171 .006 IDEAL 3.068 .1/29 ANTCAR .432 .011 NTETAN .423 .012 MEDELI .275 .014 VACREC .540 .024 BCG .867 .013 DPT3 .721/ .1122 POL3 .740 .1122 MEASLE .779 .019 FULLIM .617 .022 RESP1R .I184 .004 DIARR2 .134 .006 DIARR1 .058 .004 ORSTRE .325 .1119 MEDTRE .438 .022 5191 5268 NAC .000 .00(1 .000 5191 5268 1.927 .11711 A l l .147 5191 5268 1.606 .067 .085 .112 4842 4925 ] .560 .013 .724 .763 4796 4873 1.100 .011 4.232 4.419 971 10117 1.230 .016 7.1111 7.462 4796 4873 1.189 .011 3.499 3.659 4796 4873 1.178 .{Nil .992 997 4796 4873 1.184 .IX)l .990 .996 4796 4873 1.832 .1110 .868 902 4796 4873 1.538 .019 .548 592 4796 4873 1.6211 .030 .361 .4117 4796 4873 1.579 030 .344 .388 4796 4873 1 621 064 .104 .134 4796 4873 1.2/)1/ .033 21/6 235 4796 4873 994 .153 (X)6 01 I 1686 1783 1.301 .(HO .355 416 4796 4873 1.345 .1115 ,61)8 .646 4796 4873 1.163 .037 .159 .184 3592 3664 1.175 .010 3.(X19 3.126 5334 5389 1.319 .025 .410 .454 5334 5389 1.441/ .027 .400 .447 5334 5389 1 9118 .052 .246 304 981 1002 1 487 044 492 588 981 1002 1.185 .015 842 893 981 1002 1.530 .031 676 764 981 l(X)2 1.546 .1130 .696 783 981 1002 1.423 .1124 .741 817 981 1002 1.395 1135 .574 661 4876 4931 .984 ,050 .1175 ./)92 4876 4931 1.193 .I146 .121 146 4876 4931 1.192 072 049 066 670 660 1 ,(X)8 .060 286 363 670 6611 1 .I166 .050 .394 482 NAC = Not able to compute 222 Table C.5 Sampling errors - Urban Govemorates~ Egypt 1992 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence hmlts Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR 1.000 .000 2487 2357 NAC .000 1.1300 1.000 SECOND .43(/ .030 2487 2357 2.989 .069 .370 .489 CUWORK .200 .026 2487 2357 3.289 .132 .147 .253 AGEM20 .458 .025 2449 2322 2.447 .054 .409 .507 EVBORN 3.296 .084 2322 2201 1.753 .026 3.128 3.465 EVB40 4.684 .181 664 627 1.817 .039 4.322 5.046 SURVIV 2.938 .066 2322 2201 1.673 .022 2.807 3.070 KMETHO .999 .000 2322 2201 NAC .000 .999 .999 KSRCE .987 .003 2322 2201 1.355 .003 .981 ,993 EVUSE .801 011 2322 2201 1.343 014 .779 .824 CUSE .591 .014 2322 22(11 1.358 .023 .564 .619 CUMODE .556 .014 2322 2201 1.386 .026 528 .585 CUPILL .125 .008 2322 22(11 1.131 .(162 .109 .140 CUIUD .368 .013 2322 2201 1.342 .037 341 .395 CUCOND .041 .005 2322 2201 1.316 .132 .(1311 .052 PSOURC .376 (/29 1269 1224 2.159 .078 .317 .434 NOMORE .687 012 2322 2201 1.223 .017 .664 .711 DELAY .138 010 2322 2201 1.425 .074 .117 .158 IDEAL 2.611 .035 2086 1988 1.307 .013 2.541 2.680 ANTCAR .735 .029 1684 1557 2.290 .040 .677 .794 NTETAN .478 .015 1684 1557 I. 110 .032 .447 .508 MEDELI .683 .038 1684 1557 2.768 .(156 .606 .759 VACREC .593 .(135 296 278 1.222 .060 .522 .664 BCG .959 .013 296 278 1.157 .014 .932 .986 DPT3 .873 .(128 296 278 1.454 032 .817 .930 POL3 .896 .020 296 278 1.149 .023 .855 .937 MEASLE 909 .022 296 278 1.323 024 865 .954 FULL1M 817 .039 296 278 1 714 048 739 .894 RESPIR 070 .(X)9 16/12 1484 1 28(1 .13(I .052 .088 DIARR2 .120 .011 1602 1484 1.276 .093 .098 .142 DIARR1 .044 .(X)5 1602 1484 .899 .110 .034 .053 ORSTRE .273 049 2(18 178 1.416 .178 .176 .371 MEDTRE .516 .044 208 178 1.154 .085 .429 .604 NAC = Not able to compute 223 Table C.6 Sampling errors - Total Lower E~:ypt, Egypt 1992 Number of cases Standard Design Relative Confidence limiks Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (I)EFF) (SE/R) R 2SE R+2SE URBRUR .298 .019 3812 4067 2.572 .064 259 .336 SECOND .227 .012 3812 4067 1,780 .053 .203 .251 CUWORK .156 .008 3812 4067 1 293 .049 .141 .172 AGEM20 .629 .011 3673 3915 1.429 .018 .606 .652 EVBORN 3.839 .1149 3518 3746 1.121/ .I113 3.742 3.936 EVB40 6.090 .146 775 831 1.513 .024 5.797 6.383 SURVIV 3.370 .046 3518 3746 1.273 .014 3.279 3.462 KMETHO 1.000 .000 3518 3746 NAC .000 1.1)00 1.000 KSRCE .976 .003 3518 3746 1,317 003 .969 .983 EVUSE .734 .010 3518 3746 1.392 .1114 ,713 .755 CUSE .535 .(112 3518 3746 1 429 .1/22 .511 .559 CUMODE .513 .011 3518 3746 1.356 .1/22 .4911 .536 CUPILL .151 009 3518 3746 I 459 058 133 .168 CUIUD .326 .010 3518 3746 I 246 030 .306 .346 CUCOND .014 .002 3518 3746 I 071 154 .I)09 .018 PSOURC .367 .013 1789 1921 1.159 .036 .341 .393 NOMORE .694 .009 3518 3746 1 210 .1/14 .675 .713 DELAY .148 .I)06 3518 3746 1.047 .I142 .135 .160 IDEAL 2.716 .022 3010 3163 1.018 .I108 2.672 2.759 ANTCAR .492 .1115 3178 3408 1.465 .I131 .461 .522 NTETAN .358 .015 3178 34118 I 529 I142 .329 .388 MEDELI .398 .020 3178 3408 1.949 1151 .357 .438 VACREC .561 .028 583 642 1.367 .051/ .5/15 .617 BCG .934 .011 583 642 1.102 .1112 .911 .956 DPT3 .823 .021 583 642 1.327 .025 .782 .864 POL3 .833 .021 583 642 1.351 .025 .792 .875 MEASLE .873 .018 583 642 1.298 .I1211 .838 .909 FULLIM .744 .024 583 642 1.363 .I)33 .696 .793 RESPIR .084 006 2994 3208 I .I143 ,068 072 .095 DIARR2 .121 ,I108 2994 3208 1.288 .1166 .1115 .137 DIARR1 .I149 .11114 2994 32118 1.018 085 .041 .I)57 ORSTRE .353 027 414 387 1.1163 .1/77 .299 .408 MEDTRE .517 .1128 414 387 I 1125 1154 .461 .573 NAC = Not able to compute 224 Table C.7 Sampling errors - Urban Lower Egypt~ Egypt 1992 Standard Value error Variable (R) (SE) Number of eases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR 1.000 .000 1200 1210 NAC .000 1.000 1.000 SECOND .388 .025 1200 1210 1.803 .065 .337 .439 CUWORK .203 .009 1200 1210 .749 .043 .186 .220 AGEM20 .472 .021 1180 1190 1.452 .045 .430 .514 EVBORN 3.245 .083 1 ! 18 1120 1.295 .026 3.079 3.411 EVB40 4.863 .253 274 275 1.799 .052 4.358 5.368 SURVIV 2.977 .072 1118 1120 1.289 .024 2.832 3.121 KMETHO 1.000 .000 1118 1120 NAC .000 1.000 1.000 KSRCE .991 .004 1118 1120 1.384 .004 .983 .999 EVUSE .gll .017 1118 1120 1.424 .021 .777 .844 CUSE .603 .017 1118 1120 1.132 .027 .570 .636 CUMODE .585 .016 1118 1120 1.088 .027 .553 .617 CUPILL .173 .013 1118 1120 1.128 .074 .i48 .199 CUIUD .363 .019 1118 1120 1.340 .053 .325 .402 CUCOND .024 .005 1118 1120 1.091 .208 014 .034 PSOURC .286 .021 636 655 1.155 .072 .245 .327 NOMORE .700 .015 l l lg 1120 1.059 .021 .671 .729 DELAY .143 .011 1118 1120 1.035 .076 .122 .165 IDEAL 2.556 .035 1004 1001 .937 .014 2.485 2.626 ANTCAR .675 .032 827 820 1.627 .047 .611 .739 NTETAN .320 .026 827 820 1.341 .080 .269 .371 MEDELI .629 .039 827 820 1.945 .062 .551 .707 VACREC .626 .036 137 148 .875 .058 .554 .698 I]CG .964 .022 137 148 1.453 .023 .919 1.009 DFq'3 .906 .028 137 148 1.162 .031 .850 .961 POL3 .934 .018 137 148 .886 .019 .897 .970 MEASLE .899 .017 137 148 .690 .019 .865 .934 FULL1M .834 .031 137 148 1.013 .037 .772 .896 RESPIR .088 .014 795 789 1.291 .158 .060 .115 DIARR2 .121 .016 795 789 1.301 .131 .089 .153 DIARR1 .046 .008 795 789 1.030 .172 .030 .062 ORSTRE .271 .(/59 112 95 1.263 .218 .153 .389 MEDTRE .548 .064 112 95 1.223 .117 .420 .677 NAC - Not able to compute 225 Ta.ble C.8 Sampling errors - Rural Lower Egypt t Egypt 1992 Number of cases Variable Standard Value error (R) (SE) Design Relative Confidence hmxts Unweighted Weighted effect error (N) (WN) (DEBT) (SE/R) R-2SE R+2SE URBRUR .000 .000 2612 2857 NAC .000 000 .000 SECOND .159 .013 2612 2857 1 846 .083 .133 .186 CUWORK .137 .010 2612 2857 1 512 .074 .116 .157 AGEM20 .698 .014 2493 2725 1.472 .019 .671 725 EVBORN 4.1193 .059 2400 2626 1 068 .014 3 975 4.210 EVB40 6.697 .16/I 501 556 1.346 .024 6.377 7.017 SURVIV 3.538 056 2400 2626 1.248 .016 3.426 3.651 KMETHO 1.0(30 .0(10 2401/ 2626 NAC 000 1.000 1.0110 KMDMET 1.000 .000 2400 2626 NAC 000 1.0(10 1.000 KSRCE 97(1 I105 24/11/ 2626 1.307 .()05 .96// .979 EVUSE .701 .1112 24/10 2626 1.309 .017 .677 .726 CUSE .505 .1115 24/10 2626 1.482 .030 .475 .536 CUMODE 482 ./114 24(10 2626 1.394 .029 .454 .511 CUPILL .141 .011 24(10 2626 1.608 .081 .118 .164 CUIUD .310 .011 24(10 2626 1.148 .035 .288 .332 CUCOND .(109 .I102 24110 2626 995 .212 .005 .013 PSOURC .409 ./118 1153 1266 1.254 .044 .372 445 NOMORE .692 .012 2400 2626 1 261 .017 668 .716 DELAY .150 .{)08 2400 2626 1 052 .051 .134 165 IDEAL 2.790 .1126 2006 2162 99(1 .009 2.738 2.841 ANTCAR .434 .1116 2351 2588 1.350 1137 .401 466 NTETAN .370 .018 2351 2588 1.543 .047 .335 406 MEDEL1 .324 .023 2351 2588 1,959 .I169 .279 369 VACREC .542 .035 446 493 I 463 1164 .473 6I 1 BCG .925 013 446 493 1 031 ,014 899 ,951 DPT3 .798 .025 446 493 1.345 032 ,747 849 POL3 .803 .026 446 493 1.386 033 .751 855 MEASLE .866 .I122 446 493 1 385 .1/26 ,821 9111 FULLIM .717 030 446 493 1 414 042 .657 778 RESPIR .082 .006 2199 2419 .956 .073 .1/70 .095 DIARR2 .121 009 2199 2419 1 278 077 .1112 139 D1ARR1 .050 01)5 2199 2419 I 012 ,097 .040 1159 ORSTRE .3811 ,029 302 292 .965 1177 .322 439 MEDTRE .5117 031 3(12 292 975 .061 .444 569 NAC - Not able to compute 226 Table C.9 Sampling errors - Total Upper Egypt, Egypt 1992 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R 2SE R+2SE URBRUR .299 .029 S ECOND . 179 .017 CUWORK .103 .011 AGEM20 .716 .017 EVBORN 4.335 .089 EVB40 7.133 .140 SURVIV 3.494 .062 KMETHO .990 .002 KMDMET .988 .002 KSRCE .834 .014 EVUSE .5113 .016 CUSE .314 .015 CUMODE .297 .016 CUPILL .1117 .007 CUIUD .164 ,012 CUCOND .012 .002 PSOURC .285 .023 NOMORE .591 .011 DELAY .188 .008 IDEAL 3.2,11 .058 ANTCAR .475 .013 NTETAN .466 .013 MEDELI .297 .018 VACREC .527 .028 BCG .830 .019 DPT3 .663 .030 POL3 .704 .I128 MEASLE .721 .027 FULLIM .548 .027 RESPIR .086 .005 DIARR2 .153 .010 DIARR 1 .067 .007 ORSTRE .248 .024 MEDTRE .383 .027 3565 3440 3.757 .096 .241 .357 3565 3440 2.606 .093 .146 .212 3565 3440 2.198 .108 .1181 .126 3305 3204 2.209 .024 .682 .751 3308 3207 1.656 .020 4.157 4.512 683 676 1.166 .I1211 6.854 7.413 3308 3207 1.518 .018 3.370 3.619 3308 32117 1.259 .002 .985 .994 3308 32117 1.268 .002 .983 .993 3308 32117 2.111 .016 .807 .861 3308 3207 1.882 .033 .470 .535 33118 3207 1.918 ./149 .283 .345 33118 3207 2 033 .1154 .265 .329 3308 3207 1.386 .0711 .092 .122 3308 3207 1.897 .075 .139 .188 3308 32117 1.187 .188 (X)7 .1116 927 953 1.539 .0811 .239 .331 3308 3207 1.305 .019 .568 .613 3308 3207 1.241) .045 .171 ,205 2320 2296 1.663 .018 3.125 3.356 3830 3661 1.337 ,028 .448 .51/2 3830 3661 1.343 .028 .440 .492 3830 3661 1,979 .062 .260 .334 684 674 1.456 .053 .471 583 684 674 1.357 .023 .792 .869 684 674 1.643 045 .6113 .723 684 674 1.621 .041) .647 .761 684 674 1.573 .037 .667 .775 684 674 1.441 .050 .494 .6113 3471 3326 .921 ,054 .1/77 .096 3471 3326 1.474 .1164 133 .173 3471 3326 1.516 .101 054 .081 497 509 1.203 .096 2011 .295 497 509 1.196 .072 .328 .437 227 Table C.IO Sampling errors - Urban Upper Egypt r Egypt 1992 Number of cases Variable Standard Value error (R) (SE) Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFI') (SE/R) R 2SE R+2SE URBRUR 1.000 .000 986 1029 NAC .0(F0 1,000 1.0(X) SECOND .382 .038 986 1029 2.479 101 .31)5 .458 CUWORK 222 .026 986 1029 1.975 .118 .170 .274 AGEM20 .532 .029 956 1004 1.777 .054 .475 .590 EVBORN 3.720 .169 912 960 1.898 .045 3.382 4.1)58 EVB40 5.595 .261 213 225 1.310 047 5.073 6.116 SURVIV 3.184 .125 912 960 1.800 .039 2.933 3.434 KM ETHO .995 .003 912 960 1.438 .003 .988 1.0~12 KSRCE .947 .014 912 960 1.838 1114 .919 .974 EVUSE .702 .028 912 960 1 832 .040 647 .758 CUSE .481 .026 912 960 1.595 .1/55 ,428 .533 CUMODE .454 .028 912 960 1.727 .063 .397 .511 CUPILL .138 .014 912 960 1.245 .103 .11)9 .166 CUIUD .276 .024 912 960 1.606 .I)86 .229 .324 CUCOND .021 .006 912 960 1.321 .31)2 .008 .I)33 PSOURC .233 .038 394 435 1.759 .161 .158 .308 NOMORE .682 .021 912 960 1.383 .031 .640 .725 DELAY .166 .017 912 960 1.343 .100 .133 .200 IDEAL 2.810 .070 734 794 1.477 .025 2 669 2.951 ANTCAR .620 020 847 860 .940 .I)32 .581 .659 NTETAN .446 .025 847 860 1.231) .057 .395 .496 MEDEL1 .517 .038 847 860 1.735 ,074 .441 .594 VACREC .491 .055 149 165 1.395 .113 .380 .602 BCG .888 .038 149 165 1.517 .I)43 .812 .964 DPT3 .721 .050 149 165 1,408 ,070 ,620 821 POL3 .782 041 149 165 1.252 1)52 700 865 MEASLE .802 .053 149 165 1.675 .1/66 .695 .908 FULLIM .636 .054 149 165 1.412 .1185 .528 .744 RESPIR .090 .007 794 813 .624 .074 .077 .104 DIARR2 .173 031 794 813 2.067 178 I l l .235 DIARRI .074 .019 794 813 1.891 253 .037 ,112 ORSTRE .162 .I)41 129 141 1.292 .251 3)81 .244 MEDTRE .381 .060 129 141 1.315 .158 .260 .5112 NAC = Not able to compute 228 Table C.11 Sampling errors - Rural Upper Egyph Egypt 1992 Number of cases Standard Design Relative Confidence limits Value error Unwexghted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR .000 .000 SECOND .093 .012 CUWORK .053 .008 AGEM20 .801 .014 EVBORN 4.597 .075 EVB40 7.903 .144 SURVIV 3.627 .056 KMETHO .987 .003 KMDMET .985 O03 KSRCE .786 .016 EVUSE .417 .017 CUSE .243 .015 CUMODE .230 .015 CUPILL .093 .009 CUIUD .116 .009 CUCOND ,008 .002 PSOURC .329 .029 NOMORE .552 .014 DELAY .197 .010 IDEAL 3.468 .059 ANTCAR .431 .015 NTETAN .472 .016 MEDELI .229 .018 VACREC .539 .033 I]CG .812 .022 DPT3 .644 .035 POL3 678 .034 MEASLE .694 .030 FULLIM .520 .(/30 RESPIR .085 .006 DIARR2 .146 .008 DIARR1 .065 .007 ORSTRE .28(/ .025 MEDTRE .383 .030 2579 2411 NAC .000 .000 .(~0 2579 2411 2.095 .129 .069 .116 2579 2411 1,802 .150 .037 .069 2349 2200 1.641 .017 .774 .828 2396 2247 1.144 .016 4.448 4.746 470 451 1.053 .018 7.616 8.190 2396 2247 1.125 .015 3.514 3.739 2396 2247 1.196 .003 .982 .993 2396 2247 1.213 .003 .979 .991 2396 2247 1.934 .021 .754 .818 2396 2247 1.688 .041 .383 .451 2396 2247 1.725 .062 .212 .273 2396 2247 1.802 .067 .199 .261 2396 2247 1.522 .(~7 .075 .112 2396 2247 1.405 .079 .097 .134 2396 2247 .982 .222 .005 .012 533 517 1.429 .088 .271 .387 2396 2247 1.383 .025 .523 .580 2396 2247 1.266 ,(~2 .176 .217 1586 1502 1.309 .017 3.349 3.587 2983 2801 1.301 .034 .401 .460 2983 2801 1.405 .033 .441 .504 2983 2801 1.914 .080 .193 .266 535 509 1.516 .061 .473 .604 535 509 1.276 .1127 .768 .855 535 509 1.677 .l~4 .574 .714 535 509 1.674 .(150 .610 .746 535 509 1.492 .(~3 .635 .754 535 509 1.371 .057 .460 .579 2677 2512 1.012 .068 .074 .(N7 2677 2512 1.098 .055 .130 .163 2677 2512 1.328 102 .052 .078 368 368 1.038 .089 .230 .331 368 368 1.137 .078 .323 .443 NAC = Not able to compute 229 APPENDIX D DATA QUALITY TABLES APPENDIX D DATA QUALITY TABLES I Table D.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Egypt 1992 Males Females Males Females Age Numbe~ Percent Number Percent Age Number Percent Number Percent <1 798 2.7 733 2.5 36 253 0.9 277 0.9 1 854 2.9 767 2.6 37 256 0.9 336 1.1 2 839 2.9 777 2.6 38 336 1.1 328 1.1 3 846 2.9 811 2.7 39 219 0.7 259 0.9 4 955 3.3 925 3.1 40 472 1.6 496 1.7 5 912 3.1 898 3.0 41 217 0.7 202 0.7 6 887 3.0 887 3.0 42 306 1.0 305 1.0 7 768 2.6 783 2.6 43 211 0.7 211 0.7 8 800 2.7 786 2.6 44 224 0.8 243 0.8 9 882 3.0 845 2.8 45 365 1.2 429 1.4 10 843 2.9 824 2.8 46 211 0.7 177 0.6 11 851 2.9 740 2.5 47 216 0.7 214 0.7 12 838 2.9 746 2.5 48 204 0.7 198 0.7 13 754 2.6 753 2.5 49 131 0.4 114 0.4 14 739 2.5 756 2.5 50 228 0.8 241 0.8 15 723 2.5 691 2.3 51 128 0.4 158 0.5 16 695 2.4 669 2.2 52 226 0.8 306 1.0 17 624 2.1 619 2.1 53 137 0.5 125 0.4 18 582 2.0 603 2.0 54 126 0.4 119 0.4 19 570 1.9 508 1.7 55 267 0.9 457 1.5 20 478 1.6 642 2.2 56 176 0.6 90 0.3 21 383 1.3 444 1.5 57 124 0.4 75 0.3 22 452 1.5 502 1.7 58 122 0.4 72 0.2 23 349 1.2 487 1.6 59 121 0.4 65 0.2 24 401 1.4 369 1.2 60 261 0.9 530 1.8 25 454 1.6 653 2.2 61 77 0.3 37 0.1 26 416 1.4 413 1.4 62 148 0.5 101 0.3 27 430 1.5 485 1.6 63 113 0.4 50 0.2 28 426 1.5 455 1.5 64 82 0.3 45 0.2 29 309 1.1 349 1.2 65 303 1.0 343 1.2 30 528 1.8 619 2.1 66 56 0.2 33 0.1 31 303 1.0 316 1.1 67 80 0.3 41 0.1 32 422 1.4 410 1.4 68 55 0.2 30 0.1 33 287 1.0 321 1.1 69 36 0.1 14 0.0 34 281 1.0 290 1.0 70+ 636 2.2 579 1.9 35 482 1.6 567 1.9 Don't know/ Missing 2 0.0 3 0.0 Total 29288 100.0 29745 100.0 Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. 233 Table D.2 Age distribution of eligible and interviewed women Five-year age distribution of the de facto household population of women aged 10 54, five- year age distribution of interviewed ever-married women aged 15-49, and percentage of eligible women who were interviewed (weighted), Egypt 1992 Household population Ever-married Interviewed of women women women age 15-49 Age Number Percent Number Percent Number Percent Percentage interviewed (weighted) 10o14 3819 NA NA NA NA NA NA 15-19 3090 21,8 429 4,3 423 4.3 98.5 20-24 2445 17.2 1386 13.9 1371 13.9 98.9 25-29 2355 16.6 2043 20.5 2013 20.4 98 5 30-34 1956 13.8 1860 18.6 1842 18.7 99.0 35-39 1768 12.4 1723 17.3 17114 17.3 98.9 40-44 1457 10.3 1425 14.3 1409 14.3 98.9 45-49 1131 80 1118 11.2 11117 11.2 99.0 50 54 948 NA NA NA NA NA NA 15-49 14203 100.0 9985 llXI.O 9868 100.0 98.8 Note: The de facto population includes all residents and nonresidents who slept in the household the night before interview. NA = Not applicable 234 .Table D.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Egypt 1992 Percentage Number missing of Subject Reference group information cases Birth date Births in last 15 years Month only 11.1 26365 Month and year 0.0 26365 Age at death Deaths to births in last 15 years 0.1 3046 Age/date at first union I Ever-married women 0.0 9864 Respondent's education Ever-married women 0.0 9864 Child's size at birth Births in last 59 months 0.5 1048 Anthropometry 2 Living children age 0-59 months Height 5.5 8089 Weight 5.2 8089 Height and weight missing 5.5 8089 Diarrhea m last 2 weeks Living children age 0-59 months 0.3 8089 ll~oth year and age missing 2Child not measured 235 Table D.4 Births by calendar year since birth Distribution of births by calendar years since birth for living (L), dead (D), and all (T) children, according to reporting completeness, sex ratio at birth, and ratio of births by calendar year, Egypt 1992 Percentage w~th Sex ratuo Number of births complete birth date I at btrth 2 Calendar ratio 3 Male Female Year L D T L D T L D T L D T L I) T L D T 92 1459 51 1511 99.9 100.0 99 9 107 8 124.3 108.3 NA NA NA 757 29 786 702 23 725 91 1587 120 1707 100.0 98.8 99.9 115.1 115.8 115.2 104.9 135.2 106.5 849 64 914 738 55 793 90 1568 125 1694 99.9 100.0 99.9 105.5 124.9 106.8 97.6 93.5 97.3 805 70 875 763 56 819 89 1626 149 1774 99.9 99.3 99.9 101 5 91.3 100.6 964 104.9 97 0 819 71 890 807 78 884 88 1806 158 1964 100.0 100.0 100.0 106.6 119.1 107.6 107.6 105.0 107.3 932 86 1018 874 72 946 87 1732 152 1884 99.8 98.3 99.7 99.6 108.1 100.2 97.1 75.8 94.9 864 79 943 868 73 941 86 1763 244 2008 90.3 65.0 87.2 96.9 140.4 101.3 108.7 125.0 110.5 868 143 1010 896 102 997 85 1512 239 1751 89.7 63 6 86.2 95.9 91,8 95,4 92 2 969 92.8 740 114 855 772 124 896 84 1518 248 1766 86.0 53 1 81.4 10211 1005 11118 964 986 96.7 767 124 891 752 124 875 83 1637 265 1902 85.5 61.3 82,1 105.4 90.8 1033 NA NA NA 840 126 966 797 139 936 88-92 8046 603 8649 99.9 99.6 99.9 107.2 112.4 107.5 NA NA NA 4162 319 4481 3884 284 4168 83-87 8163 1149 9312 90.4 65.7 87.4 99.9 104.4 100.4 NA NA NA 4079 587 4666 4084 562 4646 78-82 7088 1288 8376 83.5 55 7 79 2 104.3 96.8 IO3.1 NA NA NA 3619 634 4253 3469 655 4123 73-77 4830 1240 6070 83.6 51.6 77.0 109.6 107.0 109.0 NA NA NA 2525 641 3166 2305 599 2904 <73 4281 1521 5802 79,2 47.7 70.9 109.2 106.4 108.5 NA NA NA 2235 784 3019 2046 737 2783 All 32408 5801 38209 88 7 59 3 84 3 105.3 IO4.5 105.2 NA NA NA 16620 2965 19585 15787 2836 18624 NA = Nc~ applicable t Both year and month of birth given 2(B,,/Bt)* 1(30, where B. and B~ are the numbers of male and female bLrths, respecuvely a[2FII/(B , t+B.÷l)l* 100, where lt~ is the number of btnhs in calendar year x 236 Table D.5 Reporting of age at death in days Distribution of reported deaths under 1 month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey, Egypt 1992 Number of years preceding the survey Age atdeath Total (m days) 0-4 5-9 10-14 15-19 0-19 <1 44 67 63 36 210 1 48 47 39 38 171 2 21 30 21 15 87 3 23 43 26 27 120 4 9 11 9 4 32 5 16 10 12 22 61 6 9 17 19 15 60 7 57 172 123 110 463 8 2 4 10 0 16 9 10 7 14 3 33 10 7 1 8 9 25 11 3 2 2 3 10 12 2 4 5 5 17 13 2 3 5 0 10 14 5 5 9 4 23 15 5 26 23 15 69 16 3 1 2 1 7 17 0 1 0 3 4 18 0 2 1 1 4 19 0 1 1 0 3 20 1 4 7 6 18 21 1 0 0 2 3 22 5 1 2 l 9 23 0 0 0 2 2 24 0 0 1 0 2 25 7 5 3 1 16 26 0 0 0 1 1 27 1 0 1 1 3 29 0 0 0 0 1 30 0 3 5 0 9 31+ 0 2 0 0 2 Total 0-30 283 468 410 327 1489 Percent early neonatal I 60.6 47.9 45.8 47.9 49.7 1(0-6 days/0-30 days) * 100 237 Table D.6 Reporting of age at death in months Distribution of reported deaths under 2 years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods of birth preceding the survey, Egypt 1992 Number of years preceding the survey Age at death Total (in months) 0 4 5 9 1(/-14 15-19 0-19 <l a 283 468 410 327 1489 1 21 46 43 42 152 2 28 62 54 54 198 3 29 41 69 53 191 4 26 37 63 47 172 5 18 43 26 33 121 6 32 38 66 66 202 7 31 49 47 40 168 8 10 23 4(1 54 127 9 22 34 54 32 143 10 3 9 11 6 29 11 6 11 14 15 47 12 32 51 94 119 296 13 0 3 6 4 13 14 5 4 9 10 28 15 2 6 2 3 14 16 3 4 4 5 16 17 0 3 (1 1 4 18 24 54 62 68 208 19 1 I 1 0 3 20 1 0 2 1 5 21 1 0 l) (I 1 22 1 0 0 1 2 23 0 0 l) 3 3 24+ 3 2 1 0 6 1 year 2 8 3 11 23 Total 0 11 5118 861 898 770 3038 PErCEnt neonatal b 55.7 54.3 45.7 42.5 49.(I alncludes deaths under 1 month reperted in days blUnder 1 month/under 1 year) * 1(10 238 APPENDIX E QUESTIONNAIRES EGYPT DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE IDENTIFICATION GOVERNORATE KISN/MARQAZ SHIAXHA/VILLAGE HOUSEHOLD NO. URBAN . 1 RURAL . 2 LARGE CITY.1 SMALL CITY.2 SUBSAMPLE: YES . 1 NO . 2 NAME OF HOUSEHOLD HEAD ADDRESS IN DETAIL PSU/SEGNENT NO. BUILDING NO. HOUSE NO. TOWN.,3 VILLAGE.4 GOVERNORATE Fn PSU/SEGMENT NO. I I L l l l l l HOUSEHOLD NO. URBAN/RURAL LOCAL I TY SUBSAMPLE INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE TEAM INTERVIEWER,S NAME SUPERVISOR,S NAME RESULT NEXT VISIT: DATE TIME RESULT CODES: I COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT PERSON AT HOME AT THE TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR AN EXTENDED PERIOD 4 POSTPONED 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND 9 OTHER (SPECIFY) ADDRESS CHECKED (by NAME: REIRTERVIEW DAY MONTH YEAR TEAM INTERVIEWER SUPERVISOR RESULT TOTAL VISITS TOTAL IN HOUSEHOLD TOTAL ELIGIBLE [ ~ WOMEN TOTAL ELIGIBLE MEN LINE NO. OF RESPONDENT FOR ~-~ HOUSEHOLD SCHEDULE NAME DATE SIGNATURE YES NO I 2 I E FIELD EDITOR OFFICE EDITOR CODER KEYER 0-1 241 We would like some information about the LINEI USUAL RESIDENTS AND VISITORS I HOUSEHOLD SCHEDULE usually live in your household or who are staying with you now. RELATIONSHIP TO THE HOUSEHOLD HEAD | RESIDENCE 001 002 006 >tease give me the names of What is the :he persons who usually live relationship of ¢our household and guests (NAME) to the )f the household who stayed head of the mre last night, starting with household? ;he head of the household. I °°' I ° °81 oo9 GENERATION C(TJPLE RELATIONSHIP NUMBER NUMBER TO HEAD OF HOUSEHOLD XFTER LISTING NAMES, ASK ~UESTIONE 003"005 TO BE SURE rHAT THE LISTING IS CONPLETE. tHEN GO ON TO QUESTION 006. 010 I 011 Does Did (NAME) (NAME) usually sleep live ~ here here? last night ~ II I YES NO YES NO 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 FOR CODER FOR COOER FOR CODER o, D El o, Fl o~ ~ ~ ~7-7 og , FI F-F7 ; ; ; , , Just to make sure that 1 have a coa~olete listing: 003 Are there any other persons such as small children or infants that we have not listed? 004 In addition, are there any other people who may not be n~=n~)ers of your family, such as domestic servants, lodgers or friends who usually live here? 005 DO you have any guests or temporary visitors staying here, or anyone else who slept here last night? YES F~ ~ ENTER EACH IN TABLE NO [] YES F~ " ENTER EACH IN TABLE NO [] YES [~ • ENTER EACH IN TABLE NO [] O-2A 242 SEX | AGE | MARITAL STATUS IF AGE 15 YEARS OR OLDER 012 I 013 I 014 Is I How otd (NAME) I was me[e (NAME) or at his/ female? her test birthday? What is (NAME'S) current mari ta l status? 1 MARRIED 2 WIDOWED 3 DIVORCED 4 NEVER MARRIED/ SIGNED CONTRACT M F IN YEARS ,__21 ~ D I I !il ~ D O-2B 243 ELIGIBILITY I EDUCATION I HUSBAND IF AGE 3 YEARS OR OLDER SUBSANPLE 001 015 o16 olr I o18 I 0~9 I 020 I CIRCLE LINE FOR HOUSEHOLDS Has (NARE)' NUMBER OF IN HUSBAND ever been WOMEN SURVEY to schooL? ELIGIBLE FOR SUBSANPLE: INDIVIDUAL IF YES, = INTERVIEW CIRCLE LINE ASK (i.e. w EVER- NUMBER OF QUESTIONS MARRIED MEN ELIGIBLE 018-020. WOMEN AGE FOR INDIVIDUAL IF NO, 15-49 YEARS INTERVIEW SKIP TO WHO ARE (I.E. w MEN OUESTION USUAL WHOSE WIVES 021. RESIDENTS ARE ELIGIBLE) OR STAYED THERE ON THE NIGHT BEFORE INTERVIEW) I I I I YES NO 01 01 01 1 2 02 02 02 1 2 03 03 03 1 2 04 04 04 1 2 05 05 05 1 2 06 06 06 1 2 07 07 07 1 2 08 08 08 1 2 09 09 09 1 2 10 10 10 1 2 025 ENTER THE TOTAL NUHDER OF ELIGIBLE; 026 TICK HERE IF CONTINUATION SHEET USED: IF ATTENDED SCHOOL What is the highest Level of school (NAME) attended? 0 NURSERY 1 PRIMARY 2 PREPARATORY 3 SECONDARY 4 UPPER INTER" MEDIATE 5 UNIVERSITY 6 MORE THAN UNIVERSITY What FOR is the PERSONS highest UNDER grade AGE 25: he/she Is success- (NAME) fuLLy stilt cofnpteted in at that schooL? leveL? I l lmmmm LEVEL GRADE YES NO D D S D I I ~EN MEN S O-3A 244 OCCUPATION I WORK STATUS 001 IF ABE 6 YEARS OR OLDER 021 I 022 What is the OCCUPA- main work that TIONAL (NAME) does? GROUP IF AGE 6 YEARS OR OLDER AND WORKING 023 J 024 Did ls (NAME) (NAME) usually work paid in cash during or kind for the the work last he/she does? month? 1 CASH 2 KIND 3 BOTH 4 NOT PAID FOR C~ER YES NO 01 ~--~ 12 1234 02 ~ 12 1234 03 ~ 12 1234 04 ~ 12 1234 05 ~ 12 1234 06 ~ 12 1234 07 ~ 12 1234 08 ~ 12 1234 09 ~ 12 1234 10 ~ - -12 I . 1234 O-3B 245 NO. I 027 I QUESTIONS AND FILTERS What type of dweLLing does your househoLd Live in? SKIP I COOING CATEGORIES I TO I . FREE STANDING HOUSE . 2 OTHER 3 (SPECIFY) 028 029 IS yc~Jr dwelling owned by your household or not? iF OWNED: Is it owned solely by your household or jointly with someone else? MAIN MATERIAL OF THE FLOOR. RECORD YOUR OBSERVATIONS. OWNED . I OWNED JO INTLY . . . . . . . . . . . . . . . . . . . 2 RENTED . ] OTHER 4 (SPECIFY) NATURAL FLOOR EARTH/SAND . 11 FINISHED FLOOR PARQUET OR POLISHED WOOD . 31 CERAMIC/MARBLE TILES . 32 CEMENT TILES . 33 CEMENT . 34 WALL'TO'WALL CARPET . 35 OTHER 41 (SPECIFY) 030 How many rooms are there in your dwelling (excluding the bathr(~s, kitchens and stairway areas)? ROOMS . . . . . . . . . . . . . . . . . . . . . . I l l 031 I HOW many of the rooms are used for sleeping? I ROOMS . III 032 I Is there a special room used only for cooking inside YES . 1 I or outside the dwelling? NO . 2 033 What is the source of water your household uses for drinking? PIPED WATER I PIPED INTO RESIDENDE/YARD/PLOT.11~35 PUBLIC TAP . 12 l I WELL WATER WELL IN RESIDENCE/YARD/PLOT . 21 "35 PUBLIC WELL . 22 SURFACE WATER NILE/CANALS . 31 OTHER 71 (SPECIFY) o3, I ~o. ,o,- d°es ~''ake'° g°'here' °°t water' 8 ~ c ~ . ~ck~ I MINUTEs . . . . . . . . . . . . . . . ~ 1 I ; 035 Does your household get water for other uses (e.g., for YES . 1 ,37 handwashing and dishwashing) from the same source? NO . 2 0-4 246 RO. QUESTIONS AND FILTERS 036 What is the source of water your household uses For for handwashing or dishwashing or other uses? COOING CATEGORIES PIPED WATER PIPED INTO RESIDENCE/YARD/PLOT.11 PUBLIC TAP . 12 WELL WATER WELL IN RESIDENCE/YARD/PLOT . 21 PUBLIC WELL . 22 SURFACE WATER RILE/CABALS . 31 OTHER 71 (SPECIFY) SKIP TO 037 What kind of toilet facility does your household have? MOOERN FLUSH TOILET . 11 TRADITIONAL WITH TANK FLUSH . 12 TRADITIONAL WITH BUCKET FLUSH.13 PIT TOILET/LATRINE . 21 NO FACILITY . 31 OTHER 41 (SPECIFY) 038 Are there electrical connections of the dwelling unit? In all or only part YES, IN ALL . 1 YES, IN PART . 2 HAS NO ELECTRICAL CONNECTIOBS.3 I 039 I Does your household have: I A radio with cassette recorder? A black and white television? A color television? A video? J YES NO ] RADIO . 1 2 BLACK AND WHITE TELEVISION,1 2 COLOR TELEVISION . 1 2 VIDEO . 1 2 040 Does your household have: An electric fan? A gas/etectric cooking stove? A water heater? A refrigerator? A washing machine? A sewing machine? YES NO ELECTRIC FAN . I 2 GAS/ELECTRIC EOOKIBG STOVE.I 2 WATER HEATER . I 2 REFRIGERATOR . I 2 WASHING MACHINE . I 2 SEWING MACHINE . 1 2 041 Do you or any member of your household own: A bicycle? A private car/motorcycle? Transport equipment (truck, taxi, van, bus, etc.)? Residential or coff=lercial buildings other than the dwelling unit? Farm or other land? Livestock(donkeys, horses, cows, sheep, etc.)/pouttry? Mechanical farm equipment (tractor, etc.)? YES NO BICYCLE . 1 2 CAR/MOTORCYCLE . 1 2 TRANSPORT EQUIPMENT . 1 2 RESIDENTIAL/COMMERCIAL BUILDINGS . 1 2 FARM/OTHER LAND . 1 2 LIVESTOCK/POULTRY . 1 2 FARM IMPLEMENTS . I 2 0-5 24? OBSERVATIONS THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 042-043 AS APPROPRIATE. BE SURE TO REVIEM THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD. 042 I DEGREE OF COOPERATION. POOR,°,., . °°o . 1 FAIR . 2 GO(X),, . .0,. . .,.3 VERY GOOD . 4 043 INTERVIEWER'S COMMENTS: 044 FIELD EDITOR'S CO~4MENTS: 045 SUPERVISORJS COMMENTS: 046 OFFICE EDITORJS COMMENTS: 0-6 248 IDENTIFICATION GOVERNORATE PSU/SEGMENT NO. XISM/MARQAZ BUILDING NO. SHIAKHA/VILLAGE HOUSE NO. HOUSEHOLD NO. URBAN . 1 RURAL . 2 LARGE CITY . I SMALL CITY,.2 TOUN.3 VILLAGE.4 NAME OF HOUSEHOLD HEAD ADDRESS IN DETAIL NAME OF WOMAN LINE NUMBER OF WOMAN DATE GOVERNORATE PSU/SEGMENT NO. IIIIIIII HOUSEHOLD NO. URBAN/RURAL D LOCALITY D LINE NUMBER INTERVIEWER VISITS 1 2 3 FINAL VISIT TEAM INTERVIEWER'S NAME SUPERVISORIS NAME RESULT NEXT VISIT: DATE TIME RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER (SPECIFY) FIELD EDITOR DAY MONTH YEAR TEAM INTERVIEWER SUPERVISOR RESULT TOTAL VISITS OFFICE EDITOR CODER EGYPT DEMOGRAPHIC AND HEALTH SURVEY WOMAN QUESTIONNAIRE KEYER NAME DATE SIGNATURE K3 249 1-0 SECTION I. SKIP NO. I QUESTIONS AND FILTERS | | TO 102 RECORD THE TIME. In what month and year were you born? RESPONDENT'S BACKGROUND COOING CATEGORIES .~~i°~ii~iiiiiiiiiiiiiiiiiiii~ MONTH . DON'T KNOW MONTH . 98 YEAR . [~ DON~T KNOW YEAR . 98 103 IHo,,o,d,,er,you,,,your,.s.,,,r.h., I A°E'Nc-ETE°YEA" . COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT. I . ' l WIDOWED . 2 DIVORCED . 3 101- °°ve- - °° I . I NO . 2 "110 1°' I Are Y°° °°trent Y attanding s°h°°l °r th° u°iver'itY' I YES NO . . 2 11 1° 1 I - . 1 PREPARATORY . 2 SECONDARY . 3 UPPER INTERMEDIATE . 4 UNIVERSITY . 5 MORE THAN UNIVERSITY . 6 108 What is the highest grade which you successfut(y GRADE . completed at that leveL, L~J PREPARATORY OR HIGHER F~ v I I 110 | Can you read and understand a letter or newspaper | EASILY . 1 I easily, with difficulty, or not at atl? I WITH DIFFICULTY . 2 NOT AT ALL . 3 " '1 Do you o'o'``y tea°" - '~- r or ogazine ot ' e o s t o o o e a wee,, J YESNo . . 2 I 1-1 I I. I I I b112 250 NO. J QUESTIONS AND FILTERS m 112 I How many hours on average do you listen to the radio J I each day? IF LISTENS LESS THAN 1 HOUR, WRITE "00". J COOING CATEGORIES NUMBER OF HOORS PER DAY . . . . ~-~ ALL OF THE TIME . . . . . . . . . . . . . . . . 96 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . 97 ROT SURE/DON*T KNOt/ . . . . . . . . . . . . 98 SKIP TO 11] How many hours on average do you watch television each day? IF WATCHES LESS THAN I HOUR, WRITE "00". J NUMBER OF HOURS PER DAY . . . . I l J ALL OF THE TIME . 96 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . 97 NOT SURE/DON=T KNOW . 98 114 115 116 What is your religion? CHECK QUESTION 010 IN THE HOUSEHOLD QUESTIONNAIRE. THE ~AN INTERVIEWED IS NOT A USUAL RESIDENT Ll--J ( I .E . , IF SHE IS A / VISITOR) v Now I would Like to ask about the place in which you usually live. Do you usually live in Cairo, Giza, Alexandria, another city or town, or in a village? NAME OF CITY/TOWN/VILLAGE MOSLEM . . . . . . . . . . . . . . . . . . . . . . . . . . I CHRISTIAN . . . . . . . . . . . . . . . . . . . . . . . 2 OTHER 3 (SPECIFY) THE kX)MAN INTERVIEWED IS A USUAL RESIDENT I~ LOCALITY . OUTSIDE EGYPT . . . . . . . . . . . . . . . . . . . 5 ~201 ,118 I 117 In which governorate is that located? GOVERNORATE J GOVERNORATE . . . . . . . . . . . . . . . 118 Row I would Like to ask soce questions about the household in which you usually live. In what type of dwelling does your household Live? APARTMENT . 1 FREE STANDING HOUSE . 2 OTHER 3 (SPECIFY) 119 Is your dwe l l ing owned byyour household or not? IF OWNED: Is it owned solely by your household or jointly with someone else? OWNED . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 OWNED JOINTLY . 2 RENTED . 3 OTHER 4 (SPECIFY) 120 Could you describe the main material of the floor in your dwelling? NATURAL FLOOR EARTH/SAND . 11 FINISHED FLOOR PARQUET OR POLISHED UtX~O . 31 CERAMIC/MARBLE FILES . 32 CEMENT TILES . 33 CEMENT . 34 WALL-TO*WALL CARPET . 35 OTHER 41 (SPECIFY) 1-2 251 No. I 121 I QUESTIONS AND FILTERS How many rooms are there in your dwelling (excluding the bathrooms, kitchen, and stairway areas)? I CODING CATEGORIES ROOMS . . . . . . . . . . . . . . . . . . . . . . SKIP I TO '~l"°w°n'°''her°~'reu'~'°r'°ePn~ IROS . ~1 1231 is there a special room used only for cooking inside YES . 1 I or outside of the dwelling? NO . 2 124 What is the source of water your household uses for drinking? PIPED WATER I PIPED INTO RESIDENCE/YARD/PLOT.11 "126 PUBLIC TAP . 12 | I WELL WATER WELL IN RESIDENCE/YARD/PLOT . 21 ,126 PUBLIC WELL . 22 | SURFACE WATER I NILE/CANALS . 31 OTHER 71 (SPECIFY) ' " I ~o. 'oo0 ~o,, ~ ~o ~o ~o''o~o. ~,' .~ . ~ = ~0~, 1 ''~o''s . 1 I ,' 126 Does your household get water for other uses (e.g., for YES . I ~128 handwashing and dishwashing) from the same source? J NO . 2 127 What is the source of water for such uses? PIPED WATER PIPED INTO RESIDENCE/YARD/PLOT.11 PUBLIC TAP . 12 WELL WATER WELL IN RESIDENCE/YARD/PLOT . 21 PUBLIC WELL . 22 SURFACE WATER NILE/CANALS . 31 OTHER 71 (SPECIFY) 128 I What kind of toilet facility does your household have? I MODERN FLUSH TOILET . . . . . . . . . . . . . 11 I TRADITIONAL WITH TANK FLUSH . 12 TRADITIONAL WITH BUCKET FLUSH.13 PIT TOILET/LATRINE . 21 NO FACILITY . 31 J OTHER ~ 41 1-3 252 NO. OUESTIONS AND FILTERS 129 Does the dwelling unit have electrical connections in att or onty part of the dwelling unit? COOING CATEGORIES YES, IN ALL . 1 YES, IN PART . 2 HAS NO ELECTRICAL CONNECTIONS.3 SKIP J TO I 130 Does your household have: A radio with cassette recorder? A black and white television? A color television? A video? YES NO RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 BLACK AND WHITE TELEVISION.1 2 COLOR TELEVISION . 1 2 VIDEO . 1 2 131 Does your household have: An electric fan? A gas/eLectric cooking stove? A water heater? A refrigerator? A washing machine? A sewing machine? YES NO ELECTRIC FAN . 1 2 GAS/ELECTRIC COOKING STOVE.1 2 WATER HEATER . 1 2 REFRIGERATOR . . . . . . . . . . . . . . . 1 2 WASHING MACHINE . 1 2 SEWING MACHINE . 1 2 132 DO you or any member of your household own: A bicycle? A private car/matorcycle? Transl:<~rt equipe~mt (truck, taxi, van, I~Js, etc.)? Residential or commercial buildings other than the dwelling unit? Farm or other land? Livestock(donkeys, horses, cows, sheep, etc.)/pouttry? Mechanical farm equipment (tractor, etc.)? YES NO BICYCLE . 1 2 CAR/MOTORCYCLE . 1 2 TRANSPORT EQUIPMENT . I 2 RESIDENTIAL/CO~4MERCIAL BUILDINGS . I 2 FARM/OTHER LAND . I 2 LIVESTOCK/POOLTRY . 1 2 FARM IMPLEMENTS . 1 2 1-4 253 SECTION 2. REPRODUCTION NO. I ~JESTIONS AND FILTERS 201 Now I would Like to ask about all the births you have had during your Life. Have you ever given birth? SKIP I COOING CATEGORIES I TO I YES . , I NO . 2 P206 I I 202 Do you have any sons or daughters to whom you have I YES . 1 I given birth who are now living with you? I I NO . 2 1"204 I . . . . . . . . . . . . . . . And how many daughters Live with you? DAUGHTERS AT HOME . IF NONE RECORD 'DO'. 204 Do you have any sons or daughters to whom you have I YES . 1 I given birth who are alive but do not live with you? I I NO . 2 m.206 And how many daughters are alive but do not live with you? DAUGHTERS ELSEWHERE . IF NONE RECORD =00 I. 206 Have you ever given birth to a boy or a girt who was I YES . 1 I born ative but tater died? IF NO, PROBE: Any I I baby who cried or showed any sign of life but NO . 2 .208 only survived a few hours or days? J ~0~1 ,n ~. ~o. oo~ ~o~ ~ o , ~ o ~ ~ ,o. on~ 0~,~ ,ov~ ~,°~ I ~o~ 0~0 . I IF NONE RECORD '00' . SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE RECORD tOO'. GIRLS DEAD . TOTAL . 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL births during your life, Is that correct? PROBE AND YES 9 NO ~ ~ CORRECT 201-209 AS NECESSARY v I [~ NO BIRTHS ~ "225 1 v I 2-1 254 211 NOW I would like to talk to you about ell of your births, whether still alwe or not, starting with the first one you had. 212 RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TIglNS ANO TRIPLETS ON SEPARATE LINES. COMPLETE QUESTIONS 21]-220 AS APPROPRIATE FOR EACH BIRTH. AFTER COHPLET[NG ALL BIRTHS, GO TO 221. 213 214 215 216 217 IF ALIVE: IS In what month Is (NAME) How old was (NAME) and year was still (BAME) at a boy or (NAME) born? alive? hls/her Last a girt? birthday? PROBE: RECORD AGE What is his/ IN COMPLETED her birthday? YEARS. RECORD SINGLE OR MULTIPLE BIRTH STATUS. SING.1 BOY.1 MOLT.2 GIRL.2 SING.1 BOY.1 MOLT.2 GIRL.2 SING.1 BOY.1 BULT.2 GIRL.2 SING.1 BOY.,.1 MULT.2 GIRL.2 SING.t BOY.1 MOLT.2 GIRL,.2 SING.1 BOY,.,1 MOLT.2 GIRL.2 MOBTH.~ YEAR. MOBTH,.~ YEAR. MONTH.~ YEAR. MONTH.~ YEAR,,. MONTB,,~ YEAR. YES.,1 NO.2 I v 22O YES.1 NO.2 I v 22O AGE IN YEARS YES.1 AGE IN YEARS NO.2 220 AGE IN YEARS YES.,1 NO.2 I v 22O ~lSt n ~ Was given to your (first,next) bab~ (NAME) % (NAME) (NAME) % (NAME) % (NAME) (NAME) YES.t NO,.2 I v 220 YES,.1 NO.2 I v 220 AGE IN YEARS AGE IN YEARS AGE IN YEARS 218 IF ALIVE: Is (NAME) living with you? YES . I (GO TO NEXT BIRTH),] NO . 2 YES . 1- (GO TO NEXT BIRTH)4- NO . 2 YES . 1- (GO TO NEXT BIRTH)4- NO . 2 YES . 1- (GO TO NEXT BIRTH)" NO . 2 YES . I (GO TO NEXT BIRTH)q- NO . 2 YES . )- (GO TO NEXT BIRTH)" NO . 2 219 IF LESS THAN 15 YEARS OF AGE: With whom does he/she live? IF 15 YEARS OR OLDER, GO TO NEXT BIRTH. FATHER . I OTHER RELATIVE.2 SOMEONE ELSE.,3 (GO NEXT BIRTH) FATHER . 1 OTHER RELATIVE.2 SOMEONE ELSE.] (GO NEXT BIRTH) FATHER . 1 OTHER RELATIVE.2 SOMEONE ELSE.] (GO NEXT BIRTH) FATHER . 1 OTHER RELATIVE.2 SOMEONE ELSE.,,3 (GO NEXT BIRTH) FATHER . 1 OTHER RELATIVE.2 SOMEONE ELSE.] (GO NEXT BIRTH) FATHER . 1 OTHER RELATIVE.2 SD~4EONE ELSE.,.3 (GO NEXT BIRTH) 220 IF DEAD: HOW old was he/she when he/she died9 IF "1 YEAR", PROBE: Mow many n~nths otd was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH,MONTHS IF LESS THAN T~ YEARS, OR YEARS. DAYS.1 MONTHS.2 YEARS.] (GO NEXT BIRTH) DAYS.1 MONTHS.2 TEARS.] (GO NEXT BIRTH) DAYS.1 MONTHS.2 YEARS.,.] (GO NEXT BIRTH) DAYS.1 MONTHS.2 YEARS.3 (GO NEXT BIRTH) DAYS.1 MONTHS.2 YEARS.3 (GO NEXT BIRTH) DAYS.,.1 MONTHS.2 YEARS.] (GO NEXT BIRTH) 2-2 255 212 ~11at flame was given to your next baby? o, I (NAME) % (NAME) N (NAME) N (NAME) 213 214 RECORD SINGLE OR NULTIPLE BIRTH STATUS. Is (NAME) boy or girL? 215 In ~hat ~th and year was INANE) born? PRODE~ What Is his/ her birthday? 216 IS (BANE) stilt alive? 217 IF ALIVE: BOW old was (NAME) at his/her Last birthday? RECORD AGE IN CORPLETED YEARS. 218 IF ALIVE: Is (BANE) Living with you? 219 IF LESS THAN 15 YEARS OF AGE: Uith whom does he/she tire? IF 15 YEARS OR OLDER, GO TO NEXT BIRTH. 220 IF DEAD: HOW old was he/she ~hen he/she died? IF "1 YEAR", PROBE: HOW many months old Was (NAME)? RECORD DAYS IF LESS THAN 1HONTH,MONTH$ IF LESS THAN TWO YEARS, OR YEARS. e I EoTo IFR . BIRTH)" OTHER RELATIVE.2 MONTHS.2 go . 2 SOMEONE ELSE.3 YEARS.3 (GO NEXT BIRTH) (GO NEXT BIRTH) BIRTH) OTHER RELATIVE,2 MO~THS.,2 NO . 2 SOMEONE ELSE.,.3 YEARS,,.3 (GO NEXT BIRTH) (GO NEXT BIRTH) BIRTH)- OTHER RELATIVE.2 MONTHS.2 NO . 2 SUMEOME ELSE.3 YEARS.3 (GO NEXT BIRTH) (GO NEXT BIRTH) BIRTHI. OTHER RELATIVE.2 MONTHS.2 NO . 2 SOMEONE ELSE.3 YEARS.3 (GO TO 221) (GO TO 221) CUMPARE 2S8 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS ARE ~ (PROBE AND NUMBERS DIFFERENT ,, • RECONCILE) ARE SANE v CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH LIVING CHILD: CURRENT AGE ]S RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. FOR BIRTH INTERVALS OF FOUR YEARS OR MORE: PROBE FOR UNREPORTED BIRTHS. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987. IF NONE, ENTER '0' AND GO TO QUESTION 224. FOR EACH BIRTH SINCE JANUARY 1987, ENTER "B" IN MONTH OF BIRTH IN COLUMN 1 OF CALENDAR AND "P" IN EACH OF THE O PRECEDING NONTHS. WRITE NAME OF THE CHILD TO THE LEFT OF THE "B" CODE. AT THE BOTTON OF THE 1987, ENTER NAME AND BIRTH DATE OF THE LAST CHILD BORN PRIOR TO JANUARY IF APPLICABLE. 2-3 256 NO. I 2251 QUESTIONS AND FILTERS Are you pregnant now? SKIP COOING CATEGORIES I TO 1 1 YES . 1 I I Nu~;;~iiiiiiiiiiiiiiiiiiiiiiiii12~-228 226 227 I How mny ~nths pregnant are you? I MONTHS . ~ l ENTER "P" IN COLUMN 1 OF CALENDAR IN MONTH OF INTERVIEW AND IN EACH PRECEDING MONTH PREGNANT. I At the tin you becam pregnant, did you want to ~e~ I pregnant then, did you want to wait untit later, I or did you not want to become pregnant at aLL? I THEN . 1 I LATER . 2 I NOT AT ALL . 3 2281 yoo ver'a°aPregna°c'thatmscarrieds rted or - -d n t L, rth IYES . . . . . . . . . . . . . . . . . . . . . . . . . . 11 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 "234 229 When did the last such pregnancy end? B 230 231 CHECK 229: ~;~EP~YI~I~ED~ v How many months pregnant were you when the pregnancy ended? I . YEAR . I LAST PREGNANCY ENDED ~ I BEFORE JANUARY 1987 I~ I I MONTHS . I~ I ENTER "T" IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT. 232 I Did you ever have any other such pregnancies? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I ! NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 "234 "234 ASK FOR DATES AND DURATIONS OF ANY OTHER PREGNANCIES BACK TO JANUARY 1987. ENTER "T" IN COLUMN 1 OF CALENDAR IN MONTH PREGNANCY TERMINATED, AND "P" IN EACH PRECEDING MONTH PREGNANT. 2-4 257 NO. QtJESTIOWS AND FILTERS 234 When did your Last menstrual period start? SKIP TO CODING CATEGORIES DAYS AGO . 1 WEEKS AGO . 2 MONTHS AGO . ] YEARS AGO . 4 IN MENOPAUSE . 994 BEFORE LAST BIRTH . 995 NEVER MENSTRUATED . 996 p236 I oo ,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Between the first day of a period (i.e., menstrual cycle) and the first day of her next period, are there certain times when she has s greater chance of becoming pregnant than other times? PROBE: Are there any days during this time when the Woman has a greater chance of becoming pregnant than on other days? I YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 7 DON'T KNOW . 8 ~301 I 237 During which times of the monthly cycle does a wcfnan have the greatest chance of becoming pregnant? PROBE: Whet are the days of each month when the woman should be more careful so as not to get pregnant during them? DURING HER PERIO0 . I RIGHT AFTER HER PERIOD HAS ENDED . 2 IN THE MIDDLE OF THE CYCLE . 3 JUST BEFORE HER PERIOD BEGINS.4 OTHER 5 (SPECIFY) DON'T KNOW . 8 2-5 258 SECTLOM 3: CONTRACEPTIVE KNOULEDGE AND USE 301 = ,ou, would Like to talk about family planning -- the various ways or metheds that a couple can use to I delay or avoid a pregnancy. Which Ways or methods have you heard about? CIRCLE COOE 1 IN 302 FOR EACH NETHCO MENTIONED SPONTANEOUSLY. THEN PROCEED DOUN THE COLUI4N, READING THE NAHE AND DESCRIPTION OF EACH HETHOD NOT NENTIONED SPONTANEOUSLY. CIRCLE CODE 2 [E METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH NETBOD WITH CODE 1 OR 2 CIRCLED IN 302, ASk 303-3D4 SEFORE PROCEEDING TO THE NEXT HETBOD. 11 PILL Women can take a pitt every day. 2110D Women can have a Loop or coil placed inside them by a doctor or a nurse. 3_] INJECTIONS Women can have an Injection by a doctor or nurse v~lIch stc~o6 them frombecoming pregnant for several mo~ths. NOI~PLANT Women can have small reds placed In their arm by a doctor which stops them from becoming prngnant for several years. 0 5 • DIAPHAAON.FONN,JELLY W(~r, en can place a sponge, sl~pposttory e diaphrap, jelly or cram In- side them before intercourse. •J CONDOR Men can use a rul~cer covering during sexual interco~Jrse. FENALE STERILIZATION Wcw~en can have an operation to avoid having any more children. NALE STERILIZATION Men can have an operation to avoid having any more children. 302 Have you ever heard of (HETHO0)? READ DESCRIPTION OF EACH METHCO. YES/SPONT . 1 YES/PROBED . 2 NO . YES/SPOILT . 1 YES/PROBED . 2 RO . 'l YES/SPONT . 1 YES/PROBED . 2 NO . 3] YES/SPONY . 1 YES/PROBED . 2 NO . 3 YES/SPONT . 1 YES/PROBED . 2 NO . 3 YES/SPONT . 1 YES/PROBED . 2 NO . YES/SPOBT . 1 YES/PROBED . 2 NO . 3 YES/SPORT . 1 YES/PROBED . 2 NO . 31 v 303 Have you ever used (METRO0)? 30/* Do you know where a person could go to get (WETWOU)? YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . .°2 YES . 1 gO . 2 YES . .**.1 flO . 2 YES. 1 NO. 2 Have you ever had an operation to avoid having any core children? YES. . 1 NO. . . . . . . . . . , . . . . . . . . . . . . . . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . I NO . 2 YES., 1 NO . . . . . . . . . . . . . . . . . . . . . . . . .2 YES . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 Do you know a place where a person can have such an operation? YES . 1 YES . 1 NO . 2 NO . 2 YES . 1 YES . 1 NO . 2 NO . 2 3-I 259 CONTRACEPTIVE METHOD TABLE CONTINUED 302 Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD. •J RHYTHM, PERIODIC ABSTINENCE ' Couples can avoid having sexual intercourse o~ certa|n days of them nth when thaw o man is more Likely to bec~ pregnant. 101WITHDRA•/AL Nen can be carefu[ and pu|t out before ejacutation. 1 i PROLONGED BREASTFEEDING Women can prolor~ the time that they breaatfeed their babies to delay the next pregnancy. Have you heard of any other waym or ~ethoda that wo~en or men can use to avoid pregnancy? (SPECIFY) 2 (SPECIFY) 3 (SPECIFY) YES/SPO#T . 1 YES/PRORED . 2 NO. . , , . . . . . . YES/SPONT . 1 YES/PROBED . 2 NOo.*H. . 3] v YES/SPO~T . I YES/PRO~ED . 2 HO . ,----~ v YES/SPONY . 1 NO . 3 30] Have you ever used (NETRO0)? YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 304 Oo you kno~ where a person could go to get (METHOD)? Do you know where a perso~ can obtain advice o~ how to use periodic abstinence? YES . 1 N0 . .,,. . 2 306 308 AT LEAST ONE "YES" (EVER USED) II • SKIP TO 309 Have you ever used anything or tried in any way to detay or avoid getting pregnant? I YES . 1 "308 NO . 2 ENTER "0" IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. I "351 What have you used or do~e? CORRECT 303-305 (AND 302 IF NECESSARY). 3-2 260 NO. QUESTIONS AND FILTERS 309 What is the first thing you ever did or method you ever use~:] to delay or avoid getting pregnant? CODING CATEGORIES PILL . 01 IUD . 02 INJECTIONS . 03 NORPLANT . 04 DIAPHRAGM/FOAM/JELLY . 05 CONDON . 06 FEHALE STERILIZATION . 07 HALE STERILIZATION . 08 PERIO01C ABSTINENCE . 09 WITHDRAWAL . 10 PROLONGED BREASTFEEDING . 11 OTHER 12 (SPECIFY) SKIP TO "311 310 Where did you go to get (FIRST METHO0 USED) the first time? WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHO0. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SCIJRCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION.17 CURATIVE CARE ORGANIZATION . 18 OTHER . 19 PRIVATE VOLUNTARY ORGANIZATION EGYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 PHARMACY . 26 OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT . 31 CHURCH HEALTH UNIT . 32 OTHER VENDOR (SHOP, KIOSK, ETC.) . 33 FRIENDS/RELATIVES . 41 OTHER . 42 DON'T KNOW . 98 I 311 I At the time when you first use<l, how many living NUMBER OF CHILDREN . I I I I children did you have, if any? I I I IF NONE, RECORD 'DO' AND SKIP TO 313. 312 I HOW many sons did you have? How many daughters? SONS . I DAUGHTERS . IF NONE RECORD 'DO ~. 313 When you first began to use family planning, did you want to have another child b~Jt at a later time, or did you not want to have another child at aft? WANTED CHILD LATER . I DID NOT WANT ANOTHER CHILD . 2 OTHER 3 (SPECIFY) 3-3 261 NO. 31& 315 316 317 OUESTIONS AND FILTERS CHECK 104: CURRENTLY WIDOWED/ MARRIED [~ DIVORCED F~ l CHECK 225: CODING CATEGORIES NOT PREGNANT PREGNANT OR UNSURE 9 CHECK 303: WOMAN NOT WaNAN STERILIZED [~ STERILIZED F~ Are you currently doing something or using any method to detay or avoid getting pregnant? j YES . 1 NO . 2 SKIP J TO I ,338 I P344 I -318A I ~344 318 318A Which method are you using? CIRCLE '07' FOR FEMALE STERILIZATION, PILL . 01 IUD . 02 INJECTIONS . 03 NORPLANT . 04 DIAPHRAGM/FOAM/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 PERIODIC ABSTINENCE . 09 WITHDRAWAL . 10 PROLONGED BREASTFEEDING . 11 OTHER 12 (SPECIFY) ,320 319 Why did you decide to use (CURRENT METHOD) rather than some other method of family planning? PROBE: Any other reasons? RECORD ALL MENTIONED. RECOMMENDATION OF GOVERNMENT DOCTOR/NURSE . A-- RECOMMENDATION OF PRIVATE DOCTOR/NURSE . B RECOMMENDATION OF FAMILY PLANNING WORKER/RAIDYA . C RECOMMENDATION OF RELATIVES/ FRIENDS . D SIDE EFFECTS OF OTHER METHODS.E SAW TV SPOT PROMOTING METHOD . F ~ETH(3D CONVENIENT TO USE . G EASILY AVAILABLE . H COST . I WANTED PERMANENT METHOD . J HUSBAND PREFERRED . K WANTED MORE EFFECTIVE METHOD . L OTHER M (SPECIFY) DON'T KNOW . N-- ~336 320 Why did you decide to use (CURRENT METHOD) rather than sQwne other method of family planning9 PROBE: Any other reasons? RECORD ALL MENTIONED. RECOMMENDATION OF GOVERNMENT DOCTOR/NURSE . A RECOMMENDATION OF PRIVATE DOCTOR/NURSE . B RECOMMENDATION OF FAMILY PLANNING WORKER/RAIDYA . C RECOMMENDATION OR RELATIVES/ FRIENDS . O SIDE EFFECTS OF OTHER METHOOS.E SAW TV SPOT PROMOTING METHOD . F METHOD CONVENIENT TO USE . G EASILY AVAILABLE . H COST . I WANTED PERMANENT METHOD . J HUSBAND PREFERRED . K WANTED MORE EFFECTIVE METHOD . L OTHER M (SPECIFY) DON=T KNOW . N 3-4 262 NO. QUESTIONS AND FILTERS 321 CHECK 318: SHE/HE STERILIZED USING IUD USING ANOTHER METHOD r--] • Where did the sterilization take place? • Where did you have the IUD inserted? F--'] • Where did you obtain (METHOD) the test time? WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE, (NAME AND ADDRESS OF PLACE) SKIP CODING CATEGORIES TO MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION,17 CURATIVE CARE ORGANIZATION . 18 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . 19 PRIVATE VOLUNTARY ORGANIZATION EGYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 PHARMACY . . . . . . . . . . . . . . . . . . . . . . 26 OTHER PRIVATE SECTOR MOSOUE HEALTH UNIT . 31 CHURCH HEALTH UNIT . 32 OTHER VENDOR (SHOP, KIOSK, ETC.) . 33 FRIENDS/RELATIVES . 41 OTHER . 42 DON'T KNOW . 98 ~324 P326 322 Now long does it take to travel from your home to this place? IF LESS THAN 2 HOORS, RECORD MINUTES. OTHERWISE, RECORD HOURS. 323 I Is it easy or difficult to get there? EASY . 1 I DIFFICULT . 2 324 F ~ MINUTES . 1 I I I HOURS . 2 DON'T KNOW . 9998 Why did you decide to obtain your (CURRENT METHOD) from (CURRENT SOURCE IN 321) rather than from some other place? Any other reason? (RECORD ALL RESPONSES) RECOMMENDATION OF GOVERNMENT DOCTOR/NURSE . A RECOMMENDATION OF PRIVATE DOCTOR/NURSE . B RECOMMENDATION OF FRIEND/RELATIVE . C REPUTATION OF SOURCE AS GO00 PROVIDER . D PREVIOUS EXPERIENCE . E EASY ACCESS TO SOURCE . F COST OF SERVICES REASONABLE . G OTHER H (SPECIFY) DON'T KHOW . . . . . . . . . . . . . . . . . . . . . . I 325 I Since you obtained the method from (CURRENT SOURCE), I YES . I I have you returned there for follow-up or advice about I the method? NO . 2 3-5 263 NO. 327 QUESTIONS AND FILTERS CHECK 318; USING IUO Did you get the IUD at the place where you had it inserted or did you buy it from somewhere else? SKIP COOING CATEGORIES TO USING PILL ~ I p333 USING OTHER I METNOOS [~ ~335 I YES, FRO~4 THE SAME PLACE . 1 ~331 I NO, FROM SOMEWHERE ELSE . 2 I 328 From where did you obtain the IUD? WRITE THE N/U4E AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT 06TAINED THE METHOO, PROSE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION,17 CURATIVE CARE ORGANIZATION . 18 OTHER . 19 PRIVATE VOLUNTARY ORGANIZATION ~GYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 PHARMACY . 26 OTHER PRIVATE SECTOR MOSQUE HEALTH UNiT . . . . . . . . . . . . 31 CHURCH HEALTH UNIT . . . . . . . . . . . . 32 OTHER VERDOR (SHOP, K IOSK, ETC.) . 33 FRIENDS/RELATIVES . 41 OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 DON'T KNOW . 98 329 I flow much did it cost to buy the IUD from that place? J cost (lH POUHDS) . I FREE . 96 DONJT KNOW . 98 330 Would you be willing to pay the following to ImJy the IUD from this source: (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO, SKIP TO 331.) 5 pounds? 7 pounds? 10 pounds? 15 pounds? 20 pounds? 30 pounds? More than ]O pounds? YES NO 5 POUNDS . 1 2 7 POUNDS . . . . . . . . . . . . . . . . . . 1 2 10 PDUNDS . 1 2 15 pOUNDS . 1 2 20 pOUNDS . 1 2 30 POUNDS . 1 2 MORE THAN 30 POUNDS . 1 2 I I 331 I 3-6 264 NO. QUESTIONS AND FILTERS 331 Row much did it cost to have the IUD inserted (including any extra fee for a physical examination)? SKIP I COOING CATEGORIES J TO FREE . . . . . . . . . . . . . . . . . . . . . . . . . . 996 DON'T KNOW . 998 332 Would you be wiLLing to pay the foLlowing to have an IUD inserted: (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO, SKIP TO 336. FOR AMOUNT MORE THAN 200 POUNDS, SKIP TO 336 IF YES OR NO.) 5 pounds? 10 pounds? 25 pounds? 50 pounds? 100 pounds? 150 pounds? 200 pounds? More than 200 pounds? YES NO 5 POUNDS . . . . . . . . . . . . . . . . . . 1 2- - 7 10 POUNDS . 1 2 J 25 POUNDS . 1 2 50 POUNDS . 1 2 336 100 POUNDS . 1 2 150 POUNDS . 1 2 200 POUNDS . . . . . . . . . . . . . . . . . . 1 2 - - MORE THAN 200 POUNDS . 17 27 .336 I I F ~ 333 J Now much does one cycle of pills cost you? J COST (IN PIASTRES) . [ I J J I I FREE . . . . . . . . . . . . . . . . . . . . . . . . . . 996 DON'T KNOW . 998 334 Would you be witting to pay for a cycle of pills if it cost: (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO, SKIP TO 336. FOR AMOUNT MORE THAN 5 POUNDS, SKIP TO 336 IF YES OR NO.) 50 piastres per cycle? 1 pound per cycle? 2 pounds per cycle? 3 pounds per cycle? 4 pounds per cycle? 5 pounds per cycle? More than 5 pounds per cycle? YES NO 50 PIASTRES . 1 2 1 POUND . . . . . . . . . . . . . . . . . . . . 1 2 2 pOUNDS . 1 2 3 POUNDS . I 4 POUNDS . I 5 POUNDS . I MORE THAN 5 POUNDS . 17 I ~336 2 2 2 27 ,336 335 How much did it Cost to get your method? (IF LESS THAN 1 POUND, RECORD IN PIASTRES.) COST (IN PIASTRES).I 1 1 1 1 1 COST tIN POUNDS).2 FREE . 99996 DON'T KNOW . 9<;098 33 1Arey°uhvng nY r°b°s °usng CURENTMETN I YES . 11 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,338 337 What i s the main problem? HUSBAND DISAPPROVES . 01 SIDE EFFECTS/ILLNESS CAUSED BY METHOD . 02 SPOTTING/BLEEDING . 03 PERIOD DID NOT COME . 04 OTHER HEALTH CONCERNS . 05 RAN OUT OF SUPPLIES . 06 ACCESS/AVAILABILITY . 07 COSTS TOO MUCH . 08 FORGET TO TAKE/MISPLACE . 09 INCONVENIENT TO USE . 10 STERILIZED, WANTS CHILDREN . 11 OTHER 12 (SPEC]FY) DON'T KNOW . 98 3-7 265 SKIP 339 In what month and year was the sterilization performed? MONTH . YEAR . 340 ENTER STERILIZATION METHOD CODE IN NONTB OF INTERVIEW IN COLUHN 1 OF CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION OR TO JANUARY 1987 IF OPERATION OCCURRED BEFORE 1987. 341 CHECK 339: 342 343 344 STERILIZED gEFORE JANUARY 1987 STERILIZED SINCE JANUARY 1987 CHECK 104: CURRENTLY [~ WIDOWED/ MARRIED DIVORCED [~ ENTER METHOD CODE FROM 318 IN CURRENT MONTH IN COLUMN I OF CALENDAR, THEN DETERMINE WHEN SHE STARTED USING THIS METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE. ILLUSTRATIVE QUESTIONS: - When did you start using this method continuously? - Now Long have you been using this method continuously? I would like to ask some questions about art of the (other) periods in the tast few years during which you or your husband used a method to avoid getting pregnant. PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST PERIOD OF USE AND GOING BACK TO JANUARY 1987. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. RECORD PERIODS OF USE AND NONUSE IN COLUMN 1 OF THE CALENDER. FOR EACH MONTH IN WHICH A METHOD WAS USED~ ENTER THE CODE FOR THE METHOD; ENTER "0" IN THOSE MONTHS WHEN NO METHO0 WAS USED. FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED. ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT. FOR EACH PERIOD OF USE, RECORD THE CODE FOR THE REASON FOR DISCONTINUATION IN COLUMN 2 OF THE CALENDAR NEXT TO LAST MONTH OF USE. NUMBER OF CQOES ENTERED IN COLUMN 2 MUST BE THE SAME AS THE NUMBER OF INTERRUPTIONS OF CONTRACEPTIVE USE IN COLUMN 1. ILLUSTRATIVE QUESTIONS: COLUMN 1: -kl~en was the last time you used a method? Which method was that? -When did you start using that method? How tong after the birth of (NAME)? -How long did you use the methed then? b401 ,344, ~344 3-8 266 NO, 344A 345 346 QUESTIONS AND FILTERS SKIP I CODING CATEGORIES TO COLUMN 2: -Why did yOU stop using the (METHOD)? -Did you become pregnant while using (METHOD), or did you stop to get pregnant, or stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: "How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1. CHECK CALENDAR: I I METHOD USED NO METHOD USED IN MONTH OF IN MONTH OF JANUARY 1987 [~ JANUARY 1987 r~ ,347 V m you were using (METHOD) in January 1987. MONTH . ~ 1 3 5 1 i see that When did you start using (METHOD) that time ? YEAR . I l l l --I THIS DATE SHOULD NOT PRECEDE THE DATE OF BIRTH OF ANY CHILD BORN BEFORE JANUARY 1987. 347 348 349 I see that you were not using any method of contraception in January 1987. Did you ever use a method before that? CHECK 215: HAD BIRTH NO BIRTH BEFORE JANUARY 1987 BEFORE JANUARY 1987 n v Did you use a method between the birth of (NAME OF LAST CHILD BORN BEFORE JANUARY 1987) and January 1987~ I YES . 1 I NO . 2 "351 I ,350 I YES . 1 I NO . 2 ,351 350 When did you stop using a method the last time prior to January 1987? THIS DATE SHOULD NOT PRECEDE THE DATE OF BIRTH OF ANY CHILD BORN BEFORE JANUARY 1987. 351 CHECK 104: CURRENTLY I MARRIED 9 351A CHECK 318: NOT CURRENTLY USING A METHOD L~ 352 WIDOWED/ DIVORCED CURRENTLY USING PERIODIC ABSTINENCE, WITHDRAWAL, OTHER TRADITIONAL METHOD Do you intend to use a method to delay or avoid pregnancy at any time in the future? "401 CURRENTLY USING A F~ ,401 v MODERN METHOD I (SKIP TO 357) I I ' YES . I ~354 NO . 2 I DON'T KNOW . 8 "357 3-9 267 NO. QUESTIONS AND FILTERS 353 ~at is the main reason you do not intend to use a method in the future? CODING CATEGORIES WANTS CHILDREN . 01 LACK OF KNOWLEDGE . 02 HUSBAND OPPOSED . . . . . . . . . . . . . . . . 03 COSTS TOO MUCH . 04 SIDE EFFECTS . . . . . . . . . . . . . . . . . . . 05 HEALTH CONCERNS . 06 HARD TO GET METHODS . D7 RELIGION . 08 OPPOSED TO FAMILY PLANNING . 09 FATALISTIC . 10 OTHER PEOPLE OPPOSED . 11 INFREQUENT SEX . . . . . . . . . . . . . . . . . 12 DIFFICULT TO GET PREGNANT . 13 MENOPAUSAL/HAD HYSTERECTOMY . 14 INCONVENIENT . . . . . . . . . . . . . . . . . . . 15 OTHER 16 (SPECIFY) DON'T KNC~4 . . . . . . . . . . . . . . . . . . . . . 98 Iooo nn °° re°w ° n =s l Soo° . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o . . . . . . . . . . . . . . . . . . . . . . 11 355 When you use a method, which method would you prefer to use? SKIP TO ~357 PILL . 01 IUD . 02 INJECTIONS . 03 NORPLANT . 04 DIAPHRAGM/FOAM/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 PERIODIC ABSTINENCE . 09 WITHDRAWAL . 10~ PROLONGED HREASTFEEDING . 11 OTHER 12 ~357 (SPECIFY) --98 UNSURE/DON'T KNOW . 356 Where can you get (METHOD MENTIONED IN 355)? WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT WOULD GET THE METHOD. PROSE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEM CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION.17 CURATIVE CARE ORGANIZATION . 18 OTHER . 19 PRIVATE VOLUNTARY ORGANIZATION EGYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 PHARMACY . 26 OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT . 31 CHURCH HEALTH UNIT . 32 OTHER VERDOR (SHOP, KIOSK, ETC.) . 33---- FRIENDS/RELATIVES . 41~ OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 t DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . 98~401 ~359 268 3-10 NO. I qUESTIONS AND FILTERS m m 357 I Do you know of e piece where you can obtain I a method of family planning? SKIP I COOING CATEGORIES I TO I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . 2 ~01 358 Where is that? tCRITE THE NAME ANO ADDRESS OF THE SOURCE FRON ~NICN THE RESPONDENT ICOULD GET THE METHOD. PROBE 1F NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNNENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION.17 CURATIVE CARE ORGANIZATION . 18 OTHER . 19 PRIVATE VOLUNTARY ORGANIZATION EGYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 PHARMACY . 26 OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT . 31 CHURCH HEALTH UNIT . 32 OTHER VENDOR (SHOP, KIOSK, ETC.) . 33 FRIENDS/RELATIVES . 41~ OTHER . 421 DON'T KNOW . 98~401 359 How tong does it take to travel fro~ your home to this place? l MINUTES . ' ~ l HOURS . 2 DON'T KNOW . 9998 IF LESS THAN Z HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS. 360 IS it easy or difficult to get there? I EASY . I I i I DIFFICULT . 2 3-11 269 SECTION 4: OTHER ISSUES RELATING TO CONTRACEPTION SKIP QUESTIONS AND FILTERS | COOING CATEGORIES | TO NO. 402 CHECK 303: EVER USED FAMILY PLANNING CHECK 318: CURRENTLY USING PILL 9 v | NEVER USED FAMILY PLANNING [~ NOT CURRENTLY USING PILL I 403 Is this the first time that you have ever used the I FIRST TIME USED PILL . 1 p i t t or have you used before? I USED PILL BEFORE . 2 404 At the time you used the pill for the first time, did I YES . 1 I you consult a doctor or a nurse before you began using I I i t ? NO . 2 405 P440 ~616 ~405 May I see the package of pitts you are using now? RECORD NAME OF BRAND. I PACKAGE SEEN . 1 | I BRAND NAME PACKAGE NOT SEEN . 2 ~408 COUNT AND RECORD THE TOTAL NUMBER OF PILLS IN THE CYCLE (PACKET) REGARDLESS OF THE PILLS ALREADY TAKEN. OBSERVE SEQUENCE IN WHICH PILLS TAKEN FROM CYCLE (PACKET) AND CIRCLE CORRECT COOE. 2'L . I 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I PILLS MISSING IN SEQUENCE . I PILLS MISSING OUT OF SEQUENCE.2~410 NO PILLS MISSING . 3 ~ 408 I °°Y°ukn°'thebra na'° theP'L' 'h chY°u I are using now? BRAND NAME RECORD NAME OF BRAND. DON'T KNOW . 9B 409 Why don't you have a cycle (packet) of piLLs available 7 HAS PERIOD, DOESN'T NEED YET.01 COST TOO MUCH TO BUY CYCLE . 02 FORGOT TO BUY NEXT CYCLE . 03 RESTING FROM PILL . 04 MISPLACED/CAN'T FIND . 05 HUSBAND AWAY/ILL . 06 OTHER 07 (SPECIFY) 4-1 270 NO. ~ QUESTIONS AND FILTERS m I 410 I At any time in the past month did you fail to take a I pitt for more than one day for any reason? SKIP I CODING CATEGORIES I TO I YES . 1 I NO . 2 "412 411 What was the main reason you stopped taking the pitt? SIDE EFFECTS/ILLNESS . 01 SPOTTING/BLEEDING . 02 PERIO0 DID NOT COME . 03 RAN OUT OF PILLS . 04 HUSBAND AWAY . 05 FORGOT TO TAKE/MISPLACED . 06 OTHER 07 (SPECIFY) 412 414 Just about everyone misses taking the pill sometime. What do you do when you forget to take two or more pitts? ALL OTHER SOURCES v F~ Do you usually obtain the pitt yourself? IF NO: Who obtains the method usually? START TAKING AGAIN AS USUAL . 01 TAKE EXTRA/MISSED PILLS . 02 USE ANOTHER METHOD . 03 TAKE EXTRA PILL AND USE ANOTHER METHOD . 04 OTHER 05 (SPECIFY) NEVER FORGOT . 06 I RESPONDENT HERSELF . 1 HUSBAND . 2 OTHER 3 (SPECIFY) i ~417A B I ~419 I 415 417 417A Since you began using the pitt this time, have you have you yourself ever gone to a pharmacy to obtain the method? V Now I would like to ask some questions about the last time that you used the pitt. Curing that time, did you yourself ever go to a pharmacy to obtain the pill? Since you began using the pitt this ti~e, have you yourself ever gone to a pharmacy to obtain the pill? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . 2 NEVER USED PILL F~ YES . 1 NO . 2 I ~419 I P422 I ~431 I I ~419 4-2 271 NO. 418 (~ESTIONS AND FILTERS Did anyone else obtain the pill for you at a pharmacy? SKIP I COOING CATEGORIES I TO HUSBAND . 1 O T H E R 2 ~ (SPECIFY) 422 NO ONE ELSE . 3 NEVER OBTAINED FROM PHARMACY . 4 ~ IF YES: Who obtained the pitt for you from a pharmacy? 619 NOW I would like to talk with you about the service I YES . 1 I Which you received at the pharmacy. Did the anyone I I at the pharmacy tell or show you how to use the pitt? NO . 2 420 Did anyone at the pharmacy describe side effects or J YES . 1 J other problems which you might have while using the I I the pill? NO . 2 421 Did anyone at the pharmacy ever teII you about other J YES . 1 J family planning methods which you might use? I I NO . 2 422 When you began to use the pill (this/that) time, did I YES . 1 J you consult e doctor or a nurse? I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 "431 423 Where did you go for this consultation? WRITE THE NAME AND ADDRESS OF THE SOURCE. PROSE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE COOE, (NAME AND ADDRESS OF PLACE) MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION.17 CURATIVE CARE ORGANIZATION . 18 OTHER . 19 PRIVATE VOLUNTARY ORGANIZATION EGYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT . 31 CHURCH HEALTH UNIT . 32 OTHER . 42 DON'T KNOW . 98 ~431 4-3 272 NO. I QUEST I~S AND FILTERS I C~ING CATEGORIES 1 1 I 424 ~ Now I w~ld like to talk with you about the service I YES . 1 I which you receiv~ at (S~RCE IN 423). Did y~ I think that the wait for services was too tons? NO . 2 IF YES: Was the doctor ~{e or female? EXAMINED BY FEMALE DOCT~ . 2 NOT EXAMINED . 3 any extra fee for a ~ysicat examination)? FREE . ~6 IF LESS THAN ONE P~NDj RECORD =000 I , DON'T KNOW . ~8 42' I In a='t'°n t° th° P"t' w°re'~ t°tO a~ut ° t h e r ~ t h ~ s , I ~ES"o. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~'1 -I I'" . 'l NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 429 Were you toLd a~ut problems or side effects which I YES . I I you might experience in using the piLL? I I NO . 2 430 After you ~gan using the pitt, did you return to (S~RCE IN 423) for consuttatJon or follow-up? SKIP I To I ? V 432 CHECK 303 (IUD): EVER USED IUD v~ YES . . . , . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CURRENTLY USING IUD r~ NEVER USED I UD F -~ I I "433A I f ~440 I 4-4 273 NO. 433 433A QUESTIONS AND FILTERS Row I would Like to ask some questions about the last time that you used the IUD. Where did you obtain the IUO? WRITE THE NAME AND ADDRESS OF THE SOURCE. PROSE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) CHECK 321 AND CIRCLE THE COOE FOR THE SOURCE AT WHICH THE CURRENT USER HAD THE IUD INSERTED. SKIP COOING CATEGORIES TO MINISTRY OF HEALTH FACILITY URBAN HOSPITAL . 11 URBAN HEALTH UNIT . 12 RURAL HOSPITAL . 13 RURAL HEALTH UNIT . 14 OTHER . 15 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . 16 HEALTH INSURANCE ORGANIZATION.17 CURATIVE CARE ORGANIZATION . 18 OTHER . 19 PRIVATE VOLUNTARY ORGANIZATION EGYPT FAMILY PLANNING ASSOCIATION . 21 CSI PROJECT . 22 OTHER . 23 MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC . 24 PRIVATE DOCTOR . 25 OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT . 31 CHURCH HEALTH UNIT . 32 OTHER . 42 DON'T KNOW . 9S ~440 434 Now I would like to talk with you about the service YES . 1 which you received at (SOURCE IN 432). Did you think that the wait for services was too long~ NO . 2 435 Were you given a physicai examination ~ EXAMINED BY MALE DOCTOR . I IF YES: Was the doctor male or female? EXAMINED BY FEMALE DOCTOR . 2 NOT EXAMINED . 3 436 in addition to the IUD, were you told about other YES . 1 methods? NO . 2 437 Were you told how to be sure that the IUD was in YES . I place? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438 Were you told about problems or side effects which YES . I you might experience in using the IUD? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 439 After you began using the IUD, did you return to YES . I (SOURCE IN 432) for consuLtation or follow-up? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5 274 NO. 440 QUESTIONS AND FILTERS There are many factors which help to influence the decision to use family planning. Can you tell me if any of the following ever caused you to seek more information about family planning? Advice from friends/relatives? Informational spots on television? Advice from government doctor/clinic staff? Advice from private doctor/clinic staff? Advice from raiyda or other family planning extension worker? A coemxJnity activity (e.g., a meeting)9 Other ? (SPECIFY) COOING CATEGORIES YES NO FRIEND/RELATIVES . 1 2 TV SPOTS . 1 2 GOVERNMENT DOCTOR/CLINIC.1 2 PRIVATE DOCTOR/CLINIC . 1 2 RAIYDA/OTHER FP WORKER . I 2 COMMUNITY ACTIVITY . I 2 OTHER . 1 2 SKIP TO 441 How did you first hear about family planning? TELEVISION . 01 RADIO . 02 PRINT MEDIA . 03 HUSBAND . 04 OTHER RELATIVES OR FRIENDS . 05 GOVERNMENT DOCTOR/CLINIC STAFF . 06 PRIVATE DOCTOR/CLINIC STAFF . 07 RAIYDA/OTHER FP WORKER . 08 CO@IMUNITY MEETING . 09 OTHER 10 (SPECIFY) 442 In the Last month, have you heard a message about family planning on: the radio? television? YES NO RADIO . I 2 TELEVISION . I 2 443 464 CHECK 105, 107 AND 110: ATTENDED PREPARATORY OR HIGHER LEVEL ABLE TO READ 9 9 v V In the last month have you read an articie about family planning in a newspaper or magazine? NOT ABLE TO READ P445 ! I YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 445 There ate many spots or messages regarding family planning on television. Can you tell me about the spots or messages which you have found most informative or helpful for you? RECORD THE RESPONSE IN DETAIL. IF THE ANSWER IS A SERIES (E.G., KAREEMA MUBKTAR OR THE DOCTOR), PROBE TO FIND OUT WHICH SPECIFIC SPOTS IN THE SERIES WERE MOST HELPFUL OR INFORMATIVE. RECORD UP TO THREE SPOTS. lYF 2FT NEVER SAW FP MESSAGES . 997 446 In the past year, have you ever attended a community I YES . 1 [ meeting or talk in which there was discussion about I I fami Ly planning or Egypt's pol~Jtation probtemO NO . 2 4-6 275 "0. I QUESTIONS AND FILTERS M I 447 ~ In germrat, do you approve or d i sapprove of c~les I using a ~thod to avoid pregnancy? CODING CATEGORIES APPROVES . . . . . . . . . . . . . . . . . . . . . . . . 1 DISAPPROVES . 2 DOESN'T KNOU/UNDECIDED . 8 SKIP I TO I 448 If couples wish to avoid pregnancy, do you aRorove or disapprove of their using: the corx~om? the IUD? female sterilization? withdrawal? mate sterilization? the pitt? APPR DISAPPR DK CONDOM . . . . . . . . . . . . . . 1 2 8 IUD . 1 2 8 FEMALE STER . 1 2 8 WITHDRAWAL . 1 2 8 MALE STER . 1 2 8 PILL . 1 2 8 4491Xn e°er"d°Y°u'h'nk'"a'Y°urre"g'°n'"° s I . '1 couples to use family planning or it forbids it? FORBIDS . 2 DOESN'T KNOW . 8 of couples using a method to avoid pregnancyO DISAPPROVES . 2 DOESN'T KNGW/UNDECIDED . 8 4-7 276 SECTION 5. FERTILITY PREFERENCES SKIP I COOING CATEGORIES J TO NO. QUESTIONS AND FILTERS 501 502 503 CHECK 104: CURRENTLY MARRIED ? CHECK 318: NEITHER STERILIZED v[~ CHECK 225: NOT PREGNANT OR UNSURE I V Now I have some questions about the future, Would you Like to have (a/another) child or would you prefer not to have any (more) children? DIVORCED/ WIDOWED [~ SHE OR HE STERILIZED [~ PREGNANT 9 I V Now I have socne questions about the future. After the child you are expecting, would you Like to have another child or would you prefer not to have any more children? HAVE A (ANOTHER) CHILD . 1 NO MORE/NONE . 2 SAYS SHE CAN'T GET PREGNANT . 3 UNDECIDED OR DON'T KNOW . 8 ,509 p507 -507 504 505 506 CHECK 225: NOT PREGNANT OR UNSURE [] / I V How Long would you Like to wait from now before the birth of (a/another) child? CHECK 203, 205 AND 225 HAS LIVING CHILD(REN) YES OR PREGNANT? V CHECK 225: NOT PREGNANT OR UNSURE [~ / Now old would you Like your youngest child to be when your next child is born? PREGNANT 9 Now tong would you Like to wait after the birth of the child you are expecting before the birth of another child? NO PREGNANT 9 I v How old would you Like the child you are expecting to be when your next chitd is born? iiiiiiiiiiiiiiiiiiii: OTHER 996 J (SPECIFY) DONIT KNOW . 998 I ~507 . . . . . . . . . . . . . . . . DON'T KNOW . 98 5-1 277 NO. I ~JESTIONS AND FILTERS 507 I Have you and your husband ever discussed the number m I of children you would like to have? SKIP I C~ING CATEGORIES I TO IYES . 1 1 NO . 2 508 I Do you think your husband wants the same I number of children that you want, or does he want more I or fewer than you want? I SAME NUMBER . . . . . . . . . . . . . . . . . . . . . 1 I MORE CHILDREN . . . . . . . . . . . . . . . . . . . 2 I FEWER CHILDREN . . . . . . . . . . . . . . . . . . 3 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . 8 509 CHECK 203 end 205: HAS LIVING CHILD(REN) [~ ! I V If you could go beck to the tir~e you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? NO LIVING CHILD(REN) 9 J V If you could choose exactly the number of children to have in your whole life, how many would that be? RECORD SINGLE NUMBER OR OTHER ANSWER. NUMBER . . . . . . . . . . . . . . . . . . . . . OTHER ANSWER 96-- (SPECIFY) DON'T KNOW . 98-- -511 510 How many boys ar~ how many girls9 BOYS . GIRLS . OTHER ANSWER 96 (SPECIFY) DON'T KNOW . 98 511 When a couple is making a decision, sometimes the husband has more influence, in s~ cases, the wife has more influence, while other decisions are made jointly. In your family, who has (had) the most influence in deciding whether or not to have another --you or your husber=d--or do (did) you have equal say? RESPONDENT HAS MORE INFLUENCE.1 BOTH HUSBAND AND REPONDENT EQUAL . 2 HUSBAND HAS MORE INFLUENCE . 3 OTHER 4 (SPECIFY) What do you think is the best nunt~er of months or years between the birth of one child a~ the birth of the next child? I MONTHS . I ~ I YEARS . 2 OTHER 996 (SPECIFY) 513 DO yOU expect your children (if you would have any) to help you financially when you Bet old? I YES . 1 | I NO . 2 NOT SURE/DOESN'T KNOW . 8 514 Sat is the highest level of school you would like for your daughter(s) to attain? PRIMARY . 01 PREPARATORY . 02 SECONDARY . 03 UPPER INTERMEDIATE . 04 UNIVERSITY . 05 MORE THAN UNIVERSITY . 06 DEPENDS ON CHILD . 95 NO ASPIRATIONS FOR EDUCATION.96 DON'T KNOt4 . 98 5-2 278 NO. QUESTIORS ARD FILTERS 515 What is the highest level of school you would like for your son(s) to attain? COOING CATEGORIES PRIMARY . 01 PREPARATORY . 02 SECONDARY . 03 UPPER INTERMEDIATE . 04 UNIVERSITY . 05 MORE THAN UNIVERSITY . 06 DEPENDS ON CHILD . 95 NO ASPIRATIONS FOR EDUCATION.96 DON'T KN(~W . 98 SK]P 10 516 Does (did) your husband allow you to go out alone (or with your children) to buy household items or visit relatives? YES, ALONE . 1 YES, WITH CHILDREN . 2 NOT ALLOWED TO GO OUT . 3 OTHER 4 (SPECIFY) 517 In general, if a wife disagrees with her husband, do you think she should express her opinion or keep quiet? EXPRESS OPINION . 1 KEEP QUIET . 2 NOT SURE/DON'T KNOt/ . 8 518 Some say that a woman's place is not only at home but she should be able to work. Do you agree? AGREE . 1 DISAGREE . 2 NOT SURE/DON=T KNOW . 8 519 Who should have the last word on the following--the husband, the wife, both, or so,one else? Visits to friends or re la t ives~ Household budget? Having another child? Children's education? Children's marriage plans? Use of family planning methods? Wife's employment? HUSB WIFE BOTH OTHER VISITS TO FRD/RL.1 2 3 4 HOUSEHOLD BUDGET.1 2 3 4 HAVIRG CHILD . 1 2 3 4 CHILD=S EDUC . 1 2 3 4 CHILD=S MARR . 1 2 3 4 FAMILY PLANNING.1 2 3 4 WIFE'S EMPLOYH'T.I 2 3 4 5-3 279 SECTION B. PREGNANCY AND BREASTFEEDiNG CHECk 222: ORE OR @(ORE BIRTHS SINCE JANUARY 1987 BO BIRTHS SINCE JAN~RY 1987 • (SKIP TO 644) ~2 m ENTER THE LIME NLINBER~ NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. BEGIN WITH I THE LAST BIRTH AND RECORD THINS OR TRIPLETS IN SEPARATE COLUMNS. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN MITH THE LAST EZRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS). No~ I w~uLd like to ask you soe~ more questions about the health of all your children born in the past five years. (We will talk about one child at a time.) 603 I LIME HUMBER FROR O. 212 I FROM g. 212 AND O. 216 m At the time you became pregnant with (NAME), did you want to become pregnant (h9 n, did you I want to walt until Later or did you want no (~re) children at ell? M LAST BIRTH NAME ALIVE [~ DEAD E~ v im~lJll~l v THEN . 1]1 (SKIP TO 6OS)q LATER . 2 NO MORE . 31 (SK P TO 605 • / NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH gAME NAME ALIVE [~] DEAD [~ ALIVE [~ DEAD [~ v m v v m m m m v m LATER . 2 LATER . 2 (SKIP TO 605 4 3] NO MORE . 3] ISKIP TO 605), | °1 How much to?,ger Would you Like to have waited? MONTHS . 1 i l l YEARS . 2 DON'T KNOW . 998 MONTHS . 1 i l l []D YEARS . 2 OON~T KNOt,/ . 998 MONTHS . 1 I l l l YEARS . 2 DON'T KNON . 998 | 605 Mhen you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? RECORD ALL PERSONS SEEN. HEALTH PROFESS)aNAL DOCTOR . A MURSE/J4IDW [ FE . B OTHER PERSON TRAD [ TIORAL BIRTH ATTENDANT . C OTHER D (SPECIFY) WO ONE . E (SKIP TO 609)" HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B OTHER PERSON TRADITIONAL BIRTH ATTENDANT . C OTHER D (SPECIFY) HO ONE . . . . . . . . . . . . . . . . . . . . E 1 (SKIP TO 609)~ / HEALTH PROFESSIONAL DOCTOR . A NURSE/MiDWIFE . B OTHER PERSON TRADITIONAL BIRTH ATTENDANT . C OTHER D (SPECIFY) NO ONE . E (SKIP TO 609)4 606 I tJhere did yOU receive this I enten~ltai care? PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR GVT. HOSPITAL . A BVT. HOSPITAL . A GVT. HOSPITAL . A GVT, HEALTH UNIT . B BVT, HEALTH UNIT . B GVT. HEALTH UNIT . B PRIVATE SECTOR PRIVATE SECTOR PRIVATE SECTOR PVT. HOSPITAL/CLINIC.,C PVT. HOSPITAL/CLINIC.C PVT. HOSPITAL/CLIHIC.,.C PVT. DOCTOR . D PVT. DOCTOR . D PVT. DOCTOR . D OTHER ~ ,E OTHER ~ .E OTHER ~ .E +1 " ' '+- '+°++' ° '+ . were yo~ ~hen you first MONTHS . MONTHS . saw s ~ for mn mntenataL check on this pregnancy? DON'T KNON . 98 DON T KNO~ . 98 DONmT KNO~ . 98 I 6-1 280 608 Now many antenata( visits did you have during this pregnancy? LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME NO. OF VISITS . ~-~ OORIT KNOW . 98 SECOND-FROM-LAST BIRTH NAME NO. OF VISITS . I l l DORIT KNOW . 98 609 k~en you uere pregnant with (tc~J4E) were you given YES . 1 YES . 1 YES . 1 an injection in the arm To , r . - -h .by , r . RO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2T NO . . . . . . . . . . . . . . . . . . . . . . . 21 getting tetanus, that is, (SKIP TO 611), 8] (SKIP TO 611), 8] (SKIP TO 611)* convulsion= after birth? DON=T KNO~ . DON'T KNOW . DON~T KNON . 610 Dur ing this pregnancy [] [] [~ how many times did you get TINES . TIMES . TINES . this Injection? DON~T KNOW . 8 DON~T KNOW . 8 DONJT KNOW . D 611 Where did you give birth to (NAME)? HONE YGUR HOME . 11 OTHER HONE . 12 PUBLIC SECTOR GVT. HOSPITAL . 21 GVT. HEALTH UNIT . 22 PRIVATE SECTOR PVT. HOSPITAL/EL %NIC,, .31 OTHER 41 (SPECIFY) HONE YOUR HONE . 11 OTHER HOME . 12 PUBLIC SECTOR GVT. HOSPITAL . 21 GVT. HEALTH UNIT . . . . . . . 22 PRIVATE SECTOR PVT. HOSPITAL/CLINiC.31 OTHER 41 (SPECIFY) HONE yOUR HOWE . 11 OTHER HONE . 12 ~UBL 1C SECTOR GVT. HOSPITAL . 21 GVT, HEALTH UNIT . 22 PRIVATE SECTOR PVT. HOSPI TAL/CLINIC.31 3THER 41 (SPECIFY) 612 ~/ho assisted Mith the delivery of (NAME)? Anyone etse? PROdBE FaN THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. HEALTH PROFESSIONAL DOCTOR . A NURSE/MKDWXFE . S OTHER PERSON TRADITIONAL BIRTH ATTENDANT . C RELATiVES/FRiENDS . D OTHER E HEALTH PROFESSIONAL DOCTOR . A NURSE/MIDWIFE . B OTHER PERSON TRADITIONAL BIRTH ATTENDANT . C RELATIVES/FRIENDS . O OTHER E HEALTH PROFESSIONAL DOCTOR . A NURSE/N]DW%FE . B OTHER PERSON TRAD[T]ONAL BIRTH ATTENDANT . C RELATIVES/FRiENDS . D OTHER E (SPECIFY) (SPECIFY) (SPECIFY) NO ONE . F NO ONE . F HO ONE . F 613 | Was (NAME) born on time ON TIME . 1 ON TIME . 1 ON TIME . I I or prematurely? PREMATURELY . 2 PREMATURELY . 2 PREMATURELY . 2 DON IT KNOW . 8 DONIT KNOW . 8 DON JT KNOW . S 614 IWas (NAME) detiveredby caesarian section? [ YESI40 . . 21 MQYES . . 21 [ YESNo . . 211 615 ~aaWhenhe/she:(NAME) was born. DON'T KNOW . 8 vary Large e VERY LARGE . 1 VERY LARGE . 1 VERY LARGE . 1 Larger than average, LARGER THAN AVERAGE . 2 LARGER THAN AVERAGE . 2 LARGER THAN AVERAGE . 2 average, AVERAGE . 3 AVERAGE . 3 AVERAGE . 3 fdllt(er than average e SMALLER THAN AVERAGE . 4 SMALLER THAN AVERAGE . 4 SMALLER THAN AVERAGE . 4 or very snaiL? VERY SMALL . 5 VERY SMALL . S VERY SMALL . S OON JT KNOW . 8 DON'T KNOW . D 6-2 281 El 616 I LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM'LAST BIRTH NAME NAME NAME YES . 1 YES . ] YES . 1 NO . 2 NO . 2~ NO . 2 (SKIP TO 61B)" l (SK P TO 620)¢ / (SKIP TO 620) ¢ l 6" l ' "h° I ° ( ' ) " ' " ' K ID KIL RAkS F1 __ nF l KILOGRAMS . . ~ KILOGRAMS . • . . DONIT KNOW . 98 J DON*T KNOW . 98 DONIT KNOW . 98 618 I Has your period returned YES . 1T I since the birth of INANE)? (SKIP TO 620)e / NO.,, . ,,., . 2 620 622 626 ENTER "X" IN COL,3 OF CALENDAR IN ~K)NTN AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH (Cll TO CURRENT PREGNANCY) I For how many months after the birth of (NAME) did you not have a period? Have you resumed sexual relations since the birth of (WAKE)? 621) (SKIP TO ENTER "X ml IN COL.3 OF CALENDAR FOR THE HUMBER OF $PECIF]ED MONTHS WITHOUT A PERIOD, STARTING IN THE MONTH AFTER BIRTH. IF LESS THAN ONE MONTH WITHOUT A PERIOD, ENTER "O" IN COL.3 IN MONTH AFTER BIRTH. PREGNANT OR UNSURE v~ (SKIP TO 626) YES . 1 ~,1 (SKIP TO 624), I! MO . Z ENTER "X" IN COL.4 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH N~TH TO CURRENT 140NTH, (SKIP TO 625) I For how many months after the birth of (NAME) did you not have sexual relations? . ENTER "X" IN COL.4 OF CALENDAR FOR THE HUMBER OF SPECIFIED MONTHS WITHOUT SEXUAL RELATIONS, STARTING IN THE MONTH AFTER BIRTH. IF LESS THAN ONE MONTH VITHI~JT SEXUAL RELATIONS, ENTER "0" IN COL,4 OF CALENDAR IN THE MONTH AFTER BIRTH. 625 I Did you ever I breastfeed (MANE)? YES . 1 1 (SKIP TO 626)- I NO . 2 ENTER "R" IN COL.5 OF CALENDAR IN MONTH AFTER BIRTH YES . (SKIP TO 636)q llj YES . (SKIP TO 636)q I] NO . 2 J NO . E 6-3 282 627 ~ny did you ~t breastfeed (NAME)? LAST BIRTH MOTHER ILL/UEAK . 01 CHILD ILLIVEAK . 02 CHILD DIED . O] NIPPLE/BREAST PROBLEM.04 INSUFFICIENT MILE . 05 MOTHER ~ORKING . 06 CHILD REFUSED . 07 OTHER 08" (SPECIFY) (SKIP TO 638)' NEXT-TO-LAST BIRTH NAME MOTHER ILL/k~EAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . 03 NIPPLE/BREAST pROBLEM.04 INSUFFICIENT MILK . 05 MOTHER bK)RKING . 06 CHILD REFUSED . 07 OTHER 0~ (SPECIFY) (SKZP TO 638)' SECOND-FR~-LAST BIRTH MARE MOTHER ILL/INEAK . 01 CHILD ILL/WEAK . OZ CHILD DIED . 03 NIPPLE/BREAST PRDDLEM.,.04 INSUFFICIENT MILK . 05 MOTHER k~ORKING . . . . . . . . . . 06 CHILD REFUSED . 07 OTHER 08 (SPECIFY) (SKIP TO 638)" 628 630 632 633 HOW ((mg after birth did you flrlt put (liAR) to the breast? IF LESS THAN 1 HOUR, RECORD IDOl NOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Are you s t t t i breast- feeding (NAME)? IMMEDIATELY . ODD HOURS . 1 ~ DAYN . 2 DEn [~ y v (SKIP TO 636) YES . I HO. .* . . . . . .o . . . . . . . . . . . . 2 (SKIP TO 636)" ] ENTER "X" IN COL.5 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH. I Now many times dld yOU breastfeed test night betv4Den sunset and sunrise? I F ANSk~R IS lIOT NUMERIC, PROBE FOR APPROXIMATE NUMBER HUM,. OF M NIGHTTIME FEEDINGS I Nou many times dld you brasst feed yesterday ~'r i~ the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER NUMBER OF ~-~ DAYLIGHT FEEDINGS 6-4 283 634 At any tim yesterday or test night was (NAME) given a~y of the fottowlr~?: !Pieln Mater? !Sugar Miter? Juice? i HerbaL Test :Baby formuLa? Fresh milk? Ttnr~ or powder~ milk? OTher Liquids? AnyRmhy or solid food? CHECK 634: FOOD ON LiI~JID GIVEN YESTERDAY? LAST BIRTH NAME YES NO PLAIN UATER . 1 2 SUGAR UATER . 1 2 JUICE . 1 2 HERBAL TEA . 1 R BABY FORMULA . 1 2 FRESH MILK . 1 R TINNED/I~ENED MILK.1 2 OTHER LIQUIDS . 1 Z MUSHY/SOLID FOOD . 1 2 NEXT-TO-LAST BIRTH NN4E SEC~O-FR~-LAST BIRTH GAI~ "YES" TO 639) ONE OR HRO" TO ALL v (SKIP TO (SKIP TO 640) ENTER "X" IN COL.5 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS OF BREASTFEEDING, STARTING IN THE MONTH AFTER BIRTH. IF BREASTFED LESS THAN ORE MONTH, ENTER "O" %N COL.5 %N MONTH AFTER BIRTH. 637 Why did you stop breestfeedir~ (NANE)? MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DiED . 03 NiPPLE/BREAST PROBLEM.04 INSUFFICIENT MILK . OS MOTHER WORK%NG . 06 CHILD REFUSED . 07 WEAMING AGE . OB BECAME PREGNANT . 09 STARTED USING CONTRACEPTION . 10 OTHER 11 (SPECIFY) MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . 03 NIPPLE/BREAST PROBLEM.,.04 [NSUFFIC%ENT MILK . 05 MOTHER WORKING . 06 CH%LD REFUSED . 07 WEANING AGE . OB BECAME PREGNANT . 09 STARTED USING CONTRACEPTION . 10 OTHER 11 (SPECIFY) MOTHER ILL/WEAK . 01 CHILD ILL/WEAK . 02 CHILD DIED . 03 N%PPLE/BREAST PROBLEM.04 IHSUFFIC%ENT MILK . 05 MOTHER WORKING . 06 CHILD REFUSED . 07 WEANING AGE . 08 BECAME PREGNANT . 09 STARTED USING CONTRACEPTION . 10 OTHER 11 (SPECIFY) 6-5 284 LAST BIRTH ] NEXT-TO-LAST BIRTH ] SECOND-FRON-LAST BIRTH NAME NAME NAME 639 CHECK 216: CHILD ALIVE? I Was (NAME) ever given water or anything else to drink or eat (other than breastmiLk)? ALIVE ~v DEAD (SKIP TO 6/.01 YES . . . . . . . . . . . . . . . . . . . . . . I NO . 2 7 (SKIP TO 6~3), I ALIVE@v DEAD~ (SKIP TO 640) V YES . . . . . . . . . . . . . . . . . . . . . . I NO . (SKIP TO'~3) " . ,,21 ALIVE [~v DEAD ~ J (SKIP TO 640) V YES . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . 21 | (SKIP TO 643), J | 640 How many months otd was (NAME) when you started giving the following on a regu(ar basis?: Formula or milk o ther than breastmi tk? Plain water? Other tiquids? AGE IN MONTHS . I l l NOT GIVEN . . . . . . . . . . . . . . . 96 AGE IN MONTHS . [ I NOT GIVEN . . . . . . . . . . . . . . . 96 F-~ AGE IN MONTHS . I I I NOT GIVEN . . . . . . . . . . . . . . . 96 AGE IN MONTHS . 1 [1 NOT GIVEN . 96 AGE IN MONTHS . I l l NOT GIVEN . . . . . . . . . . . . . . . 96 I----I"--'3 AGE IN MONTHS . . . . . . . I l l NOT GIVEN . . . . . . . . . . . . . . . 96 AGE IN MONTHS . . . . . . . I I NOT GIVEN . . . . . . . . . . . . . . . 96 F ~ AGE lN MONTHS . . . . . . . I I NOT GIVEN . 96 AGE IN MONTHS . I I NOT GIVEN . 96 Any mushy or solid food? AOE lN MONTNg . . . . . . . AGE IN MONTHS . . . . . . . AGE IN MONTNS . . . . . . . NOT GIVEN . 96 NOT GIVEN . 96 NOT GIVEN . 96 IF LESS THAN 1 MONTH, RECORD '00'. CHECK 216: CHILD ALIVE? (SKIP TO 643) (SKIP TO 643) ALIVE (SKIP TO 643) il]iiiil]iiiiiiil]iiiiiiiiiiil]iffil]iiiiiiiiiiii]i]ill]llllllllllffffffffffff [[[[[[[[[[[l[ffffffffffffffffffff~[ff~Z~Z~ffffffff[~ff[~ff~[[[[[~:'"'[ !ff i i ffff!ffffffff=ffff:. ;.'=,:':'~=':==~!!!=:~!!!~ - , , , , r ,.u:~m:z!= i !, , , , .z::':::~:::~!:~ff~ff~ff~ffff~ffi~ffff~ffi=ii, , :: from a bott le with ~ n i~ le NO . . . . . . . . . . . . . . . . . . . . . . . 2 =========~,~, , ,S ;=,~=~,~=¥: : : ' :=~:~=:%:~:~:~=J : ;~: :=~=~ ii iiiiiiiiiiiiiiiiiii~iiiiiiiiiiiii;ii!i2!.~:=:.:::~:~]~:] ==== . . '"'" '",':"=========::'=" ' '~ I 643 GO BACK TO 603 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 644. 6-6 285 NO. 645 QUESTIONS AND FILTERS CHECK 215: ANY BIRTH IN 1984, 1985, OR 1986? YES [~ v NAME OF LAST BIRTH PRIOR TO JANUARY 1987: (NAME) NO Did you ever feed (NAME) at the breast? SKIP COOING CATEGORIES I TO I ,.649 I YES . 1 I I NO . 2 .647 I I I 646 I How many months did you breastfeed (NAME)? I MONTHS . I I ) no__. I 0,0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (#*8 For how many months after the birth of (NAME) I MONTHS . F-~ did you not have sexual relations? I I I I NOT RESUMED . 96 649 What should be the first food or Liquid a baby gets after birth? BREAST MILK/COLOSTRUM . I SUGAR WATER . 2 INFANT FORMULA . 3 HONEY . 4 HERBAL TEA . 5 OTHER 6 (SPECIFY) 650 What health problems might be caused by bottlefeeding? RECORD ALL MENTIONED. UNSANITARY WATER USED TO MIX FORMULA . A FORMULA DILUTED SO BABY NOT ADEQUATELY NOURISHED . B COLIC . C DIARRHEA . D pOOR WEIGHT GAIN . E TOOTH DECAY . F OTHER G (SPECIFY) NONE/DON'T KNOW . H 651 HOW old should an infant before he/she is first given other foods or liquids in addition to breastmitk? NO BIRTHS SINCE JANUARY 1987 v MONTHS . ~F~ DON'T KNOW . 98 I 6-7 286 701 (1) COPY VACCINATION DATES FOR EACH VACCINE EROR THE CERTIFICATE. (2) WRITE '461 IN IDAYI COLLNB IF CERTIFICATE SHOWS THAT A VACCINATIOR WAS GIVEN, BUT NO DATE RECORDED. BCG POLIO 1 POLIO E POLIO 3 UPT I OPT 2 OPT 3 MEASLES HEPATITIS 1 HEPATITIS E HEPATITIS 3 J LINE NUMBER FROM 0. 212 I 702 | DO you have a birth certificate I where (NANE,S) vaccinations are written down? IF YES: May I see It, pLease? I ENTER THE LIME NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. BEGIN WITH THE LAST BIRTH. RECORD TWINS OR TRIPLETS IN SEPARATE COLUi4NS. ASK THE QUESTIONS ABDUT ALL Of THESE BIRTHS. BEGIN WiTH THE LAST BIRTH. (IF THERE ARE )lORE THAN 3 BIRTHSj USE ADDITIONAL FORMS). M m LAST BIRTH NEXT'TO'LAST BIRTH NAME NAME ALIVE [ ~ v m v DEAD [~ ,, ALIVE vE ~mmmllmmOEAD ~ v YES, SEEN . Ii YES, SEEN . I- (SKIP TO T04)9 ! (SKIP TO 706), YES, NOT SEEN . 2Tr YES, NOT SEEN . 2. (SKIP TO 706)~ |" (SKIP TO 700)¢ NO CARD . 3 NO CARD . 3 M SECOND" FROM" LAST BIRTH NAME ALIVE [~ DEAD YES, SEEN . J (SKIP TO 704)q I YES, NOT SEEN . 2 (SKIP TO706)q NO CARD . 3 o3 io ,oy+_ ,+. . ,ES . ,) YEs . '1 "+ . '11 vacclrmt|c41 certificate for NO (SKIP TO 706)q 2 (SNIP TO 706), (SKIP TO ;'06)• (MANE)? . NO . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 704 DAY BCG Pl PE P3 ~2 ~3 MEA H1 1t2 H3 NO YR MO YR DAY BCG Pl P2 P3 D1 D2 D3 HEA H1 HE H3 DAv 140 BCG P1 P2 P3 01 02 03 MEB H1 H2 H3 YR SECTION 7. IMMUNIZATION AND HEALTH 705 Has (NAME) received any vacclrmtions that are not recorded on this certificate? RECORD IYESI ONLY IF RESPONDENT MENTIONS BCG, DPT 1-3, POLIO 1"3~ HEPATITIS 1-3 AND/OR MEASLES VACCINE(S). YES . 1- (PROaE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY q-- COLUMN IN 704) NO. . ,,. . 2- DOM nT KNOW . (SKIP TO 708) 4 YES . 1, (PRONE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY ,- COLUMN IN 704) NO . 2 DON'T KNOW . (SKIP TO 708) • YES . 1 (PRONE FOR VACCINATIONS | AND WRITE i(~i IN THE J CORRESPONDING DNY • COLUMN IN 704) NO . , . .~ DON IT KNOW . (SKIP TO 708) 4 7-1 287 706 I Did (WANE) ever receive aW vaccirmtlons to prevent hint/her from getting diseases? LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FRON'LAST BIRTH NN4E NAME NAHE YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 NO . 2 NO . 2 LSKP,O,O ,. DON~T KNOW . DON'T KNOW . DON'T KNOW . 707 PLease tell me if (NNqE) (has) receLved any of the following vaccinati~s: A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that caused 8 scar? Polio vaccine, that IS, dr(~os in the mouth? IF YES: No~ many times? A OPT in}action? IF YES: HOW many times? An injection against ~asLes at nine months? An injection against hepatitis? IF YES: Now many times? CHECK 216: CHILD ALIVE? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . 8 YES . I NO . i DON T KNOW . 8 NUMBER OF TIMES . YES . % NO . DON*T KNOU . 8 NUMBER OF TIMES . YES . 1 NO . DON'T KNOW . 8 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . DON'T KNOW . B NUMBER OF TIMES . . . . . . . . ,.NE@v OE,D (SK IP TO 7101 YES . 1 NO . DON'T KNOW . 8 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . 2 DON~J KNOW . B NUMBER OF TIMES . YES . 1 NO . 2 DON~T KNOW . 8 OF TIMES . NUMBER YES . I NO . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . 8 YES . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . 8 NUMBER OF TIMES . ,L,VE v DE,D? (SKIP TO 710) v rio BACK TO 702 FOR NEXT BIRIM; OR, IF NO MORE BIRTHS, SKiP TO 74D. YES . 1 NO . 2 OONIT KNOW . . . . . . . . . . . . . . . 8 YES . 1 NO . DON'T KNOW . 8 NUMBER OF TIMES . [~1 YES . NO . 2 DON'T KNOW . B OF TIMES . NUMBER YES . I NO . 2 DONtT KNOW . B YES . I NO . 2 DON~T KNOW . 8 NUMBER OF TIMES . . . . . . . . [ ~ L~ ALIVE @v DEAD ? (SKIP TO 710) v 710 | Has (NAME) bee~ ill with I a fever at any time i n the Last 2 weeks? 711 | Has (NAME} been 1Lt with I a COUgh at any time in the Last 2 weeks? YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . I NO . 2 NO . 2 NO . 2 DON'T KNOW . B DON'T KNOW . 8 DON'T KNOW . B YES . 1 YES . 1 YES . 1 NO . ~ . 2] NO . , , . . . L~2 NO . 21 (SKIP TO 715) - - (SKIP TO 715)" ~ (SKIP TO 71S)4 DON'T KNOW . B J DON'T KNOW . .BJ DON'T KNOW . 7-2 288 I 712 | Has (NAME) been iLL with I a cough in the last 24 hours? LAST BIRTH NEXT-TO-LAST BIRTH NAME NAME YES . 1 YES . 1 NO . 2 NO . 2 DON'T KNOW . 8 DON'T KNOW . 8 SECOND- FROM" LAST BIRTH I NAME YES . 1 | I NO,.,. . DONIT KNOW . 8 cough tasted/did the cough DAYS . DAYS . DAYS . Last)? IF LESS THAN I DAY, RECORD =DO' 714 I w.~ (NAJ4E) had the I (((ness with a cough, did he/she breathe faster than usual with short, rapid breaths? 716 | Was anything given to treat I the fever/cough? YES . 1 NO . 2 DON'T KHON . O CSP TO 720) YES.~ . 1 NO . (SKIP TO 718)q DON't KNOW . & YES . 1 NO . 2 DON'T KNC~d . 8 "YES" IN EITHER 710 OR 711 OTHER %sxiP TO 720) YES . 1 NO . 2- (SKIP TO 718)4 DON'T KNOW . YES . 1 NO . Z DON'T KNOW . B "YES" IN EITHER 710 OR 711 OTHER TO 720) YES . 1 NO . "1 (SKIP TO 718)4 DON'T KNOW . 8 J 717 What was given to treat the fever/cough? Anything else? RECORD ALL MENTIONED. INJECTION . A ANTIBIOTIC (PILL OR SYRUP) . B COUGH SYRUP . C OTHER PILL OR SYRUP . D UNKNONN PILL OR SYRUP.E HONE REMEDY/ HERBAL MEDICINE . F OTHER G INJECTION . A ANTIBIOTIC (PILL OR SYRUP) . B COJGH SYRUP . C OTHER PILL OR SYRUP . D UNKNOWN PILL OR SYRUP,.E HOME REMEDY/ HERBAL MEDICINE . F OTHER G INJECTION . . . . . . . . . . . . . . . . A ANTIB]OTIC (PILL OR SYRUP) . B COUGH SYRUP . C OTHER PILL OR SYRUP . O UNKNOWN Pill OR SYRUP.E HOME REMEDY/ HERBAL MEDICINE . F OTHER G (SPECIFY) (SPECIFY) (SPECIFY) r . I 718 Bid you seek advice or YES . 1 YES . 1 treatment for the fever/cough? NO . NO . NO . ? (SKIP TO 720)4 (SKIP TO 720), (SKIP TO 720)q 719 Where did you seek advice or treatment 9 Anywhere else? RECORD ALL MENTIONED. PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B MEDICAL PRIVATE SECTOR PVE. HOSPITAL/CLINIC.,C PRIVATE DOCTOR . D PHARMACY . E OTHER PRIVATE SECTOR TRADITIONAL PRACTITIONER . F RELATIVES/FRIENDS . G OTHER H (SPECIFY) PUBLIC SECTOR GVT, HOSPITAL . A UVI. HEALTH UNIT . S MEDICAL PRIVATE SECTOR PVT, HOSPITAL/CLINIC.C PRIVATE DOCTOR . . . . . . . . . . D PHARMACY . E OTHER PRIVATE SECTOR TRADITIONAL PRACTITIONER . F RELATIVES/FRIENDS . G OTHER H (SPECIFY) PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.C PRIVATE DOCTOR . D PHARMACY . E OTHER PRIVATE SECTOR TRADITIONAL PRACTITIONER . F RELATIVES/FRIENDS . G OTHER H (SPECIFY) 7-3 289 720 I I Has (WANE) had diarrhea in the tamt two weeks? LAST BIRTH NANE YES . '; . 1 1 (SKIP TO 722); / NO . 2 DONIT KNOW . 8 NEXT-TO-LAST BIRTH SEOOND-FRON-LAST BIRTH l i NAME NAME YES . (SKIP TO 722), 1- YES . (SKIP TO 722I 4 1] I NO . NO . 2 DON~I KNOW . DON'T KNOW . B GO BACK TO 702 F(~ NEXT BIRTH; OR, IF NO MORE BIRTHS, SKIP TO 740. 722 I Ha, (NANE) had diarrhea YES . 1 YES . 1 YES . 1 m I in The Last 24 hours? NO . 2 NO . 2 NO . 2 I DOW'T KNOW . 8 DON'T KNOW . 8 DON'T KNOW . 8 72, ,o. h . .ny °.y. Th. diarrhea tasted/did DAYS . DAYS . DAYS . The diarrhea test}? IF LESS THAN 1 DAY, RECORD IOOI. 724 Was there any blood YES . 1 in the stools? NO . 2 726 During (NANE)'S diarrhea, did you change the frequency of breastfeeding? DON'T KNOW . . . . . . . . . . . . . . . 8 NO (SKIP TO 72B) V YES . I NO . 2 1 (SKIP TO 728)" / YES . 1 HO . 2 DON'T KNOW . 8 (SKIP TO 728) YES . 1 NO . 2 DON'T KNOW . D (SKIP TO 728) 727 m Did you increase The number of INCREASED . . . . . . . . . . . . . . . . , i I breasTfeeds or reduce Them, REDUCED . . . . . . . . . . . . . . . . . . 2 I or did yo~J STO0 comDteTe{y? STOPPED COt~PLETELY . 3 728 (Aside from braes(miLk) | Was he/she given the same SANE . 1 SAME . 1 SAME . 1 I amount TO drink as before MORE . 2 MORE . 2 MORE . 2 the diarrhea, or more, or LESS . 3 LESS . 3 LESS . 3 tess? GIVEN BREASTMILK ONLY.4 GIVEN BREASTMILK ONLY.4 GIVEN BREASTMILK ONLY.+.4 DON'T KNO~4 . B DOH~T KNOW . 8 DON'T KHO~ . . . . . . . . . . . . . . . B 729 Was anyThing given TO TreaT YES . 1 YES . 1 YES . l J the diarrhea? NO . ~2 NO . =12 NO . 2 (sx,P TO ~L, . / (sK,p TO ~1>. / (SN,P ,0 ~1>, DON'T KNOW . 8] DON'T KNOW . . . . . . . . . . . . . . . 8 J DON'T KNOW . 7-4 290 730 What was given To treat the diarrhea? Anything else? RECORD ALL MENTIONED. LAST BIRTH NANE MAHLOUL MOALGEI EL'GAFFEF . A HOMEMADE SUGAR, SALT AND MAYER SOLUTION . R ANT/BIOTIC (PILL OR SYRUP) . C OTHER PILL OR SYRUP . D INJECTION . E (I.V.) INTRAVENOUS . F HOME REMEDIES/ HERBAL MEDICINES . G OTHER H NEXT-TO-LAST BIRTH RAHE MAHLOUL MOALGET EL-GAFFEF . A HOMEMADE SUGAR, SALT AND WATER SOLUTION . B ANTIBIOTIC (PILL OR SYRUP) . C OTHER PILL OR SYRUP . D INJECTION . E (I.V.) INTRAVENOUS . F HO~4E REMEDIES/ HERBAL MEDICINES . G OTHER H SECONO-FROH-LAST BIRTH NAHE MAHLOUL MOALGET EL-GAFFEF . A HOMEMADE SUGAR, SALT AND WATER SOLUTION . B ANTIBIOTIC (PILL OR SYRUP) . C OTHER PILL DR SYRUP . D INJECTION . E (].V.) INTRAVENOUS . F HOME REMEDIES/ HERBAL MEDICINES . G OTHER H (SPECIFY) (SPECIFY) (SPECIFY) "/31 ] Did you seek advice or YES . 1 YES . 1 YES . 1 treatg~nt for the NO . 2 l I diarrhea? NO . 2 NO . 2 (SKIP TO 7"~])4 (SKIP TO 733)4 l (SKIP TO 73])4 ] 732 Where did you seek advice or treatment? Any~ere else? RECORD ALL NENT]ONED. 7'33 CHECK 73"30: NAHLOUL NOALGET EL- GAFFEF MENTIONED? PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B REDICAL PRIVATE SECTOR PVT. HOSPITAL /CL]N IC . . . .C PRIVATE DOCTOR . D PHARMACY . E 3THER PRIVATE SECTOR TRADITIONAL PRACTITIONER . F RELATIVES/FRIENDS . G 3THER H (SPEC] FY) NO, 14AHLOUL EL'GAFFEF EL'I NOT MENTIONED MEN' (SKIP v PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B HEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.,C PRIVATE DOCTOR . D PHARMACY . . . . . . . . . . . . . . . . E DTHER PRIVATE SECTOR TRADITIONAL PRACTITIONER . F RELATIVES/FRIENDS . G 3THER H (SPECIFY) YES, NO, YES, MAHLOUL MAHLCOL MAHLOUL EL'GAFFEF EL-GAFFEF EL'GAFFEF MENTIv[~NED NOT MENTIONED MENTIv~ED TO ~5 v (SKIP TO 735) PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC.C PRIVATE DOCTOR . O PHARMACY . E OTHER PRIVATE SECTOR TRADITIONAL PRACTITIONER . F RELATIVES/FRIENDS . G OTHER H (SPECIFY) NO, YES, MAHLOUL MAHLOUL EL'GAFFEF EL'GAFFEF HOT MENTIONED MENTIONED (SKIP TV[~0735: v 734 735 Was (NAME) given mahtouL maLget et-gaffef when he/she had The diarrhea? For how nmny days was (NAME) Riven rnahLout moatget el-gaffef? IF LESS THAN 1 DAY, RECORD '00'. YES . 1 YES . 1 NO . Z NO . Z (SKIP TO 736). 8] (SKIP TO 7"56). ~ DON~T KNOW . DON~T KNOW . DAYS . ~ DAYS . ~ ] ~ DOHIT KNOW . 98 DONIT KNOW . 9B YES . Ill NO . 2 (SKIP TO 736)" DON~T KNOW . 8 DAYS . ~]~t DONIT KNOW . 98 I 7-5 291 736 I CHECK 730: HOMEMADE SUGAR, SALT AND WATER SOLUTION MENTIONED? 7~7 m Was (MANE) given • soIutlon I frran sugar, satt and water k4~en he/she he~J the diarrhea? LAST BIRTH NAME NO, YES, HOME SOL~R HOME SOL'R NOT MENTIONED NENTIv~ED E~ (SKIP TO 738) ¥ YES . 1 NO . 2 (SKIP TO ~9)q | DOM'T KNOW . 8J NEXT-TO-LAST BIRTH NAME NO, YES, HOME SOL'H HO~4E SOL'R NOT MENTIONED MENTIONED [~ (SKIP TV[~07"381 v SECONO'FROR'LAST BIRTH NAME NO, YES, HOtlE SOL'N HORE SOL'N NOT MENTIONED MENTIONED (SKIP TV~o ~81 v YES . 1 YES . 1 NO . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO T~9). ~ (SKIP TO T39)" ~ DON~T KNOM . DON'T KNOW . 738 For how many days was (NAME) given the sotution made from sugar, salt and water? IF LESS THAN 1 DAY, RECORD 'SO'. DAYS . DON'T KNOW . 98 DAYS . DON'T KNO~ . . . . . . . . . . . . . . 98 GO BACK TO 702 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 740, DAYS . [ ~ DON'T KNOM . 98 7-6 292 NO. 741 QUESTIONS AND FILTERS COOING CATEGORIES CHECK 730 AND 734 (ALL COLUMNS): SKIP I ~'743 MAHLOUL MOALGET I EL-GAFFEF [~ GIVEN TO MAHLOUL MOALGET EL-GAEEEE ~ q ~ A N Y CHILD NOT GIVEN TO ANY CHILD I Have you ever heard of a speciat product called mahtout I YES . 1 I moatget et-gaffaf you can get for the treatment of I I diarrhea? NO . 2 ~801 ,,21 M'v"°u'ver ore~°r°O''°u' °'Lget e"~af'a' t ° t r o , t O,,rrhoa ,o ,our,e,, or soooe e,se~ I Y~s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' l NO . 2 ~801 "~1 ''''''~'~°°~°~'°°~'°°'°~'~' I ~°~'°~ . ~1 gaffaf did you prepare the whore packet at once or only part of the packet? PART OF PACKET . 2 744 How much water did you use to prepare rnahtoul moa(get et-gaffaf the fast time you made it? 1\2 LITER . 01 1 LITER . 02 1 1\2 LITERS . 03 2 LITERS . 04 FOLLOWED PACKAGE INSTRUCTIONS.05 OTHER 06 (SPECIFY) DON'T KN(ZX4 . 98 7-7 293 NO. I SECTION 8. MARRIAGE QUESTIONS AND FILTERS Now I would like to ask some questions about your marriage(s). Row many times have you been married? SKIP I COOING CATEGORIES I TO I . . . . . . . . . . . . . . . 802 In what nmnth and year did you first enter into a marriage contract? MONTH . ~--~ DON'T KNOW MONTH . 98 YEAR . ~--~ DON'T KNOW YEAR . 98 803 Hew aid were you when you first entered into a nmrriage contract? I AOE . . . . . . . . . . . . . . . . . . . . . . . . I DONIT KNOW AGE . 98 804 In whet month arKJ year did you start living with your (first) husbarvd? .ONTR . . . . . . . . . . . . . . . . . . . . . . J DON'T KNOW MONTH . 98 YEAR . ~ DON'T KNOW YEAR . 98 805 806 807 808 How old were you when you started Living together with your (first) husband? CHECK 804 AND 805: YEAR AND AGE GIVEN? YES 9 v RECORD CURRENT YEAR IN BOX ON RIGHT AND COMPLETE THE FOLLOWING IN ORDER TO CHECK THE CONSISTENCY OF 804 AND 805: YEAR OF BIRTH (102) ~-~ PLUS + AGE AT HARRIAGE (805) I I I CALCULATED YEAR OF MARRIAGE I l l I l l AGE . II] DON'T KNO~J AGE . 98 I F NECESSARY, CALCULATE YEAR OF BIRTH CURRENT YEAR ~T~ MINUS CURRENT AGE (103) F I I CALCULATED YEAR OF BIRTH ,808 I IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (804)? YES NO [T~ ~ ,PROBE AND CORRECT 804 AND 805. V DETERMINE MONTHS MARRIED OR IN UNION SINCE JANUARY 1987. ENTER "X" IN COLUMN 6 OF CALENDAR FOR EACH RONTN MARRIEO OR IN UNION, AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE JANUARY 1987. FON W(~4EN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PRONE FOR DATE COUPLE STOPPED LIVING TOGETHER OR DATE WIDOt#ED, AND FOR STARTING DATE OF ANY SU8SEQUENT UNION. 294 8-1 NO. I 809 810 QUESTIONS AND FILTERS CHECK COLUMN 6 OF CALENDAR: IN MARITAL NOT IN MARITAL UNION AT ANY UNION AT ANY TIME TIME SINCE r-'-t SINCE JANUARY JANUARY 1987 vL~ 1987 II Since January 1987, did you and your husband ever live apart (without visiting) for more than one month because of work, school or for any other reason? (IF WOMAN HAD MORE THAN ONE HUSBAND DURING THE PERIOO, CIRCLE COOE Jl a (YES) IF SHE LIVED APART FROM ANY OF OF HER HUSBANDS FOR MORE THAN ONE MONTH.) COOING CATEGORIES YES . 1 MO . . . . ,. . . . . . . . . . . . . . . . . . . o . ° . . 2 USE CALENDAR TO PROBE FOR ALL PERIODS THE k'OMAN LIVED APART FROM HER HUSBAND(S) SACK TO JANUARY 1987. ENTER 'X' (MOT SEPARATED) OR THE COOE FOR THE TYPE OF SEPARATION IN COLUMN 7. IF THE WOMAN MARRIED FOR THE FIRST TIME SINCE JANUARY 1987, RECORD "X" (NOT SEPARATED) IN THE MONTH AND YEAR OF MARRIAGE AND PROBE FOR PERIOOS OF SEPARATION FOLLOWING THAT DATE. FOR WOMEN MARRIED FOR THE FIRST TIME BEFORE JANUARY 1987, BEGIN WITH JANUARY 1987 AND COMPLETE THE ENTIRE COLUMN. ILLUSTRATIVE QUESTIONS Did your husband ever leave and stay somewhere else for more than one month~ When did he leave? For how many months was he away without visiting you? Was he staying somewhere else in Egypt or in soce other country? Did you ever Leave and stay elsewhere (e.g., because a family member was ill, etc.) for more than one month? When did you leave? For how many months were you away without seeing your husband? Were you staying somewhere else in Egypt or in some other country ~ 812 CHECK 804-806: BEGAN FIRST MARRIAGE BEFORE JANUARY 1987 BEGAN FIRST MARRIAGE AT ANY TIME SINCE JANUARY 1987 [~ I 8I] II CHECK COLUMN 7 OF CALENDAR: ? LIVING APART FROM HUSBAND IN JANUARY 1987 814 814A I see that you were living apart fro~ your husband in January 1987. When did you begin Living apart that time9 THIS DATE SH~LD NOT PRECEDE THE DATE OF CONCEPTION OF ANY CHILD BORN BEFORE 1987. In what month and year were you widowed (divorced from) your Last husband)? NOT LIVING APART FROM HUSBAND IN MONTH . DON'T KNOW MONTH . 98 YEAR . [~ DON'T KNOW YEAR . 98 SKIP I YO I "814A I I ,901 ,-901 1___ I "901 8-2 295 SECTION 9. HUSBAND'S BACKGROUND, RESIDENCE AND WOMAN'S WORK SKIP QUESTIONS AND FILTERS I CODING CATEGORIES I TO NO. 902 CHECK 104: CURRENTLY D l VORCED WIDOWED (SKIP TO 903) I RECORD THE LINE NUMBER OF THE WOMAN'S HUSBAND FROM THE HOUSEHOLD QUESTIONNAIRE. IF THE HUSBAND IS NOT PRESENT IN THE HOUSEHOLD, RECORD lOOt. HUSBAND'S LINE NUMBER . [ ~ "904 903 I How old was your husband on his last birthday? AGE IN COMPLETED YEARS . 904 In what month and year was your husband born? C(~4PARE AND CORRECT 903 AND/OR 904 IF INCONSISTENT. MONTH . [ ~ DON'T KNOW MONTH . . . . . . . . . . . . . . . 98 YEAR . [~ DON'T KNOW YEAR . 9B 905 Is (was) your (Last) husband your first cousin, other blond relative, or no relation at all? FIRST COUSIN . I OTHER RELATIVE . 2 NO RELATION AT ALL . 3 I I YEs . '1 906 Did your (Last) husband ever attend school? NO . 2 ,909 907 What was the highest level of school he attended? PRIMARY . 1 PREPARATORY . 2 SECONDARY . 3 UPPER INTERMEDIATE . 4 UNIVERSITY . 5 MORE THAN UNIVERSITY . 6 DON'T KNOW . ~ L909 908 I What was the highest grade which he completed GRADE . I at that Level? L~ DON'T KNOW . B I 909 | What kind of work does (did) your (Last) husband I mainly do? RECORD ANSWER IN DETAIL. 9-1 296 NO. I QUESTIONS AND FILTERS I COOING CATEGORIES CHECK 909: WORKS (WORKED) V~ IN AGRICULTURE DOES (DID) NOT WORK [--7 IN AGRICULTURE SKIP I "912 I I 911 (Does/did) your husband mainly work on his HIS/FAMILY LAND . 1~ own land or family tend, or (does/did) he rent land, RENTED LAND . 2~914 or (does/did) he work on soceone eise's land? SOMEONE ELSEtS LAND . 3 ~913 9'21 °°as (did) v°ur husband w°rk '°r s--°n° ei'e ° r , or hi-- l , , I FoR SOMEOME ELSE . . . . . . . . . . . . . . . . ' l FOR HIMSELF . 2 ~914 II°-(° m =-° I o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 914 NOW I Would like to ask some questions about places where you have lived. For most of the time until you were 12 years old, did you live in Cairo, Giza, Alexandria, another city or town or in a vitiage? (NAME OF LOCALITY AND GOVERNORATE) DAIRO/GIZA . I ALEXANDRIA . 2 OTHER CITY/TOWN . 3 VILLAGE . 4 OUTSIDE EGYPT 5 (SPECIFY) 915 916 Have you lived in only one or in more than one community since January 1987? ONE COMMUNITY . I MORE THAN ONE COMMUNITY . 2 CHECK COVER PAGE OR 0116-Ql17 (FOR VISITORS) AND ENTER THE NAME OF THE PLACE WHERE THE RESPONDENT CURRENTLY RESIDES: (NAME OF LOCALITY AND GOVERNORATE) ENTER (IN COLUMN 8 OF CALENDAR) THE APPROPRIATE CODE FOR COMMUNITY WHERE RESPONDENT CURRENTLY LIVES ("I" CAIRO/GIZA, "2" ALEXANDRIA, "]" OTHER CITY/TOWN, "4" VILLAGE, "5" OUTSIDE EGYPT) FOR VISITORS, CHECK QUESTION 116 FOR RESIDENCE. BEGIN IN THE MONTH OF INTERVIEW AND CONTINUE WITH ALL PRECEDING MONTHS BACK TO JANUARY 1987. I ~917 -918 917 In what month and year did you move to (CURRENT COMMUNITY)? ENTER (IN COLUMN 0 OF CALENDAR) "X" IN THE MONTH AND YEAR OF THE MOVE, AND IN THE SUBSEQUENT MONTHS, ENTER THE APPROPRIATE COOE FOR TYPE OF CE~4MUNITY (.1. CAIRO/GIZA, "2" ALEXANDRIA, "3" OTHER CITY/TOWN, "4" VILLAGE, OR "5" OUTSIDE EGYPT) CONTINUE PROSING FOR PREVIOUS COMMUNITIES AND RECORD MOVES AND TYPES OF COMMUNITIES ACCORDINGLY. ILLUSTRATIVE QUESTIONS - Where did you live before . ? - In what month and year did you arrive there? - Is that place in a city, a town, or in a village? ENTER THE NAME OF THE LACALITY AND THE GOVERNORATE IN WHICH THE RESPONDENT WAS LIVING IN JANUARY 1987: (NAME OF LOCALITY AND GOVERNORATE) 9-2 297 NO. QUESTIONS AND FILTERS 918 CHECK 916 OR 917 FOR RESIDENCE IN JANUARY 1987: When did you move to (PLACE OF RESIDENCE IN JANUARY 1987)? CODING CATEGORIES LIVED THERE SINCE GIRTH . 96 MONTH . ~ DON'T KNOW MONTH . 98 YEAR . [~ DON'T KNOW YEAR . 98 SKIP J TO ! ~920 919 Before you moved to (PLACE OF RESIDENCE IN JANUARY 1987), were you living in Cairo/Giza, ALexandria, another city or town or e vittage? (NAME OF LOCALITY AND GOVERNORATE) CAIRO/GIZA . I ALEXANDRIA . 2 OTHER CITY/TOWN . 3 VILLAGE . 4 OUTSIDE EGYPT 5 (SPECIFY) 920 Now 1 woutd Like to ask you some questions about working. As you know, some women take up jobs for which they are paid in cash or kind. Others sett things, have a smart business or work on the ramify farm, or in the famity business. Before you married for the first time, did you do any of these things or any work? YES . I NO . 2 921 Are you currentty doing any of these things or any other work? I i YES . I 1'924 NO . 2 922 B923 924 I i Have you ever worked since January 19877 YES . I - -~924 NO . 2 ' I ENTER "0" IN COLUMN 9 OF CALENDAR IN EACH MONTH FROM JANUARY 1987 TO CURRENT MONTH t,928 What is (was) your (most recent) occupation? That is, what kind of work do (did) you do? 925 USE CALENDAR TO PROSE FOR ALL PERIODS OF WORK, STARTING WITH CURRENT OR MOST RECENT WORK, BACK TO JANUARY 1987. ENTER CODE FOR NO WORK OR FOR TYPE OF WORK IN COLUMN 9. ILLUSTRATIVE OUESTIONS When did this job begin (and when did it end)? What did you do before that? How tong did you work at that time? Were you seLf-employed or an empLoyee~ Were you paid for this work? Did you work at home or away from home ~ 9-3 298 NO. 927 OUESTIONS AND FILTERS CHECK COLUMN 9 OF CALENDAR: WORKED IN JANUARY 1987 1 see that you were working in January 1987. When did you start that job? ; CATEGORIES SKIP ! DID NOT WORK J I IN JANUARY 1987 ,928 MONTH . ~ DON'T KNOW YEAR . . 9 ~ 92s i ''""you--not w°rk n 'n'°'rY198" IYES . 11 Did you ever work prior to January 19877 NO . 2 ~930 929 When did your last job prior to January 1987 end? 930 931 932 MONTH . . . . . . . . . . . . . . . . . . . . . . DON'T KNOW MONTH . 98 YEAR . DONIT KNOW YEAR . 98 CHECK 921: YES NO CURRENTLY t4ORKING7 v CHECK 215/216/218: HAS CHILD BORN SINCE YES NO JANUARY 1987 AND LIVING AT HOME7 9 ~1 v While you are working, do you usually have (NAME OF yOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you? b934 I I ~934 I I I USUALLY . 1~,934 S(IMETIMES . 2 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 933 Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) white you are working? RECORD THE TIME HUSBAND/PARTNER . . . . . . . . . . . . . . . . 01 OLDER CHILO(REN) . 02 OTHER RELATIVES . 03 NEIGHBORS . 04 FRIENDS . 05 SERVANTS . . . . . . . . . . . . . . . . . . . . . . . 06 CHILD IS IN SCHOOL . 07 CHILD TAKEN TO NURSERY . 08 OTHER 09 (SPECIFY) 9-4 299 SECTION 10. HEIGHT AND WEIGHT CHECK 222: ORE OR MORE BIRTHS [~ NO BIRTHS SINCE JANUARY 1987 • 1101 INTERVIEWER: IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1987 AND STILL ALIVE. IN 100] AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1987. IN 1006 ANO 100B RECORD HEIGHT AND WEIGHT OF THE RESPOMOENT AND THE LIVIMG CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1987 SHOULD BE WEIGHED AND MEASURED EVEN 1F ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN ] LIVING CHILDREN BORN SINCE JANUARY 1987, 1002 LINE NO. FROM Q.212 USE ADDITIONAL FORMS). 1003 NAME FROM Q.212 FOR CHILDREN 1004 OATE OF BIRTH FROM Q.lO] FOR RESPONDENT FROM Q.215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH 1005 BCG SCAR ON TOP OF LEFT SHOULDER 1006 HEIGHT ( in cent imeters ) 1007 WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANOING UP? 1008 WEIGHT (in k i lograms) 1009 DATE WEIGHED AND MEASURED 1010 RESULT L~J RESPONDENT (NAME) FFT F] F F-FI D DAY . MONTH . YEAR . MEASURED . I NOT PRESENT . 3 REFUSED . 4 OTHER . . . . . . . . . . 6 21 YOUNGEST LIVING CHILD (NAME) DAY . MONTH . YEAR . SCAR SEEN . I NO SCAR . . . . . . . 2 LsJ NEXT-TO- YOUNGEST LIVING CHILD (NAME) DAY . ~ I MONTH . YEAR . SCAR SEEN . 1 NO SCAR . 2 4•J SECOND'TO" YOUNGEST LIVING CHILD (NAME) DAY . MONTH . YEAR . SCAR SEEN . I NO SCAR . 2 F Fl LYING . I LYING . I LYING . I STANDING . 2 STANDING . 2 STANDING . 2 [T I.EI ITl ?. DAY . MONTH . YEAR . DAY . MONTH. YEAR. CHILD MEASURED.I CHILD SICK . 2 CHILD NOT PRESENT . 3 CHILD REFUSED.,4 MOTHER REFUSED.5 OTHER . 6 CHILD MEASURED.I CHILD SICK . 2 CHILD NOT PRESENT . 3 CHILD REFUSED.4 MOTHER REFUSED.5 OTHER . 6 DAY . MONTH . YEAR . CHILD MEASURED.I CHILD SICK . 2 CHILD NOT PRESENT . 3 CHILD REFUSED.4 MOTHER REFUSED.5 OTHER . 6 (SPECIFY) (SPECIFY) (SPECIFY) (SPECIFY) 1011 NAME OF MEASURER: NAME OF ASSISTANT: 300 lO-1 THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 1101-1102 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD. 11011 DEGREE OF COOPERATION. POOR . 1 I FAIR . 2 GO00 . 3 VERY GOOD . 4 1102 INTERVIEWER'S COMMENTS: 11031 FIELD EDITOR'S COMMENTS: I 11o4 r SUPERVISOR'S COMMENTS: 1105] OFFICE EDITOR'S COMMENTS: I 11-I 301 I INSTRUCTIONS: ONLY ONE CQOE SHOULD 9 02 FEB APPEAR IN ANY BOX. FON COLUMNS 9 01 JAN 1, 6, 8~ AND 9 ALL MONTHS SHOULD 3 BE FILLED IN. 12 DEC INFORMATION TO BE COOED FOR EACH COLUMN: 11 NOV COL.1: Births, Pregnancies, Contraceptive Use 10 OCT B BIRTHS 09 SEP P PREGNANCIES 1 08 AUG T TERMINATIONS 9 07 JUL 0 NO METHOD METHCO 9 06 JUH I PILL 2 05 t~y 2 IOO 04 APR 3 INJECTIONS 03 MAR 4 NORPLANT 02 FEB 5 OIAPHRAC, N/FOAM/JELLY 01 JAN 6 CONDCd4 12 DEC 7 FEMALE STERILIZATION 11 NOV 8 MALE STERILIZATION 10 OCT 9 PERIODIC ABSTINENCE 09 SEP L WITHDRAWAL 1 08 AUG G PROLONGED BREASTFEEDING 9 07 JUL W OTHER (SPECIFY) 9 06 JUH COL.2: Discontinuation of Contraceptive Use 1 05 HAy 1 BECAME PREGNANT WHILE USING 04 APR 2 WANTED TO BECOME PREGNANT 03 MAR 3 HUSBAND DISAPPROVED 02 FEB 4 SIDE EFFECTS 01 JAN 5 HEALTH CONCERNS 12 DEC 6 ACCESS/AVAILABILITY 11HOV 7 WANTED MORE EFFECTIVE METHOD 10 OCT 8 INCONVENIENT TO USE 09 SEP 9 INFREOUENT SEX/HUSBAND AWAY 1 08 AUG C COST 9 07 JUL E FATALISTIC 9 06 JUH A DIFFICULT TO GET PREGNANT/MENOPAUSE O 05 MAY D MARITAL DISSOLUTION/SEPARATION 04 APR W OTHER (SPECIFY) 03 MAR K DON IT KNOW 02 FEB COL.3: Postpartum Amenorrhea 01 JAN X PERIOO DID NOT RETURN 12 DEC O LESS THAN ONE MONTH 11 NOV COL.4: Postpartum Al~tinence 10 OCT X NO SEXUAL RELATIONS 09 SEP O LESS THAN ONE MONTH I 08 AUG 9 07 JUL COL.S: greastfeedin g 8 06 JUg X BREASTFEEDING 9 05 HAY O LESS THAN ONE MONTH 04 APR N NEVER BREASTFED 03 MAR COL.6: Marriage/Union 02 FEB X MARRIED 01 JAN O NOT IN UNION 12 DEC COL.7: Periods of Separation 11 NOV X NOT SEPARATED 10 OCT I HUSBAND ABROAD 09 SEP 2 HUSBAND ELSEWHERE IN EGYPT 1 OB AUG 3 WIFE ABROAD 9 07 JUL 4 WIFE ELSEWHERE IN EGYPT B 06 JUN 8 05 MAY COL.8: Moves snd Types of Commllities 04 APR X CHANGE OF COMMUNITY 03 MAR 1CAIRO/GIZA 02 FEB 2 ALEXANDRIA 01 JAN 3 OTHER CITY/TOWN 4 VILLAGE 12 DEC 5 OUTSIDE EGYPT 11 NOV 10 OCT COL. 9: Type of EmpLoyment 09 SEP 0 DID NOT WORK I 08 AUG I PAID EMPLOYEE, AWAY FROM HONE 9 07 JUL 2 PAID EMPLOYEE, AT HONE 8 06 JUN 3 SELF'EMPLOYED, AWAY FROM HONE 7 OS HAY 4 SELF-EMPLOYED, AT HONE 04 APR 5 UNPAID WORKER, AWAY FROM HONE 03 MAR 6 UNPAID WORKER, AT HONE 02 FEB 01 JAN BIRTH DATE: LAST CHILD BORN PRIOR TO JANUARY 1987 NAME : 1 2 3 4 S 6 7 8 9 I 9 o°;F-H U H EE,, JAN 3 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ! 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 i 62 63 65 67 69 ' 7O 71 72 73 74 MT ::F: R 302 i i i Z --i i Z - - - -4 - - i 03 DEC 04 NOV OS OCT 06 SEP 07 AUG 1 08 JUL 9 09 JUN 9 10 MAY ? 11 APR 12 MAR 13 FEB 14 JAN 115 DEC ~16 NOV ~17 OCT 18 SEP 19 AUG 1 20 JUL 9 21 JUH 9 22 MAT 1 23 APR 24 MAR 25 FEB 26 JAN '27 DEC 8 NOV __ 29 OCT __ 30 SEP 31 AUG 1 32 JUL 9 35 JUH 9 34 MAY 0 35 APH 37 FEB JAN 39 DEC 40 NOV 41 OCT 42 SEP 43 AUG I 44 JUL 9 45 JUN 8 46 MAY 9 47 APR 48 MAR 49 FEB 50 JAN 51 DEC 52 NOV 53 OCT 54 SEP 55 AUG I 56 JUl 9 57 JUH 8 58 MAY 8 59 APR 6O MAR 61 FEB 62 JAN 66 DEC NOV 65 OCT SEP 167 AUG q68 JUL J69 JUH 7~ MAY 71 APR MAR FEB 74 JAN 12"1 EGYPT DEMOGRAPHIC AND HEALTH SURVEY HUSBAND QUESTIONNAIRE IDENTIFICATION GOVERNORATE KISI, I/MARGAZ SHIAXHA/VILLAGE NOUSENOLD NO, URBAN . 1 LARGE CITY . 1 NAME OF HOUSEHOLD HEAD ADDRESS IN DETAIL NAME OF HUSBAND LINE NUMBER OF HUSBAND PSU/SEGMENT NO. BUILDING NO. HOUSE NO. RURAL . 2 SMALL CITY.2 TOWN.3 VILLAGE.4 GOVERNORATE PSU/SEGMENT NO. IIIIIIII HOUSEHOLD NO. URBAN/RURAL LINE HUMBER LOCAL I TY HUSBAND D INTERVIEWER VISITS 1 2 ] FINAL VISIT DATE TEAM INTERVIEWER'S NAME SUPERVISORIS NAME RESULT NEXT VISIT: DATE TIME RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 OTHER (SPECIFY) DAY MONTH YEAR TEAM INTERVIEWER SUPERVISOR RESULT TOTAL VISITS D NAME DATE SIGNATURE FIELD EDITOR OFFICE EDITOR FN CODER KEYER 0-1 303 NO, 102 SECTION 1, RESPONDENT'S BACKGROUND OUESTIONS AND FILTERS COOING CATEGORIES RECORD THE TINE. First I would Like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Cairo, Giza, Alexandria, another city or town or in a village? CAIRO/DIZA . . . . . . . . . . . . . . . . . . . . . . 1 [ ALEXANDRIA . 2 OTHER LARGE CITY/TCAJN . 3 VILLAGE . 4 OOTSIDE EGYPT . 5 SKIP I TO 1031 H°W °ng vey°u n vingc°°tinu°usY n AMEO I NUM E OFYEAS . t VILLAGE OR CITY IN WHICH INTERVIEW OCCURS)? ALWAYS . 95 I IF LESS THAN ONE YEAR, ENTER '00' . VISITOR . 96 1"-105 104 ,or, you v here, d you, v, n,c.iro. I CAZ O,GIZA . 1 I Giza, Alexandria, another city or town or in a village? ALEXANDRIA . 2 OTHER LARGE CITY/TOWN . 3 VILLAGE . 4 (NAME OF PLACE) OUTSIDE EGYPT . 5 105 In what month and year were you born? NONTH . DON'T KNOW HONTH . 98 YEAR . ~ DON4T KNOW YEAR . 98 o lH° °' er'Y°u'ty°ur' st' rthd°Y' I A°EINc'LETE°YEA s . . . . . C~PARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. 10, [ Now.ny ti.s have you ~eo ~rri~? I - - . . . . . . . . . . . . . . . . . . I= l 108 In what ~nth a~ year did you first enter into MONTH . a ~rriage contract? I l l DON'T KNOU MONTH . 98 YEAR . ~ DON'T KN~ YEAR . 98 110 In ~at ~nth a~ year did you first ~gin to Live MONTH . together (consummate your ~rriage)? DON'T KNOW MONTH . 98 YEAR . DON'T KNOW YEAR . 98 1111H°w°ldwerey°uwheny°ufirstbogant°liVetogether (consummate your morriage)? [AGE . ~ 1 1-1 304 NO. I QUESTIONS AND FILTERS 112 How many wives do you have now? SKIP I I T° COOING CATEGORIES NUMBER OF WIVES . [~ I I I I 113 I Have you ever attended school? YES . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,118 ! 114 I What is the highest level of school you attended? PRIMARY . I I PREPARATORY . 2 SECONDARY . 3 UPPER INTERMEDIATE . 4 UNIVERSITY . 5 MORE THAN UNIVERSITY . 6 115 I What is the highest grade which Y°U s u c c e s s f u t t Y c c m l p t e t e d at that level? I GRADE . [ ] i I I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 PREPARATORY OR HIGHER [~ I Can you read and understand a letter or newspaper | I easily, with difficutty, or not at all? I I EASILY . 1 | WITH DIFFICULTY . 2 I NOT AT ALL . 3 "120 119 I Do you usually read a newspaper or magazine at (east I I once a week? I I YES . 1 I I NO . 2 120 How many hours on average do you listen to the radio each day? IF LISTENS LESS THAN I HOUR, WRITE "OU". I NUMBER O, HOORS PER DAY . ~I ALL OF THE TIME . 96 NEVER . 97 NOT SURE/DON'T KNOW . 98 121 How many hours on average do you watch television each day? IF WATCHES LESS THAN 1 HOUR, WRITE "00". I NOMSER O~ NOURS PER OAY . ~1 ALL OF THE TIME . 96 NEVER . 97 NOT SURE/DON'T KNOW . 98 122 What is your religion? I MOSLEM . I | CHRISTIAN . 2 I OTHER (SPECIFY). 3 123 What kind of work do you mainly do? WRITE THE ANSWER EXACTLY AS GIVEN. 1-2 305 SKIP NO, I QUESTIONS AND FILTERS I COOING CATEGORIES I TO CHECK 123: WORKS (WORKED) v~ IN AGRICULTURE DOES (DID) NOT WORK I~1 IN AGRICULTURE ~126 I HIS/FAMILY LAND . 1 ~ RENTED LAND . 2~201 SOMEONE ELSE'S LAND . 3 ~ 125 Do you work mainty on your own Land or famity rand, or do you rent land or do you work on someone etse's tand? ,2° i Do you .or, ,or . .one .,.e or ,or yoorse,. I FOR S~EORE ELSE . ,I FOR HIMSELF . 2 ~201 127 I Do you earn a regular wage or salary? I YES . 1 I I NO . 2 1-3 306 NO. I 201 I SECTION 2. QUESTIONS AND FILTERS Now I wouLd Like to ask you about at[ your chiLdren. Do you have any children? REPROOUCT I ON SKIP I COOING CATEGORIES I TO I ,ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~203 I I . And how ~ny daughters do you have? DAUGHTERS . IF NONE ENTER 'DO'. ~o~10'0.oo .,.~ ~.~e. o~''o.~o o'o, .,.n '' '' . . - o o , . . s°,, ~,,, . ~ NO . 2 "205 I I . And how mny of your daughters have you Lost? DAUGHTERS DIED . IF NONE ENTER =00'. prefer not to have any more ch i ld ren? MO M~E/MONE . . . . . . . . . . . . . . . . . . . . 2~ UNDECIDED/DOES NOT KNOW . 8/,207 I 2°' I D°es y°ur wife wa°t t° have a 'an°ther)child °r I HAVE A'AN°TBER' CRILD . I wouLd she prefer not to have any (~re) children? NO MORE/NONE . 2 WIFE IS UNDECIDED . 3 DOESN'T KNOW WIFE'S DESIRES . 8 207 Have you and your wife ever discussed the nuo~er of I YES . 1 I children you wouLd Like to have? I I NO. . . . . . . . . . . . . . . . . . . . . . . . . . , , , ,2 208 I DO you think your wife wants the sa~ n~r of I SAME NUMBER . 1 I children that you want, or does she want ~re I MORE CHILDREN . 2 or fewer chiLdren than you want? FEWER CHILDREN . 3 DOES NOT KNOW . 8 210 v If you could go back to the time you did not have any I children and could choose exactly the number of children| to have in your who[e Life, how many would you choose? I NO, HAS NO LIVING CHILDREN 'I ~211 I L NUMBER . . . . . . . . . . . . . . . . . . . I I I 212 I OTHER ANSWER 96 ~213 (SPECIFY) I 211 If you could choose exactly the number of children to have in your whole Life, how many would that be? I NUMBER . I~I OTHER ANSWER 9~213 (SPECIFY) I 2-1 307 NO. QUESTIONS AND FILTERS 212 How many boys and how many girls? IF NONE ENTER IDOl. SKIP I CODING CATEGORIES I TO I . GIRLS . OTHER ANSWER 96 (SPECIFY) 13p What do you think is the best nurr/oer of months or years between the birth of one child and the birth of the next child? IF LESS THAN 2 YEARS, RECORD IN MONTHS. OTHERWISE RECORD IN YEARS. I MONTHS . I ~ I YEARS . 2 OTHER 9<;6 (SPECIFY) 214 When e couple is making a decision, sometimes the husband has more influence, in s~ cases, the wife has more influence, while other decisions are made jointly. In your family, who has the most influence in dec~ding whether or not to have another chiLd**you, or your wife or do you have equal say? RESPONDENT HAS MORE INFLUENCE.I BOTH RESPONDANT AND WIFE EQUAL.2 WIFE HAS MORE INFLUENCE . 3 OTHER 4 (SPECIFY) 215 Do you expect your children to help you financially when you get otd? I YES . 1 J NO . 2 I NOT SURE/DOESN'T KNOt~ . 8 216 What is the highest Level of school you would Like for your daughter(s) to attain? PRIMARY . 01 PREPARATORY . 02 SECONDARY . 03 UPPER INTERMEDIATE . 04 UNIVERSITY . 05 MORE THAN UNIVERSITY . D6 DEPENDS ON CHILD . 95 NO ASPIRATIONS FOR EDUCATION.96 DON'T KNOt,/ . . . . . . . . . . . . . . . . . . . . . 98 217 What is the highest Level of school you would Like for your son(s) to attain? PRIMARY . 01 PREPARATORY . 02 SECONDARY . 03 UPPER INTERMEDIATE . 04 UNIVERSITY . 05 MORE THAN UNIVERSITY . 06 DEPENDS ON CHILD . 95 NO ASPIRATIONS FOR EDUCATION.96 DON'T KNOW . 98 2-2 308 301 SECTION 3. CONTRACEPTION I NOW l wculd Like to talk abeut fea~tty planning " the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about? CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. TEEM pECCEEO DOk'% T)fE COLUMN, READ/NO THE NAME AND DESCRIPT ION OF EACH METRO0 k/O)" MENTIONED SPONEANEOUSLY. CIRCLE COOE 2 IF METHOD IS RECOGNIZEDt AND CODE 3 IF NOT RECOGNIZED. THENj FOR EACH RETROD WITH CODE 1 OR ;) CIRCLED IN 302~ ASK 303-]04 BEFORE PROCEEDING TO THE NEXT METHOD. 302 gave you ever 303 Have you ever 304 DO you know where heard of (METHOD)? used (METHO0)? a person could go to get (METHOO)~ READ DESCRIPTION OF EACH METHOD. 1[ PILL women can take a p(ll every day. 211UD Wo~en can have a loop or coil placed inside them by a doctor or a nurse. 31 INJECTIONS Wccen can have an injection by a doctor or nurse which stops them from becomlng pregnant for several months, O•J NORPLANT Women can have smatt rods placed in their arm by a doctor which stops them from beceming pregnant for several years. 0 5 • DIAPHRAGm,FOAM,JELLY Worsen can place a sponge, suppository, diaphragm, jelly or cream in- side them before intercourse. 06• CONDOM Men can use a ruldoer covering during sexual intercourse. O• FEMALE STERILIZATION W(~en can have an operation to avoid having any more children. O• RkLE STERILIZATION Men can have an operation to avoid having any more children. YESISPONT . . . . . . . . . . . . . . . . . . . I YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . 3] v YES/SPONT . 1 YES/PROBED . 2 NO . 3) v YES/SPONT . 1 YES/PROBED . 2 v YES/SPONT . 1 YES/PROBED . 2 NO . 3 I v YES/SPOHT . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . 31 v YES/SPONT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 3 l v YES/SPONT . I YES/PROBED . 2 NO . 3 I v YES/SPORT . I YES/PROBED . Z gO . 3 YES . 1 NO . Z YES . 1 NO . 2 YES . I YES . 1 NO . . . . . . . . . . . . . . . . 2 NO . 2 YES . I YES . I NO . 2 NO . 2 YES . I YES . I NO . 2 NO . 2 YES . 1 NO . 2 YES . I NO . 2 Has your wife ever had an operation to avoid having any more children? YES . I NO . 2 Have you ever had an operation to avotd having any more children • YES . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . Z YES . % NO . 2 Do you know a place where a person can get such an operation~ YES . 1 NO . B YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . Z 3-1 309 CO~ITBACEPTIVE METHOD TABLE COIHTINUED 302 Have you ever heard of (METRO0)? READ DESCRIPTION OF EACH METHOD. RHYTHM, PERIQOIC ABSTINENCE Couptes can avoid having sexual intercourse on certain days of the month when the woman is more Iikety to bec~ne pregnant. 1• WITHDRAWAL Men can be carefut and i~lt out before ejaculation. 1J PROLONGED BREASTFEEDING W~nen can protong the t ime that they breestfeod their babies to delay the next pregnancy. 12• Have you heard of any other ways or n~thods that wc~en or men can use to Bvold YES/SPORT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . v YES/SPORT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . 2 NO . 3] v YES/SPONT . 1 YES/PROBED . 2 NO . 3 I v YES/SPONT . I NO . 3 303 Have you ever used (METH(X))? YES . 1 NO . 2 YES . 1 NO . 2 YES . 1 NO . 2 304 Do you know where a person could go to get (METHOD)? Do you know where & person can obtain advice on how tO use periodic abstinence? YES . 1 NO . ,2 pregnancy? 1 (SPECIFY) 2 (SPECIFY) 3 (SPECIFY) YES . . . . . . . . . . . . . . . I NO . 2 YES . . . . . . . . . . . . . . . I NO . 2 YES . I NO . . . . . . . . . . . . . . . 2 3 -2 310 No I 306 I QUESTIONS AND FILTERS Have you ever discussed family planning with your wife? SKIP I CODING CATEGORIES I TO I YES . 1 I NO . 2 ~309 I 307 Who first started to discuss family planning, you or your wife? I RESPONDENT . . . . . . . . . . . . . . . . . . . . . . 1 J I HIS WIFE . 2 308 How often have you talked to your wife about family planning in the past year? I ONCE . 1 | TWC) OR THREE TIMES . 2 I FOUR TIMES OR MORE . 3 NEVER . 4 309 311 When a couple is making a decision, sometimes the husband has more influence, in some cases, the wife has more infLuence, while other decisions are made jointLy. In your family, who has the most influence in deciding whether or not to use family planning-you, or your wife or do you have equal say? RESPONDENT HAS MORE INFLUENCE.,.1 BOTH RESPONDENT AND WIFE EQUAL,,2 WIFE HAS MORE INFLUENCE . 3 OTHER 4 (SPECIFY) V AT LEAST ONE "YES" (EVER USED) • SKIP TO 313 Have you ever used anything or tried in any way to delay or avoid getting pregnant? I I YES . 1 I I NO . 2 .322 I 312 What have you or your wife used or done? CORRECT 303-305 (AND 302 IF NECESSARY). I 313 I Have you ever gone to get family planning supplies? YES . 1 I NO . 2 NEVER USED SUPPLY METHODS . 3 314 I Have you ever accompanied your wife when she went for I YES . 1 I famiLy planning? I NO . 2 SHE NEVER WENT . 3 [• NEVER USED CONDOM ~ P SKIP TO 320 v 3-3 311 NO. QUESTIONS AND FILTERS 316 Do you and your wife usuatty use the condom in co~ljunction with so~e other method? IF YES: Which mth(x~? COOING CATEGORIES PILL . 01 lob . 02 INJECTIONS . 03 NORPLAMT . 04 DIAPHRAGM/FOAM/JELLY . 05 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 PERIOOIC ABSTINENCE . 09 WITHDRAWAL . 10 PROLONGED BREASTFEEDING . 11 OTHER 12 SKIP TO (SPECIFY) USE CONDOM ONLY . 13 3,7 ] 0io you ~ en, oond-- io the past y.r, ]YES . 1 ] NO . 2 ,319 318 ] Now many packets of condoms have you bought? I NUMBER . ~ ' ~ J OTHER ANSWER 96 (SPECIFY) 319 I I B A ° oNTKNo . 3201 ,,r. current'Y d° °g anYthi°g °r us °o I YES.nyt,,, ,o .vo,d or Oe'.y gettin pregnant . I I NO . 2 "322 321 Which mtho<l are you or your wife using? PILL . 01-- IUO . 02 INJECTIONS . 03 NORPLANT . 04 DIAPHRAGM/FOAM/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 PERIODIC ABSTINENCE . 09 WITHDRAWAL . I0 PROLONGED HREASTFEEDING . 11 OTHER 12- (SPECIFY) "326 I I 322 Do you intend to use a method to detay or avoid YES . 1 ,324 pregnancy at any time in the future? NO . 2 I DONIT KNOW . 8 "326 3-4 312 NO, QUESTIONS AND FILTERS 323 What is the main reason you do not intend to use a method? SKIP COOING CATEGORIES TO WANTS CHILDREN . . . . . . . . . . . . . . . . . 01 - LACK OF KNOWLEDGE . 02 PARTNER OPPOSED . 03 COST TO0 MUCH . 04 SIDE EFFECTS . 05 HEALTH CONCERNS . 06 BARD TO GET METHOOS . 07 RELIGION . 08 OPPOSED TO FAMILY PLANNING . 09 FATALISTIC . 10 OTHER PEOPLE OPPOSED . 11 INFREQUENT SEX . 12 WIFE CANNOT GET PREGNANT . 13 WIFE MENOPAUSAL/NYSTERECTOHY.14 INCONVENIENT . . . . . . . . . . . . . . . . . . . 15 OTHER 16 (SPECIFY) DON'T KNOW . 98 *326 ,2, I 0oyou ,n,e t°us°''th th °'he°ext'2 Iv" . 1 I months? NO . 2 DON'T KNOW . 8 325 When you use a method, which method wouLd you prefer to use? PILL . 01 IUD . 02 INJECTIONS . 03 NORPLANT . 04 DIAPHRAGM/FOAM/JELLY . 05 CONDOM . 06 FEMALE STERILIZATION . 07 MALE STERILIZATION . 08 PERIOOIC ABSTINENCE . 09 WITHDRAWAL . 10 PROLONGED ABSTINENCE . 11 OTHER 12 (SPECIFY) UNSURE . 98 326 How did you first hear about family pLanning? TELEVISION . 01 RADIO . 02 PRINT MEDIA . 03 WIFE . 04 OTHER RELATIVES/FRIENDS . 05 GOVERNMENT DOCTOR/ CLINIC STAFF . 06 PRIVATE DOCTOR/ CLINIC STAFF . 07 RAIYDA/OTHER FP ~RKER . 08 COMMUNITY MEETING . 09 OTHER 10 (SPECIFY) famiLy planning on: YES NO the radio? RADIO . 1 2 television? TELEVISION . 1 2 '28 1 I" it ac°°ptabie °r n°t °°ceptab'e t° Y°° f°r family I ACCEPTARLE . . . . . . . . . . . . . . . . . . . . . . ' 1 planning information to be provided on the radio or NOT ACCEPTABLE . 2 television? DON~T KNOW . 8 3-5 313 NO. OUESTIONS AND FILTERS 329 There are many spots or messages regarding family planning on television. Can you tell me about the spots or massages which you have found most informative or helpful to you? RECORD THE RESPONSE IN DETAIL. IF THE ANSWER IS A TO SERIES (E .G . , YJ~REEMA NUHKTAR OR THE DOCTOR),PROBE TO FIND OUT WHICH SPECIFIC SPOTS IN THE SERIES WERE MOST HELPFUL OR INFORMATIVE. RECORD UP TO THREE SPOTS. COOING CATEGORIES SKIP TO 3:30 CHECK 113, 114 AND 118: ATTENDED PREPARATORY OR HIGHER LEVEL ABLE TO READ v v NOT ABLE TO READ ~332 331 In the last month have you read an article about YES . 1 family planning in a newspaper or magazine? NO . 2 332 In the pest year, have you ever attended a community I YES . 1 meeting or talk in which there was discussion about I family planning or Egypt's population problem? NO . 2 ]33 I In general, do you approve or disapprove of couples APPROVES . 1 I using a method to avoid pregnancy? DISAPPROVES . 2 DOESN,T KNOtJ/UNDECIDED . 8 3]4 In general, do you think that your religion allows I ALLOWS FP . 1 couples to use family planning or it forbids it? I FORBIDS FP . . . . . . . . . . . . . . . . . . . . . . 2 DOESN'T KNOW . 8 335 Do you think that your wife approves or disapproves I APPROVES . I I of couples using a method to avoid pregnancy? I DISAPPROVES . 2 I DOESN'T KNOW/UNDECIDED . 8 3]6 APPR DISAPPR DK If couples wish to avoid pregnancy, do you approve or disapprove of their using: the condom? the IUO? female sterilization? withdrawal? mete sterilization? the pitt? CONDOM . I 2 8 IUD . I 2 8 FEMALE STER . I 2 8 WITHDRAWAL . I 2 8 MALE STER . I 2 8 PILL . I 2 8 3-6 314 NO. 337 QUESTIONS AND FILTERS In your opinion, what is the main problem, if any, with using: the corwJom? the IUD? female sterilization? withdrawal? mate sterilization? the pitt? ENTER CODE FOR EACH METHOD FROM LIST BELOW. 01 NONE 02 NOT EFFECTIVE 03 WIFE/PARTNER DISAPPROVES 04 COMMUNITY DISAPPROVES 05 RELIGION DISAPPROVES 06 SIDE EFFECTS/HEALTH CONCERN 07 ACCESS/AVAILABILITY 08 COSTS TOO MUCH 09 INCONVENIENT TO USE 10 OTHER (SPECIFY) 98 DON'T KNOW SKIP TO CODING CATEGORIES CONDOM (SPECIFY) IUD (SPECIFY) FEMALE STERILIZATION (SPECIFY) WITHDRAWAL (SPECIFY) MALE STERILIZATION (SPECIFY) PILL (SPECIFY) 3381 w°u'dy°u°" ect y°ur "ew'nt t° a''ed°ct°r I YEs . '1 for famity planning? NO . 2 DOESN,T KNOW . 8 339 I Between the first day of a woman,s period (i.e., I YES . 1 I I menstrua[ cycle) and the first day of her I NO . 2 i next period, are there certain times DON'T KNOt# . 8 '~01 when she has a greater chance of becoming pregnant I than other times? I 340 During which times of a woman's menstruat cycle does she have the greatest chance of becoming pregnant? DURING HER PERIOD . 1 RIGHT AFTER HER PERIOD HAS ENDED . 2 IN THE MIDDLE OF THE CYCLE . ] JUST BEFORE HER PERIOD BEGINS,,,4 OTHER 5 (SPECIFY) DON'T KNOB . 8 3-7 315 ,o. I 401 I SECTION 4. WIFE'S CHARACTERISTICS QUESTIONS AND FILTERS Does your wife 9o out alone or with your children to buy household items or visit relatives? SKIP I COOING CATEGORIES I TO I . 1 YES, WITH CHILDREN . 2 NOT ALL IED TO GO ~T . 3 OTHER 4 (SPECIFY) IEX SSO 'N'ON . 1 I do you think she should express her opinion or KEEP QUIET . 2 keep o~Jiet? NOT SURE/DON'T KNOW . 8 she should be able to work. Do you agree? DISAGREE . Z NOT SURE/DON'T KNOW . 8 4O4 HUSH WIFE BOTH OTHER Who should have the last word on the following--the husband, the wife, both, or someone else? Visits to friends or relatives? Household LxJdget? Having another child? Children's education? Children's marriage plans? Use of family planning methods? Your wife's en~oloyment~ VISITS TO FRD/RL.1 2 3 4 HOUSEHOLD BUDGET,1 2 3 4 HAVING CHILD . 1 2 3 4 CHILD'S EDUC . I 2 3 4 CHILD'S MARR . I 2 3 4 FAMILY PLANRIHG.I 2 3 4 WIFE'S EMPLOYM'T.I 2 3 4 hat s 'nt each 'n'hbya family in your situation? AMOUNT . NOT SURE/DON'T KNOW . 9998 406 I Does your wife make any contribution to the household YES . 1 I ~et? NO . 2 407 I RECORD THE TIME. HOUR . I MINUTES . 4"1 316 THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 501"502 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COtIPLETERESS BEFORE LEAVING THE HOUSEHOLD. 501 I DEGREE OF COOPERATION. POOR . 1 FAIR . 2 GO00ooo.**. . 3 VERY GO00 . 4 502 INTERVIEgER~S COMMENTS: 50] FIELD EDITOR'S COMMENTS: 504 SUPERVI SORIS COHMENTS: 505 OFFICE EDITOR'S COMMENTS: 5-1 317 Front Matter Title Page Contact Information Table of Contents List of Tables List of Figures Foreword Acknowledgments Summary of Findings Map of Egypt Chapter 01 - Introduction Chapter 02 - Characteristics of Households and Respondents Chapter 03 - Fertility Chapter 04 - Knowledge, Attitudes, and Ever Use of Family Planning Chapter 05 - Current Use of Family Planning Chapter 06 - Use of the Pill and IUD Chapter 07 - Nonuse of Family Planning and Intention to Use Chapter 08 - Fertility Preferences Chapter 09 - Proximate Determinants of Fertility Chapter 10 - Infant and Child Mortality Chapter 11 - Maternal and Child Health Chapter 12 - Infant Feeding and Maternal and Child Nutrition Chapter 13 - Husband's Survey References Appendix A - Survey Staff Appendix B - Sample Design Appendix C - Estimates of Sampling Errors Appendix D - Data Quality Tables Appendix E - Questionnaires Household Schedule Woman Questionnaire Husband Questionnaire

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