Egypt - Demographic and Health Survey - 1996

Publication date: 1996

Egypt Demographic and Health Survey 1995 National Population Council ®DHS Demographic and Health Surveys Macro International Inc. World Summit for Children Indicators: Egypt 1995 Value BASIC INDICATORS Childhood mortality Childhood undemutrition Clean water supply Sanitary excreta disposal Basic education Infant mortahty rate (direct estimation) ~ Under-five mortality rate Percent stunted Percent wasted Percent underweight Percent of households within 15 minutes of a safe water supply 2 Percent of households with flush toilets Percent of women 15-49 with completed primary education Percent of men 15-49 with completed primary education Percent of girls 6-12 attending school Percent of boys 6-12 attending school Percent of women 15-49 who are literate 63 per 1,000 81 per 1,000 29.8 4.6 12.4 87.0 84.3 47.3 67.6 78.1 88.1 46.5 Children in especially difficult situations Percent of chddren who live in single adult households 1.9 SUPPORTING INDICATORS Women's Health Birth spacing Safe motherhood Family planning Nutrit ion Maternal nutritton Breastfeedmg Iodine Child Health Vaccinatmns Diarrhea control Acute respiratory infection Percent of non-first births within 24 months of a previous birth Percent of bffths with medical prenatal care Percent of births with prenatal care in first trimester Percent of births with medical assistance at delivery Percent of births tn a medical facility Percent of births at high risk Contraceptive prevalence rate (any method, married women) Percent of currently married women with an unmet need for family planmng Percent of currently married women with an unmet need Ibr family planning to avoid a high-risk birth Percent of mothers with low BMI Percent of chddren under 4 months who are exclusively breastfed Percent of households with iodized salt Percent of children whose mothers received tetanus toxoid vaccination durang pregnancy Percent of children 12-23 months with measles vaccination Percent of children 12-23 months fully vaccinated Percent of children with diarrhea in preceding 2 weeks who received oral rehydration therapy Percent of children with acute respiratory infechon in preceding 2 weeks who were seen by medical personnel 25 9 39.1 30.1 46.2 32.5 54.5 47.9 16.0 13.3 1.6 65.8 0.2 69.5 89.2 79.1 42.7 61.7 I See Chapter 9 for details. 2 Piped and well water Egypt Demographic and Health Survey 1995 Fatma E1-Zanaty Enas M. Hussein Gihan A. Shawky Ann A. Way Sunita Kishor National Population Council Cairo, Egypt Macro International Inc. Calverton, Maryland USA September 1996 The 1995 Egypt Demographic and Health Survey (EDHS-95) is part of the worldwide Demographic and Health Surveys project. Additional information about the EDHS-95 may be obtained from the National Population Council, P.O. Box 1036, Cairo, Egypt (Telephone: 3638207 or 3638093 and Fax 3639818). Additional information about the DHS project may be obtained from Macro International Inc., 11785 Beltsville Drive, Calverton, MD 20705 (Telephone 301-572-0200 and Fax 301-572-0999). Recommended citation: EI-Zanaty, Fatma, Enas M. Hussein, Gihan A. Shawky, Ann A. Way, and Sunita Kishor. 1996. Egypt Demographic and Health Survey 1995. Calverton, Maryland [USA]: National Population Council [Egypt] and Macro International Inc. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Map of Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiv CHAPTER 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography and Socioeconomic Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Health Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Objectives of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Organization and Implementation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Coverage of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 CHAPTER 2 2.1 2.2 2.3 2.4 2.5 2.6 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . 15 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Education of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Household Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 CHAPTER 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Current Fertility Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 CHAPTER 4.1 4.2 4.3 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Knowledge of Family Planning Methods and Sources . . . . . . . . . . . . . . . . . . . . . . 51 Exposure to Family Planning Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Attitudinal Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 iii 4.4 4.5 Page Ever Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 First Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 CURRENT USE OF FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Levels and Differentials in Current Use of Family Planning . . . . . . . . . . . . . . . . . . 75 Trends in Current Use of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Trends in Current Use of Family Planning by Residence . . . . . . . . . . . . . . . . . . . . 82 Sources for Modem Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Pill Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Cost of the IUD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Cost of Injectables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 CHAPTER 6 6.1 6.2 6.3 6.4 6.5 6.6 NONUSE OF FAMILY PLANNING AND INTENTION TO USE . . . . . . . . . 91 Discontinuation Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Reasons for Discontinuation of Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . 93 Intention to Use Contraception in the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Preferred Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Family Planning Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Need for Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Women with Unmet Need for Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Unplanned and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 8.6 8.7 PROXIMATE DETERMINANTS OF FERT IL ITY . . . . . . . . . . . . . . . . . . . . 111 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Marital Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Marriage between Relatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Ideal Age at Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Postpartum Amenorrhea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . 117 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 CHAPTER 9 9.1 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 iv 9.2 9.3 9.4 Page Levels and Trends in Early Childhood Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 High-risk Fertility Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 CHAPTER 10 10.1 10.2 •0.3 10.4 MATERNAL HEALTH CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Antenatal Care . . . . . . . . . . . . . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Trends in Maternal Health Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Characteristics of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 CHAPTER 11 11.1 11.2 11.3 CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Vaccination of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Fever and Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 CHAPTER 12 12.1 12.2 12.3 INFANT FEEDING AND MATERNAL AND CHILD NUTRIT ION . . . . . . 157 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Maternal Anthropometric Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 CHAPTER 13 13.1 13.2 13.3 13.4 13.5 FEMALE C IRCUMCIS ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Circumcision among EDHS-95 Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Circumcision among the Daughters of EDHS-95 Respondents . . . . . . . . . . . . . . . 173 Women's and Daughters' Experience with Circumcision . . . . . . . . . . . . . . . . . . . 174 Types of Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Eradication of Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 CHAPTER 14 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 WOMEN'S STATUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Marriage Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Perceptions about the Relative Costs of Sons and Daughters . . . . . . . . . . . . . . . . 191 Decisionmaking within Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Women's Freedom of Movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Attitudes Toward Gender Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Attitudes about Divorce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Women's Labor Force Participation, Disposal of Earnings and Workload . . . . . . 199 Financial Empowerment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Treatment of Women in the Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Page REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E SURVEY STAFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 DATA QUAL ITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 vi Table 1.1 Table 1.2 Table 1.3 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 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 3.11 TABLES Page Population of Egypt, 1937-1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Survey timetable, Egypt DHS 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Results of the household, individual and women's status interviews . . . . . . . . . . . . . . 13 Household population by age, residence, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Population by age, 1988, 1992, and 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . 20 School attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Household possessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 School attendance and reasons for leaving school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Decisions on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Trends in fertility by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Fertility rates by number of years since first marriage . . . . . . . . . . . . . . . . . . . . . . . . . 43 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 vii Table 3.12 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 4.18 Table 4.19 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 5.12 Page Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Knowledge of family planning methods and source for methods . . . . . . . . . . . . . . . . . 52 Knowledge of family planning methods and source for methods by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 First source of family planning information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Sources influencing women to seek information about family planning . . . . . . . . . . . 56 Exposure to family planning messages on radio and television . . . . . . . . . . . . . . . . . . 57 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Wives' and husbands' attitudes toward family planning . . . . . . . . . . . . . . . . . . . . . . . . 60 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Belief that religion allows or forbids family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Approval of use of specific family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Reasons for disapproval of injectables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Ever use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Trends in ever use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Ever use of family planning by background characteristics . . . . . . . . . . . . . . . . . . . . . 68 First method used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Source of first method used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Number of children at first use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Reproductive intentions at time of first use of family planning . . . . . . . . . . . . . . . . . . 72 Current use of family planning by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Current use of family planning by method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Current use of family planning by govemorate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Trends in current use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Trends in the family planning method mix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Trends in current use of family planning by residence . . . . . . . . . . . . . . . . . . . . . . . . . 82 Trends in current use of family planning by governorate . . . . . . . . . . . . . . . . . . . . . . . 83 Sources for modem family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Sources for family planning methods by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Reasons for selecting current source of supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Brand of pill used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Cost of method for pill users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 viii Table 5.13 Table 5.14 Table 5.15 Table 5.16 Table 5.17 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 7.6 Table 7.7 Table 7.8 Table 7.9 Table 7.10 Table 7.11 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Page Information received at pharmacies about the pill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Cost of method for IUD users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Amount users are willing to pay for IUD insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Cost of method for injectable users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Amount users are willing to pay for injectables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Reasons for discontining use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Future use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Reasons for not using family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Preferred method of family planning for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Profile of women with unmet need for family planning . . . . . . . . . . . . . . . . . . . . . . . 104 Family planning experience and attitudes among women with unmet need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Exposure to family planning messages or counseling among women with unmet need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . 108 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Marital exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Consanguinity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Ideal age at first marriage for sons and daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Median ideal age at first marriage for sons and daughters . . . . . . . . . . . . . . . . . . . . 117 Postpartum amenorrhea, abstinence and insusceptibily . . . . . . . . . . . . . . . . . . . . . . . . 118 Median duration of postpartum insusceptibility by background characteristics . . . . . 119 ix Table 8.10 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Table 10.9 Table 10.10 Table 10.11 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table 11.5 Table 11.6 Table 11.7 Table 11.8 Table 11.9 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Table 12.5 Page Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Trends in early childhood mortality in Egypt, 1965-1995 . . . . . . . . . . . . . . . . . . . . . . 123 Infant and child mortality by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . 125 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . 127 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Source for antenatal care, number cf antenatal care visits, and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Type cf facility providing antenatal care and number of visits by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Antenatal care and tetanus toxoid injections by background characteristics . . . . . . . . 137 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Plan for facility delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Trends m maternal health indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Delivery complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Knowledge of diarrhea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Signs of diarrheal episodes requiring medical care . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Prevalence and treatment of fever and acute respiratory infection . . . . . . . . . . . . . . . 154 Signs of acute respiratory illness requiring medical care . . . . . . . . . . . . . . . . . . . . . . 155 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Types of food received by children in the preceding 24 hours . . . . . . . . . . . . . . . . . . 161 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Table 12.6 Table 12.7 Table 12.8 Table 12.9 TaMe 13.1 TaMe 13.2 Table 13.3 Table 13.4 Table 13.5 Table 13.6 Table 13.7 Table 13.8 Table 13.9 Table 13.10 Table 13.11 TaMe 14.1 TaMe 14.2 TaMe 14.3 TaMe 14.4 TaMe 14.5 TaMe 14.6 Table 14.7 Table 14.8 Table 14.9 TaMe 14.10 Table 14.11 Table 14.12 TaMe 14.13 TaMe 14.14 TaMe 14.15 Table 14.16 TaMe 14.17 Page Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Trends in the nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Anthropometric indicators of maternal nutritional ~tatus . . . . . . . . . . . . . . . . . . . . . . 169 Differentials in mateMal anthropometric indicators . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Prevalence of female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Reasons for supporting or opposing circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Daughters' circumcision experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Age at circumcision for women and daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Aspects of circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 Severity of circumcision and reports of complications . . . . . . . . . . . . . . . . . . . . . . . . 177 Age at circumcision and person performing circumcision by selected background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Clinic-based study: characteristics of the population . . . . . . . . . . . . . . . . . . . . . . . . . 180 Clinic-based study: circumcision status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Clinic-based study: type of circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Beliefs about female circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Differences in age and education between husbands and wives . . . . . . . . . . . . . . . . . 186 Women's participation in spouse selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Perceived participation in spouse selection: women and their husbands . . . . . . . . . . 189 Residence after marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Cost of sons and daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Household decisionmaking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Women who have the final say "n househcld decisions . . . . . . . . . . . . . . . . . . . . . . . 193 Women's freedom of movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Women's freedom of movement by background characteristics . . . . . . . . . . . . . . . . . 196 Attitudes about gender roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Attitudes about divorce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Women working for cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Occupations of women working for cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Earnings and expenditure control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Women's contributions to household tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Ownership and management of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Indicators of women's financial autonomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 xi Table 14.18 Table 14.19 Table 14.20 Table 14.21 Table 14.22 Table B. 1 Table B.2 Table B.3 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 C.12 Table D. 1 Table D.2 Table D.3 Table D.4 Table D.5 Table D.6 Page Reasons given to justify a husband beating his wife . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Person(s) who administer beatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Frequency of beatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Severity of beatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Beatings during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Sample parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Primary sampling units by governorate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 Sampling errors - National sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Sampling errors - Urban sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Sampling errors - Rural sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Sampling errors - Urban Govemorates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Sampling errors - Lower Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 Sampling errors - Lower Egypt Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Sampling errors - Lower Egypt Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Sampling errors- Upper Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Sampling errors - Upper Egypt Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 Sampling errors - Upper Egypt Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Sampling errors - Frontier Govrnorates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Births by calendar yeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 xii Figure 1.I Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 5.1 Figure 5.2 Figure 5.3 Figure 5.4 Figure 6.1 Figure 7.1 Figure 8.1 Figure 9.1 Figure 9.2 Figure 10.1 Figure 10.2 FIGURES Page Crude birth rates and crude death rates, Egypt 1986-1994 . . . . . . . . . . . . . . . . . . . . . . 3 Distribution of the household population by age and sex . . . . . . . . . . . . . . . . . . . . . . 16 School attendance among children age 6-15 by age, sex, and urban-rural residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Percentage of ever-married women who watch television or listen to the radio daily by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Total fertility rates by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Trends in total fertility rates by urban-rural residence, Egypt 1986-1995 . . . . . . . . . 42 Percentage of women 15-19 who are mothers or pregnant with their first child, by educational level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Knowledge of injectables, 1992 EDHS and 1995 EDHS . . . . . . . . . . . . . . . . . . . . . . 53 Trends in ever use of family planning, Egypt 1980-1995 . . . . . . . . . . . . . . . . . . . . . . 67 Reproductive intentions by number of children at first use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Current use of family planning methods by place of residence . . . . . . . . . . . . . . . . . 76 Current use of family planning by governorate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Trends in current use of family planning, Egypt 1980-1995 . . . . . . . . . . . . . . . . . . . 81 Pill, IUD, and injectables users by source of method . . . . . . . . . . . . . . . . . . . . . . . . . 85 Contraceptive discontinuation rates by reason and method . . . . . . . . . . . . . . . . . . . . 92 Desire for more children among currently married women 15-49 . . . . . . . . . . . . . . 100 Median age at first marriage by place of residence, all women age 25-49 . . . . . . . . 116 Trends in under-five mortality, Egypt 1980-1993 . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Under-five mortality by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Trends in tetanus toxoid coverage, Egypt 1988-1995 . . . . . . . . . . . . . . . . . . . . . . . . 136 Trends in delivery care indicators, Egypt 1988-1995 . . . . . . . . . . . . . . . . . . . . . . . . 142 xiii Figure 11.1 Figure 11.2 Figure 12.1 Figure 12.2 Figure 13.1 Figure 13.2 Figure B. 1.1 Figure B. 1.2 Figure B. 1.3 Figure B. 1.4 Page Trends in vaccination coverage by type of vaccine, Egypt 1992-1995 . . . . . . . . . . 146 Percentage of children 12-23 months fully immunized by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Distribution of children by breastfeeding status according to age . . . . . . . . . . . . . . 160 Level of stunting among children under age 5 by place of residence . . . . . . . . . . . . 167 Attitudes about the continuation of female circumcision . . . . . . . . . . . . . . . . . . . . . 172 Percentage of circumcisions performed by medical personnel: women and daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Distribution of Sampling Points, Urban Govemorates . . . . . . . . . . . . . . . . . . . . . . . 235 Distribution of Sampling Points, Lower Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Distribution of Sampling Points, Upper Egypt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Distribution of Samphng Points, Frontier Governorates . . . . . . . . . . . . . . . . . . . . . 238 xiv FOREWORD The 1995 Egypt Demographic and Health Survey (EDHS-95) is the third survey in a series of Demographic and Health surveys that have been carried out in Egypt. The EDHS-95 collected information on fertility and child mortality, family planning awareness, approval and use, as well as basic information on maternal and child health. Preparations for the EDHS-95 started early in 1995, and the fieldwork was carried out between November 1995 and January 1996. This report presents the main findings from the EDHS-95. It includes information on fertility levels, reproductive intentions, and contraceptive knowledge and use. The report also provides results for key maternal and health indicators including medical care for mothers during pregnancy and at time of delivery, infant feeding practices, child immunization coverage, and the prevalence and treatment of diarrheal disease among children. It is evident that the information collected in the EDHS-95 will be instrumental in identifying new directions for the national family planning and health programs in Egypt. In addition as one of more than 70 surveys carried out in the international Demographic and Health Surveys program, it will hopefully contribute to an increased global commitment to improve the lives of mothers and children worldwide. I am deeply indebted and grateful to all of the EDHS-95 staff for their dedicated efforts to make these highly important data available in such a timely fashion. Prof. Dr. Maher Mahran Secretary General National Population Council XV ACKNOWLEDGMENTS Sample surveys are one of the basic instruments used to obtain reliable information on a country's population and health situation. The EDHS-95 is the third in a series of Demographic and Health surveys in Egypt. These surveys have been conducted to provide the data needed to monitor and evaluate the progress that is being made to improve the health of mothers and children in Egypt. The successful implementation of the EDHS-95 would not be possible without the active support and dedicated efforts of a large number of institutions and individuals. The National Population Council under the leadership of Prof. Dr. Maher Mahran has provided logistic support throughout the survey implementation. Technical assistance came from Macro International Inc. through the international Demographic and Health Survey program. Funding for the survey was provided by USAID/Cairo through the Population and Family Planning III project. A large number of individuals contributed to the successful implementation of the EDHS. In particular, the contribution of our deceased colleague, Dr. Abdel Hakim Mohamed Abdel Hakim, the Assistant Director for Survey Operation, deserves special acknowledgment. His spirit and devotion were instrumental throughout the survey. We profoundly regret that he is not present with us to see the successful conclusion of the survey on which he worked so diligently. Other individuals whose efforts were instrumental in completing the survey include Dr. Enas Hussein, Assistant Director for Sampling, and Dr. Gihan Shawky, Assistant Director for Data Processing. Mr. Mounir Ibrahim, the fieldwork coordinator, ably supervised the field teams. Dr. Rashad Hamed, the senior data processing expert, and Mr. El-Daw Abdalla El-Daw and Mr Hesham Abdel Megid, the data processing coordinators, were responsible for seeing that the data entry and editing proceeded on schedule. Dr. Effat Fakher El-Din and Dr. Abdel Monem Darwesh capably managed the training and supervision of the staff who collected the anthropometric data. Dr. Ann Way of Macro International deserves my deepest gratitude for her effort and contribution during all the survey activities. My thanks and appreciation also are extended to Dr. Alfredo Aliaga, who served as sampling expert, Dr. Sunita Kishor, who worked on the Woman Status questionnaire, and Mr. Keith Purvis, who assisted with the data processing and tabulations required for this report. I also gratefully acknowledge Dr. Richard Martin and Ms. Amani Selim in the Office of Population, USAID/Cairo, and Ms. Mary Ellen Tanamly and Dr. Nahed Matta in the Office of Health, USAID/Cairo, for their support and valuable comments throughout the survey activities. I am deeply grateful to the many individuals at the National Population Council who contributed to the successful completion of this project, especially Mr. Fawzy Abdel Ghani, the Director of the Institutional Development Project (IDP), and the staff of the central office and financial department at the NPC. Finally, this survey could not have been conducted in such a timely fashion without the efforts of each member of the EDHS-95 field and office staff. I would like to express my appreciation for the dedication and skill with which they performed their tasks. Fatma EI-Zanaty Technical Director xvii SUMMARY OF FINDINGS The 1995 Egypt Demographic and Health Survey (EDHS-95) is a nationally representative survey of 14,779 ever-married women aged 15-49. The survey is the third in a series of Demographic and Health Surveys conducted in Egypt. As in previous surveys, the main purpose of the EDHS-95 was to provide detailed information on fertility, family planning, infant and child mortality, and maternal and child health and nutrition. In addition, the EDHS-95 included a module to obtain information on female circumcision, and a special questionnaire was administered to a subsample of 7,121 respondents to collect information on key indicators of women's status. Fertility. Survey results indicate that fertility in Egypt has declined steadily from over 5 births per woman in the early 1980s to 3.6 births at the time of the EDHS-95. Differentials in fertility by place of residence are marked. In urban areas, the total fertility rate is 3 births per woman, more than one child lower than the rural rate (4.2 births per woman). The highest level of fertility is found in rural Upper Egypt (5.2 births per woman) while the lowest level is observed in urban Lower Egypt (2.7 births per woman). Women in the Frontier Govemorates are having an average of 4 births, a rate that is higher than that in any other area except rural Upper Egypt. One of the factors influencing the fertility decline in Egypt has been the steady increase in the age at which women marry. Currently, the median age at first marriage among women age 25-29 is 20.2 years, more than two years greater than the median age at first marriage among women 45-49. On average, rural women are three years younger than urban women when they first marry. Early marriage is most common in rural Upper Egypt, where the median age at first marriage among women 25-29 is 17.3 years. Childbearing begins early for many Egyptian women. One in ten teenagers has given birth or is pregnant with their first child. Teenage childbearing is almost twice as common among rural women (13 percent) as urban women (7 percent). Upper Egypt has the highest level of teenage childbearing, especially in rural areas (18 percent). Closely spaced births are also common. More than one-quarter of non-first births occur within 24 months of a previous birth. One factor contributing to short birth intervals is the relatively brief period during which the average Egyptian woman is amenorrheic following a birth. By 12-13 months after a birth, mothers of the majority of births (77 percent) have resumed menstruation. Overall, the median duration of postpartum amenorrhea is 5 months. The relatively short duration of postpartum amenorrhea is related to breastfeeding patterns, especially the early introduction of supplemental foods. Despite the reductions in fertility levels, many women are having more children than they consider ideal. At current fertility levels, the average woman in Egypt is having one birth more than she wants. For children, the higher than desired fertility is frequently associated with increased mortality risks; more than half of all births in the five-year period before the survey had at greater chance of dying because of the mother's age (under 18 and over 34), high birth order (3 or more), and short birth interval (less than 24 months). Family Planning. Knowledge of family planning methods and sources is virtually universal among currently married women in Egypt. Broadcasts of information about family planning have wide coverage. More than eight in ten ever-married women had heard a family planning broadcast on television or radio recently. Nearly four in ten women reported that television spots had influenced them to seek more information about family planning. xix Family planning use has broad support among Egyptian couples. Nine in ten married women approve of a couple using contraceptive methods, and the majority (83 percent) believe that their husband approves of family planning use. The majority of Egyptian women have experience with using family planning. Seven in ten currently married women have used a family planning method at some time and, at time of the EDHS-95, 48 percent were currently using contraception. Most current users rely on effective methods. The IUD is the most widely used method followed by the pill (30 percent and 10 percent, respectively). Both government health facilities and private sector providers play an important role in the delivery of family planning services in Egypt. The majority of pill users (86 percent) obtain their method from a private pharmacy. The median cost of a cycle of pills for a user is 66 piastres. Slightly more than half of all IUD users go to private providers for their method. Urban hospitals and health units are the most common public sector sources for the IUD (31 percent). The median amount a user pays to get an IUD varies with the type of provider, from 3.7 pounds at a government health facility to 21 pounds at a private doctor or clinic. Although contraceptive knowledge, approval and use are widespread, the EDHS-95 findings highlight a number of areas of concern for the family planning program in Egypt. Among the most important of these concerns are the marked differences in the level of contraceptive use by residence. Current use is highest among women in urban Lower Egypt (59 percent) followed closely by the Urban Governorates (58 percent). Use among rural women in Lower Egypt (53 percent) is more than twice the level among rural women in Upper Egypt (24 percent). The level of current use in the Frontier Governorates (42 percent) is lower than that in all areas except rural Upper Egypt. The slowing in the growth in contraceptive use is another area of concern. Contraceptive use in Egypt doubled between 1980 and 1995, from 24 percent to 48 percent. However, survey results indicate that the pace of the increase in contraceptive use was most rapid in the 1980s, with virtually no change occurring in the overall rate of use between 1991 and 1995. The shift toward more effective methods (particularly the IUD)--which was evident in the 1980s--continued during the first half of the 1990s but also at much slower pace. The introduction of injectables as a program method in 1994 resulted in a small increase (two percentage points) in use of this method, but this gain was offset by a continuing decline in pill use (from 13 percent in 1992 to 10 percent in 1995). A key concern for the family planning program is the rate at which users discontinue use of contraception and their reasons for stopping. Overall, 30 percent of users in Egypt discontinue using a method within 12 months of starting use. The rate of discontinuation during the first year of use is much higher among pill users (46 percent) and injectable users (52 percent) than among IUD users (14 percent). With regard to the reasons for stopping use, users are more likely to discontinue during the first year of use because they experienced side effects or had health concerns than for other reasons. There is considerable potential for increased family planning use. Overall, more than one in six Egyptian women are considered to have an unmet need for family planning. This group includes women who are not using family planning but want either to wait two or more years for the next birth (5 percent) or want no more children (11 percent). Two-thirds of the women with an unmet need for family planning live in rural areas, and more than half have never been to school. Childhood Mortality. At current mortality levels, one in twelve Egyptian children will die before the fifth birthday. Three-quarters of these early childhood deaths take place before a child's first birthday. Mortality rates are higher in rural than urban areas, and the highest levels are found in rural Upper Egypt. XX Differentials by the mother's education are also large, with children born to women who never attended school having mortality rates that are three times higher than children born to mothers who have at least a secondary education. As expected, neonatal mortality is significantly higher for boys than girls. However, the risk of dying after early infancy is lower for boys than girls. Short birth intervals are associated with higher childhood mortality; the risk of dying more than doubles if a child is born less than two years after an elder sibling. Maternity Care Indicators. The care that a woman receives during pregnancy and at childbirth reduces the risks of illness and death for both the mother and the child. Mothers received regular antenatal care (four or more visits) for only 28 percent of the births in the five-year period before the EDHS-95. Tetanus toxoid injections are given to mothers during pregnancy to prevent neonatal tetanus, a frequent cause of death in young infants. Women had at least one tetanus toxoid injection for 70 percent of births in the five- year period before the survey. This represents a significant increase over the level of tetanus toxoid coverage at the time of the 1988 Egypt DHS (11 percent). The majority of Egyptian children are born at home without assistance from trained medical personnel. Overall, less than half of the births in the five-year period before the EDHS-95 survey were assisted by doctors or trained nurse/midwives, and only around one-third of deliveries took place in a health facility. Child Health. One of the primary means for improving survival during childhood is increasing the proportion of children vaccinated against the major preventable diseases. The EDHS-95 results show that 79 percent of children 12-23 months are fully immunized against major preventable childhood illnesses (tuberculosis, diphtheria, whooping cough, tetanus, polio and measles). More than half of young children also have the recommended three doses of the hepatitis vaccine. Diarrheal and respiratory illnesses are a common cause of child deaths in Egypt. Sixteen percent of children under five years of age had diarrhea at some time in the two-week period preceding the survey. Use of ORS packets (40 percent) or a homemade solution of sugar, salt and water (5 percent) to combat the dehydration is common. Many mothers also report that they gave their child increased fluids (45 percent). Almost half of the children with diarrhea received medical attention. During the two weeks preceding the survey, 23 percent of children had a cough accompanied by short, rapid breathing, which are symptoms of acute lower respiratory illness. Around six in ten children with these symptoms were taken to a health facility or provider. Breastfeeding. Breastfeeding is nearly universal in Egypt, and the length of time that the average child is breastfed is relatively long (18.9 months). However, a significant minority of children are not put to the breast immediately after birth (25 percent), and a bottle was used in feeding around one in five breastfeeding children under eight months of age. Supplementary foods also are often introduced too early. Until 4-6 months of age, exclusive breastfeeding (i.e., without any food or liquid) is recommended because it provides all the necessary nutrients and avoids exposure to disease agents; more than 30 percent of children under four months of age are not exclusively breastfed. Children's Nutrition Status. The EDHS-95 found significant levels of tmdernutrition among young children. Overall, 30 percent of children under five years of age are stunted (or short for their age, a condition reflecting chronic undernutrition, while 5 percent are wasted (or thin for their height), a problem indicating an acute food deficit due to illness or recent food shortages. There are substantial residential variations in xxi children's nutritional status. For example, the percentage stunted among children under age five ranges from 18 percent in the Urban Govemorates to 40 percent in rural Upper Egypt. Female Circumcision. Female circumcision is virtually universal among women of reproductive age in Egypt, with 97 percent of ever-married women 15-49 having been circumcised. Moreover, among respondents with one or more living daughters, 87 percent report that at least one daughter has already been circumcised or that they intend to have the daughter circumcised in the future. Most circumcisions took place before the woman reached puberty; the median age at circumcision among both respondents and daughters was 9.8 years. Traditional practitioners including dayas were responsible for more than eight in ten circumcisions among respondents while trained medical personnel performed more than half of the circumcisions among daughters. The majority of women (82 percent) say they want female circumcision to continue. Around 70 percent agree that husbands prefer their wives to be circumcised and that circumcision is an important aspect of religious tradition. Comparatively few women recognize any adverse consequences from circumcision. For example, fewer than one in four women agree a girl may die from complications associated with circumcision. Women's Status. The data collected in the women's status module as well as in the main survey suggest that Egyptian women often have limited control over important aspects of their lives. Marriage between relatives is common, and more than three in four ever-married women did not select their spouse themselves. Large differences in age and education between husbands and wives are the norm. In general, Egyptian women appear to have limited autonomy in household decisionmaking. Married women themselves rarely have the final say on many key decisions, including deciding about seeking medical attention for children. On the other hand, women frequently mention that they participate jointly with the husband in many decisions. Notably, around four in five women say that decisions about future childbearing or family planning use are made jointly with their husband or, less often, by the women themselves. Violent treatment of women within marriage is not uncommon. Around one in three married women has been beaten at least once since they married, most often by their husbands. Among women who have ever been beaten, 45 percent have been beaten at least once in the past year, and 17 percent were beaten three or more times during the year. Whether they themselves have been beaten or not, most ever-married women agree that husbands are sometimes justified in beating their wives. Women's financial autonomy is limited. Fewer than one in five women work for cash, and among those who do have cash earnings, two in three give all of their earnings to the family. Only 14 percent of women own any assets they can sell without permission. Only a small proportion interact with the modern financial system; barely 3 percent have a bank or savings account, and only 5 percent know of a nontraditional source of credit (primarily banks or employers). Finally, despite the significant narrowing of gender differences in educational attainment, especially in urban areas, Egyptian men continue to have greater educational opportunities than women. For example, looking at school attendance data, boys are generally more likely to be attending school than girls. Only around eight in ten girls age 6-10 are in school compared with nine in ten boys. Similar differences by gender are observed in the attendance rates for older children, with the gap increasing with the age of the children. xxii Egypt MEDITERRANEAN SEA 5 2.3 24 25 26 18 19 20 RED SEA 22 21 URBAN GOVERNORATES 1 Cairo 2 Alexandria 3 Port Said 4 Suez LOWER EGYPT 5 Damis~tta 6 Dakahlia 7 Sharkia 8 Kalyubia 9 Kafr El-Sheikh 10 Gharbia 11 Manoufla 12 Bahera 13 Ismailia 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 Sinai 25 South Sinai 26 Red Sea xxiv CHAPTER 1 INTRODUCTION 1.1 Geography and Socioeconomic Indicators Geography Egypt occupies the northeastern comer of the African continent, bounded in the north by the Mediterranean, in the south by the Sudan, in the east by the Red Sea, and in the west by Libya. The total area of Egypt covers approximately one million square kilometers; however, only 6 percent of this area is inhabited (CAPMAS, 1996). Recently, the Egyptian government has adopted a policy of land reclamation and fostering of new settlements in the desert. Despite these efforts, the majority of Egyptians live either in the Nile Delta located in the north or in the narrow Nile Valley. Administratively, Egypt is divided into 26 govemorates (see Map). The four Urban Govemorates (Cairo, Alexandria, Port Said and Suez) have no mral population. Each of the other 22 governomtes are subdivided into urban and rural areas. Nine of these govemorates are located in the Nile Delta (Lower Egypt), and eight are located in the Nile Valley (Upper Egypt). The remaining five Frontier Govemorates are located on the eastern and western boundaries of Egypt. Socioeconomic Indicators The approach to economic development adopted by the government in Egypt has varied over the decades since 1960. During the period 1960-70, the Arab Socialist orientation of the government resulted in close economic ties with the Soviet Union, and a reduction in trade with capitalist economies. The complex Middle East political situation, and the several wars in which Egypt was involved between 1965 and 1975 led to massive expenditures on the military, which further complicated efforts to achieve sustained economic development during the period. Between 1974 and 1980, Egypt experienced unprecedented economic growth as it turned from the socialist strategy of the past to a more open market-oriented economy. Since the 1980s, the government has actively pursued an economic liberalization program with an emphasis on increased private sector participation. The annual gross domestic product (GDP) increased from U.S.$6,598 million in 1970 to U.S.$35,784 million in 1993 (World Bank, 1995). The annual growth in the GDP was estimated to be 9.5 percent for the period 1970-80, and 4.3 percent for the period 1980-93. The average annual inflation for the period 1980-93 was 13.6 percent. In 1960, agriculture represented 40 percent of the GDP. Since then, agriculture's share has fallen steadily. The agricultural sector now contributes less than 20 percent of the GDP while the industrial sector has expanded from 15 percent in 1960 to 22 percent (World Bank, 1995). A number of human development indicators have also improved over time. Some key areas in which improvement has occurred are: The gross national product per capita has doubled during the last 20 years to reach U.S.$660 in 1993 (World Bank, 1995). Investment in education has increased from 8 percent of governmental expenditures in 1980 to 10 percent by 1993 (World Bank, 1995). The positive impact of the government expenditures for education is reflected in increases in the overall enrollment rates as well as a decline in the illiteracy rate (World Bank, 1995). In particular, female enrollment rates have increased dramatically. At the primary stage, the female enrollment rate went from 57 percent in 1970 to 92 percent in 1992. At the secondary level, female enrollment also expanded rapidly, from 23 percent in 1970 to 73 percent in 1992 (World Bank, 1995). Although the economic and social situation has improved steadily over time, Egypt is ranked 107 out of 174 countries on the Human Development Index (UNDP, 1995). At the same time, it is classified as a low- income economy (World Bank, 1995). 1.2 Population Size and Distribution The population of Egypt was estimated to be 60,236,000 ~ in January 1996. The population is distributed somewhat unevenly across the major administrative divisions in Egypt. Slightly more than 20 percent of the total population live in the Urban Governorates. Lower Egypt is home to 43 percent of the population and 35 percent reside in Upper Egypt. In contrast, only one percent of the population live in the Frontier Governorates. The distribution of the population in Egypt has been affected by the rapid rate of urbanization in the coun- try. Table 1.1 indicates that population growth in Egypt has been accompanied by a steady increase in the propor- tion of the population living in urban areas. By 1986, urban areas represented 44 percent of the total population. Much of the inhabited area in Egypt is densely set- tied. At the beginning of 1996, the population density for the country as a whole was estimated to exceed 1,000 per- sons per square kilometer of inhabited area (CAPMAS, 1996). This figure fluctuates considerably both between and within governorates. For example, Cairo governorate is extremely crowded; the population density for the gover- norate as whole exceeds 33,000 persons per square kilome- ter, and within some kisms in the govemorate, there are over 110,000 persons per square kilometer. In contrast, there are only 23 persons per square kilometer in Suez. Table 1.I Population of Egypt~ 1937-1995 Population of Egypt and the percentage hying in urban and rural areas, 1937-1995 Total population Percent Percent Year (millions) urban rural 1937 15,921 28.2 71.8 1947 18,967 33.5 66.5 1960 26,085 38.2 61.8 1966 30,076 40.0 58.8 1976 36,626 43.8 56.2 1986 48,254 44.0 56.0 1995 58,978 U U Note: Population figures exclude Egyphans living abroad. U = Unknown (not available) Source: CAPMAS, 1995, Table 1.7 i Excludes persons who are living abroad. Fertility The rapid growth of population in Egypt is largely a result of the country's past high fertility. Fertility levels were high prior to World War II and then declined gradually following the war. By 1972, the crude birth rate (CBR) was 34.5 births per thousand population. At that point, the CBR began to rise again, peaking at 39.8 births per thousand in 1985. As Figure 1.1 illustrates, the CBR began declining again in the latter part of the 1980s, dropping to a level of 28.6 per thousand population in 1994 (CAPMAS, 1995). Mortality Mortality levels were high prior to World War II. After that, the crude death rate (CDR) dropped from a level of 30 deaths per thousand population in the 1940s to around 17 per thousand in 1960. Much of the reduction in the CDR was owed to a sharp decline in the number of deaths in early childhood. Infant mortality levels decreased rapidly after the war, falling from a rate of 200 deaths per thousand births in the 1940s to 124 deaths per thousand births in the late 1970s (Bucht and El-Barry, 1986). Further reductions in the mortality levels for children throughout the 1980s have contributed to the continuing decline in the CDR. As Figure 1.1 shows, the CDR decreased from 9.2 deaths per 1,000 population in 1986 to 6.8 per 1,000 in 1994 (CAPMAS, 1995). The impact of the mortality decline is reflected in an increase in life expectancy, which had risen to 64.8 years for females and 62.4 years for males by 1992 (UNDP, 1995). 50 Figure 1.1 Crude Birth Rates and Crude Death Rates Egypt 1986-1994 Rate per thousand population 40 30 20 16 O Crude Birth Rate '~ ~3~.1 30.9 - Crude Death Rate 9L- -¢ - - -5 ,1 ,.; 5., 6,8 6,6 I i i i I i i i i 1986 1987 1985 1989 1990 1991 1992 1993 1994 Source: CAPMAS, 1995 3 1.3 Population Policy Concerns about the problems posed by rapid population growth have been raised in Egypt since the 1930s. After the 1952 revolution, the top leaders of the new government were increasingly concerned about population growth. This concern was expressed clearly in the National Charter in which high population growth rates were seen as hindering efforts to raise the living standard of the Egyptian people. B y 1966, Egypt had established a national family planning program, which aimed at reducing fertility and, thus, population growth. However, the first national population policy was not introduced until 1973. In 1975, the policy was articulated further to recognize the simultaneous importance of the four inter-related dimensions of Egypt's population problem: growth, spatial distribution, characteristics, and structure. This refinement of the original policy stressed the need to improve population characteristics (e.g., literacy rates) within the context of overall socioeconomic development; in turn, reproductive behavior would change and population growth would slow. During the 1970s, the adoption of the first population policy was accompanied by increased governmental activities relating to family planning. The Ministry of Health established a department of family planning, and government personnel received training in family planning program management. An information, education and communication (IEC) project was undertaken by a newly established center in the State Information Service, whose objective was to increase family planning awareness. A second population policy was issued in 1980, which placed greater emphasis on face-to-face communication and community-based activities to promote family planning. Following a national population conference in 1984, the National Population Council (NPC) was established. The NPC's role was to coordinate efforts in four major areas: (1) family planning, (2) child welfare, (3) women's participation in the labor force, and (4) literacy. Implementation of programs in these areas continued to be the responsibility of the relevant ministries. The third (and current) national population policy was formulated and adopted in 1986. The policy again emphasized the seriousness of population problems and recognized the interaction between population and development. In 1994, based on the recommendations of the International Conference on Population and Development (ICPD) that was held in Cairo, a modified population strategy was developed, which placed greater emphasis on providing reproductive health services and supporting nongovernmental organizations in the development of local communities. The new strategy included statements supporting female education and the provision of employment opportunities to reduce the gender gap. At the same time, the NPC developed a proposal for a new population policy, building on the positive aspects of the ICPD plan of action. In January 1996, the Ministry of Population and Family Planning, which was established prior to the ICPD conference, was eliminated. A new population sector was created in the Ministry of Health, which was renamed the Ministry of Health and Population (MOHP). The MOHP plans to blend family planning and maternal and child health services into a broad women's health program. Currently, the MOHP is adopting targets for contraceptive prevalence in the coming decade. 1.4 Health Policies and Programs The Ministry of Health and Population (MOHP) continues to retain "Health for all by the year 2000" as the main health objective. The MOHP has a nationwide network of more than 3,700 primary, secondary, and tertiary health care facilities through which maternal and child health services are provided. In addition, the MOHP controls and regulates the work of all nongovernmental health care organizations and facilities and all service providers. The Government of Egypt (GOE) has been committed to improving the health of children as a priority following President Mubarak's declaration that the 1989-1999 decade would be the decade for the protection and development of the Egyptian child. Following this declaration, the National Council of Childhood and Motherhood was formed and is co-chaired by the Prime Minister and the First Lady. The council coordinates activities between ministries implementing programs affecting children and mothers. The health section of the GOE five-year plan for 1992-1997 enunciates policies and strategies for a new MOHP orientation in which subsidized health care will be targeted for the truly needy and fees for services will be introduced for those who can pay. The plan encourages community participation in health, and emphasizes the continual upgrading of health information systems. Maternal and child health (MCH) and family planning are identified as priority areas. In line with the above policies, the MOHP has developed national programs to control diarrhea and acute respiratory infections and instituted an expanded childhood immunization program. Targets to eradicate poliomyelitis and eliminate neonatal tetanus before the year 2000 have been set. Progress is being made in these areas, with eradication of polio possible by 1997. Significantly reduced rates of neonatal tetanus have been achieved. The MOHP is also directing attention to improving maternal health through integrated reproductive health programs as well as reducing neonatal mortality through improving the quality of care given to newborns at home and in health facilities. The MOHP, since its new merger of health and population services, is stressing the importance of integrating family planning and MCH. Emphasis is being placed on improving health services in underserved areas such as rural Upper Egypt. A policy reform agenda is under discussion which includes alternatives for health financing and expansion of health insurance to more beneficiaries, control and improvement in the quality of health services, health manpower distribution and the means to improve compensation for health workers. The importance of strengthening the information system to provide the capacity to collect, analyze, and facilitate the use of health information at all levels is recognized and steps are being taken to address this task. All these health reform plans are intended to have a positive impact on the health of women and children. 1.5 Objectives of the Survey The 1995 Egypt Demographic and Health Survey (EDHS-95) is aimed at providing policymakers and planners with important information for use in evaluating existing programs and formulating new programs and policies related to reproductive behavior and health. The survey was specifically designed to meet the following objectives: (1) Collect data on fertility and desired family size; (2) Monitor changes in family planning practice over time and investigate the availability and accessibility of family planning services in Egypt; (3) Determine reasons for nonuse and intention to use family planning; and (4) Measure the achievement of health policy objectives, particularly those concerning the GOE maternal and child health program. In addition, because information on the status of women is of increasing interest to policymakers, the EDHS-95 included a special questionnaire to collect extensive data on the lives of Egyptian women. The questionnaire was administered to eligible women in one-third of the households in the EDHS-95 sample. 1.6 Organ izat ion and Implementat ion of the Survey The Egypt Demographic and Health Survey (EDHS-95) is a nationally representative survey of ever- married women age 15-49. It is the most recent in a series of population and health surveys in Egypt. 2 The EDHS-95 was conducted between November 1995 and February 1996, under the auspices of the National Population Council (NPC). Technical support for the survey was provided by Macro International Inc, through its Demographic and Health Surveys (DHS) program, a project sponsored by the U.S. Agency for International Development (USAID) to assist countries worldwide to conduct surveys to obtain information on key population and health indicators. USAID/Cairo, under the Population/Family Planning III Project, provided funding for the survey. The survey was executed in four stages. Thefirst stage involved preparatory activities including the design of the sample and sample implementation activities such as updating the sampling frame. At the same time, the survey questionnaires were developed, pretested, and finalized. The preparatory stage was initiated in January 1995, and all of the activities were completed by July 1995. The second stage, which took place from November 1995 through January 1996, involved interviewing of eligible households and individual respondents. The third stage involved all of the data processing activities necessary to produce a clean data file, including the editing, coding, entry, and verification of the data as well as consistency checking. This stage started soon after the beginning of the fieldwork and lasted through late February 1996. The focus of thefina/stage of the survey was data analysis and report preparation. This phase began in March 1996 with publication of the preliminary report, which presented the main findings from the survey. Each of the survey phases is described in more detail below, and the survey timetable is presented in Table 1.2. A list of survey staff is included in Appendix A. Sample Design The primary objective of the sample design for the EDHS-95 is to provide estimates of key population and health indicators including fertility and child mortality rates for the country as a whole and for six major administrative regions (Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and the Frontier Governorates). 3 In addition, in the Urban Governorates, Lower Egypt and Upper Egypt, the design allows for governorate-level estimates of most key variables, with the exception of fertility and mortality rates and women's status indicators. In the Frontier Governorates, the sample size for individual govemorates is not sufficiently large to allow for separate governorate-level estimates. However, separate estimates are possible for the western Frontier Governorates (Matrouh and New Valley) and the eastern Frontier Govemorates (North Sinai, South Sinai and Red Sea). Finally, Assuit and Souhag governorates were oversampled in the EDHS-95 in order to provide sufficient cases for a special follow-up study of the reasons for nonuse of family planning in those areas. 2 The EDFIS-95 is the third Demographic and Health Survey to be implemented in Egypt; the earlier DHS surveys were conducted in 1988 and 1992. Other national-level surveys for which results are shown in this report include the 1980 Egyptian Fertility Survey (EFS-80), the 1984 Egypt Contraceptive Prevalence Survey (ECPS-84) and the 1991 Egypt Maternal and Child Health Survey (EMCHS-91). 3 The Frontier Governorates were not included in the two earlier DHS surveys. However, inclusion of the Frontier Governorates has little effect on comparisons of the EDHS-95 results with those from the 1988 and 1992 surveys or other surveys since only around one percent of the Egyptian population reside in the Frontier Governorates. 6 Table 1.2 Survey timetable, Egypt DHS 1995 Activity Starting Date Duration Updating the sample frame January 95 Mapping March 95 Quick-count operation April 95 Recruitment and training of listing staff August 95 Listing and relisting August 95 Sample selection September 95 Questionnaire design April 95 Preparation of training manuals and other documents May 95 Printing the pretest materials June 95 Pretest of household and individuals questionnaire June 95 Pretest of women's status questionnaire July 95 Finalization of questionnaires and manuals September 95 Trainmg of data collection staff September 95 Printing survey materials September 95 Fieldwork November 95 Reinterviews December 95 Office editing and coding November 95 Data entry November 95 Computer editing December 95 Prehminary report March 96 Detailed tabulations April 96 Final report preparation May 96 2 months 2 months 3 months 2 weeks 6 weeks 1 month 1 month 2 months 2 weeks 2 weeks 1 week 1 month 5 weeks 1 month 2 months 2 months 3 months 3 months 3 months 3 weeks 1 month 5 months In order to meet the survey objectives, the number of households selected in the EDHS-95 sample from each governorate was disproportional to the size of the population in the govemorate. As a result, the EDHS-95 sample is not self-weighting at the national level, and weights had to be applied to the data to obtain the national-level estimates presented in this report. For a more complete description of the EDHS-95 sample design, see Appendix B. Sampling errors for selected variables are presented in Appendix C. Sample Implementation Selection of PSUs. The EDHS-95 sample was selected in three stages. At the first or primary stage, the units of selection were shiakhas/towns in urban areas, and villages in rural areas. Information from the 1986 Census was used in constructing the frame from which the primary sampling units (PSU) were selected. Prior to the selection of the PSUs, the frame was updated to take into account all of the administrative changes which had occurred since 1986. The updating process included both office work and field visits during a three-month period. After it was completed, urban and rural units were stratified by geographical location in a serpentine order from the northwest comer to the southeast within each govemorate. Shiakhas or villages with less than 2,500 population were grouped with contiguous shiakhas or villages (usually within the same kism or marquez) to obtain the minimum size required (5,000 population). During the primary stage selection, a total of 467 units (204 shiakhas/towns and 263 villages) were sampled. Quick Count. The second stage of selection involved several steps. First, detailed maps of the PSUs chosen during the first stage were obtained and divided into parts of roughly equal size. In shiakhas/towns or villages with 20,000 or more population, two parts were selected. In the remaining smaller shiakhas/towns or villages, only one part was selected. Overall, a total of 656 parts were selected from the shiakhas/towns and villages in the EDHS-95 sample. A quick count was then carded out to divide each part into standard segments of about 200 households. This operation was conducted in order to provide an estimate of the number of households in each part so that the part could be divided into segments of roughly equal size. A group of 36 experienced field workers participated in the quick count operation. They were divided into 12 teams, each consisting of one supervisor, one cartographer and one or two counters. A one-week training course conducted prior to the quick count included both classroom sessions and field practice in a shiakha/town and a village not covered in the survey. The quick-count operation took place between late April and late July 1995. As a quality control measure, the quick count was repeated in 10 percent of the parts. If the difference between the results of the first and second quick count were within 2 percent, then the first count was accepted. There were no major discrepancies between the two counts in most of the areas for which the count was repeated; however, in a few cases in Kafr El-Sheikh govemorate, a third visit was made to the field in order to resolve discrepancies between the counts. Household Listing. Following the quick count, a total of 934 segments were chosen from the parts in each shiakha/town and village in the EDHS-95 sample (i.e., two segments were selected from each of the 467 PSUs). A household listing operation was then implemented in each of the selected segments. To conduct this operation, 16 supervisors and 32 listers were organized into 16 teams. Generally, each listing team consisted of a supervisor and two listers. A training course for the listing staff was held at the end of August for one week. The traming involved classroom lectures and two days of field practice in two urban and rural locations. The listing operation began at the end of August and continued for about 40 days. Around 10 percent of the segments were relisted. Two different criteria were used to select segments for relisting. First, segments were relisted when the number of households in the listing differed markedly from that expected according to the quick count information. Second, a number of segments were randomly selected to be relisted as an additional quality control test. Overall, few major discrepancies were found in comparisons of the two listings. However, a third visit to the field was necessary in a few segments in Gharbia govemorate because of significant discrepancies between the results of the original listing and the relisting operation. 8 Selection of the Household Sample. Using the household lists for each segment, a systematic random sample of households was chosen to be interviewed in the EDHS-95. A subsample of one-third of these households was also selected for the woman's status survey, except in Assuit and Souhag govemorates, where all households were included in the women's status survey. All ever-married women 15-49 who were usual residents or present in the household on the night before the interview were eligible for the survey. Questionnaire Development The EDHS-95 involved three types of questionnaires: a household questionnaire, an individual questionnaire, and a women's status questionnaire. The household and individual questionnaires were based on the model survey instruments developed by the Demographic and Health Surveys program for high contraceptive prevalence countries. Additional questions on a number of topics not covered in the DHS mode/questionnaires were included in EDHS-95 questionnaires. In some cases, those items were drawn from the questionnaires used for the 1988 EDHS and the 1992 EDHS. In other cases, the questions were intended to collect information on topics not covered in the earlier surveys (e.g., schooling of children and female circumcision). The women's status questionnaire was based on a special set of modules developed in the DHS program to explore a number of dimensions of the status of women. The modules were modified to obtain data of interest in understanding the position of women in Egyptian society. The household questionnaire consisted of two parts: a household schedule and a series of questions relating to the health and socioeconomic status of the household. The household schedule was used to list all usual household members and visitors and to identify those present in the household during the night before the interviewer's visit. For each of the individuals included in the schedule, information was collected on the relationship to the household head, age, sex, marital status (for those fifteen years and older), educational level and work status (for those six years and older). The second part of the household questionnaire included questions on characteristics of the physical and social environment of the household (e.g., type of dwelling, availability of electricity, source of drinking water, household possessions, and type of salt the household uses for cooking). The individual questionnaire was administered to all ever-married women age 15-49 who were usual residents or who were present in the household during the night before the interviewer's visit. It obtained information on the following topics: • Respondent's background • Reproduction • Contraceptive knowledge and use • Fertility preferences and attitudes about family planning. • Pregnancy and breastfeeding • Immunization and health • Schooling of children • Female circumcision • Marriage and husband's background • Woman's work and residence The individual questionnaire included a monthly calendar, which was used to record a respondent's fertility, contraceptive use, and marriage status during each month of nearly a six-year period beginning in January 1990. Height and weight data were obtained during the individual interview for children born since January 1990 and mothers of these children, as well as other women who had had a live birth since January 1990. The women's status questionnaire obtained more detailed information from a subsample of women on the following topics: • Parent's background • Marriage • Relations with the husband and other household members • Women's workload and eating practices • Employment • Financial Autonomy • Treatment of women in the household. Pretest The household and individual questionnaires were pretested in June 1995 following a two-week training course. Two supervisors, two assistant supervisors and eight interviewers participated in the pretest. The pretest was conducted in Gharbia and Beni-Suef governorates. A total of 303 household and 260 individual interviews were completed during the pretest, out of which 140 household and 126 individual interviews were in urban areas, with the remaining interviews being conducted in rural areas. The women's status questionnaire was pretested in July 1995 following a one-week training course for supervisors and interviewers. Two supervisors and six interviewers participated in the pretest. It was conducted with the same individuals who were interviewed in the pretest of the main survey questionnaires. A total of 229 questionnaire were completed, out of which 103 were in urban areas and 126 were in rural areas. The questionnaires from the EDHS-95 were finalized following the pretest. Both interviewer comments and tabulations of the pretest results were reviewed during the process of modifying the questionnaires. English versions of the final Arabic language questionnaires are included in Appendix D. Data Collection Activities Staff Recruitment. In order to recruit interviewers and field editors, a list was obtained from the Ministry of Social Affairs (MOSA) of female personnel who were working to fulfill the mandatory one-year period of governmental public service for university graduates. All candidates nominated by MOSA for the field staff positions were interviewed, and only those who were qualified were accepted into 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 of the governorates covered in the survey. With a few exceptions, interviewers who had previous experience in surveys were not accepted into the training program. This decision was taken to reduce any bias thai might result from previous survey experience and to ensure that all trainees had a similar background. However, previous survey experience was a basic qualification 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 including general guidelines to follow while conducting an interview, as well as specific instructions for asking particular questions in the questionnaire, 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-95 and distributed to all field workers. 10 Other training materials including special manuals describing the duties of the team supervisor and the rules for field editing were prepared. Instructions regarding anthropometric data collection were included in a manual for interviewers and assistant supervisors who were trained to collect height and weight data. Supervisor and Interviewer Training. 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 it also covered the EDHS-95 questionnaires in order to give supervisors a basic understanding of the content of the survey prior to the main training program. Interviewer training for the EDHS-95 data collection began in late September 1995. Eighteen supervisors, 22 assistant supervisors and 96 interviewers participated in the training program. The training program, which was held in Cairo for five weeks, included: General lectures related to basic interview techniques and to specific survey topics (i.e., fertility and family planning, maternal and child health, and female circumcision); • 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 covered in the survey; and • Nine quizzes. Trainees who failed to show interest in the survey, or did not attend the training program on a regular basis, or failed in the first three tests were terminated immediately. At the beginning of the third week of training, a list was prepared of the 17 trainees who had performed best during both the classroom and field exercises. These trainees were further examined in order to select 13 field editors. A special training session was held for the field editors following their selection. Forty-six trainees and all of the assistant supervisors were selected for anthropometric training, which included both classroom lectures and practice measurement in a nursery school. At the end of the program, the 31 most qualified trainees were selected to serve as measurers during the EDHS fieldwork. B y the end of the training course, 66 of the 96 candidates originally recruited for interviewer training had been selected to work as interviewers or field editors in the EDHS fieldwork. Fieldwork. The initial round of fieldwork for the EDHS-95 began on November 4, 1995 and was completed on January 1, 1996. A total of 95 staff, including one fieldwork coordinator, two assistant fieldwork coordinators, 13 supervisors, l 3 assistant supervisors, 13 field editors and 53 interviewers were responsible for the data collection. All supervisors and assistant supervisors were male while the field editors and interviewers were female. The field staff was divided into 13 teams; each team had a supervisor, assistant supervisor, field editor and three to five interviewers. Usually two of the interviewers in the team plus the field editor and the assistant supervisorwereresponsibleoftheanthropometricmeasurements. Duringthefieldworkthe 13 field teams worked in separate govemorates; the number of governorates assigned to an individual team varied from one to three, according to the sample size in the governorates. 11 As soon as the main data collection was completed in the first group of govemorates, a random sample of up to 10 percent of the households were selected for reinterview as a quality control measure. Shorter versions of the EDHS-95 questionnaires were prepared and used for the reinterviews. The visits to PSUs to conduct reinterviews also afforded an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit by the EDHS-95 interviewers. Household or individual questionnaires in which there were significant errors which could not be corrected in the office were also assigned for callbacks. Special teams were organized to handle callbacks and reinterviews. During this phase of the survey, interviewers were not allowed to work in the govemorate in which they had participated in the initial fieldwork. Callbacks and reinterviews began on December 16, 1995 and were completed on February 7, 1996. Data Processing Activities Office Editing. The central office of the EDHS-95 was responsible for collecting questionnaires from supervisors as soon as a cluster completed. Questionnaires were reviewed for consistency and completeness by office editors, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires. These reports were reviewed by the senior staff. If serious errors were found in one or more questionnaires from a cluster, the supervisor of the team working in the cluster was notified and advised of the steps to be taken to avoid these problems in the future. Machine Entry and Editing. The machine entry and editing phase began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Integrated System for Survey Analysis (ISSA), a software package developed especially for the Demographic and Health Surveys program. Eleven data entry personnel used eight IBM-compatible microcomputers to process the EDHS-95 survey. During the machine entry, one-third of each segment was reentered for verification. One of the computers was assigned solely for this purpose. By working two shifts six days per week, the data processing staff completed the entry and editing of data by the end of February 1996. 1.7 Coverage of the Survey A summary of the outcome of the fieldwork for the survey is presented in Table 1.3 by place of residence. The table shows that, during the main fieldwork and callback phases of the survey, 15,567 households selected for the EDHS-95 sample were successfully contacted, which represents a response rate of 99.2 percent. A total of 14,879 women were identified as eligible to be interviewed. Questionnaires were completed for 14,779 of those women, which represents a response rate 0f99.3 percent. A total of 7,223 respondents were in the subsample selected for the women's status interview. Questionnaires were completed for 7,121 of these women, which represents a response rate of 98.6 percent. There was almost no difference between urban and rural areas in response rates for the household, individual and women's status interviews. Looking at place of residence, the response rate for the household and individual interviews exceeds 98 percent, and the response rate for the women's status interviews exceeds 97 percent, in all areas. 12 Table 1.3 Results of the household t individual and women's status interviews Number of households and ehglble women and response rates by urban-rural residence and place of residence, Egypt 1995 Interview results Place of residence Urban Lower Egypt Upper Egypt Frontier Gover- Gover- Urban Rural notates Total Urban Rural Total Urban Rural norates Total Households sampled Households found Households interviewed Household response rate Eligible women Eligible women interviewed Eligible woman response rate Eligible for women's status Eligible for women's status and interviewed Women's status response rate 7,730 8,316 3,261 5,267 1,862 3,405 6,394 1,857 4,537 1,124 16,046 7,475 8,214 3,128 5,197 1,819 3,378 6,257 1,792 4,465 1,107 15,689 7,397 8,170 3,090 5,149 1,799 3,350 6,226 1,775 4,451 1,102 15,567 99.0 99.5 98.8 99.1 98.9 99.2 99.5 99.1 99.7 99.5 99.2 6,317 8,562 2,611 4,716 1,459 3,257 6,306 1,520 4,786 1,246 14,879 6,279 8,500 2,595 4,676 1,447 3,229 6,262 1,510 4,752 1,246 14,779 99.4 99.3 99.4 99.2 99.2 99.1 99.3 99.3 99.3 1(30.0 99.3 2,515 4,708 887 1,623 508 1,115 4,294 876 3,418 419 7,223 2,481 4,640 878 1,598 502 1,096 4,228 857 3,371 417 7,121 98.6 98.6 99.0 98.5 98.8 98.3 98.5 97.8 98 6 99.5 98.6 13 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS The objective of this chapter is to provide a demographic and socioeconomic profile of the EDHS-95 sample and a descriptive assessment of the environment in which women and children live. This is accomplished by examining the general characteristics of the households and individual respondents interviewed in the EDHS-95. With regard to households, information is presented on the age, sex, and education of the household population as well as on housing facilities and household possessions. For individual respondents, a basic profile including information on age, residence, education, work status and religion is presented first and then more detailed information is provided on differentials in education, access to mass media, and employment patterns. The profile of the EDHS-95 households and respondents provided in this chapter will help in understanding the results presented in the following chapters. In addition, it may provide useful input for social and economic development planning. 2.1 Characteristics of the Household Population The questionnaire for the 1995 EDHS included two questions distinguishing between the de jure population (persons who usually live in selected household), and the de facto population (persons who spent the night before the interview in the household). The differences between these populations are small, and since past surveys and censuses were based on de facto populations, tabulations for the household data presented in this chapter are based on the de facto definition, unless otherwise stated. Age and Sex Composition Table 2.1 presents the percent distribution of the de facto population by age, according to urban-rural residence and sex. The table shows the effects of past demographic trends on the structure of the Egyptian population and indicates the context in which a variety of demographic processes are operating. The information on sex and age distribution is used to construct a population pyramid describing the EDHS-95 household population (see Figure 2.1). The pyramid has a wide-base, with a large concentration (40 percent) of the population under 15 years of age. This pattern is typical of countries that experienced relatively high fertility in the recent past. The decline in fertility which has been occurring in Egypt since the late 1980s is evidenced by the fact that the proportion of the population age 0-4 years is somewhat smaller than the proportion age 5-9 years. As Table 2.1 shows, the proportion under age 15 is greater in the rural population than the urban population. The differences in the age distributions are evidence of lower recent fertility in urban areas compared with rural areas. Table 2.2 presents a comparison of the distribution of the household population by broad age groups for the three EDHS surveys carried between 1988 and 1995. The dependency ratio, defined as the ratio of the nonproductive population (persons under age 15 and age 65 and over) to the population age 15-64, is calculat- ed based on these figures. The dependency ratio decreased from 83 in 1992 to 78 in 1995, indicating a gradual lessening in the burden placed on persons in the productive ages to support older and younger household members. Table 2.2 also indicates that the median age of the EDHS-95 survey population was 19.3 years in 1995, slightly higher than the median age in 1992. Both the change in the dependency ratio and in the median age of the population are consistent with the gradual aging of the population that occurs as fertility declines. 15 Table 2.1 Household population by age~ residence r and sex Percent distribution of the de facto household population by five-year age groups, according to urban-rural residence and sex, Egypt 1995 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 11.6 10.6 I1.1 15.1 13.2 14.1 13.5 12.0 12.8 5-9 13.1 11.8 12.4 15.4 14.0 14.7 143 130 13.7 10-14 12.3 13.0 12.7 14.8 13.7 14.2 13.7 134 13.5 15-19 11,3 ll.O l l . l 11.8 11,3 11.6 11.6 11,2 11,4 20-24 80 8.7 8,3 6.9 8.6 7.8 7.4 8.7 80 25-29 71 7.8 7.5 6.4 7.2 6.8 67 7.5 7.1 30-34 6.8 7.1 6.9 5.9 6.0 6,0 63 6,5 6.4 35-39 6.2 7.2 6.7 51 5.6 5.4 5.6 63 60 40-44 6.0 59 6.0 4.1 4.2 4.2 5.0 4.9 5.0 45-~ 49 5.3 5,1 3.6 4,2 3.9 4.2 4.7 4.5 50-54 3.5 2,9 32 2.5 29 2.7 2.9 2.9 2.9 55-59 3.0 28 2.9 2.3 2.6 2.5 2.7 2.7 2.7 60-64 2.4 2.6 2.5 2,1 2.5 2.3 2.3 2.5 2.4 65-69 1.7 1.7 1.7 1.7 1.6 1.7 17 16 1,7 70-74 1.2 0.9 1.0 I.I 1.2 1.2 I.I I.I 1.1 75-79 0,6 0.4 05 0.5 0.5 0.5 0.5 0.4 0.5 80+ 04 0.4 04 0.6 0.6 0.6 0.5 0.5 0.5 Total 1(30.0 100.0 100.0 100.0 100.0 1000 100.0 100.0 100.0 Number 18,293 18,475 36,768 22,068 22,687 44,755 40,360 41,162 81,523 Figure 2.1 Distribution of the Household Population by Sex and Age Age 8 4 2 0 2 4 Percent EDHS 1995 16 Tab!e 2.2 Population by age) 1988 r 1992, and 1995 Percent distribution of the de facto population by broad age groups, 1988 EDHS, 1992 EDHS, and 1995 EDHS 1988 1992 1995 Age group EDHS EDHS EDHS Less than 15 41.2 41.7 40.0 15-64 55.0 54.6 56.3 65+ 3.8 3.7 3.7 Total 100.0 100.0 100.0 Median age -- 18.8 19.3 Dependency ratio 81.8 83.2 77.6 Household Composition Table 2.3 presents the distribution of households in the EDHS-95 sample by sex of the head of the household and by the number of household members. These characteristics are important because they are often associated with socioeconomic differences between households. For example, female-headed households frequently are poorer than households headed by males. In addition, the size and composition Table 2.3 Household composmon Percent distribution of households by sex of head of household and household size, according to urban-rural residence and place of residence, Egypt 1995 Characteristic Urban Rural Place of residence Urban Lower Egypt Upper Egypt Frontier Gover- Gover- notates Total Urban Rural Total Urban Rural norates Total Household headship Male 87.3 87.4 87.2 87.0 86.3 87.4 87.8 88.5 87.4 95.5 87 4 Female 12.7 12.6 12.8 13.0 13.7 12.6 12.2 11.5 12.6 4.5 12.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1000 100.0 Number of usual members I 6.1 4.6 6.6 5 0 5.9 4.5 5.0 5.5 4.8 3.2 5.4 2 10.8 7.1 11.5 8.6 10.6 7.6 7.6 9.8 6.4 7.1 9.0 3 13.0 9.5 13.2 11.6 14.3 10.3 9.3 11.2 8.4 8.6 11.3 4 19.9 10.5 21.0 13.8 19.0 11.2 12.8 18.7 9.6 16.4 ]5.3 5 20.2 15.2 20.7 18.6 21.1 17.4 14.3 18.2 12.2 16.3 17.7 6 13.3 14.6 12.9 15.0 13.6 15.7 13.4 13 9 13 2 12.8 14.0 7 7.6 12.7 6.7 11.0 8.7 12.1 11.6 8.2 13.4 10.8 10.1 8 4.2 9.1 3.8 6.3 3.5 7.7 9.2 5.8 11.0 6.8 6.6 9+ 4.6 16.7 3.5 10.0 3.0 13.4 16.7 8.6 21.0 17.7 10.5 Total 100.0 1O0.0 100.0 100.0 100.0 100.0 100.0 100.0 l(g).O 10(9.0 100.0 Mean size 4.6 6.0 4.5 5,3 4.5 5.7 5.9 5.1 6.4 6.1 5.3 Number of households 7,924 7,643 3,911 6,594 2,206 4,387 4,942 1,722 3,220 121 15,567 Note: Table is based on de lure members, i.e., usual residents. 17 of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. Unlike earlier tables, Table 2.3 is based on de jure members, i.e. usual residents. The household head was female in 13 percent of households in the 1995 EDHS. There is little variation in the proportion of female-headed households by residence, except for the Frontier Governorates, where only 5 percent of households were reported to be headed by females. There are on average 5.3 persons in an Egyptian household. Around one in four households has fewer than 4 members, while two in five households have 6 or more members. Households in rural areas are larger than households in urban areas. For example, fewer than one in ten urban households has 8 or more members compared with one in four rural households. By place of residence, household size varies from an average of 4.5 in the Urban Governorates and urban Lower Egypt to 6.4 in rural Upper Egypt. 2.2 Education of the Household Population The education level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Results from household interviews can be used to look at both educational attainment among household members and school attendance among children and young adults. Educational Attainment Tables 2.4.1 and 2.4.2 present data on the educational level of the household population age six and over. Primary education in Egypt starts at age six and continues for five years. A further three-year period, known as the preparatory stage, is considered basic education and is compulsory. The secondary stage, which includes an additional three years of schooling, is not compulsory. The results in Tables 2.4.1 and 2.4.2 confirm that there is a gap in educational attainment between males and females. Overall, 83 percent of Egyptian males have attended school compared with only 65 percent of females. Even among those who have gone to school, there is a gender gap in the number of years of schooling; the median number of years of schooling for men is 6.1 compared with 3.3 for women. An examination of the changes in educational indicators over successive cohorts indmates that there have been substantial increases over time in the educational attainment of both men and women. For example, the median number of years of schooling is 12.2 for males age 20-24 years compared with 9.7 in the 30-34 age group and 6.5 in the 40-44 age group. Women have also experienced substantial improvements in education. As a result, the differentials in educational attainment between males and females have narrowed among younger cohorts; for example, the gap in the median number of schooling for the 20-24 age group is 3.3 years, while it is around one year for those under age 20. Urban residents are both more likely to have attended school and to have remained in school for a longer period than mral residents. Gender differences in educational attainment also are less evident in urban than in rural areas. The median years of schooling among rural women is 1.0 compared with 4.9 among men. The difference is smaller in urban areas, where the median years of schooling is 6.1 for women and 7.6 for men. 18 Table 2.4.1 Educational level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, according to selected background characteristics, Egypt 1995 Primary Completed Number Median Background No Some through secondary/ of number characteristic education primary secondary higher Total persons olyears Age group 6-9 9.3 90.5 0.2 0.0 100.0 4,604 1.6 10-14 5.4 41.0 53.5 0.0 100.0 5,525 6.2 15-19 6.3 14.3 59.9 19.5 100.0 4,670 9.9 20-24 8.0 12.8 23.7 55.5 100.0 2,973 12.2 25-29 12.2 17.2 16.6 54.0 100.0 2,704 12.1 30-34 16.2 20.3 16.5 47.0 100.0 2,544 9.7 35-39 18.2 22.2 17.5 42.1 100.0 2,258 84 40-44 25.6 20.5 18.5 35.5 100.0 2,020 6.5 45-49 33.8 19.5 19.3 27.4 100.0 1,709 5.7 50-54 40.3 17.1 18.8 23.7 109.0 1,181 4.9 55-59 45.7 17.7 17.0 19.6 100.0 1,074 2.7 60-64 50.2 23A 9.7 17.1 100.0 909 0 0 65+ 63.3 16.9 10.1 9.8 100.0 1,555 0.0 Urban-rural residence Urban 11.2 28.4 28.4 32.0 100.0 15,703 7.6 Rural 23.0 34.0 25.7 17.3 100.0 18,023 4.9 Place of residence Urban Governorates 10.9 27.8 28.9 32.4 100.0 7,614 7 8 Lower Egypt 16.7 32.0 28.0 23.3 100.0 14,426 6 2 Urban 9.8 28.3 28.5 33.3 100.0 4,312 7.9 Rural 19.6 33.6 27.8 19.0 1000 10,113 5.5 Upper Egypt 23.1 33.0 24.2 19.7 100.0 I 1,383 4.9 Urban 13.6 29.7 27.2 29.5 100 0 3,585 6.9 Rural 27.5 34.5 22.8 15.2 109.0 7,797 3.9 Frontier Governorates 16.0 29.5 28.2 26.3 100.0 304 66 Total 17.5 31.4 26.9 24.2 1000 33,726 6.1 By place of residence, gender differences in the likelihood of attending school are most striking in rural Upper Egypt and least evident in the Urban Governorates. In rural Upper Egypt, only 41 percent of women have ever attended school compared with 73 percent among males. In the Urban Goveruorates, the gap is much smaller, with 80 percent of women having some education compared with 89 percent of men. 19 Table 2,4.2 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, according to selected background characteristics, Egypt 1995 Primary Completed Number Median Background No Some through secondary/ of number characteristic education primary secondary higher Total persons of years Age group 6-9 19.3 80.4 0.3 0.0 100.0 4,249 1.4 10-14 17.1 35.9 47.0 0 1 I00.0 5,504 5.0 15-19 19.4 13.4 47.5 19.7 100.0 4,598 9.3 20-24 27.8 11.6 17.4 43.2 1000 3,563 8.9 25-29 36.4 16.5 9.8 37.2 100.0 3,088 5.5 30-34 40.0 20.4 9.5 30.1 ] 00.0 2,672 3.7 35-39 44.4 23.5 9.8 22.2 100 0 2,597 2.6 40-44 47.5 22.2 12.8 17 5 100.0 2,034 1.8 45-49 54.7 21.4 13.1 10.8 100.0 1,938 0.0 50-54 62.6 19.1 8.8 9,5 100.0 1,195 0.0 55-59 65.4 19.3 8.5 6.8 100.0 1,127 0.0 60-64 68.8 21.7 5.8 3.8 100.0 1,045 0.0 65+ 80.8 11.9 5.1 2.2 100.0 1,498 0.0 Urban-rural residence Urban 20.8 28.2 25.3 25.7 100.0 16,079 6.1 Rural 47,8 27.6 15.8 8.8 100.0 19,032 1 0 Plaee of residence Urban Governorates 20.4 27.2 26.1 26.3 100.0 7,855 6.3 Lower Egypt 33.0 29.8 20.7 16.5 100.0 15,010 3.5 Urban 18.8 28.9 25.5 26.8 100.0 4,361 6.3 Rural 38.9 30.2 18.7 12.2 100.0 10,649 2.4 Upper Egypt 48.3 26.1 15.5 10.1 1(30.0 11,948 1.0 Urban 24.1 29.7 23.2 23.0 100.0 3,681 5.3 Rural 59.1 24.5 12.0 4.4 100 0 8,267 0.0 Frontier Governorates 33.9 25.8 21 0 19.2 1000 298 3.8 Total 35.4 27.9 20.1 16.5 100.0 35,111 3.3 Note: Includes 3 persons missing/don't know School Attendance Table 2.5 shows the percentage of the household population age 6 to 24 years who are currently attending school according to age, sex, urban-rural residence, and place of residence. The results show that both gender and residential differences persist in the proportion of the population currently attending school in Egypt. Looking at gender differences in the attendance data in Table 2.5, it is clear that boys are generally more likely than girls to be attending school. For example, while 89 percent of boys age 6-10 are attending school, this figure is only 79 percent for girls age 6-10. Similar differences by gender are observed in the attendance rates for older children, with the gap increasing with the age of the children. 20 Table 2.5 School attendance Percentage of the de facto household population age 6-24 years who are currently attending school, by age group, sex, urban-rural residence, and place of residence, Egypt 1995 Place of residence Urban Lower Egypt Upper Egypt Frontier Age Gover- Gover- group Urban Rural notates Total Urban Rural Total Urban Rural norates Total MALE 6-10 92,6 86.7 92.8 91.5 94.0 90.5 84.7 90.4 82.7 90.6 89.1 11-15 82.6 76,9 81.2 80.6 82.3 79,9 76.5 85,0 73.0 82.5 79.3 6-15 87.8 82.0 87,3 86.0 88.1 85.2 81.0 87.8 78.4 86.9 84,4 16-20 54.3 43.0 56.3 48.7 55.5 45.9 42.5 49.0 39.7 43.7 48.1 21-24 19.3 12,9 21.6 15,1 19.0 13.1 13.4 14.8 12.6 8.2 16.1 FEMALE 6-10 92.3 69.7 91,8 86.0 94,6 83.1 64.8 90.7 54.5 80.7 79.0 11-15 84,5 56.9 83,4 75.0 87.4 70.1 53,7 83.3 41.2 70.0 69.0 6-15 88.4 63.6 87,6 80.7 90.9 76.9 59.5 87,1 48.3 75,7 74.1 16-20 47.3 24.1 49,9 37.9 53,9 31.8 19.8 33,8 13.8 29,5 34.3 21-24 12.7 3.5 15.1 6.7 12.5 4.4 4,2 8.3 2.2 6.7 7,7 TOTAL 6-10 92.5 78.4 92.3 88.8 94.3 86,8 75.1 90.5 69.3 86.0 84.2 11-15 83.6 67.2 82.3 77.9 84.8 75.3 65.1 84.2 57.2 76.6 74.2 6-15 88.1 73,1 87.4 83.4 89.5 81.2 70,5 87.4 63.7 81.7 79.4 16-20 50.7 33.2 53,1 43.0 54.7 38.4 31.2 41.5 26.8 36,2 41.0 21-24 15.9 7.7 18.3 10,6 15.8 8,3 8.4 11.3 6,9 7.4 11.6 Considering the effect of residence, the gap in attendance rates between urban and rural areas is present for boys and even more striking for girls. For example, the attendance rate for boys age 6-10 years in urban areas is 93 percent compared with 87 percent in rural areas; for girls, the percentage is 92 percent in urban areas but only 70 percent in rural areas (see Figure 2.2). Urban-rural differentials in attendance rates are larger in Upper Egypt than in Lower Egypt, particularly for girls. While 91 percent of girls age 6-10 in urban Upper Egypt are attending school, only 55 percent of girls in this age group in rural Upper Egypt attend school. In contrast, 95 percent of girls age 6-10 years in urban Lower Egypt are currently attending school compared with 83 percent of girls in that age group in rural Lower Egypt. 21 Figure 2.2 School Attendance among Children Age 6-15 by Age, Sex, and Urban-Rural Residence p 87 100 80 50 40 20 Percent Male Female 6-10 Years Male Female 11-15 Years EDHS 1995 2.3 Househo ld Env i ronment Housing Characteristics Table 2.6 presents the distribution of households by selected housing characteristics, including the source of drinking water, type of sanitation facilities, type of flooring, and the number of persons per sleeping room. These are important determinants of the health status of household members, particularly children. They can also be used as indicators of the socioeconomic status of households. Overall, 96 percent of households have electricity. Differentials in the availability of electricity by urban-rural residence and place of residence are small. In urban areas, virtually all households have electricity, and, in rural areas, 92 percent of households have electricity. The lowest proportion of households with electricity is found in rural Upper Egypt (87 percent). In Egypt, more than eight in ten households have access to piped water, mainly within their dwelling. Urban households are somewhat more likely to have access to safe drinking water than rural households. Among urban households, 92 percent have piped water in their residence, and 4 percent obtain water from a public tap. Among rural households almost 70 percent have access to piped water, primarily in their residence (53 percent). Among the remaining rural households, most use well water. Households in rural Upper Egypt are somewhat more likely to be relying on well water than households in rural Lower Egypt (38 percent and 17 percent, respectively). 22 Table 2.6 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence and place of residence, Egypt 1995 Place of residence Urban Lower Egypt Upper Egypt Frontier Gover- Gover- Characteristic Urban Rural notates Total Urban Rural Total Urban Rural notates Total Electricity Yes 99.0 91.9 99.3 96.8 99.3 95,6 90.8 97.8 87.0 91.9 95.5 No 1.0 8.1 0.7 3.2 0.7 4.4 9.2 2.2 12.9 8.0 4.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 I00.0 I00.0 100.0 Source of drinking water Piped water Piped into residence 92.4 53.2 94.7 71,7 94.4 60.2 58.7 86.5 43.9 49 5 73.2 Public tap 4.1 16.2 4.3 14.3 3.8 19 6 9.2 4.2 ] 1.9 0 9 10.1 Well water Well in residence 0.7 13.3 0.1 6.8 0.3 10.0 12.6 2.7 18.0 1.3 6.9 Pubhc well 0.4 12.2 0.0 4.4 0.2 6.5 13.6 I 3 20.1 3.0 6.2 Nile/canal 0.0 0.3 0.0 0. I 0.0 0. I 0.3 0 0 0.5 0.1 0. I Other 2.3 4.7 0.9 2.8 1.2 3.6 5.5 5.1 5.7 45.2 3.5 Total 100.0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Time to water source Water within 15 minutes 95.9 81.3 96.2 85.8 97.4 79.9 87.0 93.9 83.2 80.7 88.7 Sanitation facility Modern Oush todet 50.4 6.2 57.7 21.8 47.4 8.9 14.7 37.4 2.6 39 1 28.7 Tradxtlonal w/tank flush 1.9 1.4 I.I 2.0 2.6 1.7 1.7 3.1 1.0 3.0 I 7 Traditional w/bucket flush 44.9 63.3 40.1 62.9 47.7 70.5 53 2 52.6 53.5 42.1 53.9 Pit toilet/latrme 1.6 17.8 0.4 9.8 1.7 13.8 16.5 4.2 23.1 8.6 95 No facility 0.9 9.6 0.5 2.9 0.5 4.1 11.9 2.4 17.0 1.0 5.2 Other 0.2 1.7 0.1 0.6 00 0.9 1 9 0.4 2.7 6.2 0.9 Total 100 0 1(30.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Flooring Earth/sand 5.9 54.0 2.6 28.7 4.6 40.8 52.3 15.1 72.1 14.8 29.5 Parqueffpohshed wood 2.4 0.0 3,8 0.3 0.8 0.0 0.6 1.6 0.0 0.1 1.3 Ceramic tiles 1.3 0.0 1.8 0.2 0.6 0.1 0.3 0.9 0.0 0.4 0.7 Cement tiles 74.0 22.0 76.6 44.1 75.2 28.5 31.8 66.9 13.1 56.8 48.5 Cement 10.4 23.4 10.1 23.6 I 1.0 29.9 12.8 9.8 14,5 23.3 16.8 Wall-to-wall carpet 4.7 0.4 3.6 2.6 6.8 0.5 1.8 4.7 0.2 3.8 2.6 Other 1.3 0.1 1.6 0.4 1.0 0.1 0.3 0.9 0.0 0.8 0.7 Total 100.0 100,0 1130.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Persons per sleeping room 1-2 66.0 47.2 67.6 56.7 67.0 51.5 48.0 60.7 41.3 65 0 56.7 3-4 27.7 39.9 26.2 34.7 27.6 38 2 38.3 31.0 42.2 30.3 33.7 5-6 4.7 9.3 4.4 6.6 3.9 7.9 9.4 6.2 11.1 4.0 6.9 7 + 1.7 3.6 1.7 2.0 1 4 2.4 4.2 2 1 5.4 0.8 2.6 Total 100.0 100.0 100.0 100.0 lO0.O 100.0 100.0 100.0 100.0 100.0 lO0.O Mean persons per room 2.5 3.1 2.5 2.8 2.5 2.9 3.1 Number of households 7,924 7,643 3,911 6,594 2,206 4,387 4,942 2.7 33 2.6 2.8 1,722 3,220 121 15,567 23 For most households, the source for their drinking water is within their dwelling or not far from their residence. Overall, 89 percent of households obtain drinking water in their dwelling or within 15 minutes of the residence. Urban households tend to be closer to the source of water than rural areas; 96 percent of households in urban areas report that the source for drinking water is in the house or within 15 minutes of the dwelling compared with 81 percent of rural households. More than a quarter of Egyptian households have a modem flush toilet, and more than half of households have traditional flush toilets. Ten percent use a pit or latrine and only 5 percent report having no toilet facilities. There are differences in the type of toilet facilities available to households by both urban- rural residence and place of residence. Households in urban areas are about equally likely to have a modem flush toilet (50 percent) or a traditional flush toilet (45 percent). Only 3 percent of urban households use a pit or latrine or report that they have no toilet facilities. In comparison, 18 percent of rural households use a pit or latrine, and 10 percent say that they have no toilet facilities. Sanitation facilities appear to be poorest in rural Upper Egypt, where 40 percent either use a pit or latrine or have no facilities. With regard to flooring, around half of households live in dwellings with cement tile floors, an additional 17 percent have a cement floor, and 30 percent have earth or sand floors. There are substantial differences in the flooring materials in urban and rural dwellings. Among urban households, 74 percent have a cement tile floor compared with 22 percent of rural households. Conversely, 54 percent of rural households live in dwellings that have earth/sand floor compared with only 6 percent of urban households. In rural Upper Egypt, more than seven in ten households live in dwellings with earth/sand floors. Information on the number of persons per sleeping room was collected in the EDHS-95 in order to provide a measure of crowding. Table 2.6 shows that 57 percent of households had one or two persons per sleeping room, and one-third had three to four persons per sleeping room. The overall mean is 2.8 persons per sleeping room. Rural households are more crowded than urban households. The mean number of persons per sleeping room is 2.5 in urban areas compared with 3.1 persons in rural areas. The most crowded area is rural Upper Egypt (3.3 persons per sleeping room). Household Possessions Table 2.7 provides information on household ownership of durable goods and other possessions. With regard to durable goods, almost eight in ten households in Egypt own a television (color or black and white), more than seven in ten households own a washing machine, more than six in ten own a radio with a cassette recorder or a stove, and more than half own a refrigerator or electric fan. Urban households are more likely to have the convenience of these items than rural households. For example, 90 percent of households in urban areas own a washing machine compared with around 60 percent of households in rural areas. Similarly, 85 percent of urban households own a gas stove compared with 40 percent of households in rural areas. Rates of ownership of various household possessions also differ by place of residence, with higher rates of ownership for most items reported among households in the Urban Govemorates, Lower Egypt, and the Frontier Govemorates than in Upper Egypt. Households in rural Upper Egypt have the lowest rates of ownership for all durable goods, with the exception of an electric fan. Table 2.7 also includes information on household ownership of a means of transportation. Overall, 8 percent of households own a car or motorcycle, with the highest rate of ownership in the Urban Govemorates (14 percent) and the lowest rate in rural Upper Egypt (3 percent). Rates of ownership of bicycles vary from 9 percent in the Urban Govemorates to 28 percent in the Frontier Govemorates. 24 Table 2.7 Household possessions Percentage of households possessing various household effects, means of transportation, property, and farm animals/implements, by urban-rural residence and place of residence, Egypt 1995 Possession Urban Rural Place of residence Urban Lower Egypt Upper Egypt Frontier Gover- Gover- norates Total Urban Rural Total Urban Rural norates Total Household effects Radio 73,4 54.6 74.9 61.7 72.0 56,5 58.8 71.6 51.9 72,0 64.2 Television 88.5 68.8 90,0 78.8 88.1 74.1 69.9 85.3 61.6 82.7 78.8 Video 14.8 1.0 18.5 4.1 10.2 i.I 5.0 12.4 1.0 6.9 8.0 Electric fan 69.7 38.6 70.7 45.4 64.3 35.8 53.5 74,2 42.5 60,0 54.4 Cooking stove 85.4 39.6 89.3 63.6 86.2 52.2 40.9 75.6 22.3 76,7 62.9 Water heater 44.3 6.5 49.6 19.4 40.6 8.7 15.4 37.6 3.6 26.8 25.8 Refrigerator 77.9 33.1 80.6 48.9 74.5 36.0 45.2 75.7 29.0 76.5 55.9 Sewing machine 22.9 9.7 23.9 15.4 22.9 11.5 11.6 20.1 7.0 27.2 16.4 Washing machine 89.8 59.4 90.8 78.7 91.2 72.4 57.0 85.5 41,8 79.6 74.9 Means of transportation Bicycle 13,5 16.0 8.6 17.4 17.3 17,5 15.5 18.7 13.8 28.0 14,7 Private car/motorcycle 12,4 4.2 14.4 6.4 9.5 4.9 6.1 11.5 3.2 15.0 8.4 Property Farm/other land 7.0 37,8 4.2 27.2 10.3 35.7 29.6 9.3 40.4 22.5 22.1 Farm animals/implements Livestock/poultry 4,0 39.8 1.5 23.6 4.8 33.0 34.8 8.4 48.9 19.7 21.6 None of the above 2.8 10.0 2.1 5.5 2.0 7.2 10.9 5,2 13.9 1.6 6.3 Number of households 7,924 7,643 3,911 6,594 2,206 4,387 4,942 1,722 3,220 121 15,567 As expected, households in rural areas were significantly more likely than urban households to own a farm or other land. More than one-third of rural households own a farm or other land compared with only 7 percent of urban households. There also was considerable variation in the proportion reporting that they owned livestock or poultry, from nearly 50 percent of rural Upper Egypt households to only 2 percent of households in the Urban Governorates. 2.4 Background Characteristics of Respondents General Characteristics Table 2.8 presents the distribution of respondents to the individual questionnaire by various background characteristics including age, marital status, urban-rural residence, place of residence, educational level, and religion. As noted in Chapter 1, ever-married women age 15-49 who were usual residents or present in the household on the night before the interviewer' s visit were eligible to be interviewed in the EDHS-95. Among the ever-married women in the sample, 93 percent are currently married, 5 percent are widowed, and 2 percent are divorced. Looking at the age distribution in Table 2.8, slightly more than one-third of EDHS-95 respondents are under age 30 and around one-quarter are age 40 and over. The percentages of women in the age groups 25 15-19 and 20-24 are smaller than the percent- age of women in the 25-29 age group. This is due to the fact that only ever-married women were interviewed in Egypt and that there has been a trend toward delaying marriage in Egypt. Marriage patterns are described in more detail in Chapter 8. More than half of the women inter- viewed (54 percent) are living in rural areas. Considering place of residence, slightly more than one-fifth of the women interviewed are from the Urban Governorates, 42 percent live in Lower Egypt, and 35 percent live in Upper Egypt. Only one percent are from the Frontier Governorates. Table 2.8 shows that the educational level of the women interviewed in the EDHS-95 varies considerably. Forty-four per- cent of the women have never attended school, 20 percent attended but did not complete the primary level, and 13 percent have completed primary school and/or attended at least some secondary school. Only around one-quarter of women have completed secondary school or higher. The results in Table 2.8 suggest that relatively few Egyptian women receive cash for any work that they do. Only 16 percent of EDHS-95 respondents reported that they are working at a job for which they are paid in cash. Finally, the majority of the women interviewed are Muslims (95 percent). Differentials in Education An overview of the relationship be- tween women's level of education and other Table 2.8 Background characteristics of respondents Percent distribuUon of ever-married women by selected background characteristics, Egypt 1995 Number of women Background Weighted Un- characteristic percent Weighted weighted Marital status Married 92.8 13,710 13,718 Widowed 5.0 746 741 Divorced 2.2 322 320 Age group 15-19 4.6 673 704 20-24 14.5 2,136 2,167 25-29 18.6 2,749 2,770 30-34 17.6 2,605 2,606 35-39 17.4 2,573 2,554 40-44 13.9 2,059 2,003 45-49 13.4 1,984 1,975 Urban-rural residence Urban 46.1 6,809 6,279 Rural 53.9 7,970 8,500 Place of residence Urban Governorates 22.4 3,312 2,595 Lower Egypt 42.0 6,207 4,676 Urban 12.4 1,830 1,447 Rural 29.6 4,377 3,229 Upper Egypt 34.7 5,125 6,262 Urban 10.7 1,583 1,510 Rural 24 0 3,543 4,752 Frontier Governorates 0.9 135 1,246 Education No education 43.7 Some primary 19.7 Primary through secondary 13,0 Completed secondary/higher 23.6 3,483 Work status Workmg for cash 15.6 2,312 Not workmg for cash 84.4 12,467 Religion Mushm 94.6 13,981 Christian/other 5 4 798 6,464 6,793 2,908 2,821 1,923 1,854 3,311 2,216 12,563 13,910 869 All women 100.0 14,779 14,779 background characteristics is provided in Table 2.9. As expected, the level of education decreases with increasing age of the respondent among respondents age 25 and over. The fact that women age 25-29 have a generally higher level of education than women in the 15-19 and 20-24 age groups should not be interpreted as evidence of a recent decline in educational attainment among young women. Since only ever-married women were interviewed, respondents in the 15-19 and 20-24 age groups are more likely to have lower educational levels than other women in these age cohorts because they left school early (either before or at the time they married). 26 Table 2.9 Level of education Percent distribution of ever-married women by highest level of education attended, according to selected background characteristics, Egypt 1995 Level of educat*on Primary Completed Number Background No Some through secondary/ of characteristic education primary secondary higher Total women Age group 15-19 43.5 19.3 26.7 10.5 100.0 673 20-24 37.8 14.6 20.6 27.1 100.0 2,136 25-29 38.9 16.8 9.9 34.4 100.0 2,749 30-34 41.2 20.1 9,8 29.0 100.0 2,605 35-39 44.7 23.8 9.7 21.8 100,0 2,573 40-44 47.3 22,3 12.6 17.7 100.0 2,059 45-49 55,4 20.6 13.5 10.6 100.0 1,984 Urban-rural residence Urban 26.5 19.5 17,7 36.4 100.0 6,809 Rural 58.5 19.9 9.0 12.6 100.0 7,970 Place of residence Urban Governorates 26.4 18.6 19.4 35.5 100.0 3,312 Lower Egypt 43.5 20.6 11.8 24. I 100.0 6,207 Urban 23.5 21.0 16,6 39.0 100.0 1,830 Rural 51.8 20,4 9.8 17.9 100.0 4,377 Upper Egypt 55.3 19.4 10.3 15.0 100.0 5,125 Urban 30.2 19.7 15.5 34,6 100.0 1,583 Rural 66.5 19.3 8.0 6.2 100.0 3,543 Frontier Govemorates 40.9 14.1 13.9 31.2 100.0 135 Work status Working for cash 21,4 8.2 4.2 66.2 100.0 2,312 Not working for cash 47.9 21.8 14.7 15.7 1(30.0 12,467 Total 43.7 19.7 13.0 23.6 100.0 14,779 Women in urban areas are more educated than those from rural areas. The percentage of urban women who have completed at least secondary school is almost three times the percentage among rural women who have completed the secondary level (36 percent and 13 percent, respectively). Educational levels are lowest among women from rural Upper Egypt, where 67 percent have never gone to school. The highest levels are found in the Urban Governorates, where only around one-quarter of women have never attended school. Not surprisingly, the majority of women working for cash have completed secondary school or higher. Reasons for Leaving School Knowledge about the reasons which lead women to drop out of school can provide guidance to programs seeking to improve educational opportunities for women. To obtain some insight into this issue, ever-married women age 15-24 years who were not currently attending school were asked during the EDHS- 95 interview about the main reason for leaving school. Table 2.10 shows the percent distribution of women 15-24 years according to whether they are currently attending school and, if not, their reasons for leaving school, according to the highest level of education attended. 27 Only a small proportion of EDHS respondents (3 percent) were attending school at the time of the inter- view. The reasons women gave for leav- ing varied according to the level of school they had attained at the time they left school. Women who had not com- pleted primary school were most likely to say that they had left because they had not liked school (33 percent) or be- cause they had failed examinations. Almost one-fifth cited the need to care for other children or to assist the family in other ways as reasons for leaving school and 11 percent said that they could not pay the school fees. Marriage (36 percent) was the principal reason for dropping out of school among women who left after completing the primary level followed by the failure to pass examinations (22 percent) and a dislike for school (18 percent). Among those who completed the secondary level, over 80 percent reported that they left because they had graduated or had enough school while 9 percent reported that they stopped going to school be- cause they married. 2.5 Access to Mass Media The EDHS collected informa- tion on the exposure of women to both broadcast and print media. These data are important because they provide some indication of the extent to which Egyptian women are regularly exposed to mass media, which are extensively used in Egypt to convey family planning and health messages to the population. The level of exposure of women to television, radio and newspapers or magazines is shown in Table 2.11. Around one-quarter of respondents read a newspaper or magazine weekly, more than 80 percent watch television daily, and 64 percent listen to radio daily. One in five women reported exposure to all three media, and only 13 percent had no media exposure. Table 2.10 School attendance and reasons for leaving school Percent dlsmbution of ever-married women 15-24 by whether attending school and reason for leaving school, according to highest level of education attended and urban-rural residence, Egypt 1995 Educational attmnment Attendance/ Primary Completed Reasons for Some through secondary/ leaving school primary secondary higher Total URBAN Currently attending 2.5 3.6 6.4 4.6 Reason for leaving Got married 7.2 Take care of younger children 5.4 Family need help 6.6 Could not pay school fees 12.6 Need to earn money 0,9 Graduated/Enough school 0.1 Did not pass exams 16.2 Did not like school 32.9 School not accessible 0.0 Other 15.6 Don't know/missing 0.0 Total 100.0 Number 143 37.7 7.8 19.4 1.4 0.0 1.6 0.9 0.0 1.7 8.0 1.4 6.2 1.5 0.0 0,8 2.1 82.7 34.9 15.9 0.1 9.4 22.3 0.0 15.2 0.1 0.1 0.1 5.8 0.8 5.7 0.6 0.6 0.5 I~ .0 1~.0 1~.0 284 3~ 727 RURAL Currently attending 0.1 1.8 3.9 2.0 Reason for leaving Got married 4.0 33.7 9.7 16.1 Take care of younger children 9.3 2.5 0.0 3.7 Family need hdp 12.9 3.1 0.0 5,0 Could not pay school fees 9.8 5.2 1.0 5.1 Need to earn money 0.3 0.9 0.0 0.4 Graduated/Enough school 0.3 2.4 82.7 30 3 Did not pass exams 15.5 27.2 0.6 14.2 Did not like school 32.5 14.2 0.0 14.7 School not accessible 1.7 1.3 0,6 1.1 Other 12.9 6.5 1.3 6.6 Don't know/missing 0.6 t.2 0.3 0.7 Total 100.0 100.0 100.0 100.0 Number 298 335 349 982 TOTAL Currently attending 0.9 2.6 5.1 3.1 Reason for leaving Got married 5.0 35.5 8.8 17.5 Take care of younger children 8.0 2,0 0.0 2.8 Family need help 10,9 2.1 0.0 3.6 Could not pay school fees 10.7 6.5 1.2 5.6 Need to earn money 0.5 1.2 0.0 0.6 Graduated/Enough school 0.2 2.2 82.7 32.3 Did not pass exams 15.7 22.0 0.4 12.2 Did not like school 32.6 17.9 0.0 14.9 School not accessible 1.1 0.7 0,4 0.7 Other 13.8 6.2 1.1 6.2 Don't know/missing 0.4 0.9 0.5 0.6 Total 100.0 100.0 100.0 100.0 Number 441 619 649 1,709 28 Table 2.11 Access to mass media 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 1995 No Read Watch Listen to All Number Background media newspaper television radio three of characteristic exposure weekly daily daily media women Age group 15-19 11.5 17.7 83.6 67.2 14.1 673 20-24 8.9 26.9 83,1 69.2 20.8 2,136 25-29 11.5 30.0 82.5 65.5 23.8 2,749 30-34 12.4 26.7 81,2 63.7 21.4 2,605 35-39 13.4 24.2 80.0 62.6 19.5 2,573 40-44 13.8 22,5 79.4 62.0 17.2 2,059 45-49 16.2 16.6 77.2 59.4 13.4 1,984 Urban-rural residence Urban 5.0 38.7 89.3 72.0 30.7 6,809 Rural 19.0 12.4 73,6 57.I 9.8 7,970 Place of residence Urban Governorates 4.5 40.6 89.7 71.0 31.5 3,312 Lower Egypt 11.2 25,0 81.8 65.7 20.1 6,207 Urban 3.6 42.1 89.7 76.1 34.0 1,830 Rural 14.3 17.8 78.5 61.4 14.3 4,377 Upper Egypt 19.4 13.6 73.9 57.3 10,8 5,125 Urban 7.8 30.7 87.6 69.4 25.0 1,583 Rural 24.5 5.9 67,8 51.9 4.4 3,543 Frontier Governorates 12.2 29.6 79.1 67.5 23.6 135 Education No education 21.6 0.5 71.4 51.9 0,3 6,464 Some primary 12.0 7.6 80.8 61.3 5.2 2,908 Primary through secondary 3.2 42.8 90.0 75.6 31.9 1,923 Completed secondary/higher 1.4 73.4 93.2 82.3 59.9 3,483 Work status Working for cash 8.2 54.6 85.6 72 5 44.7 2,312 Not working for cash 13.4 19.0 79.9 62.4 14.8 12,467 Total 12.5 24.6 80.8 64.0 19.4 14,779 Women living in urban areas are more likely to be exposed to mass media than other women. For example, 90 percent of urban women say they watch television dally compared with 74 percent of women in rural areas. The level of exposure to radio broadcasts is also greater among urban than rural women. Reflecting the higher rates of illiteracy among rural women, only 12 percent say they read a newspaper or magazine weekly compared with nearly 40 percent of urban women. Overall, only 5 percent of urban women were not exposed to any of the three media compared with 19 percent of rural women. Considering place of residence, a majority of women in every residential category reported watching television or listening to the radio daily (see Figure 2.3). The percentage who read a newspaper or magazine weekly varies considerably, from 6 percent in rural Upper Egypt to over 40 percent in urban Lower Egypt and the Urban Governorates. Lack of exposure to any of the three media varies from 4 percent of women in urban Lower Egypt to 25 percent of women in rural Upper Egypt. 29 Figure 2.3 Percentage of Ever-Married Woman Who Watch Television or Listen to the Radio Daily by Place of Residence Percent 100 80 6O 4O 20 0 Urban Total Urban Rural Total Urban Rural Frontier Governoratas Lower Egypt Upper Egypt Governorates EDHS 1995 There is a strong association between the level of education and exposure to mass media; as education of EDHS-95 respondents increases, the percentages who reported exposure to each of the three mass media increases. 2.6 Employment In the 1995 EDHS, respondents were asked a number of questions about their employment, including whether they were currently working and, if not, whether they had worked during the year before the survey. Women who were currently working were then asked a number of questions about the kind of work they were doing and whether they were paid in cash or not. Those who earned cash for their work were asked about who made the decision about how their earnings were used. If they had small children, they were asked about the arrangements they had for child care when they were working. Current Employment Table 2.12 shows the percent distribution of respondents according to current and past employment. For those respondents who were currently working, the table provides information on whether the woman was working full-time or not. Overall, 19 percent of women were currently engaged in some economic activity. Most of the women who were not working at the time of the survey did not report recent work experience; only 2 percent of respondents said that they had worked in the 12-month period before the survey. Most of the women who were working reported that they were employed full-time (five or more days per week). 30 Table 2.12 Employment Percent distribution of ever-married women by employment status and continuity of employment, according to background characteristics, Egypt 1995 Not currently employed Currently employed Did not work Worked All year in last in Number Background 12 last 12 5+ days <5 days Season- Occasion- of characteristic months months per week per week ally ally Total women Age 15-19 95.8 1.2 1.5 0.2 1 1 0.1 100 0 673 20-24 89.7 2.3 5.1 0.8 1.4 07 100.0 2,136 25-29 81.3 2.0 12.6 1.2 2.7 0,3 100.0 2,749 30-34 72.5 1,6 20.8 1 0 3.0 1 1 100.0 2,605 35-39 74.6 1 0 20.1 1.0 2.7 0.7 100.0 2,573 40-44 75,1 1.4 193 0.9 26 0.7 100.0 2,059 45-49 81 6 0.6 13 2 1.4 24 0.9 100.0 1,984 Residence Urban 76.1 1.8 20.4 0.6 0.7 04 100.0 6,809 Rural 82.6 1.2 10.0 1.3 3.9 0.9 100.0 7,970 Place of residence Urban Governorates 77.8 1.8 19 0 0.5 0.5 0.4 100.0 3,312 Lower Egypt 75 7 1.8 15.8 1.5 4.4 0.8 100.0 6,207 Urban 72.3 2 0 23.4 0.8 1,2 0 3 100.0 1,830 Rural 77.1 1.8 12.6 1.8 5.7 1 0 100.0 4,377 Upper Egypt 85.6 0.8 10.6 07 1.4 08 100,0 5,125 Urban 77.5 1.3 19.3 0 7 0.4 0 7 100.0 1,583 Rural 892 0.6 6 7 0.7 1 8 0.9 99.9 3,543 Frontier Governorates 77.7 1.1 20.4 0.3 0.5 0.0 100.0 135 Education No education 86.0 0.8 6.7 1 4 4.0 1.0 100 0 6,464 Some primary 89 1 I. I 6.1 1.0 1.9 0 8 I00.0 2,908 Primary through secondary 92.7 1.3 4.6 0 2 0.8 0 4 100.0 1,923 Completed secondary/higher 52.6 3.1 42.7 06 0.7 0.2 100.0 3,483 Total 79,6 1 5 14.8 1.0 2.4 0.7 100.0 14,779 The differentials presented in Table 2.12 indicate that women in the 30-44 age group are more likely to be currently employed than older or younger women. The comparatively small proportion of women who work in the younger cohorts may be related to the greater child care responsibilities of women under age 30. Urban women and highly educated women are significantly more likely to be involved in work than other women. Overall, 22 percent of urban women are currently engaged in some economic activity compared with 16 percent in rural areas. Highly educated women are the most likely to be employed; 44 percent of women who completed secondary or higher are currently working. Occupation As Table 2.13 shows, 55 percent of the women who reported that they were currently working at the time of the survey were in professional, technical, managerial or clerical occupations, 22 percent worked in agricultural occupations, 13 percent worked in sales or services, and the remainder were involved in skilled manual labor or in household or domestic labor. As expected, the proportion involved in professional, tech- 31 Table 2.13 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non- agricultural employment, according to background characterisUcs, Egypt 1995 Agricultural Non-agricultural Prof./ tech./ Household Number Background Own Farnlly Rented Other's manzg./ Sales/ Skdled and of characteristic land land land land cler.t services manual domesuc Missing Total women Age 15-19 9.1 15.3 19.9 14.6 1.2 294 10.5 0.0 0.0 100.0 20 20-24 4.5 16.1 4.6 5.3 45 9 9.7 13.9 0.0 0 0 100.0 171 25-29 3.8 8.1 3.5 8.2 56.3 13.3 5.2 1.3 0.4 100.0 458 30-34 2.3 5.5 4.2 7.1 582 12.5 6.7 3.0 0.6 100.0 674 35-39 3.5 5.6 5.3 6.7 63.2 9.3 4.3 2.1 0.1 100.0 629 40-44 4.7 4.7 5.6 6.9 53.4 15.0 5.4 3.8 0.5 100.0 485 45-49 6.2 6.1 2.9 8.6 41.2 21.6 80 4.9 0.6 100.0 354 Residence Urban 0 2 1.0 0.8 0.7 76.6 10.2 6.6 3.3 0.6 100.0 1,505 Rural 8.3 13.1 8.9 15.0 29.4 17.2 6.0 1.9 0.2 100.0 1,286 Place of residence Urban Governorates 0.0 0.6 0.6 0.3 74.2 12.2 7.2 4 6 0.3 100.0 674 LowerEgypt 5.0 8.6 6.1 11.4 48.0 13 3 5.3 2 1 0.2 1(30.0 1,395 Urban 0.5 1.1 1.7 1.4 78.1 8.3 7 0 1.6 0 4 100.0 471 Rural 7.3 12.4 8.4 16.5 32.6 15.9 4.4 2.3 0.2 100.0 924 Upper Egypt 5.6 8.7 54 6.0 48.6 15.2 7.6 2.1 0.8 100.0 693 Urban 0.0 1.8 0 1 0.4 78.5 9.5 5.1 3.2 1.4 100.0 335 Rural 10.9 15.1 10.4 11.2 20,6 20.6 10.0 1.1 0.1 100.0 358 Frontier Governorates 0.0 1.0 0.3 0.3 86.6 4.4 3 4 3.9 0.0 100.0 29 Education No education I1.0 17.0 11.0 21.2 2.2 24.5 8.8 4.1 0.2 100.0 850 Some primary 4.9 11.5 9.7 7.0 3.1 37.5 17.4 8.8 0.0 100.0 284 Primary through secondary 1.7 3.3 5.6 1.5 20.2 18.8 36.4 12.5 0.0 100.0 I 15 Compl. secondary/higher 0.0 0.2 0.0 0.1 96.0 2.5 0.6 0.0 0.6 100.0 1,542 Total 3.9 6.6 4.6 7.3 54.8 13.4 6.3 2.7 0.4 t00.0 2,790 Professional, technical, managerial, and clerical occupations nical or managerial occupations was greater among urban residents and among highly educated women than among other women, while rural women and less educated women were more likely to be involved in agricultural occupations. Employer and Form of Earnings Table 2.14 shows that, among working women, 18 percent are self-employed, around 12 percent are working for relatives, and 70 percent are working for someone else. Rural women, particularly from Upper Egypt, are more likely to be self-employed or to work for a relative than urban women. Similarly, less educated women are more likely to be self-employed or to work for a relative than highly educated women. Among employed women who never attended school, for example, around 40 percent are self-employed, and more than one-quarter of these women work for relatives. In contrast, only around 2 percent of working women with secondary education or higher are self-employed or working for a relative. 32 Table 2.14 Employer and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to background characteristics, Egypt 1995 Employed by Employed by Self-employed a non-relative a relative Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women Age 15-19 25.2 0,0 24.3 0.0 0.0 50.4 0.0 100.0 20 20-24 17.0 2.3 51.9 2.8 2.7 22.5 0.7 100.0 171 25-29 11.5 3.6 67.0 2.6 1.5 13.6 0,2 1(30.0 458 30-34 13.2 4.3 70.5 1.6 2.4 8.0 0.0 100.0 674 35-39 10.0 5.9 74.0 1.3 1.5 7.2 0.0 100.0 629 40-44 14.1 4.8 69.2 1,1 0,2 9.9 0.7 100.0 485 45-49 18.5 7.6 60.2 0.3 2.0 11.5 0.0 100.0 354 Residence Urban 7.5 0.9 86.5 0.2 1.6 3.2 0.1 100.0 1,505 Rural 20.3 9.6 45.6 3.0 1.7 19.5 0.3 100,0 1,286 Place of residence Urban Govemorates 8.0 0.9 85,7 0.0 1.7 3.5 0.3 100.0 674 Lower Egypt 12.7 6.4 64.6 1.5 1.6 12.9 0.3 100.0 1,395 Urban 5.9 1.4 87.9 0.7 1,2 2.8 0.1 100.0 471 Rural 16.2 8.9 52.8 1.9 1.9 18.0 0.4 100.0 924 Upper Egypt 20.2 6.0 55.4 3.1 1.6 13.8 0.0 1130.0 693 Urban 8.8 0.2 85.8 0.0 1.9 3.3 0.0 100.0 335 Rural 30.8 11.4 26.9 6.0 1,2 23.6 0.0 100.0 358 Frontier Governorates 5.3 0.3 91.1 0.0 1.3 2.0 0.0 100,0 29 Education No education 28.0 12.2 27,3 4.5 2.9 25.0 0.1 100.0 850 Some primary 32,7 9.5 30.4 1.0 3.5 22.7 0.4 100.0 284 Primary through secondary 21.3 4.1 61.3 0.0 1.1 12.2 0.0 100.0 115 Completed secondary/higher 1.2 0.1 97.3 0.1 0.6 0.5 0.2 100,0 1,542 Total 13.4 4.9 67.7 1.5 1.6 10.7 0.2 100.0 2,790 Table 2.14 also shows that, among women who work, 83 percent earn cash for the work they do. The proportion earning cash varies according to the type of employer. Women who are employed by a non- relative almost always report earning cash, and the majority of self-employed women receive cash for the work they do. Among the women who work for relatives, however, the majority say that they are not paid in cash for their work. Control of Earnings Women who earn cash for their work were asked about who mainly decides how their earnings will be used. Table 2.15 shows that two in five women report that they are mainly responsible for making decisions on how their earnings will be spent. Among the remaining women, most women say that they make these decisions jointly (primarily with the husband); only 2 percent say that it is the husband who decides. 33 Table 2.15 Decisions on use of earnings Percent distribution of women recetwng cash earnings by person who decides how earnings will be used, according to background characteristics, Egypt 1995 Person who dec~des how earnings wdl be used Jointly Jointly Number Background Self with Someone with of characteristic only Husband husband else someone Total women Marital status Currently married 33.4 2.6 63.3 0.5 0 2 100.0 2,054 Not married 94.9 0.0 0.0 0 9 4.2 100.0 257 Age 15-19 0.0 2.4 64.1 13.4 20.0 100.0 10 20-24 41.5 3.6 54.5 0.3 0.1 100.0 124 25-29 32.4 2.9 62.7 0.5 1.5 100.0 366 30-34 34.6 3.1 61.5 0.9 0.0 100.0 580 35-39 45.6 1.7 51.6 0.2 1.0 100.0 538 40-44 40.0 1.1 58.3 0.1 0 5 100.0 408 45-49 53.3 2 2 43.3 0.9 0.4 100.0 285 Residence Urban 41.7 1.4 565 0.3 0.1 100.0 1,440 Rural 38 0 3.8 55.7 0.9 1.6 100.0 871 Place of residence Urban Governorates 47.5 1 9 50.3 0.4 0 0 100 0 644 Lower Egypt 35.6 2.2 60.4 06 1 I 100.0 1,105 Urban 36.3 0.5 62.3 0.5 0 4 100 0 448 Rural 35.2 3.4 59.1 0 8 1.6 100.0 657 Upper Egypt 42.3 2 9 53.6 0.6 0.6 100.0 534 Urban 39.2 1.4 59.4 0.0 0.0 100.0 323 Rural 47.2 5.1 44 7 1.4 1.5 100.0 211 FronUer Governorates 17.9 3.2 78.2 0.0 0.7 100.0 28 Education No educaUon 53. I 4.6 39.0 1.0 2.2 100.0 494 Some primary 48.9 2.2 44.9 1.6 2.4 100.0 190 Primary through secondary 55.5 0.0 42.0 2.2 0.4 100.0 96 Completed secondary/higher 34.1 1.7 64.0 0.1 0.0 I00.0 1,531 Total 40.3 2.3 56.2 0.5 0.7 100.0 2,312 Almost all women who are widowed or divorced say they alone are responsible for deciding how to use their earnings. Among currently married women, only one-third say that they make the decisions about how their earnings will be used themselves, while 63 percent report that the decisions are made jointly with their husband. There are no significant differences between urban and rural women in who makes the decision about how a woman's earnings will be spent. By place of residence, the proportion reporting that decisions are made jointly varies from a high of 78 percent among working women in the Frontier Governorates to 45 percent in rural Upper Egypt. With respect to educational differentials, working women are more likely to decide jointly with the husband how to spend the money they earn if they have completed secondary school or higher than if they have less education. 34 Child Care The welfare of children under six years whose mothers are working is the focus of Table 2.16. Overall, slightly more than half of all women who are employed have children under six. Less than one-fifth (17 percent) of working mothers with young children take care of their children while working. This proportion varies according to residence, education and the type of employment. Working women in rural areas, especially those living in Upper Egypt, and those who have not completed secondary school are more likely to say they care for their children while at work than other working mothers. This is due, at least in Table 2.16 Child care while working Percent distribution of currently employed women by whether they have a child under six years of age, and the percent distribution of employed mothers who have a child under six by person who cares for child while mother is at work, according to background characteristics, Egypt 1995 Employed wot3~en Chdd's carelaker, among employed mothers who have chlldrett <6 years Chdd One Or 15 In more school/ Not Number No chd- Re- Other Other Other Netgh- insu- worked of Background child dren spond- Hus- female male rela- bor/ tutlonal since employed charactenstw <6 <6 ent band chdd chdd twe friend care birth Other M~ssmg Total women Residence Urban 51 6 48 4 I 1.7 3 1 3.3 1 6 28.0 1.7 43,2 4 3 2.5 0.6 100,0 1,505 Rural 41,2 58.8 21 8 2.4 12 3 2.4 45 8 2.2 6.0 1 1 4.7 1.3 100 0 1,286 Place of residence Urban Govemorates 54 2 45 8 12.1 3 9 2.7 1 3 25.0 1 2 47.5 4.5 0.6 1.2 100,0 674 Lower Egypt 47 8 52.2 13 6 2.3 8.9 2.7 45.4 2 5 16.2 1 7 5 8 1.0 1130 0 1,395 Urban 53.3 46.7 11 I 1,3 4.4 2.2 30 8 3.3 37.4 3 1 6.3 0 2 100 0 471 Rural 44.9 55 I 14,6 2.8 10.8 2 9 51 7 2.2 7 0 1.1 5 5 1.4 100.0 924 Upper Egypt 38,3 61 7 26,4 2 8 10,3 1.4 32 2 I 6 19.3 3,1 2 4 0.6 100.0 693 Urban 454 54,6 12.5 4 I 34 1.5 30,7 06 40,1 5.8 1.3 0,0 1000 335 Rural 316 684 368 1.8 154 1.3 33.3 23 3,9 1 1 3,1 10 1000 358 Fronoer Governorates 34 9 65, I 4 5 2 0 0.5 0 9 22.9 0 5 67 6 0.0 I 0 0 0 100 0 29 Education No education 46 8 53.2 29.1 3 0 17 5 2.4 37 9 3.3 0.8 0 4 4.2 1 4 100.0 850 Some primary 51.6 484 34,1 27 20.0 17 204 5.1 107 0.0 39 14 100.0 284 Primary through secondary 54.5 45,5 38 5 3.5 3 8 4 O 16.0 O,O 23.6 7,8 2 S 0,0 100 0 115 Completed secondary/htgher 45,4 54.6 6.1 2.6 1 0 1.7 40 6 0,9 39 I 4.0 3 3 0 6 100.0 1,542 Employer For family member 36 6 63.4 27.6 0.7 14.9 2 4 45.2 1 7 2.6 0 0 4.4 0.4 100.0 344 For someone else 47 1 52 9 7 6 3.3 3 9 2,1 38.7 2,1 33,7 3 7 4 0 09 1600 1,931 Self-employed 52 6 47 4 46 3 2 5 18,6 1.3 22 7 1,6 4 0 0 7 I. I I 3 100 0 510 Occupation Agncuhural 44.6 55 4 22 6 2,4 19 1 2.4 43.9 4 0 0 5 0.0 4 2 0 9 100.0 624 Non-agricultural 474 52.6 152 2.9 45 19 34,9 1,4 314 3,5 35 09 1000 2,156 Employment status All year, full-time 46,6 53.4 15 2 2,0 5.7 1 7 36.2 1,3 30.2 3.2 3.4 1.1 100.0 2,182 All year, part-time 43.6 56 4 19 9 8.4 17 4 0 5 42.5 3 3 5 1 0,0 2,8 0 0 100.0 147 Seasonal 46 7 53.3 18 8 5,1 17 3 4.6 42 8 4,5 1 I 0 0 5.8 O 0 100 0 358 Occasional 56 9 43,1 45 8 2 1 8.3 2 3 24,6 6.4 3 1 3 8 1,8 1.8 100 0 104 Total 46 8 53 2 16.9 2 8 7.9 2 0 37.1 2,0 24.2 2 6 3,6 0.9 100 0 2,790 Note: Totals include 6 women wUh employer missing and 10 women wuh occupatton missing. 35 part, to the fact that rural women and less educated women are likely to be found in the types of jobs where there are greater opportunities for caring for children. For example, as noted earlier, working women in rural areas are more likely to be self-employed or working for a relative than other working women. As Table 2.16 shows, significantly higher proportions of women in these types of employment report caring for children at work than other working mothers. The child care arrangements among working mothers vary. Around half of all working mothers rely on either immediate family members (i.e., their husband (3 percent) or other children (10 percent)) or other relatives (37 percent) to care for their young children. Only about one-quarter of all working mothers with young children use nursery schools or other institutional child care providers. Use of institutional child care providers is highest among working mothers who are highly educated, employed full-time and working in non-agricultural occupations. 36 CHAPTER 3 FERTILITY This chapter examines levels, patterns, and trends of both current and cumulative fertility. The data for these fertility measures were collected in the EDHS-95 in several ways. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who may have died. Next, a complete history of all of the woman's births was obtained, including the name, sex, month and year of birth, age, and survival status for each of the births. For living children, a question was asked about whether the child was living in the household or away. For dead children, the age at death was recorded. Finally, information was collected on whether currently married women were pregnant at the time of the interview. 3.1 Current Fertility Levels Measures of current fertility presented in this chapter include the total fertility rate, age-specific fertility rates, the general fertility rate, and the crude birth rate. These rates are generally presented for the three-year period preceding the survey, a period covering the calendar years 1993-1995. The three-year period was chosen for calculation of these rates (rather than a longer or a shorter period) in order to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. The total fertility rate (TFR) which is shown for women age 15-44 and women age 15-49 is a useful measure for examining the overall level of fertility. 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 TFR is calculated by summing the age-specific fertility rates, r 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 measures are based on the birth history data for the three-year period before the survey and the age-sex distribution of the household population. Table 3.1 presents estimates of current fertility levels for Egypt as a whole and for the main residential groups. The total fertility rate shown in the table indicates that, if fertility rates were to remain constant at the level prevailing during the period 1993-1995, an Egyptian woman would bear 3.6 children during her lifetime. In urban areas, the TIeR is 3 births per woman, more than one child lower than the rate in rural areas (4.2 births per woman). Differentials by place of residence are significant (see Figure 3.1). The TFR is 2.8 births per woman in the Urban Governorates, almost two children lower than the rate in Upper Egypt (4.7 births). Women in 1 Numerators for the age-specific fertility rates were obtained by identifying the births which had occurred in the period 1-36 months preceding the survey (as determined by the date of interview and the birth of the child) and classifying those births into five-year groups according to the age of the mother at the time of the birth (as determined by the mother's birth date and the date of birth of the child). The denominators of the rates are the number of woman- years lived in each of the specified five-year age groups during the period 1-36 years before the survey. Although the survey interviewed ever-married woman only, estimates are provided for all women, regardless of marital status, using information on fertility from ever-married and information in the household questionnaire, these estimates assume that women who have never been married have had no children. 37 Table 3.1 Current fertility Age-specific and total fertility rates and the crude birth rate and general femhty rate for the three years preceding the survey, by urban-rural residence and place of residence, Egypt 1995 Age group Place of residence Urban Lower Egypt Upper Egypt Fronuer Gover- Gover- Urban Rural notates Total Urban Rural Total Urban Rural norates Total 15-19 37 80 32 47 21 59 97 65 112 56 61 20-24 154 238 134 198 157 214 244 192 268 209 200 25-29 191 228 182 192 174 199 252 227 264 222 210 30-34 129 151 132 111 106 114 183 149 200 187 140 35-39 66 97 65 64 51 70 118 88 135 93 81 40-44 21 33 19 26 19 31 34 30 37 25 27 45-49 3 I1 0 3 3 4 18 10 22 7 7 TFR 15-44 2.99 4 13 2.82 3.20 2.64 3.43 4.65 3.75 5.08 3.96 3.59 TFR 15-49 3.01 4.19 2.82 3.21 2.66 3.45 4.73 3.80 5.19 4.00 3.63 GFR 101 145 95 109 85 120 164 130 181 140 124 CBR 23.9 31.4 22.7 25.3 208 27.1 34.5 29.5 36.7 31.6 28.0 Note: Rates are for the period 1-36 months preceding the survey. Rates tbr age group 45-49 may be shghtly biased due to truncation. TFR: Total fertihty 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 Figure 3.1 Total Fertility Rates by Place of Residence Births per woman Urban Total Urban Rural Total Urban Rural Frontier Governorates Lower Egypt Upper Egypt Governorates EDHS 1995 38 the Frontier Govemorates have an average of 4 births, a rate that is higher than any other area except Upper Egypt. The highest level of fertility is found in rural Upper Egypt (5.2 births per woman), two and half children more than the lowest level observed in urban Lower Egypt (2.7 births). Significantly, the TFR in rural Lower Egypt (3.5 births per woman) is not only lower than the rate in rural Upper Egypt, but also considerably lower than the rate in urban Upper Egypt (3.8 births per woman). Overall, Egyptian women have children early in the childbearing period. According to the age- specific fertility rates shown in Table 3.1, the average Egyptian woman will give birth to 1.3 children by age 25 and 2.4 children by age 30. An examination of age-specific rates by urban-rural residence indicates that the age pattern of fertility shows little variation, except that fertility peaks in age group 25-29 (191 births per thousand women) in urban areas and in age group 20-24 (238 births per thousand women) in rural areas. Rates are higher in every age group for rural women compared with urban women. Looking at place of residence, the rates are much higher in every age group in rural Upper Egypt than in the other areas. Estimates of the crude birth rate and the general fertility rate are also presented in Table 3.1. For the period 1993-95, the crude birth rate was 28 births per thousand popula- tion and the general fertility rate was 124 births per thousand women. There are sub- stantial differences by residence in both the CBR and the GFR. The lowest rates are found in urban Lower Egypt, where the CBR is 21 births per thousand population and the GFR is 85 births per thousand women. In contrast, in rural Upper Egypt where the rates are highest, the CBR was estimated to be 37 births per thousand population, and the GFR was 181 births per thousand women. 3.2 Fertility Differentials Table 3.2 shows the total fertility rate, the percentage of women currently pregnant, and the mean number of children ever born to women age 40-49 by selected background characteristics. The mean number of children ever burn (CEB) is an indicator of cumulative fertility; it reflects the fertility performance of older women who are nearing the end of their reproductive period, and thus represents com- pleted fertility. If fertility has remained stable over time, the two fertility measures--the TFR and mean CEB--wil l be equal or similar. Accordingly, comparison of the two fertility measures provides an indication of the direc- tion and the magnitude of fertility change in Egypt during the past 20-25 years. Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and the mean number of children ever born to women age 40-49, by selected background character- istics, Egypt 1995 Mean number of children Total Percent ever born Background fertility currently to women characteristic rate1 pregnant age 40-49 Urban-rural residence Urban 3.01 5.6 4.69 Rural 4.19 8.2 6.45 Place of residence Urban Governorates 2.82 5.5 4.38 Lower Egypt 3.21 6.2 5.49 Urban 2.66 4.9 4.63 Rural 3.45 6.7 5.95 Upper Egypt 4.73 9.0 6.67 Urban 3.80 6.8 5.63 Rural 5.19 10.1 7.18 Frontier Governorates 4.00 9.5 5.86 Education No education 4.57 7.2 6.37 Some primary 3.72 7.2 5 73 Primary through secondary 3.07 4.8 4.71 Completed secondary/higher 3.00 8.2 3.06 Work status Working for cash 2.68 6.0 4.03 Not working for cash 3.79 7.1 5.86 Total 3.63 7.0 5.54 I Women age 15-49 years 39 The results in Table 3.2 suggest that there has been a substantial decline in fertility levels during the past several decades. Women age 40-49 have had an average of 5.5 births, almost two births more than the current fertility level. The residential differentials in current fertility described above are evident in the mean number of children ever born (cumulative fertility). The decline in fertility implied by a comparison of the TFR with completed fertility has been greater in urban than in rural areas. The largest implied decline in fertility by place of residence is observed in rural Lower Egypt, where the TFR is 2.5 births lower than the mean number of children ever born to women 40-49. Differentials by educational level are marked. The TP'R for women with no education is more than 1.5 births higher than the rate for women who have completed secondary or higher (4.6 births and 3 births per woman, respectively). The differentials in completed fertility among educational groups are even more striking; the mean number of children ever born is 6.4 among women with no education compared with 3.1 among women who have completed secondary school or higher. Apparently, lower fertility has characterized women with a secondary or higher education for some time. Among women in this category, the TFR for the three-year period before the survey is identical to the mean number of children ever born (completed fertility) among women age 40-49, indicating that fertility levels among highly educated women have been relatively stable for several decades. Current fertility is around one birth lower among women who are working for cash than among other women. Cumulative fertility is also lower among women who work in the cash economy than among other women. However, the decline in fertility implied by a comparison of the TFR with the mean number of children ever born has been greater among women who are not working in the cash economy than among women who are working for cash. Another indicator of current fertility, the percentage of women who are currently pregnant is included in Table 3.2. Overall, 7 percent of EDHS respondents were currently pregnant at the time of the survey. This percentage varies by urban-rural residence and place of residence. Women in rural Upper Egypt have the highest percentage currently pregnant (10 percent) while the percentage is lowest in urban Lower Egypt (5 percent). Surprisingly, the percentage of women who are currently pregnant is highest for women with a secondary or higher education. This is probably due to the fact that highly educated women are on average younger than women in the other education categories and, thus, more likely to be in the family building stage than other women. 3.3 Fertility Trends Fertility trends in Egypt may be explored in two ways. First of all, trends can be evaluated by comparing the results of the 1995 EDHS with those of earlier fertility surveys. Recent changes in fertility can also be examined by looking at the trend in age-specific fertility rates for successive five-year periods, using data from the birth histories obtained from the EDHS-95 respondents. Comparisons with Previous Surveys Table 3.3 presents the total fertility rate and age-specific fertility rates from the 1995 EDHS along with results from the two earlier DHS surveys (EDHS-88 and EDHS-92), the 1991 Egypt Maternal and Child Health (PAPCHILD) Survey (EMCHS-91), the 1984 Egypt Contraceptive Prevalence Survey (ECPS-84), and the 1980 Egypt Fertility Survey (EFS-80). This table can be used to examine the trend in fertility in Egypt since 1980. During this period, fertility levels fell by around 30 percent, from 5.3 births at the time of the Egypt Fertility Survey to 3.6 births at the time of the EDHS-95. The pace of fertility decline slowed somewhat in the 1990s compared with the 1980s. 40 Table 3.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, Egypt 1979-1995 Age group EFS-80 ECPS-84 EDHS-88 EMCHS-91 EDHS-92 EDHS-95 1979- 1983- 1986- 1990- 1990- 1993- 19801 19841 19882 19911 19922 19952 15-19 78 73 72 73 63 61 20-24 256 205 220 207 208 200 25-29 280 265 243 235 222 210 30-34 239 223 182 158 155 140 35-39 139 151 118 97 89 81 40-44 53 42 41 41 43 27 45-49 12 13 6 14 6 7 TFR 15-44 5.22 4.79 4.38 4.06 3.90 3.59 TFR 15-49 5.28 4.85 4.41 4.13 3.93 3.63 GFR U U U U 136 124 CBR U U U U 29.7 28.0 u = Unknown (not available) 1 Rates are for the 12-month period preceding the survey 2 Rates are for the 36-month period preceding the survey Source: EFS-80: Hallouda et al., 1983, Volume II, Table 4.16 ECPS-84: Unpublished results EDHS-88: Sayed et al., 1989, Table 3.2 EMCHS-9I: Abdel-Azeem et al., 1993, Table 7.14 EDHS-92: E1-Zanaty et al., 1993, Table 3.1 Comparison of age-specific fertility rates for the 1995 EDHS with age-specific rates in the earlier surveys indicates that fertility has declined in all age groups in Egypt since 1980. For example, in the youngest age group (l 5-19), fertility declined from 78 births per thousand women in 1979-80 to 61 births per thousand women in 1993-95. A sharp decline has occurred among women age 20-34, which is reflected in the change in the shape of the age-specific fertility curve. Table 3.3 also shows that a decline was observed in both the crude birth rate and the general fertility rate between the 1992 EDHS and the 1995 EDHS. The GFR decreased from 136 births per thousand women in 1990-1992 to 124 births per thousand women in 1993-1995. Similarly, the crude birth rate has declined from 29.7 per thousand population in 1990-92 to 28 births per thousand persons in 1993-95. Using information from the three rounds of the DHS in Egypt and the 1991 EMCHS, the trend in fertility by residence during the period 1988-95 is shown in Table 3.4. It is clear from the table that rural women are currently having 1.2 births more than urban women. The differential in fertility between urban and rural women was larger at the time of the earlier surveys (2 births), indicating that rural fertility fell at a faster pace than urban fertility during the period 1992-95 (see Figure 3.2). In fact, there was no significant change in urban fertility during the period 1992-95 following a period of moderately rapid decline between 1988 and 1992. By place of residence, the decline in fertility levels during the period 1988-95 was greatest in Lower Egypt, in both urban and rural areas. Fertility also fell rapidly throughout this period in rural areas in Upper Egypt. However, both the Urban Governorates and urban Upper Egypt show small rises in fertility during the period 1992-95. Although these changes are not significant, they are indicative again of a plateaning of fertility in urban Egypt. 41 Table 3.4 Trends in fertility by residence Trends in total fertility rates by urban-rural residence and place of residence, Egypt 1986-1995 EDHS-88 EMCHS-91 EDHS-92 EDHS-95 Background 1986- 1987- 1990- 1993- characteristic 19881 19912 19921 19951 Urban-rural residence Urban 3.48 3.3I 2.91 3.01 Rural 5 35 5.63 4.91 4.19 Place of residence Urban Governorates 3 01 2 93 2.69 2.82 Lower Egypt 4.45 U 3.70 3.22 Urban 3.81 3 46 2.80 2.66 Rural 4.73 4.89 4.10 3.45 Upper Egypt 5.39 U 5.17 4.73 Urban 4.17 3.86 3.58 3.80 Rural 6.15 6.71 5.97 5.19 Frontier Governorates U U U 4.00 U = Unknown (not available) t Rates are for the 36-month period preceding the survey a Rates are for the 48-month penod preceding the survey Source: EDHS-88: Sayed et al., 1989, Table 3.1 EMCHS-9h Abdel-Azeem et al., 1993, Table 7.11 EDHS-92: EL-Zanaty al., 1993, Table 3.1 Figure 3.2 Trends in Total Fertility Rates by Urban-Rural Residence Egypt 1986-1995 Births per woman 7 '~' ,~4 g Rural 3~55 3.~ q~.~g Urban ~.0 EDHS EMCHS EDhS ED'HS 1988 1991 199"2 1995 42 Trend in Age-specific Fertility among EDHS-95 Respondents Fertility trends can also be investigated using retrospective data from a single survey. Tables 3.5 and 3.6 were generated from the birth history data collected in the 1995 EDHS. The rates shown in brackets in Tables 3.5 and Table 3.6 are truncated because they do not include the fertility experience of women who were in the childbearing ages during the period for which the rates are calculated, but who were age 50 and older at the time of the EDHS and, thus, not interviewed. For example, in Table 3.5, rates cannot be calculated for women age 45-49 for part of the period 5-9 years before the survey and all of the period 10-14 years prior to the survey, because those women would have been 50 years or older at the time of the survey. Table 3.5 shows age-specific fertility rates for successive five-year periods before the EDHS-95. The results in Table 3.5 confirm that fertility has fallen among all age groups, with the most rapid relative decline occurring in the 15-19 age group. Overall, the cumulative fertility rate for women age 15-34 has decreased from 4.8 births per woman during the period 15-19 years before the survey to 3.2 births per woman in the five-year period preceding the survey. Fertility rates for ever-married women by the duration since first marriage are shown in Table 3.6 for five-year periods preceding the survey. These rates are similar to the ones presented in Table 3.5 and are subject to similar problems of truncation. Reductions are observed in rates at all marriage durations, confirming again that fertility has been steadily declining in Egypt over time. Table 3.5 Age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age, Egypt 1995 Number of years preceding the survey Mother's age 0-4 5-9 10-14 15-19 15-19 67 101 124 126 20-24 211 238 277 283 25-29 213 256 282 311 30-34 147 198 230 246 35-39 83 120 [151] 40-44 29 [48] 45-49 [7] Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. Table 3.6 Fertility rates by number of years since first marriage Fertility rates for ever-manned women by number of years since first marriage, for five-year periods preceding the survey, Egypt 1995 Years Number of years preceding the survey since first marriage 0-4 5-9 10-14 15-19 <4 343 373 387 384 5-9 238 275 317 345 10-14 153 215 256 301 15-19 101 151 206 [266] 20-24 53 100 [157] 25-29 23 [49] Note: Fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. 3.4 Children Ever Born and Living Table 3.7 presents the distribution of all women and currently married women by the number of children they have had. Since only ever-married women were interviewed in the EDHS-95, information on the reproductive histories of never-married women are not available. Thus, in calculating these fertility measures for all women, never-married women were assumed to have had no births. The data in Table 3.7 represent the accumulation of births over time and, thus, are not relevant in considering the current fertility situation in Egypt. Nevertheless, the results are useful for understanding the overall fertility experience of the EDHS-95 respondents. The marked differences between the results for 43 Table 3.7 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 1995 Number of children ever born (CEB) Number Mean no Mean no. Age of of of hvmg group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB chddren ALL WOMEN 15-19 927 6.0 1.1 01 00 0.0 0.0 0.0 00 0.0 0.0 100.0 4,700 009 008 20-24 542 19 1 15.5 7.7 26 0.6 02 0 1 0.0 0.0 0.0 100.0 3,677 0.88 0.81 25-29 20.7 13.9 23 5 19 8 12.6 5.6 27 1.2 0 1 0.0 00 100.0 3,174 2.24 2 02 30-34 9.8 64 177 20.3 172 121 8.4 47 2.0 I 1 04 1000 2,745 344 306 35-39 7.3 34 105 16.1 160 143 11.4 91 6.4 29 25 1000 2,642 445 385 40-44 51 2.6 70 149 145 131 138 96 75 62 57 1000 2,099 514 4,29 45-49 39 25 62 98 112 [39 11 1 108 93 80 133 1000 2,c)07 595 4.73 Total 36,4 8.5 114 115 9.1 69 54 3.9 27 19 22 I/Xt I~ 21,045 2.60 2.23 CURRENTLY MARRIED WOMEN 15-19 48.9 41.9 80 0.9 03 00 0.0 00 00 0.0 00 100.0 663 062 0.57 20-24 208 32.5 27 I 13.5 46 10 03 02 0.0 0.0 00 1000 2,083 1 54 1.41 25-29 g.2 15.6 27 4 22 9 14.7 6.6 30 1.4 0 2 (I 0 00 100 0 2.677 2.60 2,36 30-34 43 5.9 18.7 218 18.4 13.0 90 51 2.2 12 04 I000 2,466 370 329 35-39 4.5 30 101 16.7 166 148 12.2 9.5 69 31 27 100.0 2,392 465 404 40-44 30 19 5.8 153 150 132 142 103 85 67 62 1000 1,816 539 4.52 45-49 25 19 54 9.2 I10 139 11.6 112 102 8.0 150 1000 1,614 6.23 498 Total 94 121 164 165 131 9.7 76 55 4.0 26 31 ItY00 13,710 369 318 currently married women and for all women at the younger ages are due to the comparatively large numbers of never-married women in those age groups who, as noted above, are assumed to have had no births. The number of children women have increases with age, reflecting the natural family building process. The level of fertility among teenagers is low. Only 7 percent of women age 15-19 have had a child. The past high fertility of Egyptian women can be seen from the relatively large proportion of women age 45- 49 who have had 10 or more children (13 percent). Since voluntary childlessness is virtually nonexistent, the proportion of women who are childless at age 40 or above can be taken as evidence of primary infertility. The data from the EDHS-95 indicate that 3 percent of currently married women over age 40 have never given birth. Finally, the last two columns in Table 3.7 show the average number of children ever born and the average number of children who are still living according to mother's age. Differences in the mean number of children born and living are minimal in the younger ages, becoming more noticeable after age 25. Among women age 45-49, the difference is more than one birth. 3.5 Birth Intervals A child's health status is closely related to the length of the preceding birth interval. Children born after a short birth interval are at greater risk of illness and death than those born after a long interval. In addition, short birth intervals may have consequences for other children in the family. The occurrence of closely spaced births gives the mother insufficient time to restore her health, which may limit her ability to take care of her children. The duration of breastfeeding for the older child may also be shortened if the mother becomes pregnant. 44 Table 3.8 shows the percent distribution of second order and higher (non-first) births in the five years preceding the survey by length of the previous birth interval. Overall, birth intervals are relatively long. Around one-quarter of non-first births occurred four or more years after a previous birth, and almost three- quarters occurred at least two years after a prior birth. The median interval was 32 months, which is slightly longer than the median interval in the 1992 EDHS (30 months). Although the majority are appropriately spaced, 26 percent of non-first births are born too soon after a prior birth, i.e., within 24 months of a previous birth. Table 3.8 Birth intervals Percent distribution of births m the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Egypt 1995 Number of months since previous birth Charactensnc 7-17 18-23 24-35 36-47 48+ Median number of months Number since of previous Total btrths bffth Age of mother 15-19 39.6 24.9 28.4 7.1 0 0 100 0 70 20 3 20-29 15 5 16.8 38.2 17 9 l 1.5 100.0 4,064 28.6 30-39 9.0 l 1.9 29.0 19.8 30.3 100.0 3,754 36.0 40 + 6 4 7 3 19 9 15.1 51 3 100.0 801 48.4 Birth order 2-3 13 8 15.7 33.8 17 5 19.2 100 0 4,349 30.5 4-6 10.6 11.7 31.2 18.9 27.5 100.0 3,015 34.2 7 + 9.5 12.7 31.2 20.0 26.6 100.0 1,324 34.2 Sex of prior birth Male 107 13.2 31.9 19.2 25.1 100.0 4,423 33.6 Female 13.5 14.5 33.1 17.5 21.3 100.0 4,265 30.8 Survival of prior birth Living 10.3 13.5 32.9 18.9 24.3 100.0 7,818 33.0 Dead 28.0 17.1 28.3 13.5 13.2 100.0 870 25.4 Urban-rural residence Urban 9.7 12.1 26.2 19.6 32.3 100.0 3,134 36.9 Rural 13.3 14.9 36.0 17.7 18.1 100.0 5,554 30.1 Place of residence Urban Governorates 8 I 12.2 26.2 17.0 36.4 100.0 1,399 38.4 Lower Egypt 11.7 13.2 30.7 19.1 25 3 100.0 3,221 33.2 Urban 8.4 9.6 24.5 23.7 33.8 100.0 738 39.8 Rural 12.7 14.2 32.5 17.8 22.8 100.0 2,484 31 7 Upper Egypt 13.7 15.0 36.1 18.2 17.0 100.0 3,982 30.1 Urban 13.2 13.9 27.3 20.3 25.4 100.0 950 34.3 Rural 13.8 15.4 389 17.6 143 1000 3,032 29.4 Frontier Governorates 13.3 14 6 33 0 18 8 20.4 100 0 85 31,8 Education No education 11.8 149 35.1 18.9 19.2 1000 4,441 31.1 Some primary 10.0 I 1.6 31 8 17 6 29.1 100 0 1,691 34 4 Primary through secondary 11 7 13.3 27.8 18.7 28.5 100.0 850 34.4 Completed secondary/higher 14.9 13.7 28.6 17.6 25.2 100.0 1,706 32.7 Work status Working for cash I 1.4 11.4 29.2 17.2 30.8 100.0 1,078 35.3 Not working for cash 12.1 14.2 32.9 18.5 22.2 100.0 7,610 31.9 Total 12.0 •3.9 32.5 18.4 23.2 100.0 8,688 32.3 Note: F~rst-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended m a hve birth. 45 Younger women have shorter birth intervals than older women. The median interval varies from 20 months among women age 15-19 to 48 months among women age 40 and older. For children whose preceding sibling is dead, the median interval between births is 8 months shorter than for children whose preceding sibling is still alive (25 months and 33 months, respectively). Birth intervals do not vary quite as much with the child's birth order or sex. However, there are marked residential differentials in the length of the birth interval. The median birth interval in urban areas is 37 months compared with 30 months in rural areas. Additionally, birth intervals are significantly longer in the Urban Governorates and urban Lower Egypt than they are in urban Upper Egypt. Within rural areas, the median interval is longer in Lower Egypt (32 months) than in Upper Egypt (29 months). There are only small differences in the median months since the previous birth according to the mother's educational level. Intervals are slightly longer among births to women who are working for cash than to other women. 3.6 Age at FirstBirth The onset of childbearing is an important indicator of fertility. In many countries, the postponement of the first birth, largely the outcome of a later age at first marriage, has made a large contribution to the overall fertility decline. Table 3.9 shows the distribution of women by age at first birth. The median age at first birth is not shown for women under age 25 because less than 50 percent of women in those cohorts had given birth at the time of the survey. The results in Table 3.9 indicate that there has been a steady rise in the age at first birth. The proportion of women giving birth before age 20 decreases with age of the mother. For example, among women age 45-49, nearly one in two had become a mother before the age of 20, while only around one in three women age 25-29 gave birth before age 20. Overall, the median age at first birth has increased from 20.3 years among women age 45-49 to 22 years among women age 25-29. Table 3.9 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Egypt 1995 Current age Women Median wah Age at first b~rth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 92.7 0A 4.6 2.3 0.0 00 00 1000 4,700 a 20-24 54.2 2.3 12.3 14 3 11.5 5 4 0 0 100 0 3,677 a 25-29 20.7 3.4 15.6 16 1 15.3 204 8 6 100.0 3,174 22 0 30-34 9 8 3.5 18.1 16.8 15.8 18.1 17.8 100.0 2,745 21.4 35-39 7.3 4.1 16.4 17.2 18.2 19.1 17.7 100.0 2,642 21.3 40-44 5.1 4.6 15.3 17.6 16.9 18.3 22.1 100.0 2,099 21.5 45-49 3 9 7.1 23.6 16.7 14.5 15.3 18.9 100.0 2,007 20.3 NA = Not apphcable aLess than 50 percent of the women in age group x to x+4 have had a birth by age x Table 3.10 presents the median age at first birth for different subgroups and examines the trend across age cohorts within these subgroups. The measures are presented only for women age 25-49 years to ensure that half of the women have already had a birth. 46 Table 3.10 Median age at first birth Median age at first birth among women age 25-49 years, by current age and selected background characteristics, Egypt 1995 Current age Background Ages characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Urban.rural residence Urban 23.6 23.4 22.8 22.9 21.1 22,9 Rural 20,6 20,0 20.0 20,1 19,7 20.1 Place of residence Urban Governorates 24.2 23.4 23.5 23.2 21.8 23,3 Lower Egypt 22.2 21.2 21.4 21.4 20.4 21.4 Urban 24,1 23,3 22.9 23,3 20,9 23,0 Rural 21.5 20.6 20.6 20.6 20.1 20.7 Upper Egypt 20.1 20.2 20.1 20.2 19.4 20.0 Urban 22.0 23.4 21.5 21.5 19.7 21.8 Rural 19,4 18,8 19.3 19,3 19.2 19.2 Frontier Governorates 22.4 21.8 22.1 21.2 19.8 21.6 Education No education 19.3 19.5 20.0 20.0 19.5 19.7 Some primary 20.0 20.0 20.3 21.0 20.1 20.3 Primary through secondary 20.9 21.2 21.2 22.1 21.0 21.3 Completed secondary/higher 24.6 25.2 25.5 26.1 26.7 a Work status Working for cash a 24.4 24 7 25.4 25,7 24.9 Not working for cash 21.3 20.6 20.6 20.7 19.9 20.6 Total 22.0 21,4 21.3 21.5 20.3 21.4 Note: Medians for the 15-19 cohort and the 20-24 cohort could not be determined because half of the women have not yet had a birth. a Medians were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. Results of the 1995 EDHS indicate that there are wide differences in the age at which women have their first child. Overall, the median age at first birth is 21.4 years. Urban women start childbearing nearly three years later than their rural counterparts. On average, women in rural Upper Egypt have their first birth one and a half years earlier than women in rural Lower Egypt and around four years earlier than women in the Urban Governorates and urban Lower Egypt. Looking at the patterns by education within age groups, it is clear that highly educated women have their first birth around five years later than women with less than a secondary 9ducation. There is a difference of more than four years in the median age at first birth between women who work for cash and other women. 3.7 Teenage Pregnancy and Motherhood Teenage fertility is of major social and health concern because teenage mothers and their children are at higher risk of illness and death. At the same time, women who have became mothers in their teens are more l ike ly to curtai l their educat ion. 47 Overall, as Table 3.11 shows, 10 percent of teenagers in Egypt have begun childbearing, with 7 percent having already given birth and 3 percent pregnant with their first child. This percentage has not changed since the 1992 EDHS when the proportion of teenagers who had begun childbearing was also 10 percent. The proportion who have begun childbearing rises rapidly throughout the teenage years, from less than one percent among 15-year-olds to 9 percent among women 17 years of age and 25 percent among women 19 years of age. There are significant residential differences in the level of teenage childbearing. In rural areas the level of teenage fertility (13 percent) is almost twice that in urban areas (7 percent). B y place of residence, Upper Egypt has the highest level of teenage childbearing, especially in the rural areas ( 18 percent), while urban Lower Egypt has the lowest (4 percent). Table 3.11 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant w~th their first child, by selected background characteristics, Egypt 1995 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characterisuc Mothers child bearing women Age 15 0.6 0.3 0.9 1,050 16 2.0 1.4 3.3 1,049 17 6.3 2.9 9.3 958 18 12.3 5.2 17.5 905 19 19.7 5.6 25.3 738 Urban-rural residence Urban 5.0 1.7 6.7 2,081 Rural 9.1 3.7 12 9 2,624 Place of residence Urban Governorates 4.3 1.6 5.9 982 Lower Egypt 5.3 2.2 7.6 2,105 Urban 2.8 1.0 3.8 606 Rural 6.4 2.7 9. ] 1,499 Upper Egypt 11.9 4.5 16.4 1,571 Urban 9.4 2.8 12.2 471 Rural 13.0 5.2 18.2 1,100 Frontier Governorates 5.9 2.5 8.4 42 Education No education 16.3 5.0 21.3 914 Some primary 11.8 4.1 15.9 623 Primary through secondary 4.4 1.8 6.2 2,234 Completed secondary/higher 2.5 2.3 4.8 958 Work status Working for cash 4.6 1.6 6.2 126 Not working for cash 7.4 2.9 10.3 4,575 Total 7.3 2.9 10.2 4,700 48 The level of teenage fertility is closely associated with a woman's educational level (see Figure 3.3). The lowest levels are observed for women who completed secondary school or higher (5 percent), and the highest levels are among teenagers with no education (21 percent). Table 3.12 presents the distribution of women age 15-19 by the number of children ever born. Among women who are mothers, most have only one child; only 18 percent have two or more children. Figure 3.3 Percentage of Women 15-19 Who Are Mothers or Pregnant with Their First Child, by Educational Level Percent No Soma Completed prim./ Completed sac,/ education primary Some secondary Higher EDHS 1995 Table 3.12 Children born to teenagers Percent distribution of women 15-19 by number of children ever born (CEB), Egypt 1995 Age 0 Number of Mean children ever born number Number of of 1 2+ Total CEB women 15 99.4 0.6 0.0 100.0 0.01 1,050 16 98.0 1.9 0.0 100.0 0.02 1,049 17 93.7 5.3 1.1 100.0 0.08 958 18 877 108 1.4 100.0 0.14 905 19 80.3 14.6 5.1 100.0 0.26 738 Total 92.7 6 0 1.3 100.0 0.09 4,700 49 CHAPTER 4 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING Although the government of Egypt has had a family planning program for a long time, family planning activities increased substantially during the 1980s. As part of the expanded program activities, a strong education and communication program initiated by the State Information Service has promoted family planning awareness through mass media nationwide. This chapter considers a number of indicators from the EDHS-95 relating to the family planning education efforts, including knowledge of methods and sources, sources of information about family planning and exposure to media messages about family planning, The chapter also looks at attitudes toward family planning use and the level of ever use of family planning. 4.1 Knowledge of Family Planning Methods and Sources Awareness of both family planning methods and of sources from which methods can be obtained are crucial in the decision whether to use a contraceptive method and which method to use. One of the main objectives of the EDHS-95 was to determine the level of knowledge of contraceptive methods and sources. In the survey, the level of awareness of family planning methods was measured as follows: (1) 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). (2) 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 description was read were recorded as known after probing (prompted knowledge). Information on knowledge of specific methods was collected for eight modern methods (i.e., the pill, IUD, injectables, Norplant, vaginal methods (foam, jelly, or diaphragm), the condom, female sterilization, and male sterilization), and three traditional methods (periodic abstinence, withdrawal, and prolonged breastfeeding). In addition, provision was made in the questionnaire to record any other method named spontaneously by respondents. For each modem method known, respondents were asked if they knew where a person could go to get the method. Women knowing about periodic abstinence were asked if they knew where a person could go to get advice about the method. 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 only after hearing it described. Thus, knowledge of a family planning method in the 1995 EDHS 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. Similarly, women are considered to know about a source for the method if they were able to name any place where the method could be obtained. 51 Level of Knowledge of Methods and Sources Table 4.1 indicates that knowledge of family planning methods is almost universal among Egyptian women, and over 90 percent know about at least one place where they can obtain a method. Almost all currently married women know about the pill and IUD, and knowledge of injectables is only slightly less common (97 percent). Seven in ten women know about female sterilization, while one in two know about the condom. Prolonged breastfeeding is the most commonly recognized traditional method among Egyptian women (79 percent). 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 1995 Know method Know a source Ever- Currently Ever- Currently Family planning married married mamed married method women women women women Any method 99.8 99.8 NA NA Any modern method 99.8 99.8 91.3 92.3 Modern method Pill 99,6 99.6 88.3 89.3 IUD 99.4 99.5 86.2 87.5 Injectables 96.2 96.7 75.7 77. I Diaphragm/foam/jelly 30.4 31,0 25.1 25.7 Condom 51.0 52.4 42.4 43,9 Female sterilization 71.0 71,8 59.2 60.2 Male sterilization 12.8 13.2 8.9 9.3 Norplant 44.0 44,9 32.1 32.9 Any traditional method 85.4 86.0 NA NA Periodic abstinence 41.7 42.7 NA NA Withdrawal 25.6 26.4 NA NA Prolonged breastfeeding 78.9 79.4 NA NA Folk methods 2.5 2.5 NA NA Number of women 14,779 13,710 14,779 13,710 NA = Not applicable With respect to knowledge of sources for modem methods, the levels vary significantly by method. Currently married women were most likely to know about a source for the pill (89 percent) and IUD (88 percent) and least likely to know about a source for male sterilization (9 percent). Comparing levels of knowledge in the EDHS-95 with levels observed in the 1992 EDHS, there was a substantial increase in the level of knowledge only for injectables (see Figure 4.1). The proportion of currently married women knowing about injectables increased from 82 percent in 1992 to 97 percent in 1995 EDHS. The increase in the proportion who were able to name a source for this method was also substantial, from 60 percent in 1992 to 77 percent in 1995 (Figure 4.1). The increased awareness of injectables is likely due to the fact that injectables were introduced as a program method during the period between the two EDHS surveys. 52 100 80 60 40 20 0 Percent Figure 4.1 Knowledge of Injectables 1992 EDHS and 1995 EDHS 97 / Know method Know source -------7 Differentials in Knowledge of Methods and Sources The percentages of currently married women who know any method of contraception and any modem method, and the percentage who know a source are presented in Table 4.2 by background characteristics. The table also shows the mean number known for all methods and modern methods. Knowledge of a method is almost universal among all subgroups. However, there are some differences in the knowledge of sources of methods. For example, women age 15-19 are less likely to know about a source than older women. A marked difference in the percentage of women who know about a source is evident between urban and rural women (98 percent and 88 percent, respectively). Women in rural Upper Egypt have the least knowledge of source (78 percent). The number of methods known also varies among subgroups. On average, urban women know 7.4 methods, while rural women know about an average of 5.9 methods. By place of residence, the mean number of methods known varies from 5.5 methods in rural Upper Egypt to 7.5 methods in the Urban Governorates. There is a clear relationship between the number of methods recognized by a woman and her educational level; the mean number of methods known varies from 5.7 methods among women with no education to 8.3 methods among women with secondary or higher education. There

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