Egypt - Demographic and Health Survey - 2004

Publication date: 2004

Egypt Interim Demographic and Health Survey 2003 EGYPT INTERIM DEMOGRAPHIC AND HEALTH SURVEY 2003 Fatma EI-Zanaty Ann A. Way January 2004 *t i Ministry of Health and Population El-Zanaty and Associates National Population Council ORC Macro Additional "information about the 2003 EIDHS may be obtained from the National Population Council, P.O. Box 1036, Cairo Egypt (Telephone: 5240425 or 5240505; Fax: 5240219). Additional information about the Measure DHS+ project may be obtained from ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (Telephone: 301-572-0200; Fax: 301-572-0999). Recommended citation: E1-Zanaty, Fatma and Ann A.Way. 2004. 2003 Egypt Interim Demographic and Health Survey. Cairo Egypt: Ministry of Health and Population [Egypt], National Population Council, E1-Zanaty and Associates, and ORC Macro. TABLE OF CONTENTS CHAPTER 1 INTRODUCTION . 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Background . 1 Survey Design and Implementation . 1 Survey Coverage . 3 Household Socio-economic Characteristics . 3 Household Wealth . i . 10 School Attendance . 11 Background Characteristics of EIDHS Respondents . 13 Exposure to Mass Media . 14 CHAPTER 2 FERT IL ITY . 15 2.1 2.2 2.3 2.4 • 2.5 Current Fertility . 15 Trends in Fertility . 16 Proximate Determinants of Fertility . 18 Fertility Preferences . 23 Premarital Examination: Knowledge and Practice . 27 CHAPTER3 FAMILY PLANNING . 29 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Knowledge and Ever Use of Family Planning . 29 Level and Differentials in Current Use of Family Planning . 30 Trends in Current Use of Family Planning . 34 Need for Family Planning . 36 Intention to Use Family Planning in the Future . 38 Contact of Nonusers with Family Planning Providers . 39 Exposure to Family Planning Messages . 41 Perceptions and Attitudes about Family Planning Use . 42 CHAPTER 4 FAMILY PLANNING SERVICES . 45 4.1 4.2 4.3 4.4 4.5 Source of Family Planning Methods . 45 IUD Use . 47 Pill Use . 48 Injectable Use . 49 Service Assessment Indicators . 50 CHAPTER 5 MATERNAL HEALTH . 53 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Pregnancy Care . 53 Content of Pregnancy Care . 57 Perceptions about ANC Coverage . 59 Exposure to Safe Pregnancy Messages . 60 Delivery Care . 62 Postnatal Care . 62 Trends in Maternal Health Indicators . 69 Table of Contents [ iii CHAPTER 6 CHILD HEALTH AND NUTRIT IONAL STATUS OF CHILDREN AND WOMEN . 71 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Immunizations . 7 I Diarrhea . 73 Acute Respiratory Infection . 75 Breastfeeding and Supplementation . 77 Nutritional Status of Children . 81 Nutritional Status of Women . 83 Micronutrient Supplementation . 85 CHAPTER 7 EARLY CHILDHOOD MORTAL ITY . 89 7.1 7.2 7.3 7.4 7.5 Levels of Early Childhood Mortality . 89 Trends in Early Childhood Mortality . 89 Socio-Economic Differentials . 90 Demographic Differentials . 91 High-Risk Fertility Behavior . 91 CHAPTER 8 KNOWLEDGE OF A IDS, HEPAT IT IS C, AND SAFE IN JECT ION PRACTICES . 95 8.1 8.2 8.3 Knowledge of AIDS . 95 Knowledge of Hepatitis C . 98 Knowledge of Safe Injection Practices . 101 CHAPTER 9 FEMALE C IRCUMCIS ION . 105 9.1 9.2 9.3 9.4 Prevalence of Female Circumcision . 105 Support for Female Circumcision . 106 Communication about Female Circumcision . 108 Beliefs about Circumcision . 109 REFERENCES . 111 APPENDIX A SAMPL ING ERRORS . 113 APPENDIX B 2003 EGYPT INTERIM DEMOGRAPHIC AND HEALTH SURVEY QUEST IONNAIRES . 115 iv [ Table c)f Contents LIST OF TABLES AND FIGURES CHAPTER 1 INTRODUCTION . 1 Table I. 1 Table 1.2 Table 1.3 Table 1.4 Table 1.5 Table 1.6 Table 1.7 Table 1.8 Table 1.9 Table 1.10 Table 1.11 Sample results . 3 Housing type and tenure . 4 Housing characteristics . 5 Drinking water facilities . 6 Sanitation facilities . 8 Hand-washing materials . 9 Household possessions . 10 Wealth index . 11 School attendance . 12 Background characteristics of respondents . 13 Exposure to mass media . 14 CHAPTER 2 FERT IL ITY . 15 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Current fertility . 15 Trends in fertility . 16 Trends in fertility by residence . 17 Age at first marriage . 18 Median age at first marriage by background characteristics . 19 Age at first birth . 20 Median age at first birth by background characteristics . 20 Birth intervals . 21 Teenage pregnancy and motherhood . 22 Fertility preferences by number of l iving children . 23 Ideal number of children . 24 Mean ideal number of children by background characteristics . 25 Wanted fertility rates . 26 Premarital examination . 27 Figure 2.1 Trends in fertility by residence . 17 Figure 2.2 Total fertility rates and wanted fertility rates by wealth level . 26 CHAPTER 3 FAMILY PLANNING . 29 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 Family planning knowledge and ever use . 29 Current use of family planning methods by residence . 3 I Current use of family planning methods by background characteristics . 33 Trends in current use of family planning . 34 Trends in current use of family planning by residence . 35 Trends in current use of family planning by socio-economic characteristics . 36 Need for family planning . 37 Future use of family planning . 38 Reasons for not using family planning . 39 Preferred family planning method . 39 Contact of nonusers with family planning workers and health facilities . 40 List of Tables and Figures ] v Table 3.12 Table 3.13 Table 3.14 Table 3.15 Exposure to family planning messages . 41 Most recent source of family planning information . 42 Opinion about extent and trend in family planning use . 43 Timing of use of family planning by newly married couples . 44 Figure 3.1 Current use of modem family planning methods by place of residence . 31 CHAPTER 4 FAMILY PLANNING SERVICES . 45 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 Source for modem family planning methods . 45 Trends in source for modem family planning methods by residence . 46 Cost of method for IUD users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Amount users are will ing to pay for IUD insertion . 48 Brand of pill used . 48 Cost of method for pill users . 49 Amount users are will ing to pay for the pill . 49 Cost of method for injectable users . 50 Amount users are will ing to pay for injectables . 50 Service assessment indicators for clinical providers . 51 Figure 4.1 Trend in percentages of users obtaining IUD and all modem methods from public sector providers . 47 CHAPTER 5 MATERNAL HEALTH . 53 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 Table 5.13 Table 5.14 Antenatal care . 53 Tetanus toxoid coverage . 54 Medical care other than visit for antenatal care or tetanus toxoid injection during pregnancy . 55 Care during pregnancy . 56 Content of pregnancy care . 58 Perceived coverage of antenatal care . 59 Coverage of safe pregnancy messages . 61 Delivery characteristics . 62 Medically-assisted deliveries by background characteristics . 63 Postnatal care for mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Postnatal care for mother by background characteristics . 65 Postnatal care for child . 66 Postnatal care for child by background characteristics . 68 Trends in maternal health indicators . 69 Figure 5.1 Antenatal care by place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 CHAPTER 6 CHILD HEALTH AND NUTRIT IONAL STATUS OF CHILDREN AND WOMEN . 71 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Vaccinations by background characteristics . 72 Prevalence and treatment of diarrhea . 74 Prevalence ant treatment of acute respiratory disease . 76 Initial breastfeeding . 78 vi [ L i s to fTab lesandF igures Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 6.9 Table 6.10 Table 6.1 I Table 6.12 Breastfeeding status . 79 Median duration and frequency of breastfeeding . 80 Nutritional status of children . 82 Trends in nutritional status of children . 83 Nutritional status of women by background characteristic . 84 Vitamin A supplementation among postpartum mothers . 85 Vitamin A supplementation among children 12-23 months . 86 Iodized salt . 87 CHAPTER 7 EARLY CHILDHOOD MORTAL ITY . 89 Table 7. I Table 7.2 Table 7.3 Table 7.4 Table 7.5 Early childhood mortality rates . 89 Trends in early childhood mortality in Egypt, 1965-2003 . 90 Early childhood mortality by socio-economic characteristics . 91 Early childhood mortality by demographic characteristics . 9i High-risk fertility behavior . 92 CHAPTER 8 KNOWLEDGE OF AIDS, HEPAT IT IS C, AND SAFE IN JECTION PRACTICES . 95 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Knowledge of AIDS . 96 Knowledge of ways a person can contract AIDS . 97 Knowledge of hepatitis C . 99 Knowledge of ways a person can contract hepatitis C . 100 Knowledge about safe injection practices . 101 Safe injection practices . 102 CHAPTER 9 FEMALE C IRCUMCIS ION . 105 Table 9. i Table 9.2 Table 9.3 Table 9.4 Prevalence of female circumcision . 106 Attitude about continuation of female circumcision . 107 Communication about female circumcision . 108 Beliefs about female circumcision . 110 APPENDIX A SAMPL ING ERRORS . 113 Table A. 1 Sampling errors for selected variables: National sample, 2003 Egypt Interim Demographic and Health Survey . 114 List of Tables and Figures I vii 1 INTRODUCTION 1.1 Background The 2003 Egypt Interim Demographic and Health Survey (2003 EIDHS) is the most recent of seven DHS surveys to be undertaken in Egypt. ~ The 2003 EIDHS was conducted under the auspices of the Ministry of Health and Population and the National Population Council. ORC Macro provided technical support for the survey through the MEASURE DHS+ project. USAID/Egypt provided funding for the survey under its bilateral population and health projects. This interim survey was undertaken to provide the information needed to track changes in major family planning, health and nutrition. This report presents the principal findings of the 2003 EIDHS. 1.2 Survey Design and Implementation Sample Design and Selection The sample for the 2003 EIDHS was designed to provide estimates of population and health indicators including fertility and mortality rates for the country as a whole and for five major subdivisions (Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, and rural Upper Egypt). In addition to the base sample, Menya govemorate and slum areas in Greater Cairo were oversampled in order to provide separate estimates for the USAID programs targeting these areas. The findings for Menya governorate and for the slum areas in Greater Cairo are presented in separate reports. The Frontier Governorates, which represent less than 2 percent of the total population, were excluded from the survey. A systematic random sample of more than 10,000 households was chosen for the main 2003 EIDHS sample (including the oversampling of Menya); in addition, around 4,000 households from the slum areas in Greater Cairo were chosen for the survey. The households were drawn from among those found in the 490 primary sampling units (PSU) selected for the 2003 EIDHS; 466 PSUs came from the original 2000 EDHS sample, 24 additional PSUs were selected in Menya, and 50 PSUs were selected from slum areas in Greater Cairo. In the process of selecting the 2000 EDHS sample, each of the PSUs was divided into parts. The number of parts selected for inclusion in the sample varied according to PSU size; in large PSUs (i.e., PSUs with 20,000 population or more), two parts were chosen for the sample while only one part was chosen in smaller PSUs. In new PSUs selected for the 2003 EIDHS, a similar procedure was used to select parts. In all PSUs selected for the main EIDHS sample, two segments were selected from each part. Thus, a total of 980 segments were selected for the main survey. An additional 90 segments were drawn in slum areas, for a grand total of 1,070 segments. In planning for the 2003 EIDHS, it was decided to obtain new household listings for all PSUs rather than employing the listings from the 2000 EDHS. Thus, a household listing operation was carried out in the segments chosen for the 2003 EIDHS prior to the main fieldwork. Using these listings, a systematic random sample of households was selected within each segment for the survey. JEarlier flail-scale DHS surveys were conducted in 1988, 1992, 1995 and 2000. In addition, interim DHS surveys were conducted in 1997 and 1998. Other national-level surveys for which results are shown in this report include the Egyptian Fertility Survey (1980 EFS), the 1984 Egypt Contraceptive Prevalence Survey (I 984 ECPS), and the 1991 Egypt Maternal and Child Health Survey (1991 EMCHS). Introduction [ 1 In order to allow for sub-regional estimates, the final number of households selected from each governorate in the 2003 EIDHS is disproportionate to the size of the population in the governorate. Thus, the 2003 E1DHS sample is not self-weighting at the national level. Questionnaires In order to collect information needed, two questionnaires were developed: a household questionnaire and a woman's questionnaire. The 2003 EIDHS household and woman questionnaires are similar to the questionnaires used in the 2000 EDHS in terms of the broad topics for which information is collected. However, a number of questions in the 2000 EDHS questionnaires were dropped from the 2003 survey instruments, and some questions were added to the 2003 EIDHS questionnaires in order to investigate new topics. Overall, the EIDHS questionnaires are more focused and limited in scope than the 2000 EDHS questionnaires. The EIDHS household questionnaire collected information on the names and characteristics (age, marital status, education, work, etc.) of all household members and on housing and household possessions. Height and weight measures also were obtained for eligible women and children. The EIDHS woman's questionnaire included questions on background characteristics of respondents (age, education, work, etc.). The questionnaire also collected information about reproduction, contraceptive knowledge and use, fertility preferences and attitudes towards family planning use, maternal health care including pregnancy care, infant feeding practices, child immunization and health, female circumcision, and husbands' background. In addition, new questions were added relating to knowledge about HIV/AIDS, Hepatitis C, and safe injection practices. Finally, the questionnaire contained a monthly calendar in which information was recorded on marital status, pregnancies and births, contraceptive use and discontinuation, and breastfeeding and postpartum amenorrhea. The calendar covered a 66-month period including the month in which the survey interview took place. A training manual for interviewers was prepared including general guidelines to follow in conducting an interview, as well as specific instructions for administering the EIDHS questionnaire. Data Collection Field staff were trained for four weeks during April and early May. Twelve teams collected data for the 2003 EIDHS. Each team consisted of four interviewers, one field editor, one assistant supervisor, and one supervisor. The field editor and the assistant supervisor were responsible for the height and weight measurements. All of the interviewers and field editors were females, and the assistant supervisor and supervisors were males. Two teams were assigned to work in Cairo, and the other teams were assigned to work in one to three governorates. The data collection started on May 9 th. Re-interviews and call backs started as soon as the first team completed the data collection. All call backs and re-interviews were completed by June 28 th Data Processing and Editing The data processing staff including coders, office editors and data entry personnel, attended the interviewer training program in order to become familiar with the questionnaires. Completed questionnaires were sent from the field to the office for registration and limited manual coding. Data were entered using microcomputers and the Integrated System for Survey Analysis (ISSA), a software package developed in the DHS program to facilitate processing of the survey data. Twelve computers were used for data entry. Verification was carried out for 100 percent of the questionnaires. A 2 [ Introduction consistency program was prepared to assure the quality and accuracy of the data. The data entry, verification and consistency checking, which overlapped with the field activities, took around three months to complete. 1.3 Survey Coverage Table 1.1 presents the results of the fieldwork for the main 2003 EIDHS sample (excluding slum areas) for both the household and individual interviews. The table shows that, out of 10,417 households selected for the 2003 EIDHS, 10,204 were found and 10,089 were successfully interviewed. This represents a household response rate of 99 percent. A total of 9,217 women were identified in those households as eligible for the individual interviews. Questionnaires were completed for 9,159 women, which represents a response rate of 99 percent. Table 1.1 Sample results Distribution of households (HH) and eligible women (EW) by the result of the interview, and response rates, according to urban- l~aral and place of residence, Egypt 2003 Interim Demographic and Health Survey Place of residence Urban Lower Egypt Upper Egypt Gover- Interview results Urban Rural norates Total Urban Rural Total Urban Rural Total Dwellings sampled 4,849 5,568 2,097 3,443 1,259 2,184 4,877 1,493 3,384 10,417 Households found 4,700 5,504 2,034 3,373 1,221 2,152 4,797 1,445 3,352 10,204 Households interviewed 4,611 5,478 2,000 3,310 1,177 2,133 4,779 1,434 3,345 10,089 HH response rate 98. I 99.5 98.3 98.1 96.4 99. I 99.6 99.2 99.8 98.9 Eligible women 3,630 5,587 1,482 3,147 950 2,197 4,588 1,198 3,390 9,217 EW interviewed 3,596 5,563 1,473 3,105 929 2,176 4,581 1,194 3,387 9,159 EW response rate 99.1 99.6 99.4 98.7 97.8 99.0 99.8 99.7 99.9 99.4 1.4 Household Socio-economic Characteristics In the following section, a profile of the characteristics of the households selected for the EIDHS sample is presented. Information on housing characteristics, housing facilities, and household possessions are highlighted. Housing TVDe Table 1.2 presents the housing type and tenure for the interviewed households. The majority of households in urban areas live in apartments (83 percent), whereas in rural areas the majority live in a free-standing house (71 percent). Nine in 10 rural households own their dwelling, with slight variations among regions. Ownership is less common in urban areas, particularly in the Urban Governorates, where 41 percent own or jointly own their dwellings. Households not owning their dwelling were asked about the possibility of being evicted. As shown in Table 1.2, the great majority of these households (90 percent) are not concerned about the possibility of eviction. Urban households were slightly more likely than rural households to report that there is no possibility of being evicted (90 percent and 87 percent, respectively). Housing Characteristics Table 1.3 presents the distribution of households by selected housing characteristics including electricity, type of cooking fuel, flooring, and the number of rooms. Overall, 99 percent of households have electricity. Differentials in the availability of electricity by residence are small, ranging from 96 Introduction [ 3 percent of households in rural Upper Egypt to nearly 100 percent of households in the Urban Governorates and urban Lower Egypt. Looking at the cost of electricity, 35 percent of households pay L.E.20 or more monthly for electricity, 20 percent pay L.E. 15-19, 24 percent pay L.E. 10-14, and 18 percent pay less than L.E. l 0. Possibly reflecting higher electrical usage, urban households pay higher amounts for electricity than rural households. Table 1.2 Housing type and tenure Percent distribution of households by housing type and tenure, according to urban-rural residence and place of residence, Egypt 2003 Place ofresidcncc Urban Lowcr Egypt Upper E~3ypt Housing type Gover- and tenure Urban Rural noratcs Tota l Urban Rural Total Urban Rural Total Type of dwelling Apartment 82.9 26.8 92.2 50.3 81.2 34.2 35.7 67.8 17.4 54.8 Free standing house 14.7 71.1 4.9 48.2 16.8 64.4 61.6 302 796 42.9 Other 2.4 2.1 2.9 1.6 1.9 1.4 2.6 2. I 30 22 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 10031 100.0 100.1) 100.0 Number of households 5,047 5,042 2,319 4,259 1,451 2,808 3,51 I 1,278 2,233 10.089 Dwelling owned/rented Owned/Owned jointly 52.0 90.7 40.8 80.1 61.3 89.9 80.9 61.9 91.8 71.4 Rented 43.7 4.3 55.1 14.4 33.0 4.8 15.0 35.1 3.6 24.0 Other 4.3 5.0 4.1 5.5 5.7 5.3 4.0 3.1 4.6 4.6 Total percent 100.0 100.0 10031 100.0 100.0 I/gh0 100.0 100.0 100.0 100.0 Number of households 5,047 5,042 2.319 4,259 1,451 2,808 3,51 I 1,278 2,233 10.089 Possibility of eviction Very likely 2.9 3.3 2.4 3.6 4.0 2.8 3.4 3.1 4.1 3.0 Somewhat Likely 1.5 2.9 1.8 1.5 0.8 3.0 1.9 1.6 2.8 1.7 Not very likely 2.4 4.4 2.2 2.5 2.8 1.9 4.1 2.4 8.4 2.7 No possibility of eviction 90.2 86.9 91.5 89.6 89.3 90.0 862 87.8 819 897 Don't know/missing 3.0 2.5 2.2 2.8 3. I 2.3 4.4 5. I 2.7 2.9 Total percent 100.0 1110.0 100.0 100.0 100.0 100.0 100.0 100.0 I00.0 100.0 Number of households 2,42l 467 1,373 846 562 285 669 487 182 2,888 The majority of households in both urban areas (98 percent) and rural areas (88 percent) usc LPG/natural gas as a cooking fuel. Use of kerosene is most common in rural Upper Egypt, where 20 percent of households use this type of fuel. With regard to flooring, more than half of households live in dwellings with cement tile floor, 19 percent report cement floors, and 15 percent have earth/sand floors. There are substantial differences in the flooring materials between urban and rural dwellings. Slightly more than one-quarter of rural households have a sand or earth floor compared with 3 percent among urban households. On the other hand, around three-quarters of urban households have a cement tile floor compared with 38 percent of rural households. With regard to the number of rooms, Table 1.3 shows that 10 percent of households have one or two rooms, and 69 percent have three to four rooms. The overall mean number of rooms per household is 3.8, and the mean number of persons per room is 1.4. 4 i Introduction Table 1.3 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence and place of residence, Egypt 2003 Place of residence Urban Lower Egypt Upper Egypt Gover- Housingcharacteristic Urban Rural notates Total Urban Rural Total Urban Rural Total Electricity Yes 99.7 97.8 99.9 99.2 99.7 98.9 97.5 99.5 96.3 98.8 No 0.2 2.2 0.1 0.8 0.3 1.1 2.5 0.4 3.7 1.2 Totalpercent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Average monthly electricity cost Free 0.3 0.2 0.3 0.1 0.1 0.0 0.3 0.4 0.3 0.2 1-9 LE 13.5 21.4 14.1 17.9 15.1 19.4 18.9 10.6 23.9 17.4 10-14 LE 21.3 26.9 18.9 27.1 25.6 27.9 23.9 20.9 25.6 24.l 15-19 LE 19.8 20.9 20.3 20.8 18.4 22.1 19.8 20.5 19.3 20.3 20+ LE 43.0 27.6 44.5 31.3 38.2 27.7 34.2 45.5 27.6 35.4 Don't know/missing 2.2 3.1 2.0 2.8 2.7 2.9 2.9 2.1 3.3 2.6 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 0.4 0.3 0.8 0.2 0.2 0.2 0.3 0.0 0.5 0.4 LPG, natural gas 97.5 87.6 97.6 96.8 98.5 95.9 84.1 96.2 77.2 92.6 Kerosene 1.9 10.8 1.4 2.8 1.2 3.6 14.0 3.6 20.0 6.4 Charcoal 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 Firewood/straw/dung 0.0 0 9 0.0 0.0 0.0 0.1 1.3 0.0 2.1 0.5 Other 0.1 0.1 0.1 0.1 0.0 0.2 0.1 0.0 0.1 0.1 Missing 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 Totalpercent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Flooring Ceramic/marble tiles 14.1 2.5 19.1 5.0 8.4 3.2 5.2 11.6 1.5 8.3 Cement tiles 72.1 37.7 71.2 54.7 75.8 43.8 44.5 69.7 30.1 55.0 Cement 6.5 32.4 3.7 30.3 10.5 40.5 16.7 7.2 22.2 19.4 Wall-to-wall carpet 1.9 0.8 1.5 1.6 2.6 1.1 0.9 1.9 0.4 1.3 Vinyl 0.4 0.0 0.3 0.2 0.5 0.0 02 0.6 0.0 0.2 Parquet/polished wood 1.9 0. I 2.8 0.5 1.3 0.1 0.3 0.7 0.0 1.0 Wood planks 0.1 0.1 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.1 Earth/sand 2.8 26.3 1.0 7.6 0.9 1 ] 31.9 8.2 45.5 14.5 Other 0.0 0.1 0.1 0.1 0.0 0.1 0.1 0.0 0.2 0.1 Missing 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.1 0.0 0.0 Totalpercent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of rooms 1-2 9.0 10.1 10.3 6.0 6.8 5.6 13.4 9.3 15.8 9.6 3-4 76.3 61.8 74.4 67.7 78.9 61.9 67.2 76.9 61.7 69.1 5+ 14.4 28.0 15.3 26.3 14.0 32.6 19.1 13.4 22.3 21.2 Missing/DK 0.2 0.1 0.1 0.1 0.2 0.0 0.3 0.4 0.2 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Mean rooms per household 3.6 4.0 3.6 4.0 3.7 4.2 3.7 3.6 3.8 3.8 Mean persons per room 1.3 1.5 1.3 1.3 1.3 1.4 1.6 1.4 1.8 1.4 Numberofhouseholds 5,047 5,042 2,319 4,259 1,451 2,808 3,511 1,278 2,233 10,089 Drinking Water Information on the source of water that households use for drinking and on storage practices employed for drinking are presented in Table 1.4. As the table shows, more than eight in ten Egyptian households have access to piped water, mainly within their dwelling. Introduction [ 5 Urban households haxe almost universal access to sate drinking w'ater; 99 percent report they have piped water in their residence, and most of the remaining households obtain water fiom a public tap. Alnong rural households, these proportions are markedly lower; 74 percent have access to piped water, and 6 percent drink water from public taps. Among the remaining rural households, almost all report they obtain drinking water from covered wells. I ab le l 4 Drinkin~ water flicilities Percent distiibution of b(~uscbolds by drinking watei lacility, according to urban rural residence and place ofresidence, Egypt 2003 Place ofresidence Urban IowerEgypt Upper Egypt Gover [)linking wiacrl~lcilitios Urban Rula/ Iloratcs Total Urban Rural Iotal lYrban Rural Total Source of dr ink ing ~ater Piped into residence/plot Pubbc tap (?pen well Co~eicd well Nile/canals Other I oral percent Numbc~ l hne to ~ater source Water witbbl 15 minutes %% ater supply interrupted Daily/a/most daily Few times per week Less b cquently Not interrupted I)on't know/udssing Total pm cent Numbm Water stored Yes No Don't know!nnissing I oral pclcent Number Storage containers co~ered All covered Y, om~+ co~ trod None cox eied Nol able to observe/mi>sing 7 oral percent N kllllbor Type of storage container Wide nloutb N~lrrOx~ lUOutb Botb types Missing Total perceiU NumbeI 98.6 736 993 832 98.7 752 80.8 97 1 7/.5 86.1 1.2 64 05 30 12 3.9 7.0 23 96 3.8 0 I 1.3 0.1 07 0 0 I 1 1.0 0.2 1 5 0.7 02 16.0 0. l 11.6 0.1 175 92 1) 4 142 8.1 00 0.0 0.0 0.0 00 00 00 00 01 0.0 00 2.7 0.1 1.5 0.0 23 2{I O0 3.1 1.3 /00 0 1000 100.0 100.0 100.0 100 0 1000 100.0 100.0 100.0 5,047 5,(/42 2,319 4,259 1.451 2,808 3.5l / 1,278 2,233 10,089 996 94.7 997 97.2 997 959 95.4 99.2 93.3 97 1 95 10.5 11.9 91) 78 9.6 10.0 7.2 11.6 100 15.0 17.4 13.5 179 181 178 159 14.1 16.9 16.2 8.8 6.8 9.2 10.0 128 8.6 41 34 45 78 66 2 6%0 64.8 62.8 60.9 637 69.6 749 66.6 65.6 115 04 0.6 0.4 0.5 0.3 0.4 04 0.4 0.5 100.0 /000 100.0 100.0 100.0 100.0 1000 100.0 100.0 I00.0 5.047 5.042 2,319 4,259 1,451 2,808 3.51/ 1,278 2.233 10,089 22.7 39.2 2 /3 314 25.8 343 36.8 21.8 45.4 30 9 772 607 78.6 685 742 636 63.1 78.0 54.6 690 0 1 0.0 0 1 0.0 00 0.1 0.1 0.3 0.0 0 I 1000 1000 100.0 100.0 I000 1000 I000 tO00 IO00 I00.0 5.047 ";.042 2.319 4.259 1,451 2.808 3,511 1,278 2,233 10.089 893 75.2 89.6 786 889 746 787 892 75.8 80.4 8.5 209 87 16.7 71 20.4 189 99 213 16.3 1.6 35 1 0 39 30 4.3 2.2 06 27 2.8 07 0.5 0.7 0.8 I0 07 0.2 03 02 06 IOOf) I000 1000 1000 1000 1000 I00.0 1000 100.0 100.0 1,145 1.977 493 1,338 374 964 1.29/ 278 1,013 3,122 282 46.5 18.0 416 388 427 46.1 320 51).0 398 44 5 343 43.3 43.1 490 40 8 309 40.7 28.2 38.1 273 19.1 38.7 15.2 122 163 230 27.3 21.8 221 0.0 0 I 0.0 O. ] O0 02 Od) 1) 0 0.0 0.0 100.0 1000 1000 1000 1000 100.0 100.0 100(/ 100.0 1000 [, lg7 1.968 48 c) 1,328 370 957 1,288 277 1.011 3,105 With regard to access to source of drinking water, 97 percent of households can fetch water within 15 minutes. 6 I ll~fl'°dz~cli°~7 Households were also asked about interruptions in the water supply. Sixty-six percent of households reported that the water supply is never interrupted while 10 percent of the households mentioned that water supply is interrupted daily. Drinking water that is stored may become contaminated if the storage container is not clean or covered. Table 1.4 presents data on the extent to which water for drinking purposes is stored and on the containers used for storage. Overall, 31 percent of households store drinking water and, among these households, 80 percent use covered containers to store the water. Forty percent of households use wide mouth containers, 38 percent use narrow mouth containers, and 22 percent use both. Households in rural areas are more likely to store water than households in urban areas; this is particularly the case among households in rural Upper Egypt where 45 percent of households store water. In the majority of both urban and rural households where water is stored, the containers are covered; however, around one-quarter of rural households and 10 percent of urban households had some containers that were not covered. Sanitation Facilities Two in 5 households have a modem flush toilet, with significant differences by residence (Table 1.5). For example, 68 percent of urban households have a modem flush toilet compared with only 13 percent among rural households. Eighty percent of households in the Urban Govemorates have a modem flush toilet compared to 8 percent among rural households in Upper Egypt. The type of drainage system varies by residence. The majority of urban households are connected to public sewers, especially in the Urban Governorates, where 97 percent are on public sewers. Among rural households, almost half have a septic system. Households in rural Upper Egypt are more likely to have Bayars than any other drainage system (46 percent). More than three-quarters of the households had no problems with the drainage system. Problems with the drainage system are more common in the Urban Governorates and in Lower Egypt than in Upper Egypt. Information also was collected about whether the toilet facilities were shared with other households. Only four percent of households share their toilet facility with other households. There are slight variations by place of residence, with rural Upper Egypt having the highest percentage (8 percent) of households sharing their toilet facility. The condition of the toilet was observed by interviewers. In 90 percent of the toilets observed, no fecal matter was present. Fecal matter was observed in the toilet area more often in rural households than urban households (10 percent and 4 percent, respectively). Rural Upper Egypt had the largest proportion of households (12 percent) where fecal matter was observed. Interviewers also asked to see the place where household members washed their hands. Household members are much more likely to wash their hands regularly after using the toilet if the place for hand washing is adjacent to the toilet. Nearly all urban households had a place for hand washing and, in 91 percent of these households, the place used for hand washing was adjacent to the toilet facility. In contrast, 40 percent of rural households either did not have a place for hand washing (22 percent) or the place used for hand washing was not adjacent to the toilet facility (18 percent). Introduction I 7 Table 1.5 Sanitation facil it ies Percent distribution of households by sanitation facilities, according to urban rural residence and place of residence. Egypt 2003 Sanilation fl~cilities Urban [)lace of residence Urban Lower Egypt Upper Egypt Gover Rural norates [ora l Urban Rural 9ota] Urban Rural Tolal Toilet facility Modern flush toilet 678 1331 80.2 32.5 62.t) 172 238 523) 7 7 4P.4 TJadit ionalwith tank flush 1 0 20 0.5 2 3 15 2.7 1 2 1.6 1.0 I 5 Traditgmal with bucket flush 30~ 789 19.3 637 360 77.9 67 2 44.6 80.1 54,7 Pit Ioilct/latrine 0.4 3.5 0.1 I .I 0 2 1 5 42 I 2 53) 1 9 No [hcili ly/bush (12 27 00 0.5 03 116 q6 0 6 5.3 1 5 Total percent 1000 I000 1000 100.0 1000 1000 10(h0 100.0 1003) 100.0 Number 5.047 5.042 2,319 4.259 1,451 2.808 3.51 I 1,278 2,233 10.089 Drainage system Public sewer 846 21.7 966 538 900 351 23.7 564 4 / 530 Vauh (Bayara) 82 25.1 19 62 09 90 394 278 463 165 Septicsyslcm 69 48.9 14 377 87 528 328 14.7 437 276 Pipe to canal 02 1.5 0 1 ] 6 04 2 ~ 0 3 0 1 ([.4 08 Pipe to groundwater 0 1 0.2 0.0 02 00 ()~ 1) 2 03 02 02 Emptied (11o connection) 02 2.5 0.0 0 4 0.1 05 3 5 07 5.2 I 3 Other 00 0 1 0.0 00 0.0 0.1 0 I 00 0.2 0 0 Total percent 100.0 1000 100.0 1000 10(I.0 100.0 1000 100 0 100.0 1000 Number 5,036 4.907 2,319 4,238 1,447 2.791 3,386 1.270 2.116 9,942 Problems with drainage system 8"cs 25.8 22.4 348 32.7 362 324 150 218 130 230 No 73.6 77.2 62 9 66.9 638 67 1 84 6 778 866 766 Don't know/missing 05 0.4 23 04 00 0~ 04 0 4 ft.4 04 Total percent 1000 100.0 100.0 1000 1000 1000 1000 1000 1000 1000 Number 766 3.713 78 1.94(I 144 1.796 2,4(H 945 1.917 4.479 Toilet facility shared Toilet not shared 97.3 95 1 966 97.0 98.1 97t 943 977 923 962 Toilet shared with: 1 household 0.7 1.2 06 (18 1.0 0.7 1.4 04 19 10 2 households 09 1.9 I 1 1 0 06 1.2 2.1 [) 8 2 8 1.4 3+ households I 0 17 15 05 03 07 23 10 3J) 1.5 Not sure/missing (10 00 0 1 00 0dl 0 1 00 00 P3) 00 [ oral percent 1000 100.0 1000 1000 1000 1000 1000 1000 1000 1000 Number 5,036 4.907 2,319 4,238 1,447 2,791 3,386 1,270 2,116 9,942 Condition of toilet facility Condition observed Fecal matter prcscm 36 95 2.6 6 8 4.6 8,0 8.9 4 4 I [.6 6.5 No l~cal matter present 94 2 858 95.5 91(I 935 89,6 85.3 927 808 90.1 Not determined I (I 37 04 1.0 117 I I 47 2.3 6 1 "~ I Not observed/missing I .I 1 4 I 5 1 3 1 2 1,3 I I 00 1.6 1.3 Total percent 1000 100.0 100.0 1000 1000 100,0 100.0 1000 100.0 100.9 Numbel 5,036 4,907 2,319 4,238 1,447 2.79I 3.386 1.27(I 2,1 t6 9.942 Place for hand ~ashing Place observed Same area/adjacent to toilet 90.5 594 92 7 782 918 71.2 592 850 44.5 749 Area not near toilet 5.3 17.5 3 7 9.5 5 1 I 1,8 187 8.4 24.6 I 1 4 No toilet ihcil ity 0. I 0.4 0 0 0.2 0.2 02 05 0.0 0.7 fl,2 Not able to observe 08 0.5 1 2 (I.6 (1.5 0.6 0 4 0.4 0.3 0.6 None/missing 34 22.2 2.4 II 6 2.5 16.2 21.2 62 298 12.8 9otal percent 100.0 I ()(I.0 100.0 100.0 1000 1000 100.0 100.0 100.0 1000 Number 5,047 5,042 2,319 4,259 1,451 2,8fl8 3,511 1,278 2,233 10,089 Disposal of kitchen waste/trash Collected b'om home 51.6 17.7 51(~ 317 499 223 270 ~36 118 346 Collected li'om container in street 268 3,2 392 88 190 36 6.6 13.4 2 7 150 Dtunped into street/empty plot 17.6 31.2 83 26.1/ 26.6 257 330 24.4 38(1 244 Dumped into canal/drainage 13 19.1 04 164 2.1 23.9 9 2 2.2 13.1 10.2 Burned 2.(I 211 03 135 2.4 19.2 166 46 23.4 leg Fed to animals/ 0 3 5 3 D.I 2.6 (/ I 3.8 4.9 1.0 7 1 2 8 Otber/don't know 0.3 25 0 / 1.0 0.1 1 4 2 8 08 3.8 1 4 Total percent 100.0 1000 100.(} 1000 1000 100.0 100(} 100.0 1(10.0 100 0 Number 5,047 5,042 2,319 4,259 1,451 2,808 3,511 1,278 2,233 10,089 8 I Introduction With regard to disposal of kitchen waste and trash, 52 percent of urban households have their waste collected from home compared to 18 percent of rural households. Dumping waste in the street, an empty plot, or into a drainage canal or ditch is a common practice among rural households (50 percent) while around 20 percent of rural households burn their trash. Hand-wash ing Mater ia ls Interviewers observed the hand-washing area to determine the presence of the following items: water/tap, soap, basin, and towel or cloth. Table 1.6 shows that 40 percent of all households had all the hand-washing materials present. Looking at the specific items, water or a tap was available in the hand washing area for 85 percent of households, 71 percent had soap or ash, and 79 percent had a basin. The item most likely to be lacking was a towel or cloth, which less than half the households had. Urban households were more than twice as likely to have all the items as rural (56 percent and 24 percent, respectively). Table 1.6 also shows considerable variation in the presence of hand-washing materials by place of residence. Households in urban Lower Egypt (61 percent) most often had all of the items while households in rural Upper Egypt households (11 percent) were least likely to have them. Table 1.6 Hand-washing materials Percentage of households with hand-washing materials by urban-rural residence and place of residence, Egypt 2003 Water or Soap/ Towel/ All Residence tap ash Basin cloth items Total Urban-rural residence Urban 94.7 85.4 93.5 57.5 56.0 5,047 Rural 75.9 56.7 64.5 25. I 24 1 5,042 Place of residence Urban Governorates 94. I 85.3 95.2 61.3 59. I 2,319 Lower Egypt 86.8 74. I 77.9 44.8 43.5 4,259 Urban 96.8 88.5 93.8 62.4 61.3 1.451 Rural 81.7 66.7 69.6 35.7 34.3 2,808 Upper Egypt 77.7 57.9 69.8 23.9 23.3 3.511 Urban 93.3 82.0 90.3 45.2 44.3 1.27S Rural 687 44.1 58.1 I 1.7 113 2,233 Total 85.3 71.1 79.0 41.3 40.1 10,089 Househo ld Possessions Table 1.7 provides information on household ownership of durable goods and other possessions. More than nine in ten households own a television, and around 80 percent have a washing machine (other than automatic). Around 47 percent of households have a telephone, and 17 percent have a mobile phone. Urban households are more likely to have most household effects than rural households. For example, more than 60 percent of urban households have a telephone compared with 30 percent of rural households, and 92 percent of urban households own a refrigerator compared with 67 percent of rural households. Ownership of various household possessions also varies by place of residence, with highest rates of ownership among households in the Urban Governorates and the lowest ownership in among households in rural Upper Egypt. Table 1.7 also includes information on household ownership of means of transportation. Overall, nine percent of households own a car, with the highest rate of ownership in the Urban Governorate (19 Introduction I 9 percent) and the lowest rate in rural Upper Egypt (3 percent). Rates of ownership of bicycles vary from 5 percent in the Urban Governorates to 27 percent in rural Lower Egypt. Table 1.7 Household possessions Percentage of households possessing various household effects, means of transportation, property and farm animals, according to urban-rural residence and place of residence, E~ypt 2003 Place of residence Urban Lower Egypt Upper Egypt Gover- Possession Urban Rural norates Total Urban Rural Total Urban Rural Total Household effects Radio 90.6 77.8 92.5 84.3 89.9 81.4 78.5 87.7 73.2 84.2 Television 96.2 89.2 95.9 93.9 96.6 92.4 S9.1 96.1 85.1 92.7 Video 27.6 4.9 34.7 9.7 17.9 5.4 12.1 25.8 4.2 16.3 Satellite dish 12.5 2.7 16.8 4.8 8.4 2.9 4.9 9.2 2.4 7.6 Telephone 63.9 29.8 70.9 39.4 53.7 32.11 40.0 62.7 27.0 46.8 Mobile telephone 28.4 5.9 35.7 12.3 21.7 7.5 10.8 22.8 4.0 17.2 Personal home computer 13.4 0.9 18.0 3.2 7.6 0.8 4.8 11.5 0.9 7.1 Electric fan 92.6 81.9 91.8 85.2 91.5 82.(/ 86.7 95.2 81.8 87.2 Air conditioner 7.6 0.4 I 1.2 1.0 2.3 0.4 2.9 7.0 0.5 4.0 Water heater 65.8 18.8 73.2 35.8 59.4 23.6 29.9 59.7 12.9 42.3 Refrigerator 91.7 67.2 93.6 78.8 90.1 72.9 70.9 90.0 60.0 79.4 Freezer 6.3 1.0 9.5 1.8 3.4 1.0 1.9 3.7 0.9 3.6 Automatic washing machine 33.5 4.1 41.6 11.0 23.7 4.4 13.2 29.9 3.6 18.8 Other washing machine 78.6 81.1 76.3 88.8 85.7 90.4 71.3 74.5 69.4 79.9 Gas/electric stove 84.2 64.7 86.8 74.1 78.4 71.9 66.6 85.9 55.6 74.4 Dishwasher 2.5 0.1 4.4 0.3 0.6 (hi 0.4 1.1 0.0 1.3 Sewing machine 10.7 6.0 11.7 8.4 1 I. I 7.1 6.0 8.2 4.7 8.3 Means of transportation Bicycle 12.5 24.7 4.8 24.3 18.7 27.2 20.8 19.4 21.5 18.6 Motorcycle/scooter 1.7 2.4 1.2 2.8 2.3 3.1 1.6 1.9 1.5 2.0 Car/van/truck 14.1 4.2 18.6 6.3 9.1 4.9 6.4 11.6 3.4 9.2 Property Farm/other land 6.0 38.5 3.7 28.5 8.7 38.8 26.9 7.2 38. I 22.2 Farm animals Livestock/poultry 12.5 66.5 4.0 48.3 17.7 64.1 52.2 21.9 69.5 39.5 None of the above 0.6 1.7 0.5 0.5 0.3 0.6 2.3 1.0 3.0 I.I Number of households 5,047 5,042 2,319 4,259 1,451 2,808 3,511 1,278 2,233 10,089 As for land ownership, rural households own land more than urban households (39 percent and 6 percent, respectively). Land ownership varies markedly by place of residence; only four percent of households in the Urban Governorates own [and compared to slightly less than 40 percent in rural Upper and Lower Egypt. A similar pattern is observed for ownership of farm animals. 1.5 Household Wealth The wealth index 2 uses information on household assets to derive a measure of the standard of living of households. Wealth index values were calculated as follows: • The value one was ass igned i f the asset ex isted in the household, and the value zero i f the asset did not exist. Assets that are not d ichotomous were g iven their actual values. 2The wealth index used here is a proxy for long-tern1 economic status of the household. The index has been compared against both po',erty rates and gross domestic product pcr capita for India, and against expenditure data from household surveys in Nepal, Pakistan and Indonesia (Filmer and Pritchet0 1998, 2001) and Guatemala (Rutstein 1999). The evidence from those studies suggests that the assets index is highly comparable to conventionally measured consumption expenditures 10 I Introduction • The unweighted mean and standard deviation of each asset was calculated. • Factor analysis was used to obtain a weight for each asset reflecting the ability of the asset to differentiate between the non-poor and the poor. These weights are called factor scores. • Standardized household asset scores were calculated and summed for all the assets. • Households were ranked according to the standardized scores, and the appropriate quintile cut- off points were defined. Table 1.8 presents the distribution of households according to the wealth index. The table shows that a much larger proportion of households in urban areas than in rural areas fall in the highest wealth index group (44 percent and 6 percent, respectively). In turn, rural households are much more likely than urban households to be in the lowest wealth index group (31 percent and 4 percent, respectively). Table 1.8 Wealth index Percent distribution of households by poverty level, according to urban-rural residence and place of residence, Egypt 2003 Wealth index Urban Urban Lower Egypt Upper Egypt Gover- Rural notates Total Urban Rural Total Urban Rural Total First (lowest) quintile 4.1 31.2 2.9 15.7 3.4 22.1 29.8 7.2 42.7 17.7 Second quintile 6.6 27.0 3.8 22.3 8.4 29.5 18.8 9.7 24.0 16.8 Middle quintile 14.7 23.2 9.9 23.8 19.4 26.1 19.0 18.0 19.6 18.9 Fourth quintile 30.3 12.9 29.9 21.9 34.7 15.4 15.8 26.2 9.8 21.6 Fifth (highest) quintile 44.3 5.6 53.6 16.2 34.2 7.0 16.6 39.0 3.9 25.0 Total percent 100.0 I00.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,047 5,042 2,319 4,259 1,451 2,808 3,511 1,278 2,233 10,089 Households in rural Upper Egypt are generally poorer than households in other areas, while households from Urban Governorates are wealthier than other areas. For example, 43 percent of households in rural Upper Egypt fall in the lowest wealth index group, while more than half of the households from Urban Governorates fall in the highest wealth index group. 1.6 School Attendance Table 1.9 presents data on the school attendance for the year 2002-2003 for the household population age 6-24. The results in Table 1.9 indicate that 84 percent of children age 6-10 were attending school while the level was 87 percent among those aged 11-15. 3 School attendance decreases rapidly in the higher age groups. Fifty-two percent of individuals in the age group 16-20 were enrolled in school, while only 13 percent in the age group 21-24 were enrolled in the year 2002-2003. ~Attendance may be lower for the age group 6-10 than that of the 11-15 group because a number of the children who were age 6 at the time that the EIDHS interviews, which took place primarily May 2003, had not reached their sixth birthday in time to be eligible to enroll in school in the year 2002-2003. Introduction [ 11 Table 1.9 School attendance Percentage of the de-facto household population age 6-24 years who were attending school during the 2002-2003 school year by sex and age group, according to urban-rural residence and place of residence, Egypt 2003 Place ofresidence Urban Lower Egypt Upper Egypt Gove~ Age group Urban Rural norates Total Urban Rural Total Urban Rural Total MALE 6-10 86.4 83.2 87.8 86.5 86.1 86.7 81.1 84.7 79.8 84.5 11-15 92.2 89.7 91.8 90.7 92.2 90.1 902 92.6 89.2 90.7 6-15 89.4 86.5 89.8 88.7 80.4 88.4 85.8 88.9 84.6 87.7 16-20 65.3 51.9 64.1 57.0 66.0 53.5 55.2 66.3 50.2 57.5 21-24 22.3 12.2 23.9 15.0 20.8 13.1 14.2 21.0 11.2 16.5 FEMALE 6-10 87.9 80.0 90.6 87.2 88.0 86.8 76.1 83.9 72.8 83.2 11-15 92.8 77.7 92.3 9(/.I 94.9 88.2 735) 91.4 67.6 83.5 6-15 90.3 78.8 91.5 88.6 91.5 87.5 75.0 87.7 70.0 83.4 16-20 60.2 36.4 58.5 49.3 64.6 43.6 37.4 58.7 28.1 46.3 21-24 15.7 5.0 17.5 9.0 17.2 5.9 6.3 11.2 3.9 9.7 TOTAL 6-10 87.1 81.7 89.2 86.8 87.1 86.7 78.8 84.3 76.5 83.9 I I-15 92.5 83.8 92.0 90.4 93.5 89.2 82.3 92. I 78.5 87.2 6-15 89.9 82.8 90.6 88.7 90.4 88.0 80.6 88.3 77.6 85.6 Urban-rural differentials in school attendance are quite evident, particularly in the older age groups. For example, more than 60 percent those in the 16-20 age group in urban areas are attending school compared to 44 percent in rural areas. The Urban Goveruorates and urban Lower Egypt generally have higher school attendance levels than urban Upper Egypt. Similarly, school attendance levels are higher in rural Lower Egypt then in rural Upper Egypt in all age categories. Gender differentials in school attendance favor males. The gap between male and female school attendance which is quite small (1 percentage point) in the 6-10 age group becomes increasingly more evident at older ages. For example, looking at the 16-20 age group, 58 percent of males are attending school compared with only 46 percent among females. Looking at the relationship between gender and residence, gender differences in school attendance levels are less evident among urban children than rural children, especially in the younger age cohorts. Rural Upper Egypt generally has the largest gender differentials in school attendance. For example, among children 6-10 years, 80 percent of boys were attending school compared to 73 percent of girls. The gap widens in the older age groups, with 89 percent of boys 11-15 years in school compared to 68 percent of girls. In contrast, in rural Lower Egypt, school attendance rates are virtually identical for boys and girls 6-10 years, and the gender gap in the 1 1-1 5 age group is quite small (2 percentage points). 12 I Introduction 1.7 Background Characteristics of EIDHS Respondents Table 1.10 presents the distribution of inter- viewed women in the 2003 EIDHS by back- ground characteristics, including marital status, age, education, occupation, place of residence and wealth index. Overall, 92 per- cent of interviewed women are currently married, while 5 percent are widowed and 3 percent were either divorced or separated. Reflecting the effects of the increasing age at first marriage, few women fall in the age group 15-19 (4 percent). Women in the other age groups are fairly equally distributed with the largest proportion found in the age group 25-29 (20 percent) and the smallest proportion in 45-49 group (14 percent). Fifty-seven percent of the 2003 EIDHS re- spondents live in rural areas, while 43 per- cent are urban residents. Looking at place of residence, 18 percent of women reside in the Urban Governorates, 45 percent live in Lower Egypt, and 37 percent live in Upper Egypt. The table shows the educational level of women as well. Overall, 38 percent of women never attended school, 13 percent attended school but did not complete the primary level, 14 percent completed prima/-y school or had some secondary education, and 36 percent completed the secondary level or higher. The low educational level is reflected in the high illiteracy rate; 44 percent of the women could not read at all. Table 1.10 also shows that comparatively few women are working in occupations for which they are paid in cash. Overall, 84 per- cent of women are not working or are not paid in cash for work they do. As expected given the manner in which the wealth index is constructed, women are fairly evenly distributed across the wealth quintiles. Twenty-one percent of women fall in the highest quintile, while 19 percent fall in the lowest quintile. Table 1.10 Background characteristics of respondents Percent distribution of ever married women age 15o49 by selected background characteristics, Egypt 2003 Number of women Background Weighted Un- characteristic percent Weighted weighted Current marital status Married 92.2 8,445 8,430 Widowed 4.8 442 447 Divorced 2.2 205 216 Separated 0.7 67 66 Age 15-19 3.7 343 402 20-24 15.0 1,372 1,453 25-29 19.5 1,782 1,733 30-34 15.4 1,415 1,419 35-39 17.3 1,588 1,574 40-44 15.1 1,380 1,332 45-49 14.0 1,279 1,246 Urban-rural residence Urban 42.7 3,908 3,596 Rural 57.3 5,251 5,563 Place of residence Urban Governorates 18.2 1,666 1,473 Lower Egypt 44.8 4,105 3,105 Urban 12.9 l,I 81 929 Rural 31.9 2,924 2,176 Upper Egypt 37.0 3,388 4,581 Urban I 1.6 1,061 1,194 Rural 25.4 2,327 3,387 Education No education 37.7 3,452 3,681 Some primary 12.7 1,167 1,176 Primary comp./some secondary 13.9 1,270 1,203 Secondary comp./higher 35.7 3,270 3,099 Literacy Cannot read at all 43.9 4,016 4,250 Able to read only parts of sentence 7.5 685 677 Able to read whole sentence 3.3 304 291 Preparatory/higher education 45.3 4,146 3,934 Missing 0.1 7 7 Work status Working for cash 15.9 1,455 1,443 Not working for cash 84.1 7,701 7,714 Missing 0 3 2 Wealth index Lowest quintile 18.6 1,699 2,184 Second quintile 19.3 1,769 1,787 Middle quintile 20.5 1,874 1,759 Fourth quintile 21.2 1,937 1,753 Highest quintile 20.5 1,879 1,676 Total 100.0 9,159 9,159 Introduction I 13 1.8 Exposure to Mass Media The 2003 EIDHS collected information on the exposure of women to various mass media including television, radio, and print (i.e., magazines and newspapers). These data, which are presented in Table 1.11, are important for designing family planning and health media campaigns. As noted in previous surveys, television has the widest coverage of the three media, with 93 percent of women watching TV weekly. Around two-thirds of women listen to the radio weekly and 21 percent read newspaper/magazines weekly. Sixteen percent are exposed to all of the three media on a weekly basis. Five percent of women are not regularly exposed to any media. Urban women are more likely to be exposed to the different media than women in rural areas. Exposure to the different media increases directly with a woman's educational levels and with the household's socio-economic status as assessed through the wealth index. Table 1.11 Exposure to mass media Percentage of ever-married women age 15-49 who watch television weekly, listen to radio weekly, read newspapers/ magazines weekly by selected background characteristics, Egypt 2003 Read Watch Listen to magazine/ Number Background TV radio newspaper All lhree No media of characteristic weekly weekly weekly media exposure women Age 15-19 92.9 60.2 10.0 7.6 4.4 343 20-24 93.9 64.6 17.0 12.9 3 9 1,372 25-29 94.4 66.9 20.6 15.3 3.7 1,782 30-34 94.2 66.7 25.5 19.7 3.6 1,415 35-39 93. I 61.5 23.4 19.0 5.0 1,588 40-44 90.6 63.5 23.8 18.9 6.7 1,380 45 49 90.4 57.5 16.8 13.0 6.6 1,279 Urban-rural residence Urban 95.9 69.8 35.0 26.5 1.9 3,908 Rural 90.7 58.9 10.4 8.5 7.0 5,25 I Place of residence Urban Governorates 95.0 67.8 37.5 26.8 1.9 1.666 Lower Egypt 93.2 67.0 17.7 14.3 4.4 4,105 Urban 95.6 72.6 31.0 24.7 2. I I,I 81 Rural 92.3 64.8 12.4 10. I 5.3 2,924 Upper Egypt 91A 57.2 16.5 13.2 6.9 3,388 Urban 97.4 69.6 35.4 27.9 1.7 1,06 I Rural 88.6 51.5 7.8 6.5 9.2 2,327 Education No education 87.3 49.2 0.8 0.6 9.9 3,452 Some primary 92.9 60.2 4.2 3.4 4.7 I,I 67 Primary complete/some secondary 95.4 72.2 20.2 14.4 1.7 1,270 Secondary complete/higher 97.8 76.4 48.3 37.9 0.7 3,270 Work status Working lbr cash 93.7 69.7 48.8 38.0 4.2 1.455 Not working for cash 92.7 62.4 15,6 12.1 4.9 7.701 Wealth index Lowest quintile 77. I 39.5 2. I 1.5 18. I 1,699 Second quintile 94.8 60.3 6.2 5.0 3.3 1,769 Middle quintile 95.6 67.5 13.2 10.5 2.6 1,874 Fourth quintile 97.0 73.2 26.0 20.5 0.9 1.937 Highest quintile 98.4 743 543) 41.3 0.6 1.879 Total 92.9 63.5 20.9 16.2 4.8 9,159 14 I Introduction 2 FERTILITY The chapter reviews information on fertility behavior and attitudes from the 2003 EIDHS that is useful in monitoring the progress and evaluating the impact of the population program in Egypt. Levels, patterns, and trends in current fertility are presented first. The chapter then looks at data on the age at first marriage, the age at which women initiate childbearing, and the length of interval between births. Finally, the chapter considers women's fertility preferences and assesses the level of wanted fertility. 2.1 Current Fertility To collect data on fertility patterns, each E1DHS respondent 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 died. Then, 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. Finally, information was collected on whether currently married women were pregnant at the time of the survey. Table 2.1 presents several measures of current fertility derived from the retrospective birth history data obtained in the EIDHS including the total fertility rate, age-specific fertility rates, general fertility rate, and crude birth rate. The total fertility rate (TFR) indicates that, if fertility rates were to remain constant at the level prevailing during the three-year period before the 2003 EIDHS (approximately May 2000-April 2003), an Egyptian woman would bear 3.2 children during her lifetime. In rural areas, the TFR is 3.6 births per woman, one birth higher than the rate in urban areas (2.6 births per woman). Much of the overall urban-rural differential is due to the significantly higher fertility levels among rural women under age 30 compared to urban women in the same ages. For example, the age- specific fertility rate for rural women 15-19 is almost twice the rate among urban women in the same age group, and the rate of rural women 20-24 is around 60 percent higher than the rate for urban women in the same age group. Table 2.1 Current fertility Age-specific and total fertility rates and the general fertility and crude birth rates for the three years preceding the survey, by urban-rural residence, Egypt 2003 Place ofresidence Urban Lower E~pt Upper Egypt Mother's age Gover- at birth Urban Rural norates Total Urban Rural Total Urban Rural Total Age-specific rates 15-19 31 58 25 40 23 45 66 44 75 47 20-24 136 224 109 195 154 211 215 161 242 185 25-29 167 209 160 198 189 202 197 154 218 190 30-34 126 129 103 111 137 100 162 153 167 128 35-39 51 71 49 47 46 47 88 60 103 62 40-44 10 27 8 20 14 24 23 9 31 19 45-49 2 9 0 6 4 6 10 4 14 6 Fertility rates TFR 15-49 2.6 3.6 2.2 3.l 2.8 3.2 3.8 2.9 4.3 3.2 TFR 15-44 2.6 3.6 2.2 3.1 2.8 3.2 3.8 2.9 4.2 3.2 GFR 87 126 77 107 90 112 128 95 144 I09 CBR 21.7 29.8 19.1 26.6 23.5 27.8 29.6 23.7 32.3 26.3 Note: Rates are for the period 1-36 months preceding the survey (approximately May 2000 April 2003). TFR-Total fertility rate expressed per woman GFR General fertility rate (births divided by number &women 15-44 and expressed per 1,000 women) CBR-Crude birth rate (births divided by total population and expressed per 1,0001 Fertility I 15 Looking at the differentials across the place of residence categories, the highest fertility rate is found in rural Upper Egypt (4.3 births per woman). The TFR for rural Lower Egypt (3.2 births per woman) is more than one birth lower than the rural Upper Egypt rate. Unlike the situation in rural areas, there is almost no difference in the fertility level between urban Lower Egypt and urban Upper Egypt (2.8 births and 2.9 births, respectively). The Urban Govemorates have the lowest TFR (2.2 births per woman), more than two births lower than the rate in rural Upper Egypt. Estimates of the general fertility rate and crude birth rate also are included in Table 2.1. For the period 2000-2003, the general fertility rate was 109 births per thousand women, and the crude birth rate was 26.3 per thousand population. Striking differences are apparent by residence in both the general fertility rate and crude birth rate. For example, the general fertility rate GFR is highest in rural Upper Egypt (144 births per thousand women), close to double the G FR in the Urban Goveruorates (77 births per thousand women). A similar pattern is observed for the crude birth rate; the CBR is 32.3 births per thousand population in rural Upper Egypt compared to 19.1 births per thousand population in the Urban Governorates. 2.2 Trends in Fertility Using data from earlier surveys as well as 2003 EIDHS, Table 2.2 shows the trend in fertility since the late 1970s. Overall, as seen in Figure 2.1, fertility levels fell by more than two births during the period, from 5.3 births at the time of the 1980 Egyptian Fertility Survey to 3.2 births at the time of the 2003 EIDHS. The pace of decline was faster in the 1980g than in the 1990s. Considering the decline in the age-specific rates, Table 2.2 shows that fertility fell at a relatively faster pace among women age 30 and over and among those under 20 years of age than among other women. Table 2,2 Trends in i%rtiliw Age-specific fertility rates (per 1,000 women) and total fertility rates for women 15-49, Egypt 1979-2003 EFS ECPS EDHS- EMCHS EDHS EDHS EIDHS EIDHS EDHS EIDHS 1980 1984 1988 1991 L992 1995 1997 1998 2000 2003 1979- 1983 1986- 1990- 1990- 1993- 1995- 1996- 1997- 2000- Age I9801 19841 19882 19911 1992 ~ 19952 19972 19982 20002 20032 15-19 78 73 72 73 63 61 52 64 51 47 20-24 256 205 220 207 21)8 200 L86 192 196 [85 25-29 280 265 243 235 222 211) 189 194 208 190 30-34 239 223 182 158 155 140 [35 135 147 128 35-39 139 151 118 97 89 81 65 73 75 62 40-44 • 53 42 41 41 43 27 18 22 24 19 45 49 12 13 6 14 6 7 5 I 4 6 TFR 15-49 5.3 4.9 4.4 4.1 3.9 3.6 3.3 3.4 3.5 3.2 Rates are for the 12-month period preceding the survey. 2 Rates are for the 36 month period preceding the survey. Note: Rates for the age group 45-49 may be slightly biased due to truncation. Source lbr rates L 979 2000: EI-Zanaty and Way, 2001, Table 4.3 Table 2.3 shows trends in fertility by residence for the period between 1988 EDHS and the 2003 EIDHS. The large decline in rural fertility helped to reduce the gap between the urban and rural fertility rates, from almost two births in the mid-1980s to only one birth in 2003 (Figure 2.1). Considering place of residence, Table 2.3 shows that the decline in fertility during the past two decades was greatest in rural Upper Egypt. Between the 1988 EDHS and 2003 EIDHS, for example, the TFR declined by two births in rural Upper Egypt, a much more rapid decline than that experienced in rural Lower Egypt in the same period. Fertility also fell at a somewhat faster pace in urban areas in Upper Egypt than in urban Lower Egypt. The TFR in urban Upper Egypt dropped by 1.3 births, from a 1 6 I Fertility level of 4.2 births at the time of 1988 EDHS to 2.9 births at the time of the 2003 EIDHS. In comparison, the TFR declined by one birth in urban Lower Egypt and by 0.7 births in Urban Governorates during the same period. Figure 2.1 Trends in Fertility by Residence r 1987 1990 1991 1994 1996 1997 1998 2001 I " Urban " " " Rura l - - - -Tota l I I I Table 2 3 Trends in fertility by residence Total fertility rates by urban-rural residence and place of residence, Egypt 1986-2003 EDHS-88 EMCHS-91 EDHS-92 EDHS-95 EIDHS-97 EIDHS-98 EDHS-00 EIDHS-03 1986- 1990- 1990- 1993- 1995- 1996- 1997- 2000- Residence 19882 19911 19922 19952 19972 19982 2000: 20032 Urban-rural residence Urban 3.5 3.3 2.9 3.0 2.7 2.8 3.1 2.6 Rural 5.4 5.6 4.9 4.2 3.7 3.9 3.9 3.6 Place of residence Urban Governorates 3.0 2.9 2.7 2.8 2.5 2.7 2.9 2.3 Lower Egypt 4.5 U 3.7 3.2 3.0 3. I 3.2 3.1 Urban 3.8 3.5 2.8 2.7 2.6 2.4 3.1 2.8 Rural 4.7 4.9 4.1 3.5 3.2 3.2 3.3 3;2 Upper Egypt 5.4 U 5.2 4.7 4.2 4.3 4.2 3.8 Urban 4.2 3.9 3.6 3.8 3.3 3.3 3.4 2.9 Rural 6.2 6.7 6.0 5.2 4.6 4.5 4.7 4.2 TFR 15 -49 4.4 4.1 3.9 3.6 3.3 3.4 3.5 . 3.2 ' Rates are for the 12-month period preceding the survey. 2 Rates are for the 36-month period preceding the survey. U -Unavailable Source for rates 1986-2000: EI-Zanaty and Way, 2001, Table 4.4 Fertility [ 17 2.3 Proximate Determinants of Fertility This section explores EIDHS results relating to a number of factors other than contraception which affect a woman's chances of becoming pregnant and, thus, help to determine fertility levels in Egypt. The factors which are considered include: age at first marriage; age at first birth; length of the birth interval; and teenage pregnancy. Age at First Marriage The age at which women first marry is considered among the most important proximate determinants of fertility. When women delay marriage, they shorten the length of the period they are exposed to the risk of pregnancy and, thus, ultimately the number of children they will bear. Increases in the age at first marriage are, therefore, associated with declines in fertility levels. Table 2.4 shows the percentages of women who have ever married by selected exact ages and the median age at first marriage, according to current age. The results indicate that there has been steady increase over the past decades in age at which Egyptian women marry. For example, the median age at first marriage among women age 25-29 is 20.9 years, more than two years older than that among women age 45-49 (18.7 years). Table 2.4 also documents a marked decline in the proportion of women marrying at very young ages; the percentage of women married by exact age 15 dropped from 13 percent among women age 45-49 to only 3 percent among women age 20-24. Table 2.4 A~e at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage according to current age, Egypt 2003 Percentage of women who were married by exact ai~e: Percentage Current age 15 18 20 22 25 never married Number Median 15-19 1.3 NA NA NA NA 88.8 3,074 a 20-24 2.7 18.5 36.3 NA NA 45.9 2,537 a 25-29 5.8 23.9 40.8 58.0 78.8 14.0 2,073 20.9 30-34 8.9 28.3 43.7 62.0 80.0 6.6 1,514 20.6 35-39 11.6 38.1 53.9 67.9 81.0 3.0 1,638 19.5 40-44 10.9 37.6 54.3 67.2 81.8 2.3 1,413 19.4 45-49 12.7 43.7 60.8 73.7 85.8 1.6 1,300 18.7 25-49 9.6 33.4 49.7 65.0 81.2 6.2 7,937 20.0 NA-Not applicable "Omitted because less than 50 percent of women in the age group x to x + 4 have married for the first time by age x Table 2.5 presents differences in the median age at first marriage by selected background characteristics. Early marriage is more common in rural than urban areas; the median age at first marriage among rural women age 25-49 is 18.6 years, almost three years younger than the median age at first marriage among urban women. Marked differentials also are observed by place of residence. On average, women in rural Upper Egypt marry at younger ages (17.7 years) than women in rural Lower Egypt (19.3 years). Differentials in the median age at first marriage also exist between urban Upper Egypt (21 years), urban Lower Egypt (21.7 years) and the Urban Govemorates (22.3 years). The strong effect that education has on the age at which women marry is clear in Table 2.5. There is a difference of more than five years in the median age at first marriage between women with secondary education (23.2 years) and women who never attend school (17.6 years). Large differences in the age at first marriage are also evident according the rank on the wealth index. The median age at first marriage among women in the highest wealth quintile is 23 years, more than five years higher than the median age at first marriage among women in the lowest wealth quintile ( 17.5 years). 18 ] Fertility Table 2.5 Median age at first marriage by background characteristics Median age at first marriage among women 25-49 years, by current age and selected background characteristics, Egypt 2003 Current a~e Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Urban-rural residence Urban a 22.4 22.3 21.5 21.7 20.5 a 21.8 Rural a 20.2 19.4 17.9 17.8 17.2 19.1 18.6 Place of residence Urban Governorates a 22.9 22.8 22.3 21.8 19.9 a 22.3 Lower Egypt a 20.9 20.5 19.4 19.2 18.7 a 20.0 Urban a 22.4 21.9 21.4 21.6 20.9 a 21.7 Rural a 20.6 20.1 18.6 18.4 17.8 19.7 19.3 Upper Egypt a 20.0 19.5 17.9 18.0 17.5 19.3 18.7 Urban a 21.3 21.7 20.6 21.5 20.4 21.0 Rural 19.7 19.2 18.4 17.1 16.9 16.8 18.3 17.7 Education No education 19.2 18.5 17.9 17.3 17.4 17.1 17.8 17.6 Some primary 19:6 19.1 17.9 18.2 18.5 18.2 18.6 18.5 Primary complete/some secondary 19.9 19.2 20.1 18.8 20.0 18.8 19.5 19:3 Secondary complete/higher a 23.0 22.6 23.3 23.9 24.0 a 23.2 Wealth index Lowest quintiLe 19.9 18.6 17.6 17.3 17.2 16.8 18.0 17.5 Second quintile a 19.9 19.1 17.8 18.1 17.5 18.9 18.5 Middle quintile a 20.6 20.1 18.5 18.4 17.5 19.8 19.2 Fourth quintile a 21.6 21.6 20.7 20.7 18.9 a 21.0 Highest quintile a 23.4 23.2 22.7 23.1 22.4 a 23.0 Total a 20.9 20.6 19.5 19.4 18.7 a 20.0 Note: Medians are not shown for women 15-19 and 20-24 because less than 50 percent have married by age 15 and age 20, respectively for most subgroups shown in the table. "Omitted because [ess than 50 percent of women in the age group x to x + 4 have married for the first time by age x Age at First Birth In Egypt , where v i r tual ly al l ch i ldbear ing occurs w i th in mar i ta l unions, the age at wh ich women marry is a p r imary determinant o f the age at wh ich ch i ldbear ing begins. The postponement o f the first birth resul t ing from the trend toward latter marr iage has been one o f the major factors in f luenc ing the overa l l fert i l i ty dec l ine in Egypt. Tab le 2.6 presents the distr ibut ion o f women by age at f irst birth, accord ing to their current age. The median age at f irst birth is not shown for women under age 25 because less than 50 percent o f women in those ages had g iven birth at the t ime o f the survey. The results in Tab le 2.6 indicate that there has been a noteworthy rise in the age at wh ich women begin chi ldbear ing. For example, 39 percent o f women age 45-49 had become mothers before age 20 compared to less than one--quarter o f women age 20-24. The marked change that has been occurr ing in the age at wh ich women begin ch i ldbear ing is also ev ident in the increase in the med ian age at f irst birth across age cohorts, f rom 21.4 years among women 45-59 to 22.7 years among women age 25-59. Tab le 2.7 presents the med ian age at f irst birth by background character ist ics. The table also examines the trend across di f ferent age cohorts wi th in the subgroups. The table is l imited to women age 25-49 years to ensure that ha l f o f the women have a l ready had a birth. Fertility I 19 Table 2.6 ARe at first birth Percent distribution of women age 15-49 by age at first birth, according to current age, Egypt 2003 Women Age at first birth Current with no Number of age births <15 15-17 18-19 20-21 22-24 25+ Total women Median 15-19 94.4 0.2 3.1 2.3 0.0 0.0 0.(/ I00.0 3,074 a 20-24 57.t 0.7 7.3 15.3 13.5 6.2 0.0 100.0 2,537 a 25 29 23.0 1.9 10.9 14.5 18.0 21.7 10.1 100.0 2,073 22.7 30-34 11.8 2.9 14.3 13.2 16.6 22.3 18.9 100.0 1,514 22.4 35 39 6.6 2.7 153l 18.5 16.4 19.0 21.9 100.0 1,638 21.7 40-44 6.1 3.5 12.7 17.8 16.4 19.6 23.9 100.0 1,413 21.9 45-49 5.3 3.2 18.2 17.7 15.8 19.1 20.6 100.0 1,300 21.4 25-49 11.6 2.8 13.9 16.2 16.8 20.4 18.4 100.0 7,937 22.1 "Omitted because less than 50 percent of women in the age group x to x + 4 have given birth for the first time by age x Overall, the median age at first birth for women age 25-49 is 22.1 years. However, the results in the table show that there are large differences across population subgroups in the age at which women have their first child. Rural women start their childbearing three years earlier than urban women (20.8 years and 23.7 years, respectively). Women from rural Upper Egypt had their first child earlier than women from rural Lower Egypt (20.4 years and 21.2 years, respectively). Looking at the patterns by education, highly educated women were nearly five years older on average than women who never went school when they had their first child. The difference in the median age at first birth between women in the highest and lowest quintiles on the wealth index is equally large. Table 2.7 Median age at first birth by background characteristics Median age at first birth among women age 25-49 years, by current age and background characteristics, Egypt 2003 selected Background Current age Women characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Urban-rural residence Urban 24,0 23.8 23.5 23.6 23.2 23.7 Rural 21.7 21.2 20.3 20.4 20.1 20.8 Place of residence Urban Governorates 24.2 24.4 24,4 23.7 23.2 24.0 Lower Egypt 22.6 22.0 21,4 21.7 21.1 21.9 Urban 24.1 23.5 23,1 23.5 23.3 23.6 Rural 22.0 21.6 20.8 20.7 20.2 21.2 Upper Egypt 21.8 21.5 20.5 21.1 21.0 21.2 Urban 23.0 23.2 22.7 23.8 22.9 23. I Rural 21.2 20.5 19.8 20.0 20.1 20.4 Education No education 20.4 19.8 19.8 20.0 20.3 2(I.0 Some primary 20.5 19.5 20.3 20.9 20.4 20.5 Primary complete/some secondary 20.6 22.2 20.6 21.7 20.5 21.0 Secondary complete/higher 24.5 23.9 24.9 25.7 26.0 24.8 Wealth index Lowest quintile 20.5 19.7 19.8 20.1 20.5 20.1 Second quintile 21.4 20.9 20.2 20.5 20.0 20.6 Middle quintile 22.5 21.8 20.9 20.7 20.0 21.2 Fourth quintile 23.2 23.2 22.3 22.6 21.7 22.8 Highest quintile 24.8 24.5 24.5 24.9 24.6 24.7 Total 22.7 22.4 21.7 21.9 21.4 22.1 20 I Fertility Birth Intervals The period of time between two successive live births is referred to as a birth interval. Research has shown that children born soon after a previous birth are at greater risk of illness and death than those born after a long interval. In addition, short birth intervals may have adverse 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 all her children. The duration of breastfeeding for the older child also may be shortened if the mother becomes pregnant. Table 2.8 shows the percent distribution of second order and higher (non-first) births in the five years preceding the 2003 EIDHS by the number of months since the previous birth. Table 2.8 Birth intervals Percent distribution of nonfirst births in the five years preceding the survey by number of months since the previous birth according to selected background characteristics, Egypt 2003 Background Months since previous birth characteristic 7-17 18-23 24-35 36-47 48+ Total Number Median Mother's age 15-19 16.4 20-29 12.7 30-39 6.2 40+ 4.8 Birth order 2-3 11.1 4-6 6.0 7+ 8.1 Sex of prior birth Male 8.3 Female 10.4 Survival of prior birth No 30.7 Yes 8.1 Urban-rural residence Urban 8.3 Rural 9.9 Place of residence Urban Governorates 8.8 Lower Egypt 8.8 Urban 6.6 Rural 9.6 Upper Egypt 10.0 Urban 9.4 Rural 10.2 Education No education 8.6 Some primary 5.9 Primary complete/some secondary 10.4 Secondary complete/higher 10.8 Work status Working for cash 9.6 Not working for cash 9.3 Wealth index Lowest quintile 11.7 Second quintile 8.2 Middle quintile 10.8 Fourth quintile 7.3 Highest quintile 7.9 Total 9.3 23.4 45.3 15.0 0.0 100.0 27 24.9 14.8 37.7 20.7 14.1 100.0 2,198 31.0 7.5 24.3 19.0 43.0 100.0 1,810 43.5 5.9 19.1 12.6 57.5 100.0 381 57.1 11.8 33.4 20.1 23.7 100.0 2,777 33.7 10.3 25.8 17.2 40.7 100.0 1,292 40.9 8.8 27.1 19.9 36.0 100.0 348 39.6 11.5 28.3 20.4 31.5 100.0 2,231 36.7 10.8 33.l 18.1 27.6 100.0 2,186 34.3 17.8 22.7 13.7 15.0 100.0 241 24.4 10.7 31.l 19.6 30.5 100.0 4,175 36.0 10.0 26.9 18.7 36.2 100.0 1,601 38.6 11.8 32.8 19.6 25.9 100.0 2,815 34.1 9.1 25.1 19.6 37.5 100.0 608 39.8 9.6 28.6 20.8 32.1 100.0 1,792 37.2 7.3 28.2 17.8 40.0 100.0 503 40.1 10.5 28.8 22.0 29.1 100.0 1,289 36.4 13.1 34.1 17.8 25.0 100.0 2,017 33.5 13.9 27.7 18.5 30.6 100.0 490 35.6 12.8 36.2 17.6 23.2 100.0 1,527 32.8 11.2 31.1 17.8 31.2 100.0 1,706 35.6 12.3 30.5 20.7 30.6 100.0 509 36.7 10.1 34.3 20.1 25.1 I00.0 710 34.0 11.1 28.5 20.0 29.6 100.0 1,491 35.8 9.3 20.7 21.7 38.7 100.0 553 40.9 11.4 32.1 18.9 28.3 100.0 3,864 34.8 11.6 35.2 16.7 24.8 100.0 1,069 33.1 11.9 32.3 21.1 26.5 100.0 942 34.8 11.0 30.4 20.4 27.3 100.0 885 35.2 10.9 29.3 19.0 33.5 100.0 867 37.3 9.7 23.0 19.6 39.8 100.0 653 40.7 11.1 30.7 19.3 29.6 100.0 4,417 35.5 Fertility ] 21 In general, birth intervals in Egypt are relatively long. However, around 20 percent of births in the five years before the E1DHS took place less than two years after a previous birth, and more than half of all non-first births occurred less than three years after a prior birth. The median interval is around 36 months, which is slightly longer than the median interval recorded in the 2000 EDHS (34 months). Younger women have shorter birth intervals than older women. Table 2.8 shows that the median interval varies with the age, from 25 months among women age 15-19 to 44 months among those age 30-39. The median birth interval is longer for fourth and higher order births than for second and third order births, and it is somewhat longer i f the previous birth was a boy than i f it was a girl. The average birth interval is twelve months longer in cases where the prior birth is alive than when that child has died (36 months and 24 months, respectively). As Table 2.8 shows, the median birth interval in urban areas is 39 months compared with 34 months in rural areas. Birth intervals are longest in urban Lower Egypt and the Urban Governorates (40 months). Within rural areas, the median birth interval is slightly longer in Lower Egypt (36 months) than in Upper Egypt (33 months). No clear association is observed between the woman's educational level and the average birth interval. However, intervals are longer for births to women who are working for cash than for births to other women (41 months and 35 months, respectively). There also is a clear association between the birth interval and household wealth; the birth interval rises from 33 months among nonfirst births to women in the lowest wealth quintile to 41 months for births to women in the highest quintile. Teenage Pregnancy and Motherhood Teenage pregnancy is a health con- cern because teenage mothers and their children are at greater risk of illness and death. Also, teenage preg- nancy and motherhood usually has an adverse impact on women's educa- tion. Table 2.9 shows that around 1 in 12 Egyptian teenagers have begun childbearing, with less than six per- cent having already given birth and around three percent pregnant with their first child. The proportion of teenagers that has begun childbearing rises rapidly with age, from one per- cent among girls age 15-16 to 13 per- cent among women age 17-19. In rural areas, the proportion of teen- agers who have begun childbearing is 11 percent, more than double the level among urban teens. Looking at place of residence, rural Upper Egypt (11 percent) has highest level of teenage childbearing, while the Urban Gover- norates have the lowest level (3 per- cent). Table 2.9 Teenage prcKnancy and motherhood Percentage of women age 15 19 who arc mothers or pregnant with their first child, by background characteristics, Egypt 2003 Percentage who are: Percentage Number Pregnant who have of Background with first begun women characteristic Mothers child childbearing 15-19 Age 15-16 0.7 0.3 1.0 1.307 17-19 9.2 4.2 13.4 1.767 Urban-rural residence Urban 2.9 1.8 4.7 1,269 Rural 7.5 3.0 1{I.5 1.809 Place of residence Urban Governorates 2.3 I 0 3.3 55 I Lower Egypt 5.6 2.8 8.4 1,325 Urban 2.8 2.1 4.9 362 Rural 6.6 3.1 9.7 961 Upper Egypt 7.1 2.9 10.0 1,206 Urban 4.0 2.8 6.8 358 Rural 8.4 3.0 I 1.3 853 Education No education 15.5 4.2 19.8 459 Some primary I 0. I 3.3 13.3 169 Primal~ complete/some secondary 2.8 1. I 3.9 1.764 Secondary complete/higher 4.9 4.8 9.7 692 Wealth index Lowest quintile 8.4 2.5 21.8 642 Second quintile 6. I 2.5 17.3 685 Middle quintile 5.5 4.1 19.3 654 Fourth quintile h.0 2.3 16.5 586 Highest quintile 0.9 0.9 3.6 513 Total 5.6 2.5 8.1 3,074 22 I Fertility The likelihood that a teen will have begun childbearing is related to both her educational level and to her position on the wealth index. The level of teenage childbearing among women in the lowest wealth quintile is 22 percent, around five times the level observed among young girls in the highest wealth quintile (4 percent). 2.4 Ferti l i ty Preferences An in-depth understanding of fertility preferences in a population is important for predicting future fertility behavior. Women were asked in the 2003 EIDHS about their intention to have another child in the future and about the family size they would prefer. Their responses to these questions are used to explore the level of wanted fertility in Egypt. Desire for More Children In order to obtain information on fertility preferences, currently married women who were not using female sterilization 4 were asked the following question: "Would you like to have (another) child or would you prefer not have any (more) children?" For pregnant women, the question was prefaced by the wording, "After the child you are expecting.". Women who wanted additional children were then asked about the t iming of the next child. Table 2.10 shows the percent distribution of currently married women by reproductive intention according to the number Of l iving children (including any current pregnancy). The results indicate that the majority (64 percent) of currently married women do not want any more children or are sterilized. Around 28 percent want another child. However, the latter group differs as to t iming desired for the next child; 12 percent want another child within two years, 15 percent want to wait at least two years, and one percent want another child but are not sure when. Table 2. I 0 FertiliN preferences by number of living children Percent distribution of currently married women by desire for children, according to number of living children, Egypt 2003 Desire for Number of living children t children 0 1 2 3 4 5 6+ Toml Wants within 2 years 90.5 25.3 9.5 2.6 1.2 0.3 0.4 12.2 Wants after 2+ years 0.4 60.4 20.6 5.2 1.6 0.9 0.0 15.3 Wants, unsure timing 0.3 1.9 1.4 0.9 0.1 0.0 0.1 0.9 Undecided 0.0 3.7 9.7 5.7 2.6 3.1 0.7 4.7 Wants no more 0.5 7.6 56.9 81.7 89.3 91.2 91.1 63.0 Sterilized 0.0 0.1 0.5 0.9 2.2 1.5 1.2 0.9 Declared infecund 8.3 1.0 1.4 2.9 2.9 3.0 6.5 3.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 509 1,288 1,874 1,899 1,244 759 872 8,445 Note: Women who have been sterilized are considered to want no more children. qncludes current pregnancy The desire for more children is associated with the living number of chi ldren the woman has. While more than nine in ten women with no living children want a child soon, only one in ten women with two children want another child within two years. The proportion desiring to cease childbearing rises rapidly with the number of children, from 57 percent among women with two children to 91 percent among women with six or more children. 4Stehlized women were considered to want no more children. Fertility [ 23 I dea l Number o f Ch i ld ren Another question in the 2003 EIDHS attempts to capture information on a woman's lifetime childbearing goals by asking about the ideal number of children the woman would choose to have in her life i f she were to begin childbearing again, regardless the number she already had borne. The results of these questions are presented in Table 2.1 1. Table 2.11 Ideal number of children Percent distribution of ever-married women by ideal number of children and mean ideal number of children for ever-married women and currently married women, according to number of living children, Egypt 2003 Ideal number Number of livin~ children / of children 0 I 2 3 4 5 64 Total I 2 3 4 5 6 Non-numeric response Total percent Number of women Mean ideal number Ever-married women Number of women Currently married women Number of women 7.6 4.5 1.8 1.8 0.9 0.6 1).3 2.2 42.1 56.7 54.5 28.6 25.6 20.3 15.4 37.0 [7.2 21.5 25.2 41.3 15.1 19.7 14.4 24.5 10.3 6.6 7.1 9.2 30.4 18.6 19.4 13.5 1.3 0.6 0.6 1.8 1.9 7.8 4.6 2.1 1.6 0.7 1.1 1.5 1.3 2.4 7.6 2.0 19.9 9.4 9.7 15.8 24.8 30,6 38.3 18.7 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 615 1,418 1,998 2.010 1,353 822 943 9,159 2.5 2.4 2.5 2.8 3.2 3.4 3.8 2.8 493 1.285 1,805 1,693 1.018 571 582 7,445 2.6 2.4 2.5 2.8 3.2 3.4 3.8 2.8 410 1.171 1.698 1.615 950 531 539 6,914 Note: The lncan excludes women who gave non numeric answers. tlncludes current pregnancy In ascertaining the ideal number of children, the respondent is required to perform the difficult task of considering abstractly and independently of the actual family size, the number of children she would choose of she could start again. A substantial proportion (19 percent) of women gave a non-numeric response, indicating the difficulty the women have with the question. In considering the results of Table 2.1 1, it also is important to remember that there is a correlation between the actual and ideal number of children. This is due to the |hct that women who want large families tend to have larger families. Also, women may rationalize the ideal number family size, such that, as the actual number increases, their preferred number of children also increases. Table 2.1 1 shows that most women want small families. Overall, the mean ideal family size among ever-married women is 2.8 children. Thirty-seven percent of ever-married women prefer a two-child family, and one-quarter consider a three-child family ideal. Around 18 percent reported four or more children as ideal. As discussed earlier, higher-parity women show a preference for more children; the mean ideal number of children among women rises from 2.5 children among women who currently have two children or less to 3.8 children among women with six or more children. The results in the table also indicate that many women have had more children than they would prefer, which suggests there is a considerable level of unwanted fertility. =~ i b~rtilit~' Table 2.12 presents the mean ideal number of children for ever-married women among various subgroups. The number of children considered ideal varies across age groups; in general, older women tend to want larger fami~,y than younger women. Women from the Urban Govemorates, urban Lower Egypt, women with a secondary or higher education, and women ranked at the top of the wealth index have the lowest ideal number of children (2.6 children). The highest ideal number is observed among women in rural Upper Egypt (3.3 children). T~ble 2.12 Mean ideal number of children by background characteristics Mean ideal number of children for ever mawied women, by age and selected background characteristics, Egypt 2003 Background characteristic Age of women 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Urban-rural residence Urban 2.6 2.4 2.5 2.7 2.7 2.8 3.0 2.7 Rural 2.6 2.7 2.8 2.9 3. I 3.3 3.5 2.9 Place of residence Urban Governorates 2.1 2.3 2.4 2.6 2.6 2.8 3.0 2.6 Lower Egypt 2.4 2.4 2.6 2.7 2.8 2.9 3.1 2.7 Urban 2.5 2.3 2.4 2.7 2.7 2.7 3.0 2.6 Rural 2.4 2.4 2.6 2.6 2.9 3.0 3.2 2.7 Upper Egypt 2.8 2.9 2.9 3.1 3.2 3.4 3.5 3.1 Urban 3.0 2.8 2.6 2.9 2.9 2.8 3.0 2.8 Rural 2.8 3.0 3.0 3.2 3.4 3.9 4.0 3.3 Education No education 2.6 2.8 2.8 3.1 3.0 3.4 3.5 3.1 Some primary 2.7 2.8 2.7 2.7 3. I 3.1 3.2 2.9 Primary complete/some 2.6 2.6 2.8 2.7 3.0 2.9 3.1 2.8 secondary Secondary complete/higher 2.5 2.5 2.5 2.6 2.7 2.6 2.7 2.6 Work status Working for cash 2.3 2.5 2.7 2.7 2.7 3.0 2.7 Not working lor cash 2,8 2.6 2.7 2.8 3.0 3.2 3.3 2.9 Wealth index Lowest quintile 2.6 2.8 2.8 3.1 3.0 3.5 3.6 3. I Second quintile 2.7 2.6 2.8 2.9 3.0 3.1 3.3 2.9 Middle quintile 2.6 2.5 2.7 2.8 3.0 3.2 3.5 2.9 Fourth quintile 2.4 2.5 2.6 2.7 2.9 2.9 3.2 2.7 Highest quintile 2.3 2.4 2.4 2.6 2.7 2.8 2.9 2.6 Total 2.6 2.6 2 .7 2.8 2.9 3.0 3.2 2.8 Wanted Fer t i l i ty Data from the EIDHS can be used to estimate what the fertility rate would be i f Egyptian women were to achieve the childbearing goals they reported in the survey. The wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births are excluded from the numerator. Unwanted births are defined as those which exceed the number considered ideal by the respondent. For this purpose, women who do not give numeric response to the ideal family size question are assumed to want all their births. The wanted fertility rate may be overestimated to the extent that women are not wil l ing to say that they want fewer children than the number they currently have. Table 2.13 presents the total wanted fertility rates and total fertility rates for the three-year period prior to the EIDHS by selected background characteristics. Overall, the wanted fertility rate is 2.5 births per woman, 0.7 births less than the actual fertility rate. Thus, i f all unwanted births could be eliminated, the total fertility rate would drop by 22 percent. Fertility I 25 l.ooking at the difTerentials by residence, the gap between the wanted and the actual fertility rates varies ber, veen 0.5 and 0.8 births, with the largest gap evident among x~omen in rural Upper Egypt and the smallest gap apparent among women in the Urban Governorates. If women in the Urban Governorates were to avoid all unwanted births. they would achieve below replacement fertility ( 1.8 births pet woman). Among women who never attended school, the wanted t~l-tility rate is 3.1 births per woman, aroLmd 20 percent lower than the actual fertility rate t\)r this group (3.9 births). Women in other educational categories also report significant levels of unwanted fertility. Women in the highest quintile of the wealth index are closest to achieving their ideal f'amily size, i.e., the gap between actual and wanted fertility is smallest for these women (0.4 births pet- woman). The TFR l'or this group would have been substantially beh)w the replacement level if the women had had only the number of children they desire (Figure 2.2). The gap between the wanted and actual TFR is greatest liar the lowest wealth quintile; if w'omeo were to achieve the fertility they consider ideal, the TFR would fall fl'om 4 births to 3 births in this group. j';~lqe 2 13 Want¢~rt i l i ty roles Total wanted fragility lares and total l•nilitv rates [br the tinct years preceding the SLErvcy, by selected backgromld characteristics, Egypt 2003 Total wad/ted Total I~ackgtound t~cl'tilily Ik'ltility cllaractcristic rate rate 1. rban-rura l residence [Ji ban 21 26 I~,ural 2.9 36 Place of residence UFb~ln Govcl'lloraic?~ i S ~.]~ lower Egypt 2.4 3 / Urban 22 2.8 Rural 25 %.2 t Jppet [gypt 30 3.8 Ulban 23 29 Rural 34 4 ) Eduea|ion No education 31 39 Some primary 2.4 ~.2 Primary complete/some sccondalw 24 32 Secondary complete/higher 24 29 X~, ealth index [ owest quintile ~0 40 Second quintilc 2.6 33 Middle quintile 26 33 t:ourth quimile 23 29 Highest qtdntiIc 21 25 Total 25 32 4.0 Figure 2.2 Total Fertility Rates and Wanted Fertility Rates by Wealth Level 2.6 3.3 3.3 2.9 9 1 2.5 l+m~est quinlile Second quintile Middle quintile Fourlh quintile llighesl quintile • Total Wanted Fertil it) RAIL' lbtal l,'ertilil) Rate I [] 26 I l:erulio' 2.5 Premarital Examination: Knowledge and Practice The 2003 EIDHS survey was the first DHS survey to ask women questions about the practice of seeing a medical provider for a premarital examination. Women were first asked if they were aware of the practice. Women who heard about premarital examination were then asked if they had had an examination before their first marriage. Table 2.14 presents the percentage of ever-married women age 15- 49 knowing about premarital examination and the percentage of women who had an examination prior to first marriage. More than eight in ten women have heard about premarital examinations. Knowledge is most common among younger women, women from urban areas, women with secondary or higher education, women working for cash, and women who fall in the highest quintile of wealth index. Women in the lowest quintile of wealth index (61 percent), women with no education (67 percent), and women age 45- 49 years (71 percent), are least likely to have heard about premarital examinations. Despite the high levels of knowledge, only two percent of women had an exam before first marriage. Table 2.14 Premarital examination Percentage of ever-married women age 15-49 who have heard about premarital examination and ",vho had an examination prior to marriage, Egypt 2003 Percentage Percentage having knowing premarital about examination Number Background premarital before first of characteristic examinations marriage women Age 15-19 87.7 1.4 301 20-24 86.5 2.3 I, 187 25-29 86.3 2.3 1,538 30-34 85.5 1.2 1,210 35-39 80.6 1.5 1,279 40-44 76.9 0.6 1,061 45-49 71.2 0.4 9[0 Urban-rural residence Urban 90.3 2.0 3,529 Rural 75.3 1.1 3,956 Place of residence Urban Governorates 90.0 2.2 1,498 Lower Egypt 80.0 1.6 3,283 Urban 90.2 2.1 1,065 Rural 75.9 1.4 2.218 Upper Egypt 79.8 1.0 2,704 Urban 91.1 1.4 967 Rural 74.7 0.7 1.737 Education No education 67.3 0.4 2,322 Some primary 76.2 0.6 889 Primary complete/some secondary. 88.7 2.1 l, 126 Secondary complete/higher 96.2 2.7 3,147 Work status Working for cash 88.8 2.6 1,292 Not working for cash 80.4 [.3 6.193 Wealth index Lowest quintile 61.3 0.6 1,042 Second quintile 72.5 0.8 1,282 Middle quintile 84. I 1.2 1,576 Fourth quintile 92.0 2.0 1,781 Highest quintile 96.0 2.5 1,803 Total 81.7 1.5 7.485 Fertiliiy I 27 3 FAMILY PLANNING Egypt has had a family planning program for four decades. As a result, family planning services are widely available in both the public and private sector. The family planning program also has a strong education and communication program, which promotes family planning awareness through mass media. This chapter considers a number of indicators from 2003 E1DHS useful in monitoring the success of family planning eflbrts, including the level of family planning knowledge and use and exposure to media messages about family planning. The chapter also looks at the level of unmet need for family planning and attitudes toward family planning use. 3.1 Knowledge and Ever Use of Family Planning Information on knowledge and ever use of specific methods was collected in the 2003 EIDHS for eight modem methods (the pill, IUD, injectables, implant, foam/jelly/diaphragm, condoms, female sterilization, male sterilization) and three traditional methods (periodic abstinence, withdrawal, and prolonged breastfeeding). In addition, provision was made in the questionnaire to record other methods that respondents mentioned spontaneously. Table 3.1 presents information from the 2003 EIDHS on the levels of knowledge and ever use of family planning methods. Level of Knowledge The results in Table 3.1 show that knowledge of family planning methods 5 is almost universal among Egyptian women. All currently married women know about the pill and IUD, almost all are aware of the injectable (100 percent), and 94 percent have heard of the implant. Although female sterilization and the condom are less widely recognized, the majority of women also are familiar with these methods (68percent and 59 percent, respectively). Comparatively few women, however, know about male sterilization (12 percent). Prolonged breastfeeding is the most commonly recognized tradi- tional method (82 percent). Levels of Ever Use Table 3.1 also shows the percentages of currently married women who have ever used a family planning method by method. Overall, the results indicate that 81 percent of currently married women have used a family planning method at some time. Almost all currently women who have ever used a method have experience with modem methods. The most commonly used modem method is the IUD (61 percent), followed by Table 3.1 Family planning knowledge and ever use Percentages of currently married women age 15-49 who know family planning method and who have ever used a family planning method, by method, Egypt 2003 Know Ever used Methods method method Any method 100.0 81.0 Any modern method 100,0 78.5 Pill 100.0 39.7 IUD 100.0 61.4 Injection 99.6 20.2 Diaphragm/foam/jelly 34.6 0.7 Condom 58.7 4.1 Female sterilization 68.2 0.9 Male sterilization 12.0 0.0 hnplant 93.9 1.0 Any traditional method 84.8 15.2 Periodic abstinence 34.4 2.3 Withdrawal 32.9 1.6 Prolonged breast feeding 82. I 12.2 Other 0.7 0.3 Number of women 8,445 8,445 Sin collecting the information on knowledge in the 2003 EIDHS, no questions were asked to elicit information on depth of knowledge of these methods (e.g., on the respondent's understanding of how to use a specific method). Therefore, in the following analysis, knowledge of a family planning method is defined simply as having heard of a method. Family Planning I 29 the pill (40 percent). A much smaller proportion of women report that they have used the injectable (20 percent). Fifteen percent of currently married women have had experience using any traditional method. The most widely used traditional method is prolonged breastfeeding (12 percent), followed by periodic abstinence (2 percent). 3.2 Level and Differentials in Current Use of Family Planning The data on the current use of family planning is among the most important data collected in the EIDHS since it provides insight into one of the key determinants of fertility and serves as a central measure for assessing the success of the national family planning program. Level of Current Use by Residence The level of current use of contraception by method and residence is presented in Table 3.2. The table shows that 60 percent of currently married women in Egypt are using contraception, with 57 percent depending on modern methods and 3 percent using traditional methods. The IUD, pill, and injectables are the most widely used methods: 37 percent of married women are using the IUD, 9 percent currently rely on the pill, and 8 percent are using an injectable. Relatively small proportions of married women are using other modern methods, e.g., one percent each report using the condom, and implant. Prolonged breastfeeding is used by two percent of married women. The level of contraceptive use differs significantly by residence (Table 3.2 and Figure 3.1). The level of current use among urban women is 10 percentage points higher than the level among rural women (66 percent and 56 percent, respectively). Looking at the differentials by place of residence, the use rate is highest in the Urban Governorates (69 percent), followed by urban Lower Egypt (66 percent), while rural Upper Egypt has the lowest level (45 percent). There is a 20 percentage point difference in use levels between rural Upper Egypt (45 percent) and rural Lower Egypt (65 percent). The level of use among women in rural Lower Egypt is higher than the level of use in urban areas in Upper Egypt (60 percent). The IUD is the most frequently used method in all residential categories. The extent to which the IUD dominates the method mix varies somewhat across residential subgroups. The pill is the second most widely used method in all areas except rural Lower Egypt and rural Upper Egypt, where the proportion of women using the injectable is slightly higher than that relying on the pill. Women in the Urban Governorates and rural Lower Egypt rely on IUD more often than women from other areas. For example, women from both areas are roughly more than five times as likely to be using an IUD as the pill. In other residential areas, there are two to four times as many IUD users as pill users. 30 [ Family Planning rab/e ~ 2 ('~krrc l lxbe of fhmily plafltlmL.Lmetlmds hyrQs dc ce Percent distribution ol'cuHently married women age 15 49 by l~mfily pl mnh/g nacthod CtuTently used, according to urban rtual icxidence and j21acc of ~ebidence. E~ypt 2003 Place of residcncc [ Ji ban Lower E&Ypl Upper [gvpL ()reel . . . . Mclhod I Jlbatl Rural noiates "1 olaI [ than Rural Total {hbm~ Rtual Total Ally method 65 5 55.9 685 65.2 663 64.8 494 508 447 600 Any modern method 615 330 64.5 624 622 62> 45.7 5~)0 41.0 3(~f) Pill 11.0 8 I 9.4 96 13.4 80 9.0 107 82 93 l iD 423 325 46.4 4/.5 40.5 41 9 25.9 378 20.6 367 ]njcclion 48 t03 ~0 87 45 103 85 48 10.2 79 Oiaphragm/fk)amicl[y 0 1 00 0 1 0.0 0.0 00 0 1 02 00 0. l Condom I 4 0.5 15 0.7 14 0.4 09 13 07 0.9 I:cmale steriUzation 12 07 I 4 1.0 16 0.8 0.6 0(, 05 0.9 Implant (Norplanl) 07 (19 07 09 07 1.0 08 07 09 09 Any traditional method 4.0 3.0 4.0 28 4 ] 23 38 qg 3.8 34 Pciiodicabstinence 1.7 0.1 18 05 I.b 0.1 0.7 19 0 1 08 Withdrawal 0.7 0.2 07 05 1.2 02 02 03 0.1 04 Prolonged breastfi:cding I 5 2.5 1 ~, 17 14 151 2.8 1.5 33 ~.1 Other O0 0.2 O0 0. I 00 0. I 02 O0 02 01 Not using 34.5 44 1 3/.5 34.8 337 35.2 :~06 402 55.3 40(1 Total percent 100.0 1000 1000 1(1{} 0 100.0 1000 1000 H){},{} 100.0 100,{} NLmaber ol:womcn 3,589 4,856 1,533 3,797 1,083 2,713 3,116 973 2.143 8,445 65 Figure 3.1 Current Use of Modern Fami ly P lann ing Methods by Place of Residence 62 62 63 56 Urban "l-{}tal Urban Rural (;overnorales Lo~er Egypt T . ta l Urban Rural Upper Egspl k'amilv PlanninL, I 3 ; Differentials by Selected Other Background Characteristics Differentials in the levels of current use by background characteristics other than residence are presented in Table 3.3. Current use is clearly associated with a woman's age; younger and older women are less likely to be using contraception than women age 25-44. The lowest level of use is found among women age 15-19 (25 percent). The IUD is the most popular method among women in all age groups, with the highest levels of IUD use found among women age 30-44 (44 percent or more). Use rates for the pill peak in the 40-44 age group while injectable use is highest among women age 35-39. Contraceptive use is associated with the number of living children a woman has. Use levels increase from 45 percent of women with one child to 74 percent among women with three children and then drop off to 68 percent among women with four or more children. A negligible number of women use family planning before having the first child; only 0.2 percent of childless women are currently using a method. Looking at the patterns for specific methods, rates of pill and IUD use increase directly with the number of children before dropping off among women with four or more children. In contrast, use levels for the injectable increase steadily with the number of children, peaking at 14 percent among women with four or more children. There is association between current use and a woman's educational level, the proportion currently using a method varies from 57 percent among women with no education to 63 percent of those with secondary or higher education. The IUD is the most commonly used method among women at every level of education. The pill is most popular among women with a primary or higher education while the highest use rate for the injectable is observed among women who never attended school. Finally, the level of current use rises steadily across wealth quintiles, peaking at 68 percent among women in the highest quintile. IUD use rises steadily with the wealth quintile, from 26 percent in the lowest to 46 percent in the highest quintile. Pill use increases from seven percent among women in the lowest wealth quintile to 10 percent among women in the middle quintile, before peaking at 11 percent among women in the highest quintile. Injectable use exhibits the opposite pattern, with the peak use rate found among women in the lowest quintile (14 percent) and the lowest rate observed among women in the highest quintile (3 percent). 32 ] Family Planning Table 3.3 Current use of family olanning methods by background characteristics Percent distribution of currentl~¢ married women by family plannin~ method currently used, accordin~ to selected background characteristics. E~:~cpt 2003 Dia- Any Pro- Any phragrrd Female Implant tradi- Periodic longed Number Background Any modem lnjec- foam/ Con- sterili- (Nor- tional absti- With- breast- Not Total of characteristic method method Pill IUD tion )elly dora zation plant) method nence drawal feedin~ Other using percent women Age 15-19 25.4 23.0 5.7 14.3 2.7 0.0 0.0 0.0 0.2 2.5 0.0 0.0 2.5 0.0 74.6 100.0 332 20-24 48.0 44.2 8.7 29.1 5.6 0.0 0.2 0.0 0.7 3.8 0.2 0.0 3.6 0.0 52.0 100.0 1,343 25-29 57.2 53.6 8.8 35.8 7.3 0.0 0.8 0.1 0.9 3.5 0.1 0.2 3.2 0.0 42.8 100.0 1.703 30-34 69.2 65.2 9.8 43.5 9.7 0.0 0.8 0.5 0.9 4.0 0.8 0.1 3.0 0.0 30.8 100.0 1,346 35-39 73.3 70.1 10.8 45.5 10.3 0.1 1.5 0.9 1.0 3.2 0.8 0.8 1.2 0.3 26.7 100.0 1,462 40-44 71.9 68.8 11.6 43.6 8.8 0.2 1.1 2.0 1.3 3.0 1.6 1.0 0.3 0.2 28.1 100.0 1,205 45-49 46.9 44.0 6.8 25.7 7.0 0.0 1.3 2.9 0.3 2.8 2.2 0.5 0.1 0.0 53.1 100.0 1,054 Number of living children 0 0.2 0.2 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 99.8 100.0 806 1 45.1 41.7 9.7 29.3 2.2 0.0 0.2 0.1 0.1 3.4 0.5 0.3 2.6 0.0 54.9 100.0 1,240 2 70.1 65.9 10.9 47.6 4.9 0.0 1.2 0.5 0.8 4.2 1.0 0.6 2.6 0.0 29.9 100.0 1,774 3 74.3 69.7 11.2 46.0 9.6 0.2 0.9 1.0 0.8 4.5 1.4 0.5 2.6 0.0 25.7 100.0 1,837 4+ 68.1 65.0 9.6 37.4 13.6 0.0 1.2 1.8 1.5 3.1 0.7 0.4 1.7 0.2 31.9 100.0 2,788 Education No education 57.4 54.2 7.8 32.0 11.9 0.0 0.6 0.9 1.0 3.2 0.2 0.3 2.5 0.2 42.6 100.0 3,080 Some primary 59.0 55.9 8.6 35.8 8.4 0.3 0.7 0.7 1.4 3.0 0.4 0.1 2.5 0.1 41.0 100.0 1,053 Primary complete/ some secondary 59.2 56.7 11.8 35.5 7.5 0.0 0.5 0.7 0.7 2.6 0.4 0.5 1.7 0.0 40.8 100.0 1,190 Secondary complete/higher 63.2 59.1 10.1 42.0 4.1 0.1 1.4 1.0 0.6 4.0 1.7 0.6 1.6 0.0 36,8 100.0 3,122 Wealth index Lowest quintile 52.2 48.5 6.5 25.7 14.4 0.0 0.4 0.6 0.9 3.6 0.0 0.1 3.2 0.4 47,8 100.0 1,525 Second quintile 59.1 55.6 8.8 34.1 10.5 0.1 0.6 0.5 1.0 3.5 0.1 0.1 3.1 0.1 40,9 100.0 1,621 Middle quintile 57.5 54.8 9.8 34.8 7.5 0.0 0.8 0.8 1.1 2.7 0.5 0.3 1.9 0.0 42,5 100.0 1,742 Fourth quintile 62.0 59.3 10.4 40.6 5.3 0.1 1.1 1.1 0.6 2.7 0.5 0.6 1.6 0.0 38,0 100.0 1,793 Highest quintile 68.0 63.5 10.7 46.2 3.1 0.1 1.4 1.5 0.6 4.4 2.8 0.9 0.8 0.0 32,0 100.0 1,765 Total 60.0 56.6 9.3 36.7 7.9 0.1 0.9 0.9 0.9 3.4 0.8 0.4 2.1 0.1 40.0 100.0 8,445 3.3 Trends in Current Use of Family Planning Using results from the 2003 EIDHS as well as earlier surveys, the pattern of change in contraceptive use levels in Egypt since 1980 can be examined. Trend by Method Table 3.4 highlights the trend in family planning use at the national level between 1980 and 2003. The pace of change was rapid in the 1980s, with increases of around 1.5 percentage points annually during the eight-year period between 1980 and 1988 and a near doubling of use levels between 1980 and 1992 (from 24 percent to 47 percent). The use rate remained relatively stable at around 47 percent during the early 1990g to mid-1990s and then began to rise again, reaching 60 percent in 2003. Table 3.4 Trends in current use of family planning Percent distribution of currently married women by the family planning method currently used, Egypt 1980-2003 1980 1984 1988 1991 1992 1995 1997 1998 2000 Method EFS ECPS EDHS EMCHS EDHS EDHS EIDHS EIDHS EDHS 2003 EIDHS Any method 24.2 30.3 37.8 47.6 47.1 47.9 54.5 51.8 56.1 60.0 Any modern method 22.8 28.7 35.4 44.3 44.8 45.5 51.8 49.5 53.9 56.6 Pill 16.6 16.5 15.3 15.9 12.9 10.4 10.2 8.7 9.5 9.3 IUD 4.1 8.4 15.7 24.2 27.9 30.0 34.6 34.3 35.5 36.7 Injection U 0.3 0.1 U 0.5 2.4 3.9 3.9 6.1 7.9 Implant (Norplant) U U U U 0.0 0.0 0. I 0.0 0.2 0.9 Diaphragm/foam/jelly 0.3 0.7 0.4 U 0.4 0. I 0.2 0. I 0.2 0. I Condom 1.1 1.3 2.4 U 2.0 1.4 1.5 I. I 1.0 0,9 Female sterilization 0.7 1.5 1.5 U 1.1 I. I 1.4 1.3 1.4 0.9 Any traditional method 1.4 1.6 2.4 3.3 2.3 2.4 2.7 2.3 2.2 3.4 Periodic abstinence 0.5 0.6 0.6 U 0.7 0.8 0.6 0.8 0.6 0.8 Withdrawal 0.4 0.3 0.5 U 0.7 0.5 0.4 0.3 0.2 0.4 Prolonged breastfeeding U 0.6 l. I U 0.9 1.0 1.5 1.1 1.2 2.1 Other 0.3 0.1 0.2 U 0.1 0.1 0.1 0A 0.1 0.1 Not using 75.8 69.7 62.2 62.2 52.9 52. I 45.5 48.2 43.9 40.0 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 8,012 9,158 8,221 8,406 9,153 13,710 5,157 5,971 14,382 8,445 U - lnibnnation on the inethod was not collected or reported. Source: EI-Zanat~ and Associates, 1999, Table 3.2 and F. EI-Zanat~, and A. A. Wa~,, 2001, Table 6.1 The shift toward the IUD, which first became evident in the 1980s, continued during the 1990s although at a slower pace. 1UD use rose continuously, from 4 percent in 1980 to 37 percent in 2003. In contrast, the rate of use of the pill declined from 17 percent in 1980 to 9 percent in the late 1990s, where it has remained stable. Use of the injectable has risen continuously following its introduction into the family planning program in the 1990s, increasing from less than one percent in 1992 to 8 percent in 2003. Trend by Urban-Rural Residence and Place of Residence Table 3.5 presents trends in the rate of current use of family planning methods between 1984 and 2003 by residence. In urban areas, the current use rate rose most rapidly in the first half of the period, increasing by 12 percentage points between 1984 and 1992, from 45 percent to 57 percent. Urban use levels remained at that level between 1992 and 1995 and then increased at a somewhat slower rate, rising by 10 percentage points between 1995 and 2003. In rural areas, the decade of the eighties was also a period of substantial growth in contraceptive use. The rural use rate doubled between 1984 and 1992, from a level of 19 percent to 38 percent. At that point, the pace of change continued but at a 34 [ Family Planning slower rate; between 1992 and 2003, rural use levels increased by an average of 1.6 percentage points per year I Table 3.5 Trends in current use of fanfily planning b'¢ residence Percentage of currently married women currently using a family planning method by urban-rural residence and place of residence, Egl,pt 1984-2003 1984 1988 1992 1995 1997 1998 2000 2003 Residence ECPS EDHS EDHS EDHS EIDHS EIDHS EDHS EIDHS Urban-rural residence Urban 45.1 51.8 57.0 56.4 63.1 59.3 61.2 65.5 Rural 19.2 24.5 38.4 40.5 47.1 45.6 52.0 55.9 Place of residence Urban Governorates 49.6 56.0 59.1 58.1 67.0 62.1 62.7 68.5 Lower Egypt 34.1 41.2 53.5 55.4 61.6 592 62.4 65.2 Urban 47.6 54.5 60.5 59.1 65.9 62.2 64.9 66.3 Rural 28.5 35.6 50.5 53.8 59.9 58.1 61.4 64.8 Upper Egypt 17.3 22.1 31.4 32.1 37.4 36.5 45.1 49.4 Urban 36.8 41.5. 48.1 49.9 52.1 50.8 55.4 59.8 Rural 7.9 I 1.5 24.3 24.0 30.3 29.9 40.2 44.7 Total 30.3 37.8 47.1 47.9 54.5 51.8 56.1 60.0 Table 3.5 also shows that there were significant differences in the trends according to the place of residence. The greatest absolute increase in use during the period occurred in rural Upper Egypt. The increase in use in rural Upper Egypt was especially rapid between 1995 and 2003, when the rate rose from 24 percent to 45 percent. Rural Lower Egypt also experienced rapid increase over the period; the use rate in rural Lower Egypt rose by more than 20 percentage points between 1984 and 1995 (from 29 percent to 54 percent) and then increased by an additional 1 l percentage points to 65 percent in 2003. The Urban Governorates and urban areas in both Lower and Upper Egypt experienced moderate increases in contraceptive use rates during the period 1984-88. Between 1988 and 1992, use rates continued to rise at a moderate pace in urban areas in both Lower Egypt and Upper Egypt; however, there was noticeable slowing in the rise in the use rate in the Urban Governorates during that period. Between 1992 and 1995, contraceptive use levels in the Urban Governorates, urban Lower Egypt, and urban Upper Egypt remained virtually unchanged. After 1995, use rates experienced an upward trend again in all of the urban areas. Trend by Other Background Characteristics Table 3.6 presents trends in contraceptive use during the period between 1988 and 2003 by selected background characteristics of women for all methods and for the pill, IUD, and injectable. Looking at the entire period, the use rate increased markedly across all age groups. Similarly, the use level increased substantially in each family size category through the period, except among women who had not yet begun childbearing. Among childless women, a negligible percent were using at any time during the period. Considering education, the change in use over the period was greatest among women who never attended school; the use rate doubled from 28 percent in 1988 to 57 percent in 2003. Smaller increases were observed during the period among educated women. As a result the gap in use according to educational level narrowed substantially during the period. During the period, all groups experienced increases in the use of the IUD and the injectable and a drop in the use of the pill. Family Planning I 35 Table 3.6 Trends in current use of flamily planning by socio-economic characteristics Percentage of currently married women age 15-49 currently using any method, the pill. characteristics, Egypt 1988-2003 IUD and injectables by selected background Background Any method Pill IUD li\iection characteristic 1988 1992 1995 2000 2003 1988 1992 1995 2000 2003 1988 1992 1995 2000 2003 1988 1992 1995 2000 2003 Age 15-19 5.5 13.3 16,1 23.4 25.4 3.5 4.1 3,2 43 5.7 1.7 8.4 11.3 15.0 14.3 g.0 0.0 I.I 2,4 2.7 20-24 24.3 29.7 33.2 42.7 48.0 10.8 6,8 6.6 6.6 8.7 10.7 21.2 21.7 29.6 29.1 0.0 02 2.1 3.9 5.6 25-29 37.1 46.0 47.6 57.0 57.2 14.9 13.3 9.8 9.2 g.8 17.7 29.3 33.1 38.3 35.8 0.0 0.2 2.2 5.8 7.3 30-34 46.8 58.8 5g.I 67,2 69.2 19.2 16.2 13.3 11.3 9.8 20.2 36.7 37.3 42.9 43.5 0.2 0.5 3.2 7.8 9.7 35-39 52.8 59.6 60.7 68.0 73.3 23.2 18.2 13.8 12.4 10.8 21.2 34.0 37.2 42.8 45.5 0,1 0,8 3.2 7.8 10.3 40-44 47.5 55.5 58.8 63.4 71.9 15.5 14.0 12.5 113 11.6 18.5 28.9 34.4 37.4 43.6 03 1.1 2.5 %0 8.8 45 49 23.4 34.5 333 420 46.9 8.6 7.9 7.6 6.4 6.8 6.6 14.9 16.2 233 25.7 0.0 0.5 12 4.7 7.0 Number of living children 0 0.7 0.5 1.2 0.4 0.2 O.I 0.3 0,5 0.3 0.0 0.4 02 0.5 0.0 0.2 0.0 0,0 0.0 O.0 0.0 I 23.t 31.6 31.6 42.3 451 7.6 6.7 4.7 7.3 9.7 11.4 22.4 23.3 30.8 29.3 0.0 0.0 0.9 1.9 2.2 2 43.4 52.5 53.9 66.0 701 14.7 12.7 8.9 9,2 10.9 20.5 34.3 38.9 46.9 47.6 0.0 0.0 1.6 4.9 4.9 3 47.8 59.3 65.4 69.3 74.3 19.9 171 137 11.2 1[.2 19.6 34.8 40.3 47.[ 460 0.0 0.5 3.8 5.6 96 4+ 44.4 54.3 53.9 62,2 68.1 17.1 15.8 13.9 117 9.6 17.1 30.0 30.6 338 37.4 11.2 1.0 3.2 99 13.6 Education No education 27.5 37.5 40.6 51.5 57.4 13.4 12.0 11.0 8.9 7.8 10.0 20.7 23.8 29,6 32.0 0.1 0.5 2.3 8.3 11.9 Someprinlary 42.5 53.5 50.5 57.5 59.0 20.3 17.6 12.2 10.3 8.6 16.3 29.4 30.2 337 35.8 0.1 1t5 3.1 7.9 84 Prim. comp./ somesec. 52.3 56.1 51.2 57.2 59.2 15.6 13.7 10.1 II.9 11.8 23.9 34.g 32.8 36,3 355 11.0 06 2,3 4.4 7.5 Secondary comp/higher 53.2 58.0 56.5 61.2 63.2 13.8 9,8 8.3 8.9 10.1 271 40.0 39.g 43.9 42.0 0.1 0.4 20 3.2 4.1 Total 37.8 47.1 47.9 56.1 60.0 15.3 12.9 10.4 9.5 9.3 15.7 27.9 30.0 35.5 36.7 0.1 0.5 2.4 6.1 7.9 3.4 Need for Family Planning One of the major concerns of family planning programs is to define the size of the potential demand for contraception and to identify women that are most in need of contraceptive services. Table 3.7 presents estimates of unmet need and of met need for family planning services, and of the total demand for family planning in Egypt as a whole and for various subgroups. Women with an unmet need for family planning (shown in columns 1-3 of Table 3.7) include the following: Currently married women who are in need of family planning for spacing purposes. This group includes (a) pregnant women whose pregnancy is mistimed (i.e., wanted later); (b) amenorrheic women whose last birth was mistimed; and (c) nonusers who are neither pregnant nor amenorrheic and who either want to delay the next birth at least two or more years, are unsure whether they want another child, or want another child but are unsure when to have the birth. Currently married women who are in need of family planning for limiting purposes. This group includes: (a) pregnant women whose pregnancy is unwanted; (b) amenorrheic women whose last child was unwanted; and (c) nonusers who are neither pregnant nor amenorrheic and who want no more children. Menopausal and infecund women are excluded from the unmet need category as are pregnant or amenorrheic women who became pregnant while using a method. The latter group is considered to be in need of better contraception. 36 ] Family Planning Table 3.7 Need for family plannin~ Percentage of currently married women with unmet need for family planning and with met need for family planning, and the total demand for family planning, by selected background characteristics, Egypt 2003, and trend in the percentage with unmet need and met need and in the total demand for family planning, E~ypt 2000-2003 Met need for Per- Unmet need fbr family planning Contraceptive Total demand for centage family plannin~ I (currently using) 2 failure 3 family plannin~ 4 of For For For For For For For For demand Background spacing limiting Total spacing limiting Total spacing limiting Total spacing limiting Total satis- characteristics (I) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) fled Total Age 15-19 8.3 0.8 9.1 23.0 2.4 25.4 0.6 0.0 0.6 31.9 3.2 35.1 74.2 332 20-24 9.0 1.7 10.7 32.6 15.4 48.0 1.3 0.0 1.3 42.9 17.1 60.0 82.1 1,343 25-29 4.9 4.0 8.9 19.9 3%3 57.2 1.4 0.3 1.6 26.1 41.6 6%7 86.9 1,703 30-34 2.8 7.7 10.5 11.2 58.0 69.2 0.2 0.9 1.1 14.3 66.6 80.9 87.0 1,346 35-39 1.5 8.9 10.4 4.5 68.8 73.3 0.3 1.3 1.6 6.3 79.0 85.3 87.8 1,462 40-44 0.4 7.8 8.2 1.7 70.2 71.9 0.0 0.2 0.2 2.1 78.1 80.2 89.8 1,205 45-49 0.4 8.0 8.4 0.3 46.5 46.9 0.0 0.0 0.0 0.8 54.5 55.3 84.8 1,054 Urban-rural residence Urban 1.9 4.3 6.2 13.8 51.7 65.5 0.5 0.5 1.0 16.2 56.5 72.7 91.5 3,589 Rural 4.8 7.3 12.0 12.3 43.6 55.9 0.7 0.4 I.I 17.7 51.3 69.0 82.6 4,856 Place of residence Urban Govemorates 1.6 3.6 5.1 13.9 54.6 68.5 0.3 0.4 0.6 15.7 58.5 74.3 93.1 1,533 Lower Egypt 2.5 4.5 7.0 14.2 51.0 65.2 0.6 0.5 1.1 17.3 56.1 73.3 90.4 3,797 Urban 1.5 3.7 5.2 14.1 52.2 66.3 0.7 0.7 1.4 16.3 56.5 72.9 92.9 1,083 Rural 2.9 4.9 7.7 14.2 50.6 64.8 0.6 0.4 1.0 17.6 55.9 73.5 89.5 2,713 Upper Egypt 5.8 9.0 14.8 11.0 38.5 49.4 0.7 0.5 1,1 17.5 47.9 65.4 77.4 3,116 Urban 3.0 6.1 9.0 13.2 46.6 59.8 0.6 0.6 1.2 16.8 53.2 70.0 87.1 973 Rural 7.2 10.3 17.4 10.0 34.8 44.7 0.7 0.4 1.1 17.9 45.5 63.3 72.5 2,143 Education No education 3.6 8.2 11.8 7.6 49.9 57.4 0.2 0.6 0.8 11.4 58.6 70.0 83.2 3,080 Some primary 3.5 9.6 13.1 8.5 50.5 59.0 0.8 0.3 1.0 12.8 60.3 73.1 82.1 1,053 Primary comp./ some secondary 3.7 5.0 8.7 15.3 44.0 59,2 0.6 0.1 0.8 19.6 49.1 68.7 87.3 1,190 Secondary complete/higher 3.5 3.0 6.5 18.9 44.3 63.2 0.9 0.5 1.4 23.2 47.8 71.0 90.9 3,122 Wealth index Lowestquintile 5.2 9.0 14.2 9.3 42.8 52.2 0.7 0.6 1.2 15.2 52.4 67.6 79.0 1,525 Second quintile 4.7 7.1 11.9 10.5 48.5 59.1 0.9 0.3 1.1 16,1 56.0 72.1 83.5 1,621 Middle quintile 3.7 6.3 10.0 14.4 43.2 57.5 0.3 0.4 0.7 18.3 50.0 68.3 85.4 1,742 Fourth quintile 2.9 4.2 7.1 14.3 47.7 62.0 0.6 0.7 1.3 17.8 52.6 70.4 90.0 1,793 Highestquintile 1.6 3.9 5.4 15.6 52.4 68.0 0.5 0.2 0.7 17.6 56.5 74.2 92.7 1,765 Total 2003 EIDHS 3.5 6.0 9.5 12.9 47.1 60.0 0.6 0.4 1.0 17.1 53.5 70.6 86.5 8,445 Total2000 EDHS 3.6 7.6 11.2 11.4 44.7 56.1 0.4 0.5 1.0 15.4 52.9 68.2 83.5 14,382 J Unmet need for 3pac'tng includes pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning and say they want to wait 2 or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted and women who are neither pregnant nor amenorrheic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrheic women who became pregnant while using a method (these women are in need of better contraception) Also excluded are menopausal or infecund women, Us n 8 for spacing s det ned as women who are using some me hod of famdy planmng and say hey want to have ano her oh1 d or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Contraceptive failure includes pregnant or amenorrheic women who became pregnant while using a contraceptive method. These women are considered in need of better contraception. 4 Total demand includes pregnant or amenortheic women who became pregnant while using a method (contraceptive failure) in addition to the unmet and met need for family, planuin . Women with a met need for family planning (shown in columns 4-6 of Table 3.7) include those women who are currently using contraception. The total demand for family planning (shown in columns 10-12 of Table 3.7) represents the sum of unmet need and met need. In addition, the total demand includes pregnant and amenorrheic women who became pregnant while using a family Family Planning [ 37 planning method (i.e., women in need of better contraception). The percentage of the total demand that is satisfied is shown in the last column of Table 3.7. The total unmet need in Egypt is 10 percent; around a third of this need represents a desire to space the next birth and the remainder show an interest in limiting. The total met need for family planning (i.e., the proportion of women currently using contraception) is 60 percent. The majority of users are limiters, with 2l percent of users (i.e., 13 percent of all women) reporting a desire to delay the next birth for two or more years. Overall, the total demand for family planning comprises 71 percent of married women in Egypt. Presently, 87 percent of the total demand for family planning in Egypt is satisfied. A comparison of the 2000 EDHS and 2003 EIDHS survey findings indicates that both the total demand for family planning and the proportion of the demand that was satisfied rose slightly between the two surveys. Looking at the differentials in the percentage of the demand for family planning that is satisfied, the most striking finding in Table 3.7 is the fact that around three-quarters of the demand for services is satisfied in all subgroups. Overall, the level of satisfied demand is lowest among women in rural Upper Egypt (73 percent) and highest (93 percent) among those Jiving in the Urban Governorates, Urban Lower Egypt, and those who fall in the highest quintile of the wealth index. 3.5 Intention to Use Contraception in the Future To obtain additional information about potential demand for family planning services, all currently married women who were not using contraception at the time of the survey were asked abut their intention to adopt family planning methods in the future. Women who said they did not plan to use were asked about what was the main reason they had for not using. Women who indicated they would use in the future were asked about the method that they preferred to use. Intention to Use Table 3.8 shows the percent distribution of nonusers by their intention to use in the future, according to number of Jiving chil- dren. Among all currently married nonus- ers, 47 percent intend to use in the future, 50 percent do not plan to use in the future, and three percent are not sure about their intentions. There is a clear association be- tween the number of children the woman has and her intention to use. Nonusers with idw parity (I-3 children) have higher pro- portions intending to use in the future than other women. Table 3.8 Future use of family planning Percent distribution of currently married women who are not using a family planning method by intention to use in the future, according to number of living children, Egypt 2003 N umber of living children ~ Future intention 0 1 2 3 4+ Total Intends to use 36.3 60.9 58.2 52.4 35.7 46.8 Unsure about use 1.2 2.2 3.4 5.3 4.1 3. I Does not intend 62.5 36.9 37.7 41.7 60.2 49.9 Missing 0.0 0.0 0.6 (I.6 0.0 0.2 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 Number&women 805 681 531 472 889 3,378 Ilncludescurrentpre~nanc~ Reasons for Nonuse The reasons for nonuse given by those women who indicate that they are not planning to use in the future are of interest to the family planning program since they help to identify areas for potential interventions to encourage nonusers to adopt contraception. Since the reasons for nonuse typically vary with the age of the woman, Table 3.9 presents the distribution of currently married women who 38 [ Family Planning' are not intending to use family planning in the future for two age groups; under age 30 and age 30 and over. The main reason for not planning to use family planning is the desire for more children, mentioned by around half of women. As expected, the proportion of younger women who gave this reason (92 percent) is much higher than the proportion of older women who reported this reason (26 percent). Around 30 percent of the nonusers who are not planning to use believe that they are at low risk of pregnancy either because they are not sexually active or have sex infrequently (5 percent) or they consider themselves to be subfecund or infecund (24 percent). In addition, 10 percent are not planning to use because they are menopausal or have had a hysterectomy (10 percent). The proportion considering themselves unable or unlikely to become pregnant varies by age of the woman; around 57 percent of women 30 years or older indicated that they are unable or unlikely to get pregnant compared with 3 percent of those under age 30. Table 3.9 Reason for not using family planning Percent distribution of currently nmrried nonusers who do not intend to use in the future by main reason for not using, according to age, Egypt 2003 Reason 15-29 3049 Total Fertility-related 95.0 82.4 86.6 Not having sex 0.0 2.2 1.5 Infrequent sex 1.0 4.6 3.4 Menopausal/had hysterectomy 0.0 14.6 9.7 Subfecund/infectuld 2.3 35.5 24.4 Wants more children 91.7 25.5 47.6 Opposition to use 1.8 2.7 2.4 Respondent opposed 0.7 0.7 0.7 Husband opposed 0.9 1.9 1.5 Others opposed 0.0 0.0 0.0 Religious prohibitions 0.2 0.2 0.2 Method-related 3.1 12.4 9.4 Health concerns 0.9 7.4 5.3 Fear side effects 2.1 4.5 3.7 Lack of access 0.0 0. I 0, I Cost too much 0.0 0.1 0.1 Inconvenient to use 0.0 0.1 0.1 Interfere with body 0.0 0.2 0.I Other 0.1 1,9 1.3 Don't know/not sure 0.0 0.6 0.4 Total percent 100.0 100:0 100.0 Number of women 562 1,125 1,687 Around 1 in 11 women have method-related concerns part of the husband). Older nonusers are about four times as likely as younger nonusers to give these reasons for not planning to use in the future. Preferred Method Among nonusers who planned to use family planning in the future, Table 3.10 shows that the majority of women prefer modern contraceptive methods. More than one third of all nonusers prefer the 1UD. Following the IUD, the most popular methods are the pill (14 percent) and injectable (9 percent). A significant proportion reported that they will use the method that recommended by the doctor (17 percent). 3.6 Contact of Nonusers with Family Planning Providers The 2003 EIDHS collected information on whether or cited opposition to use (principally on the Table 3,10 Preferred Family planning method Percent distribution of currently married women who are not using a family planning method but who intend to use in the future by preferred method, Egypt 2003 Preferred method Total Pill 14.3 IUD 35.5 Injections 9.0 Female sterilization 0.6 Implant (Norplant) 1.8 Periodic abstinence 0.2 Withdrawal 0. I Prolonged breastfeeding 0.0 Other 0.8 As doctor recommends 17.4 Suitable method 2.4 Don't know 17.8 Total percent 100.0 Number of women 1,581 nonusers had any recent contact with family planning providers either through home visits or health facilities visits. Such contacts provide an opportunity to counsel the nonuser about the need for family planning. To obtain this information, nonusers were asked whether they had been visited at home at any anytime during the six months preceding the survey by a family planning outreach worker (e.g., a raiyda refia) or anyone else who had talked with them about family planning. They were also asked Family Planning [ 39 about any visits they had made to governmental health facilities or private doctors or clinics during the six months preceding the survey and, if they had visited any of these providers, whether anyone had spoken to them about family planning during their visit(s). Table 3.11 presents the results of these questions by background characteristics. Around half (46 percent) of nonusers had some type of contact with a health provider (26 percent at a public facility and 33 percent with a private provider) or family planning worker (4 percent) during the six months preceding the EIDHS survey. Family planning was discussed in only 19 percent of all of the encounters that nonusers had with family planning workers or health providers during the six-month period. Among all nonusers, only 9 percent had had any recent contact with a health provider or family planning worker in which family planning was discussed. Table 3.11 Contact of nonusers with family planning workers and health facilities Percentage of nonusers of family planning who were visited at home by a family planning worker, who visited a health facility, and who discussed family planning at a health facility, during the 6 months preceding the survey, according to selected background characteristics, Egypt 2003 Visited Visited Had some Discussed FP public Visited private Visited contact with with FP Visited at health PHF, health PrHF, FP worker worker or staff Background home by facility discussed facility discussed or health at health characteristics PP worker (PHF) FP (PrHP) FP facility facility Total Age 15-19 2.7 35.5 9.0 39.0 4.2 61.3 12.3 259 20-24 5.9 36.6 9.3 45.7 7.3 64.4 14.6 728 25-29 3.0 36.0 8.0 43.6 6.9 58.5 12.1 808 30-34 4.7 26.8 5.7 41.1 6.7 54.0 I 1.3 483 35-39 3.4 20.9 4.5 26.5 2.8 39.2 6.8 514 40-44 2.9 13.2 2.1 19.1 1.6 26.3 3.7 510 45-49 1.9 12.0 0.7 17.3 0.8 25,1 1.3 784 Urban-rural residence Urban 1.4 23.6 4.4 38.6 4.7 48.1 7.5 1,553 Rural 4.8 26.9 6. I 29.8 4.3 45.3 9.4 2,533 Place of residence Urban Governorates 0.1 23.4 4.8 39.0 5.6 48.5 8.3 615 Lower Egypt 3.2 28.9 5.7 38.5 4.7 50.7 9.0 1,625 Urban 1.1 25.6 2.6 43.1 4.0 50.7 5.6 460 Rural 4.0 30.3 6.9 36.7 5.0 50.7 10.4 1,165 Upper Egypt 4.9 23.5 5.4 26.5 3.8 41.8 8.5 1,846 Urban 3.2 21.8 5.5 33.8 4.1 45.2 8.5 478 Rural 5.5 24.0 5.4 23.9 3.6 40.6 8.5 1,368 Education No education 3.4 22.0 3.9 20.2 2.5 35.2 5.9 1,681 Some primary 3.7 25.4 5.2 29.3 4.6 42.4 8.7 543 Primary complete/some secondary 4.6 28.9 8.3 36.5 5.4 51.5 12.0 565 Secondary complete/higher 3.1 29.0 6.4 50.0 6.4 60.2 10.8 1,298 Wealth index Lowest quintile 5.9 23.2 5.4 19.4 2.1 36.1 7.2 904 Second quintile 5.2 26.2 5.3 27.0 3.5 42.2 8.0 810 Middle quintile 3.1 30.5 7.4 35.0 5.1 50.9 10.8 869 Fourth quintile 1.8 24.4 5.3 39.0 5.6 49.1 9.9 824 Highest quintile 0.9 23.4 3.3 49.3 6.3 55.9 7.4 679 Total 3.5 25.6 5.4 33.1 4.4 46.4 8.7 4,086 Look ing at the d i f ferent ia ls in Tab le 3.11, it is c lear that o lder nonusers , nonusers w i th no educat ion , and nonusers in the lowest qu in t i le o f the wea l th index are less l i ke ly to have had a recent contact w i th a hea l th prov ider or a fami ly p lann ing worker than other nonusers . Desp i te the lower level o f contact , the resu l ts ind icate that there remain a s ign i f i cant number o f 'm issed ' oppor tun i t ies for counse l ing 40 ] Family Planning women about family planning even among these groups. For example, while 35 percent of the nonusers who never attended school had had some contact with a health provider or a family planning worker in the six-month period before the survey, family planning was discussed in only 1 in 6 of these encounters. 3.7 Exposure to Family Planning Messages Since the mid-1980s, a strong mass media public information and education program conducted by the State Information Service with technical assistance from USAID has been one of the main components of the Egyptian family planning program. After focusing initially on general "population awareness" messages, the education and communication effort has increasingly moved to providing more specific advice and information on family planning. The 2003 EIDHS obtained information on the proportion of who have been recently exposed to family planning information and the channels through which they are receiving the information. This information may be useful in guiding future information and education efforts in Egypt's family planning program. Level of Exposure to Family Planning Messages Table 3.12 shows that two-thirds of ever-married women reported that they had heard or seen some type of family planning message during the six-month period prior the interview. Significant differences in the exposure to family planning messages exist among subgroups. Women were most likely to have been exposed to family planning messages i f they were from urban Upper Egypt (81 percent) or were in the highest quintile of wealth index (78 percent). Groups in which the level of exposure was lowest include women 45-49 (57 percent), women with no education (58 percent), and women in the lowest wealth quintile (55 percent). Recent Source of Family Planning Information Table 3.13 presents the distribution of ever-married women who had heard messages about family planning during the six-month period before the EIDHS survey by the most recent source of family Table 3.12 Exposure to family planning messages Percent distribution of ever-married women age 15-49 by whether they have heard or seen any message about family planning in the six months preceding the interview, according to selected background characteristics and use status, Egypt 2003 Heard/seen EP message Background Total Number characteristic No Yes percent of women Age 15-19 32.5 67.5 100.0 343 20-24 28.0 72.0 100.0 1,372 25-29 27.1 72.9 100.0 1,782 30-34 31.4 68.6 100.0 1,415 35-39 33.0 67.0 100.0 1,588 40-44 36.1 63.9 100.0 1,380 45-49 43.5 56.5 100.0 1,279 Urban-rural residence Urban 27.8 72.2 100.0 3,908 Rural 36.5 63.5 100.0 5,251 Place of residence Urban Governorates 30.3 69.7 100.0 1,666 Lower Egypt 37.7 62.3 100.0 4,105 Urban 32.7 67.3 100.0 1,181 Rural 39.7 60.3 100.0 2,924 Upper Egypt 28.1 71.9 100.0 3,388 Urban 18.6 81.4 100.0 1,061 Rural 32.4 67.6 100.0 2,327 Education No education 41.9 58.1 100.0 3,452 Some primary 38.2 61.8 100.0 1,167 Primary comp./some secondary 25.5 74.5 100.0 1,270 Secondary complete/higher 24.1 75.9 100.0 3,270 Wealth index Lowest quintile 44.7 55.3 100.0 1,699 Second quintile 37.8 62.2 100.0 1,769 Middle quintile 32.0 68.0 100.0 1,874 Fourth quintile 28.7 71.3 100.0 1,937 Highest quintile 22.2 77.8 100.0 1,879 Total 32.8 67.2 100.0 9,159 planning information. Television is the recent source of family planning information for the of women followed by medical providers (88 percent and 9 percent, respectively). majority Family Planning [ 41 Table 3.13 Most recent source of t'amilv planning intbrmation Percent distribution of ever-married women age 15-49 who heard about FP within the six months before the survey source of family planning information, according to selected background characteristics, Egypt 2003 News- Other Friends/ Background characteristic paper/ Pamphlet/ Medical rela- neigh- TV Radio magazine brochure Poster provider Husband tives bors Age 15-19 82.4 0.0 0.0 0.0 0.0 I 1.6 20-24 83.5 0.4 0.2 0.0 0.1 12.9 25-29 85.5 0.2 0.0 0.3 0.3 l 1.6 30-34 88.5 0.0 0.0 0.0 0.1 8.3 35-39 89.6 0.0 0.0 0.3 0.2 7.8 40-44 89.8 0.3 0.2 0.7 0.3 5.4 45-49 92.2 0.1 0.3 0.4 0.0 4.0 Urban-rural residence Urban 89.4 0.1 0.2 0.4 0.2 7.6 0.2 Rural 86.2 0.2 0.0 0.1 0.2 9.9 0.3 Place of residence Urban Governorates 88.6 0.0 0.4 0.5 0.2 7.9 0.4 Lower Egypt 83.5 0.3 0.0 0.4 0.3 12.1 0.1 Urban 85.9 0.3 0.0 0.7 0.3 9.8 0.2 Rural 82.4 0.3 0.0 0.2 0.3 13. I 0. I Upper Egypt 91.5 0.1 0.0 0.0 0.0 5.9 0.3 Urban 93.7 0.1 0.0 0.1 0.0 5.1 0.0 Rural 90.3 0.1 0.0 0.0 0.0 6.3 0.5 Education No education 90.0 0.2 0.0 0.0 0.0 6.8 0. I Some primary 86.6 0.0 0.0 0.0 0.2 9.6 0.6 Primary comp./ some secondary 88.8 0.0 0.0 0.2 0.0 8.3 0.2 Secondary complete/higher 85.6 0.2 0.2 0.6 0.3 10.4 0.3 Wealth index Lowest quintile 86.5 0.4 0.0 0.0 0.0 8.9 0.3 Second quintile 85.6 0.0 0.0 0.0 0. I 11.3 0.2 Middle quintile 88.2 0.1 0.0 0.0 0.2 9.5 0.2 Fourth quintile 89.2 0.1 0.0 0.2 0.3 7.7 0, I Highest quintile 88,0 0.2 0.4 0.9 0.1 7.4 0.5 Total 87.6 0.2 0.1 0.3 0.2 8.8 0.3 by most recent Total Number Other percent of women 0.8 3.4 1.8 0.0 100.0 232 0.2 2.0 0.8 0.0 100.0 988 0.2 1.0 0.9 0.0 100.0 1,299 0.5 1.1 1.3 0.2 100.0 970 0.0 0.8 1.2 0.2 100.0 1,063 0.3 2.1 0.7 0.3 100.0 882 0.2 1.8 0.8 0.0 t00.0 723 1.0 0.7 0.2 100.0 2,820 1.8 1.3 0.0 100.0 3,337 0.9 0.8 0.3 100.0 I,~61 1.9 1.4 0.0 100.0 2,557 1.8 0.9 0.1 100.0 795 2.0 1.6 0.0 100.0 1,763 1.2 0.7 0.1 100.0 2,438 0.4 0.4 0.2 100.0 864 1.7 0.9 0.1 100.0 1,574 1.8 I.I 0.0 100.0 2,006 1.2 1.8 0.0 100.0 721 1.6 0.8 0.0 100.0 946 1.2 0.8 0.3 100.0 2,483 2.2 1.7 0.0 100.0 939 2.1 0.7 0.0 100.0 1,100 0.6 1.0 0. I 100.0 1,274 1.6 0.8 0.0 100.0 1,381 1.2 1.0 0.3 100.0 1,463 1.5 1.0 0.1 100.0 6,156 3.8 Perceptions and Attitudes about Family Planning Use Nine in ten women interviewed in the EIDHS approved of the use of family planning (not shown in table). To obtain additional information on the attitudes of these women about family planning, the 2003 EIDHS included questions relating to their perceptions about the extent of contraceptive use in their community and their attitudes about the appropriate time to begin contraceptive use. Opin ion about Fami ly P lanning Use in the Communi ty To obtain informat ion on percept ions concern ing the extent o f fami ly p lann ing use in the communi ty , all women in the E IDHS sample were asked: "Wou ld you say that most, some, very few or none of the couples in the reproduct ive ages l iv ing in this area are us ing fami ly p lanning?" . They were also asked i f the use of fami ly p lanning was increasing, decreasing, or s tay ing the same in their communi ty . Table 3 .14 presents the results o f these quest ions. 42 [ Family Planning Overall, the majority of women consider that most couples (72 percent) are using family planning. However, there are variations in the extent to which women share this perception. For example, while 84 percent of women in rural Lower Egypt perceive that most couples in their community use family planning, only 56 percent of women in rural Upper Egypt have this perception. Looking at the question with regard to the trend in family planning use, the majority of women (79 percent) see use as increasing in their area. The percentages who share this perception again vary across subgroups. For example, 91 percent of women in rural Lower Egypt consider family planning use increasing compared with 66 percent in rural Upper Egypt. Table 3.14 Opinion about extent and trend in family planning use Percent distribution of ever~married women according to their opinion about the extent of family planning use and about the trend in family planning in their area, according to selected back~ound characteristics, Egypt 2003 Extent of family planning use Trend in family planning use About Number Background Don't Increa- Decrea- the Total of characteristic Most Some Few None know sing sing same Not sure percent women Age 15-19 69.3 16.6 3.4 0.7 9.9 76.9 2.1 8.8 12.3 100.0 343 20-24 72.0 15.7 2.9 0.6 8.8 79.9 1.8 5.9 12.4 100.0 1,372 25-29 74.4 14.6 2.5 0.4 8.0 80.0 1.6 6.5 11.8 100.0 1,782 30-34 75.9 14.2 2.5 0.4 7.0 83.0 1.4 4.7 10.8 100.0 1.415 35-39 71.3 16.0 2.7 0.2 9.7 77.1 1.7 6.7 14.4 100.0 1,588 40-44 71.8 14.3 2.0 0.3 11.6 78.0 1.3 6.2 14.6 100.0 1,380 45-49 69.2 15.2 3.1 0.5 12.0 76.4 2.5 6.5 14.6 100.0 1,279 Urban-rural residence Urban 73.4 9.8 1.8 0.2 14.8 77.9 1.0 4.4 16.7 100.0 3.908 Rural 71.7 18.9 3.2 0.6 5.5 79.9 2.2 7.5 10.3 100.0 5,251 Place of residence Urban Governorates 70.9 7.1 1.8 0.0 20.2 74.0 0.5 4.2 21.3 100.0 1.666 Lower Egypt 83.5 10.2 1.2 0.1 5.1 89.6 1.0 3.5 6.0 100.0 4,105 Urban 82.0 8.1 1.1 0.0 8.7 86.7 0.9 3.3 9.1 100.0 1,181 Rural 84.0 11.1 1.2 0.1 3.6 90.7 1.0 3.6 4.7 100.0 2,924 Upper Egypt 59.8 24.8 4.9 1.0 9.5 68.7 3.2 10.5 17.6 100.0 3.388 Urban 67.7 16.0 2.7 0.5 13.0 74.1 2.0 6.1 17.8 100.0 1,061 Rural 56,2 28.8 5.9 1.3 7.9 66.3 3.8 12.5 17.5 100.0 2,327 Education No education 65.6 21.0 3.3 0.7 9.4 73.9 2.3 8,5 15.4 100.0 3,452 Some primary 74.5 15.7 2.5 0.6 6.7 80.8 1.5 7.1 10.5 100.0 1,167 Primary complete/some secondary 77.0 12.7 2.5 0.2 7.6 83.1 1.8 5,2 9.8 100.0 1,270 Secondary complete/higher 77.1 9.5 2.0 0.1 11.2 82.2 1.1 3,9 12.8 100,0 3,270 Wealth index Lowest quintile 60.7 23.6 5.3 1.4 9.0 70.1 3.1 9.7 17.1 100.0 1.699 Second quintile 73.6 18.1 2.8 0.4 5.1 82.5 1.6 7.3 8.6 100.0 1,769 Middle quintile 75.2 16.7 1.9 0.1 6.1 81.8 1.6 6.3 10.3 100.0 1,874 Fourth quintile 77.3 11.0 1.9 0.2 9.6 81.6 1.5 5.6 11.3 100.0 1,937 Highest quintile 74.1 7.1 1.5 0.1 17.2 78.5 0.9 2.6 18.0 100.0 1,879 Total 72.4 15.1 2.6 0.4 9.4 79.0 1.7 6.2 13.0 100.0 9,159 Family Planning [ 43 Att i tude about T iming o f Use The 2003 EIDHS included questions about the appropriateness of a couple's use of family planning before the first pregnancy and after the first birth. These questions were not asked of the ever-married women who disapproved of a couple using family planning at all (2 percent of all ever-married women). The results presented in Table 3.15 indicated that most women (90 percent) consider it appropriate for a couple to start using family planning after the first child. However, only 5 percent consider use before the first pregnancy as appropriate. Women in the lowest quintile on the wealth index and in rural Upper Egypt are least likely to approve of family planning use either before the first pregnancy or after the first birth. Table 3.15 Timing of use of family plannine by newly married couples Percentage of ever-married women who do not disapprove of family planning use by atlitude about appropriateness of a couple's using family planning before the first pregnancy and after the first birth, according to selected background characteristics, Egypt 2003 Percentage believing family planning use is __ appropriate: Number Background Before first After first of characteristics pregnancy birth women Age 15-19 6.4 89.6 339 20-24 4.4 92.9 1,339 25-29 4.9 9 [. I 1,760 30-34 4.7 91.4 1,389 35-39 4.2 87.7 1,563 40-44 5.8 88.6 1,341 45-49 4.6 84.9 1,226 Urban-rural residence Urban 5.6 93.7 3,866 Rural 4.3 86.4 5,092 Place of residence Urban Governorates 5.9 94.8 1,650 Lower Egypt 5. I 91,2 3,989 Urban 5.4 93.0 1,162 Rural 5.0 90.4 2;827 Upper Egypt 4.0 85.0 3,319 Urban 5.3 92,9 1,054 Rural 3.4 81,3 2,265 Education No education 3.7 84.0 3,340 Some primary 5.2 89.0 I, [ 34 Primary comp./some secondary 4.8 90.7 1.256 Secondary complete/higher 5.9 9531 3,228 Wealth index Lowest quintile 3.3 81.2 1,638 Second quintile 3.6 88.6 1,71 I Middle quintile 5.6 89.5 1,834 Fourth quintile 4.7 92.3 1,911 Highest quintile 6.7 95.0 1.864 Approves of family planning Approves 4.9 90. I 8,887 Unsure if approves 0.7 16.4 71 Total 4.8 89.5 8,958 44 I Family Planning 4 FAMILY PLANNING SERVICES The 2003 EIDHS obtained information on a number of aspects of the family planning service delivery including the source from which users had obtained their method, the cost of obtaining services, and the wil l ingness to pay, and the extent of information provided to women obtaining family planning services from clinical sources. This information is presented in this chapter. 4.1 Source of Family Planning Methods Detailed information was collected in the 2003 EIDHS on the sources from which family planning methods were obtained. To obtain these data, current users of modern methods were asked for the name and location of the source where they got their methods at the beginning of the current segment of use. The findings of the 2003 EIDHS presented in Table 4.1 indicate that the users are more likely to obtain their methods from the public sector facilities (56 percent) than from private medical or other sources. Table 4.1 Source for modern family plannin~ methods Percent distribution of current users of modem family planning methods by most recent source, according to specific methods, Egypt 2003 Female Source Pill IUD Injection Condom sterilization Total Public sector 14.8 61.2 82.0 14.0 34.0 55.6 Urban hospital 1.8 7.5 7.7 1.5 16.0 6.9 Urban health unit 1.7 21.2 I 1.3 4.1 0.0 16.0 Rural hospital 1.1 4.1 8.2 0.0 2.4 4.0 Rural health unit 8.1 16.7 45.7 2.3 0.0 18.8 MCH centre 0.8 7.0 4.7 3.7 0.6 5.5 Mobile unit 1.1 3.1 3.3 2.0 0.0 2.7 Other MOHP unit 0.0 0.3 0.0 0.0 0.0 0.2 Teaching hospital 0.0 0.1 0.3 0.0 2.1 0. I Health Insurance Organization 0.0 0.6 0.3 0.3 0.0 0.4 Curative Care Organization 0.0 0. I 0.3 0.0 0.0 0.1 Other governmental 0.2 0.7 0.2 0.0 12.8 0.8 Private sector 84.4 38.7 14.7 83.2 62. I 43.5 Egypt Family Planning Association 0.0 1.7 1.0 0.3 0.0 1.3 Clinical Services Improvement project 0.0 2.6 0.4 0.0 0.0 1.7 Other NGO/PVOs 0.1) 0.3 0.3 0.0 0.0 0.2 Mosque health unit 0.0 1.6 0.8 0.0 2.1 1.2 Church health unit 0.0 0.3 0.2 0.0 0.0 0.2 Private hospital/clinic 0.2 1.9 0.5 0.0 10.4 1.6 Private doctor 23) 30.3 5.8 2.3 49.5 21.7 Pharmacy 82.2 0.0 5.6 80.5 0.0 15.6 Other 03) 0.1 3.1 0.5 4.0 0.7 Friends/relative 0.8 0.0 1.1 0.0 0.0 0.3 Other 0.0 0.1 2.0 0.5 4.0 0.5 Don't know 03) 0.0 0.3 2.3 0.0 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 786 3,095 670 75 84 4,787 NGO-Nongovernmental organization PVO-Private voluntal3, organization Table 4.1 shows that the source for family planning methods varies markedly by method. The majority of current users of the IUD (61 percent) have the method inserted at a public sector source, mainly at Ministry of Health and Population (MOHP) facilities. In general, those users relying on a government Family Planning Services" ] 45 source fbr the IUD get the device inserted at a static facility; however, 3 percent of IUD users obtain the method from MOHP mobile clinics. Around one-third of IUD users go to private physicians, hospitals or clinics for the method, while 5 percent obtain the method at clinics operated by nongovernmental private voluntary organizations and an additional 2 percent get the method at Facilities operated by a mosque or a church. Table 4.1 shows that the public sector is the main source for injectables, with 82 percent of injectable users obtaining the method from governmental sources. As was the case with the IUD, most injectable users obtain their method at a static facility, especially rural health units (43 percent). Only three percent get the injectable from a mobile clinic. With regard to the sources for other methods, pill users mainly get their method from a pharmacy (82 percent), as do couples using the condom (81 percent). The small number of sterilization users is more likely to have had the operation performed at a private facility than public facility. Trends in the source of family planning methods during the period between the 1995 and 2003 DHS surveys are presented by residence in Table 4.2 for IUD users and fbr users of all modern methods. Overall, the table indicates that there has been an increase in the likelihood that a user will rely on public sector for family planning methods since 1995. The percentage of users of modern methods who obtained their method from a governmental provider increased from 36 percent in 1995 to 56 percent at the time of the 2003 EIDHS. Much of that change is due to increased reliance on the public sector for the IUD. Table 4.2 shows that the percentage of users who obtained the IUD at a public sector provider increased from 45 percent in 1995 to 61 percent in 2003. Table 4.2 Trends in source for modern Ihmily planning methods by residence Percentage of current users of IUD and all modern family planning methods who obtained their method fiom a public sector source, according to urban-rural residence and place of residence, Egypt 2003 IUD Total Residence 1995 2000 2003 1995 2000 2003 Urban-rural residence Urban 42.8 48~7 55.0 34.0 42.0 46.3 Rural 46.7 59.4 67. I 37.7 54.8 63.6 Place of residence Urban Governorates 46.5 48.8 59.3 39.7 43.5 51. I Lower Egypt 44.4 54.9 62. I 35.2 50.2 56.8 Urban 37.4 47.5 51.4 27.5 40.9 40.2 Rural 47.3 58.0 66.2 38.6 54. I 63.5 Upper Egypt 42.1 57.3 61.1 32.3 50.0 56.8 Urban 39.9 50. I 5 I. I 29.6 40.8 45.3 Rural 44.5 63.5 69.3 34.8 56.3 63.9 Total 44.5 54.0 61.2 35.7 48.6 55.6 Considering the variation by residence, the trend toward an increased reliance on public sector providers was observed among users in all areas. However, the magnitude of the increase was somewhat greater for rural users than urban users. Within rural areas, the trend was considerably more evident among users in rural Upper Egypt than among users from rural Lower Egypt. 46 I Family Planning Services 45 Figure 4.1 Trends in Percentages of Users Obtaining IUD and All Modern Methods from Public Sector Providers gll m 61 54 1995 211011 2003 • I[;D El All Modern Methods ] 4.2 IUD Use IUD users represent ll]O['C than hvo-thirds o f all users. Informat ion was col lected fl-om women using an IUD on the actual cost of" obta in ing the method ( inser l ion and purchasing) and also on their wi l l ingness lo pay specif ic amounts l\~r the method. Actual Cost Table 4.3 presents the actual amount that IUD users paid. F ive percent had the method inserted for free. Around two-th i rds (62 percent) paid 15 pounds or less to obtain the method, with 52 percent paying 5 pounds or less. The median amount IUD users paid for the method was 4. I pounds; this is 1.7 pounds be low the median cost reported in the 2000 EDHS. The cost di f ferential is largely due to flw greater number o f users obta in ing the method at publ ic sector faci l i t ies m 2003 than in 2000. Pe]cetlt distribution of current usels o f lUD by cost of lhe lnclhod {in pounds), according to the type of plovidcl, Fgypt 2003 Public Plivate NGO/ MOSqLIC/ health doctill PVO church (ost ot IUD fhcility clinic clinic clinic [ otal Flee 74 2.4 0.9 Off 5.3 3 pot,nds 4-~ 4 0.5 7.1 39 28.3 3 5pounds 357 19 22.2 11 ~ 235 6 10pounds 54 4.4 68 94 52 ' 11-15 pounds 2.2 6.7 27.8 I81 52 16-20pounds 10 148 17.0 15.7 64 21 30 pounds 0.9 227 9.5 21.4 8.8 31 50 pounds 0.• 22.2 3.8 147 7.9 51 pounds ol more 02 I 1.o 1.0 2 8 40 Don't know/missing 13 13.2 4.0 2.8 53 ] ota[ 100.0 100.0 100.0 100.0 1000 N unlbcl Of" \volllcn 1,893 999 142 60 3,095 i Medim 29 277 128 179 4 I Mean 38 32.5 14.0 21.1 13.1 t=amilv Planning Sere'ices ] 47 The amount that a user paid to obtain an 1UD varied by type of provider. The lowest median amount a user paid was observed among users who got the 1UD inserted at public facility (2.9 pounds). The median cost paid at a private doctor (27.7 pounds) is around ten times the cost paid at a public facility, while the median cost of lUD at the mosque/church clinic is about six times the cost that at the public sector facility (17.9 pounds). Willingness to Pay To investigate whether higher prices might be charged for IUD, all current IUD users were asked about their willingness to pay various amounts for the method. The amounts asked about ranged from 5 to more than 200 pounds. The results in Table 4.4 indicate that many IUD users would be willing to pay considerably more for the method than they currently pay. As expected, the proportion willing to pay a specific amount decreases as the suggested amount increases. Virtually all IUD users (96 percent) would be willing to pay 5 pounds, and 85 percent say they are willing to pay 10 pounds. Almost 60 percent of women would be willing to pay 25 pounds, and 33 percent express a willingness to pay 50 pounds. Relatively few women would be willing to pay 100 pounds or more for an IUD; 10 percent of IUD users say they would pay 150 pounds for an IUD, and 6 percent would be willing to pay more than 200 pounds. Table 4.4 Amount users are willing to pay for IUD insertion Percentage of current users of the IUD willing to pay various amounts tor the method, Egypt 2003 Amount Total 5 pounds 964 I0 pounds 85.3 25 pounds 58.4 50 pounds 32.6 100 pounds 16.5 150 pounds I 0.0 200 pounds 7.(1 More than 200 pounds 5.5 Number of users 3,095 The large degree of variance between what users currently pay for the 1UD and the amounts that they say they would be willing to pay suggests that the method may be considerably underpriced in both the public and private sector. However, some caution must be exercised in interpreting the results in this manner. The question on willingness to pay is hypothetical, and women may have been embarrassed to tell an interviewer that they were unwilling to pay more for the method. 4.3 Pill Use Overall, 15 percent of all family planning users rely on the pill. In the 2003 EIDHS, current users of the pill were asked questions on the brand of pills they used, the cost of a pill cycle, and the amount that would be willing to pay for a cycle. Brand Information about the brands used by women was collected by ask- ing pill users to show the packet of pills. If the packet was available, the interviewers recorded the name of the brand. I ra user was unable to show the EIDHS interviewer the packet, she was asked to name the brand she was using. Around a quarter of all users of the pill were not able to show a packet or identify the brand they were using. Table 4.5 shows that that Microvlar is the most commonly used brands (44 percent each), followed by Triovlar and Nordette (11 percent and 8 percent, respectively). Table 4.5 Brand of pill used Percent distribution of pill users by the brand of pill currently used, Egypt 2003 Brand I'ota[ Microv[ar 43.5 Nordette 7,9 Triovlar I 1.3 Norminest (1.7 Primovlar 0.9 Other 12.3 Don't know/missing 23.4 Total percent 100.0 Number of women 786 48 I Family Planning Services Cost of Pill To obtain information on cost, current users were asked about the amount that they paid for the most recent packet of pills. According to the results in Table 4.6, virtually all pill users are paying more than 50 piastres for a cycl e of pills, 42 percent pay more than one pound (100 piastres), and around one-quarter pay more than two pounds (200 piastres). The median cost of a cycle is 100.4 piastres, somewhat higher than in the 2000 EDHS when median price for a pill cycle was 95.2 piastres. Willingness to Pay Pill users were asked about their willingness to pay specific amounts for the pill in order to ascertain whether they would be likel3, to pay a higher price for the method. The amount asked ranged from 50 piastres to more than 5 pounds. Table 4.7 indicates that many of pill users would be willing to pay more than they do. As expected, the proportion expressing a willingness to pay is directly associated with the amount mentioned. Almost all pill users would be willing to pay 50 or 75 piastres, and 93 percent would be willing to pay one pound. Three-quarters of pill users (76 percent) would be willing to pay two pounds. There is greater reluctance to pay higher amounts, with around a half of pill users indicating that they would be willing to pay 5 pounds and two-fifths said that they would be willing to pay more than 5 pounds for a cycle of pills. 4.4 Injectable Use Table 4.6 Cost of method for pill users Percent distribution of current users of the pill by cost of a cycle of pills (in piastres), Egypt 2003 Cost of pill Total Free 1.4 1-50 piastres 0.1 51-75 piastres 36.8 76-100 piastres 15.8 101-200 piastres 16.6 More than 200 piastres 25.8 Don't know/missing 3.5 Total 100.0 Number of women 786 Median 100.4 Mean 315.5 Table 4.7 Amount users are willing to pay for the pill Percentage of current users of pill willing to pay various amounts to obtain the method, Egypt 2003 Amount Total 50 plashes 99.9 75 piastres 97.8 1 pound 92.8 2 pounds 75.7 5 pounds 48.1 More than 5 pounds 39.9 Number of women 786 Overall, 13 percent of all current family planning users are using an injectable. In the 2003 EIDHS, current users of the injectables were asked questions on the periodicity of receipt the injectable, the cost of an injectable, and the amount that would be willing to pay for an injectable. Type of Iniectable Most injectable users (95.7 percent) indicated that they received an injection every three months (not shown in table). Only a small percentage reported that they received the injectable at one-month intervals (3.6 percent). The small number of remaining users either reported getting the injectable at a two-month interval or was unable to specify the interval at which they received the injection. Family Planning Services [ 49 Actual Cost Table 4.8 shows that five percent of injectable users get the method for free, and around three-quarters (72 percent) paid less than 3 pounds for the method. The median cost was 1.7 pounds, which is lower than the average cost for the injectable at the time of 2000 EDHS (2.3 pounds) and substantially lower than the average cost MOHP reduced the cost of the injectable to one pound in late 1999 and provided the method for free at mobile clinics from that point. This is at least in part responsible for the decline in the average cost of the injectable since MOHP facilities provide the method to the majority of injectable users. Willingness to Pay Injectable users were asked about their willingness to pay specific amounts for the method in order to ascertain whether they would be likely to pay a higher price for the method. The amounts asked about ranged from 2 to more than 20 pounds. Table 4.8 Cost of method for iniectablc USerS Percent distribution of cunent users of injectables by the cost of the method (in pounds), Egypt 2003 Cost of injectable Total Free 5.0 <3 ponnds 71.7 34 pounds 7. I 56 pounds 5.9 %8 pounds 4.7 0-10 pounds 27 I I+ pounds 23 Don't kn,aw/missing 0.8 Total 100.0 Number of women 670 Median 1,7 Mean 2.3 Table 4.9 indicates that many injectables users would be willing to pay more for the method. As expected, willingness to pay is directly associated with the amount mentioned. Almost all injectable users (96 percent) would be willing to pay 2 pounds for the method, around three-quarters would pay 5 pounds, and around 40 percent would be willing to pay 10 pounds. Considerably fewer users expressed a willingness to pay larger amounts for injectables, with only 8 percent reporting they would be willing to pay more than 20 pounds. 4.5 Service Assessment Indicators All current users were asked a series of questions in order to assess the quality of services from the source from which they obtained "Fable 4.9 Amount users are willing to pay foriniectables Percentage of current users o[ injectables willing to pay various amounts to obtain the method, Egypt 2003 Amount willing to pay tbr an injectable Total 2 pounds 95.6 5 pounds 75.9 10 pounds 38.5 15 pounds 17.6 20 pounds I 1.7 More than 20 pounds 7.8 Number of women 670 the method. The results of these questions are presented in Table 4.10. Overall, they suggest that there is adequate information exchange in only about half of the encounters between current users and the providers from which they obtain their methods. Looking at specific items, more than half of users (56 percent) reported that the provider told them about other methods than the one the user received. Providers described the side effects to also more than half of the users, while around 46 percent of current users reported that the provider told them what to do about side effects. The level of information exchange differed by method, with IUD users generally likely to receive more information from providers than users of other methods. For example, providers advised 48 percent of IUD users about what to do if they experienced side effects compared with 34 percent among pill users and 40 percent of users relying on other methods. The level of information exchange also differed according to the type of provider. In general, private providers appear to be somewhat better at counseling users than public sources. 50 ] Family Planning Services' Table 4.10 Service assessment indicators lbr clinical providers Percentage of current users consulting a clinical source at the beginning of the segment of use (since January 1998) who reported they were advised about various aspects of the method they obta!ned according to type of source and method, Egypt 2003 NGO/ Private Public PVO clinic/ Service assessment indicator clinic clinic doctor Total IUD Told about other methods 54.4 61.5 58.6 56. I Told about side effects During current segment of use 46.9 56.6 59.3 51.5 Ever but not during current segment 7.1 5.2 5.1 6.4 Told what to do about side effects 44.7 52.1 54. I 48.2 P ILL Told about other methods 53.3 73.3 55.8 Told about side effects During current segment of use 29.4 49.8 32.0 Ever but not during current segment 9.9 17.0 10.8 Told what to do about side effects 31.4 51.6 33.9 OTHER METHODS Told about other methods 54.7 63.9 56. I 55.1 Told about side effects During current segment of use 44.6 21.0 51.7 45. I Ever but not during current segment 6.4 7.1 7.6 6.6 Told what to do about side effects 39.0 21.0 46.0 39.6 TOTAL Told about other methods 54.4 61.7 58.6 55.9 Told about side efl~cts During current segment of use 45.5 53.1 58.5 49.5 Ever but not during current segment 7.1 5.4 5.5 6.6 Told what to do about side effects 42.6 49.1 53.3 45.9 NGO Nongovernmental organization PVO Private vo[untat-y organization Family Planning Services J 51 5 MATERNAL HEALTH Both mother and child benefit when a woman receives proper medical care during pregnancy and childbirth. To obtain data on women's utilization of maternity care services, E IDHS respondents were asked a series of questions relating to the types of health care services that they received during pregnancy, at delivery and in the postnatal period for each birth during the five-year period before the survey. This chapter reviews these data and also examines trends in key maternal health indicators. 5.1 P regnancy Care Antenata l Care Coverage Early and regular antenatal checkups by medical providers are very important in assessing the physical status of women during pregnancy. Table 5.1 presents data from the 2003 EIDHS on the coverage of antenatal care services for births during the five-year period prior to the survey. A birth is considered to have received antenatal care i f the mother said that she had made at least one antenatal care visit, i.e., a visit to a medical provider for care for the pregnancy. Egyptian women received antenatal care from a medical provider for more than two-thirds of the births occurring during the five-year period before the survey. Most women saw a doctor for the care with less than one percent reporting that they had had care only from a trained nurse/midwife. Women were more likely to obtain antenatal care from a private doctor or clinic (45 percent) than a public provider (23 percent). At least four antenatal visits are recommended during a woman's pregnancy to ensure proper care. Most women who obtained antenatal care at all reported that they had regular care. Overall, women received regular antenatal care (i.e., they made four or more visits to a provider) for 56 percent of all births prior to the survey. Considering only those births for which care was received, the median number of antenatal visits was 6.9. It is also recommended that a woman have the first antenatal checkup early in the pregnancy to help prevent problems. EIDHS respondents saw a provider for care for the first time before the sixth month of pregnancy for more than 9 in 10 of the births for which antenatal care was reported (i.e., in 65 percent of all births). In order to detect problems that might affect the delivery, a woman should also see a provider late in the pregnancy. Respondents saw a provider within the last two months of pregnancy in 9 in 10 of the which the mother had any antenatal care (i.e., in 62 percent of all births). Table 5.1 Antenatal care Percent distribution of births during the five- year period before the survey by type of provider for antenatal care, the type of facility where ANC care was sought, the number of antenatal care visits, and the stage of pregnancy at the time of the first and last visits, Egypt 2003 Total ANC provider Doctor 68.6 Trained nurse/midwife 0.1 Daya/missing 0.1 No care 31.2 Source for ANC Public sector 23.4 Hospital 5.0 Health unit 15.6 MCH center 2.7 Private doctor/clinic 44.9 Other/missing 0.5 No care 31.2 Antenatal visits for pregnancy None 31.2 1 1.3 2 3.9 3 5.6 4 or more visits 55.6 Don't know/missing 2.4 Median 6.9 Timing of first antenatal check No antenatal care 31.2 Less than 4 months 50.2 4-5 months 14.5 6-7 months 3.0 8+ months 0.8 Don't know/missing 0.3 Months pregnant at last visit No antenatal care 31.2 < 4 months 0.5 4-5 months I. I 6-7 months 4.6 8+ months 62.3 Don't know/missing 0.3 Total / 00.0 Number of births 6,314 Maternal Health [ 53 Coverage of Tetanus Toxoid Vaccinations Tetanus toxoid injections are given to women during pregnancy to prevent infant deaths from neonatal tetanus. Neonatal tetanus can result when sterile procedures are not followed in cutting the umbilical cord following delivery. Table 5.2 shows that women received at least one tetanus toxoid (TT) vaccination in the case of 78 percent of the births during the five-year period prior to the EIDHS. In the case of slightly more than 2 in 5 of these births, mothers received two doses of the TT vaccine. More than 9 in 10 women who received a TT injection reported they obtained it from a public sector provider. The MOHP has stressed the importance of using the contact providers have with pregnant women during the provision of the TT vaccinations to encourage women to obtain regular antenatal care and to discuss the use of family planning. To assess the impact of this effort, the 2003 EDHS collected information from women who had received a TT vaccination prior to the last birth on whether anyone had encouraged them to seek antenatal care and whether anyone had talked with them about family planning at the time that they received the injection(s). The results in Table 5.2 indicate that 29 percent of the women who received a tetanus toxoid injection prior to the last birth (i.e., 22 percent of all women) reported that they were encouraged to obtain antenatal care, and 15 percent (i.e., 12 percent of all women) said that someone talked to them about family planning. Medical Care Unrelated to the Pregnancy Table 5.2 Tetanus toxoid coverage Percent distribution of births during the five- year period before the survey by the number of tetanus toxoid (TT) injections and source for injections and, among births where the mother reported receiving a TT injection, the percent distribution according to the type of advice given about ANC or family planning at the time of the TT injection(s), Egypt 2003 Total Tetanus injections None 21.2 One dose 43.4 Two doses or more 34.6 Don't know/missing 0.8 Source for TT injection Public sector 73. I Hospital 6.7 Urban/rural health unit 60.6 MCH center 5.8 Private doctor/clinic 4.3 Other/missing 1 4 No TT injection 21.2 Total 100.0 Number of births 6,314 Advice about ANC/FP Advised to seek ANC t2.4 Told about FP 2.7 Both ANC and FP discussed 9.4 Neither ANC or FP discussed 54.0 No TT injection/missing 21.6 Total 100.1) Number of last births 4,574 In addition to the questions on antenatal care and tetanus toxoid vaccinations, the 2003 EIDHS included a number of questions designed to determine whether women received other medical care during pregnancy. These questions were asked both of women who reported receiving antenatal care and those who did not report seeing anyone for care for the pregnancy. They were intended to ascertain the full range of medical care women received during pregnancy and, particularly, to identify women who did not have antenatal care but had received medical care unrelated to the pregnancy. Table 5.3 takes this information into account in looking at the overall proportion of births in the five years preceding the survey for which women reported receiving any type of medical care during pregnancy according to the type of care received. Overall, women saw a medical provider during pregnancy for some type of care in 92 percent of all births that occurred during the five-year period prior to the survey. Women received both antenatal care and at least one TT injection prior to around half of the births. Tetanus toxoid coverage was not universal among women who had had antenatal care; women reported that they received antenatal care but had not had a tetanus toxoid vaccination in the case of 13 percent of the births. Similarly, Table 5.3 shows for around 22 percent of births women got a TT injection without seeing anyone for antenatal care. 54 ] Maternal Health T~lble ~ 3 M~'c {)the)" thai1 visit fbr antenatal ca ie or tetamis toxoid iniectintlduring pkcgnancy Perccnl distribution of births during the five year period bcl)re the survey by mother'sreporl of sechlg doctor o~ other health worker at any time during the pregnancy Ibr care other than antenatal care (ANC) checkup or tetanus toxoid (TT) injection, according to mothcr'sANC and TT status. Egyp~ 2003 ANC Neither ANC Received olher medical ANC and TT TI iRiection nor 1T car,: du) ing plcgnancy only ii!jection only injection To~al Had other care 16 6.4 3 2 1.3 12.6 No other cal e 11.5 49.2 192 7.6 87.4 "1 otaI ] 3. I 55.6 22.4 8.9 100,0 Finally, wolnen reported seeking medical care for an illness or problem unrelated to the pregnancy in the case of 12 percent of the births. Most of the women who reported they had seen a medical provider for care unrehttcd to their pregnancy had also seen a provider for antenatal care and/or a TT injection. Different ia ls in P regnancy Care lndicaturs Table 5.4 presents differences across subgroups for five pregnancy care indicators: any antenatal care during pregnancy, regular antenatal care, at least one tetanus toxoid injection, medical care unrelated to the pregnancy, and any type of medica[ care during pregnancy. Looking at the age patterns, the differentials are mixed. In general, however, mothers age 35 and over are least likely to report receiving any type of care during pregnancy. The association between the child s birth order and the care indicators is negative, except in the case of care unrelated to the pregnancy. The various care indicators are generally higher for urban than rural births. For example, the percentage of urban births in which the mother received regular antenatal care is substantially higher compared to the proportion among rural births (74 percent and 45 percent, respectively). 111 the case of tetanus toxoid coverage, however, the level is slightly higher tbr rural than for urban births (82 percent and 71 percent, respectively). Births in Upper Egypt rank lowest on all of the pregnancy care indicators. Coverage of antenatal care services is especially low in rural Upper Egypt (Figure 5.1 ). I 00 80 60 40 20 0 m [ rban ( ;o~er- norRtes m Total Figure 5.1 Antenatal Care by Place uf Residence m m m i Ilrban Rural Total Urban Littler Egypt Upper Egypt • Four+~isits El 1-3 visi(s m Rural 3/[aZcrna/Hen/Us J 55 Table 5.4 Care during pregnancy Percentage of births in the five-year period before the survey whose mother received any antenatal care and regular antenatal care from a medical provider, one or more tetanus toxoid injections, other medical care unrelated to the pregnancy and any medical care during the pregnancy, by selected background characteristics, Esypt 2003 Antenatal care One or Other Any Number Background more TT medical medical of characteristic Any Regular injections care care births Age at b i r th < 20 66.8 52.1 84.7 12.0 93.9 735 20-34 69.9 56.9 79.6 12.4 93.7 4,905 35-49 62.1 50.3 59.2 14. I 81.4 674 Birth order I 80.3 68.9 84.3 12.6 97.4 1,858 2-3 69.9 56.3 79.6 12.3 94.4 2,816 4-5 59.5 45.5 71.8 13.8 88.6 1,038 6+ 43. I 28.9 62.2 I 1.7 74.2 602 Urban-rural residence Urban 82.7 73.5 71. I 15. I 95.8 2,362 Rural 60.3 44.9 82.1 1 I. 1 90.4 3,952 Place of residence Urban Governorates 83.9 75.4 66.2 19.0 96.0 911 Lower Egypt 75.0 6 I. I 83.6 10.7 95.9 2,688 • Urban 85.8 76.4 75.0 11.0 96.3 751 Rural 70.8 55.2 86.9 ] 0.5 95.7 [ ,937 Upper Egypt 57.4 43.5 76.5 12.3 87.8 2,715 Urban 77.8 68.0 73.5 14.2 95. I 700 Rural 50.3 35.0 77.5 I 1,6 85.2 2,015 Education No education 48.8 34.4 76.8 10.2 84.2 2,142 Some primary 61.1 45.8 79.2 12.7 91.3 638 Primary complete/some secondary 69.0 56.3 82.2 15.0 95.9 1,023 Secondary complete/higher 87.5 75.9 77.1 [ 3.6 98.3 2,511 Work status Working for cash 8 I. I 71.3 71.9 13.5 93.7 755 Not working for cash 67.0 53.5 78.8 12.4 92.2 5,559 Wealth index Lowest quintile 45.2 29.2 75.8 I 1.3 83.3 1,366 Second quintile 58.7 44.4 82.9 10.3 90.5 1,279 Middle quintile 71.4 56.0 83.4 12.0 93.8 1,323 Fourth quintile 81.6 70.7 81.9 15.3 97.2 1,319 Highest quintile 92.4 84.9 62.9 14.4 98.9 1,029 Total 68.7 55.6 78.0 ~ 2.6 92.4 6,314 Note: A birth is considered to have received antenatal care if there was at least one antenatal care consultation with a medical provider during the pregnancy. Regular care refers to four or more antenatal visits during the pregnancy. A birth is considered to have received any medical care if the mother reported at least one antenatal care visit, at least one tetanus toxoid injection, and/or at least one visit to a provider for medical care that the mother considered to be unrelated to the pregnancy. There generally is a positive association between the women's education status and the various pregnancy care indicators. The relationship is particularly marked in the case o f regular ANC, with such care being more than twice as common among births to women who have a secondary or higher education than among births to women who have never attended school. Except for tetanus toxoid, the levels for the pregnancy care indicators are higher for births to women who work for cash than other women. Both the likelihood a woman will receive any antenatal care and the likelihood she will receive regular care increase markedly with a household's position on the wealth index• TT coverage 56 I Maternal Health is more variable, with women living in households ranking in the highest quintile having the lowest coverage levels. 5.2 Content of Pregnancy Care In the 2003 EIDHS, women who reported that they received antenatal care, tetanus toxoid injections or other medical care unrelated to the pregnancy were asked questions related to the types of routine screening they may have received during the visit to their provider for the care. These women were also asked if they had been told about the signs of pregnancy complications, and, if they were told, whether they received any information about where to go if they experienced any complications. Finally, women were also asked if they were given iron tablets or syrup. Iron supplementation during pregnancy is recommended to prevent iron deficiency anemia, which is a common problem among pregnant women. Table 5.5 6 shows that around half of the mothers were given a maternal card. In the case of around three-quarters of births in which mothers who saw a medical provider during pregnancy, the woman reported that she had been weighed or her blood pressure monitored. Mothers reported that urine and blood samples were taken in around 3 in 5 births while the mother's height was measured in the case of a little more than half of the births. Iron tablets/syrup were received or bought in 45 percent of the births. Mothers were advised about the complications that they might experience in the case of 32 percent of the births and told were to seek assistance if they actually had problems in the case of 28 percent of the births. Table 5.5 shows that the proportions who reported the various care items were generally somewhat higher among women who received regular antenatal care than among other mothers. In turn, mothers who had some but not regular antenatal care were more likely than mothers who had had no antenatal visits to indicate that routine antenatal care procedures were performed, that they had had advice about pregnancy complications, and they had received or bought iron supplements. Marked differentials in the content of care are evident by the demographic and socioeconomic characteristics shown in Table 5.5. For example, there is a very strong negative association between the child's birth order and routine antenatal care procedures. In general, the procedures were more likely to have been performed in the case of urban than rural births, with particularly low levels found for births in rural Upper Egypt. A positive association is observed between the woman's education status and the indicators of the quality of pregnancy care presented while a negative association exists between the proportion reporting receiving a pregnancy care indicator and the household's position on the wealth index. The indicators were also more common among births to women who worked for cash than other births. %pine caution must be exercised in considering the information in Table 5.5 since it is dependent on the mother's understanding of the questions, e.g. her understanding of what blood pressure measurement involves. It is also dependent on the mother's recall of events during visits to the provider that may have taken place a number a number of years before the 2003 EIDHS interview. Nonetheless, the results are useful in providing insights into the content of the care Egyptian women receive during pregnancy. Maternal Health [ 57 Table 5,5 Content of pregnancy care Percentage of births in the five-year period before the survey whose mothers received any care during the pregnancy, by content oftbe care and selected background characteristics, Egypt 2003 Told Given Received/ Told about where to mater- Height BP bought iron signs of go for Number Background nal mea- mea- Urine Blood tablets/ compli- compli- of characteristic card Weighed sured sured sample sample syrup cations cations births Medical care during pregnancy Had ANC 68.7 89.1 68. I 90.6 75.9 77.5 58.4 40.3 35.8 4,338 Four or more visits 70.5 90.2 69.6 92.5 78.3 79.9 61.4 41.7 37.2 3,511 Fewer than 4 visits 60.9 84.5 61.9 82.5 66.0 67.4 45.7 34.4 30.0 827 NoANC 18.1 47.3 26.7 39.4 23.4 26.4 16.0 13.2 10.8 1,976 TT or other care 23.9 62.3 35.2 51.9 30.8 34.7 19.4 17.4 14.1 1,496 Type of provider Public sector 52.0 78.2 55.7 69.6 55.9 58.2 34.4 25. I 21.5 2,503 Private sector 54.2 80.9 59.8 90.3 68.7 68.9 59.3 44.4 39.9 1,018 Both 64.6 87.8 64.4 89.1 72.1 75.2 59.2 40.3 35.7 2,291 No care/missing 1.3 1.4 1.1 1.2 0.9 0.9 6.0 0.9 0.9 502 Age at birth <20 50.7 77.3 54.2 72.5 60.5 64.1 42.2 31.4 27.7 735 20-34 54.0 77.4 56.4 76.3 60.6 62.6 46.7 32.4 28.2 4,905 35-49 47.1 64.5 47.3 64.2 50.4 50.9 37.2 28.3 26.4 674 Birth order 1 61.5 84.4 62.3 84.6 71.6 74.3 53.0 38.5 33.8 1,858 2-3 53.1 78.0 56.9 76.4 59.9 61.6 46.7 31.0 27.4 2,816 4-5 46.6 68.9 49.9 65.1 49.8 52.1 37.2 28.0 24.2 1,038 6+ 35.8 53.1 34.5 51.3 36.9 38.0 27.2 21.3 19.2 602 Urban-rural residence Urban 62.4 83.0 64.8 84.9 70.5 71.0 56.6 39.2 35.1 2,362 Rural 47.2 71.8 49.4 68.4 52.9 55.8 38.3 27.4 23.7 3,952 Place of residence Urban Governorates 65.2 84.2 67.3 88.2 75.2 76.2 62.0 45.9 42.3 91 I Lower Egypt 59.8 81.1 56.0 82.6 64.5 67.7 47.2 36.4 31.2 2,688 Urban 66.3 84.3 64.9 86.6 72.0 72.6 56.8 45.2 39.2 751 Rural 57.3 79.9 52.5 81.1 61.6 65.8 43.5 33.0 28.1 1,937 Upper Egypt 41.9 68.2 50.3 62.0 49.3 50.5 37.4 22.5 20.0 2.715 Urban 54.6 80.1 61.3 78.9 62.7 62.7 49.4 24.2 21.5 700 Rural 37.4 64.1 46.5 56.2 44.6 46.2 33.3 21.9 19.4 2,015 Education No education 40.9 63.8 44.6 58.8 45.0 48.0 29.7 21.7 18.7 2,142 Primary incomplete 46.7 70.6 47.4 67.5 49.9 51.5 37.3 28.3 24.3 638 Primary complete/ some secondary 51.1 79.4 53.8 78.8 61.4 62.7 44.8 34.1 30.3 1,023 Secondary complete/ higher 65.3 86.4 66.7 88.1 73.5 75.1 60.4 40.4 35.9 2,511 Work status Working for cash 63.7 81.5 63.7 82.5 72.0 72.4 55.6 40.2 34.1 755 Not working for cash 51.4 75.3 54.0 73.5 57.8 60.0 43.7 30.7 27.2 5,559 Wealth index Lowest quintile 35.1 60.8 39.4 55.6 42.5 45.2 28.3 20.6 17.7 1,366 Second quintile 47.2 71.8 50.9 69.2 53.3 55.3 36.6 28.0 24.7 1,279 Middle quintile 57.0 78.3 55.7 75.7 61.9 65.7 43.7 35.1 30.5 1,323 Fourth quintile 61.8 82.3 61.0 84.1 65.9 68.1 55.6 37.4 32.4 1,319 Highest quintile 66.7 90.4 73.4 92.7 78.4 77.2 66.5 40.0 36.7 1.029 Total 52.9 76.0 55.2 74.6 59.5 61.5 45.1 31.8 28.0 6,314 58 [ Maternal Health 5.3 Perceptions about ANC Coverage The 2003 E IDHS inc luded two quest ions re lat ing to women's percept ions about antenata l care. The first quest ion re lated to the woman's percept ion about the extent to wh ich women seek antenata l care. Table 5.6 shows that 61 percent o f ever -marr ied women thought that most Egypt ian women rece ived antenata l care, 21 percent bel ieve at least some seek care, f ive percent i re o f the opinion that very few women get care, and 13 percent were unsure. Table 5.6 Perceived coverage of antenatal care Percentage of ever-married women age 15-49 by perceptions of coverage of antenatal care and lrend in antenatal care coverage, E~ypt 2003 Women go for prenatal care How many women seek antenatal care are increasin$ or decreasin~ Stay- Background Very Don't lncrea- Decrea- ing Don't Num- characteristic Most Some few None know Total sin~ sin[~ same know Total ber Antenatal eare Had birth 61.9 22.0 5.2 0.5 10.4 100.0 70.9 2.0 8.3 18:7 100.0 4,574 Antenatal care 66.3 19.8 3.4 0.3 10.2 100.0 75.3 1.7 6.9 16.0 100.0 3,326 No care 50.2 27.7 9.9 1.1 11.0 100.0 59.2 2.9 12.0 25.9 100.0 1,248 No birth 59.8 20.1 4.3 0.4 15.4 100.0 69.1 1.4 7.4 22.1 100.0 4,585 Age 15-19 55.8 21.3 4.6 0.9 17.4 100.0 65.6 1.6 8.4 24.3 100.0 343 20-24 62.5 20.6 5.4 0.2 11.2 100.0 71.1 2.1 7.0 '19.7 100.0 1,372 25-29 63.0 21.0 4.7 0.5 10.8 100.0 70.7 1.5 8.3 19.5 100.0 1,782 30-34 62.7 21.4 4.7 0.2 11.1 100.0 72.8 1.6 7.2 18.4 100.0 1,415 35-39 59.4 22.0 4.6 0.7 13.3 100.0 68.7 1.9 8.4 20.9 100.0 1,588 40-44 59.8 19.7 4.1 0.6 15.8 100.0 68.8 1.5 7.4 22.2 100.0 1,380 45-49 58.5 21.4 5.0 0.3 14.9 100.0 68.9 L5 8.4 21.2 100.0 1,279 Urban-rural residence Urban 63.8 15.2 2.4 0.2 18.4 100.0 72.1 0.7 5.0 22.3 100.0 3,908 Rural 58.7 25.4 6.5 0.6 8.8 100.0 68.4 2.5 10.0 19.1 100.0 5,251 Place of residence Urban Governorates 63.4 I 1.4 1.7 0.1 23.4 100.0 72.0 0.2 3.6 24.2 100.0 1,666 Lower Egypt 66.6 18.8 4.5 0.5 9.6 100.0 76.6 1.3 5.3 16.8 100.0 4,105 Urban 68.9 15.4 1.9 0.4 13.5 100.0 75.5 0.7 4.4 19.4 100.0 1,181 Rural 65.7 20.2 5.6 0.5 8.0 100.0 77.1 1.5 5.7 15.7 100.0 2,924 Upper Egypt 52.6 28.5 6.5 0.6 11.8 100.0 61.0 2.9 13.0 23.0 100.0 3,388 Urban 58.8 20.9 4.0 0.3 16.1 100.0 68.6 1.3 7.7 22.4 100.0 1,061 Rural 49.8 32.0 7.6 0.7 9.9 100.0 57.6 3.7 15.4 23.3 100.0 2,327 Education No education 53.9 25.9 6.5 0.8 13.0 100.0 63.4 2.5 11.0 23.1 100.0 3,452 Some primary 58.9 24.4 4.3 0.4 11.9 100.0 70.7 1.4 8.7 19.2 100.0 1,167 Primary comp./some secondary 64.3 20.0 4.7 0.1 11.0 100.0 72.7 1.2 8.7 17.4 100.0 1,270 Secondary comp./ higher 67.6 15.1 3.1 0.2 14.0 I00.0 75.7 1.1 4.0 19.2 100.0 3,270 Work status Working for cash 64.2 16.9 4.2 0.4 14.3 100.0 74.0 1.4 5.7 18.9 100.0 1,455 Not working for cash 60.2 21.8 4.8 0.4 12.7 100.0 69.3 1.7 8.3 20.7 100.0 7,704 Wealth index Lowest quintile 46.6 29.9 9.2 1.2 13.1 100.0 56.6 3.8 14.0 25.6 100.0 1,699 Second quintile 61.9 23.8 5.3 0.3 8.7 100.0 69.8 2.3 10.0 17.9 100.0 1,769 Middle quintile 64.1 22.0 4.4 0.3 9.2 100.0 74.3 1.3 7.4 17.0 100.0 1,874 Fourth quintile 66.5 17.4 3.0 0.2 12.8 100.0 75.8 0.6 5.2 18.3 100.0 1,937 Highest quintile 63.7 13.3 2.2 0.2 20.6 100.0 72.0 0.7 3.5 23.7 100.0 1,879 Total 60.9 21.0 4.7 0.4 12.9 100.0 70.0 1.7 7.9 20.4 100.0 9,159 MaternalHealth I 59 The second question asked women to provide an opinion about the trend in antenatal care in Egypt. Seven in ten women said that it was increasing, eight percent thought it was remaining at the same level, and less than two percent felt it was declining. The proportion of women who were unsure about trend was 20 percent. Looking at the differentials, it is clear that a woman's own experience with antenatal care is associated with her responses to these questions. Women who had had a recent birth and who had not themselves received antenatal care prior to the birth(s) were among the least likely to think that most Egyptian women were getting antenatal care and also the least likely to see ANC coverage going up. In general, other demographic and socioeconomic differentials in the distributions of women on these two questions follow expected patterns; younger women, rural women, women from Upper Egypt, women with no education, women who are not working or working in a job for which they are not paid in cash are less likely than other women to perceive that most women receive antenatal care and see antenatal care as becoming more common. Women living in households in the bottom quintile on the wealth index and ~vomen living in rural Upper Egypt are the least likely to believe that most women receive care and to see antenatal care as increasing. 5.4 Exposure to Safe Pregnancy Messages Media messages designed to make women more aware of the danger signs during pregnancy are part of the information, education and communication campaign to promote safe pregnancy. The 2003 EIDHS asked all respondents if they had heard or seen any message about pregnancy danger signs during the six month period prior to the survey and, if so, the last source from which they had received the information. Table 5.7 shows that slightly more than half of ever-married women had received information on the danger signs to watch for during pregnancy. Women age 45-49, women with no education and those living in households ranked in the lowest quintile on the wealth index were least likely to have heard a message (41 percent, 43 percent, and 40 percent, respectively). Women with a secondary or higher education (62 percent) were the most likely to have heard or seen a message. With regard to the most recent information source, 71 percent of these women said that they had last received the information through television. With the exception of medical providers who were the most recent source of information for 20 percent of women, less than 5 percent of women mentioned other information sources (e.g., radio or print media). Television was cited most frequently by women living in rural Upper Egypt (85 percent). The largest proportions mentioning medical providers were found among women under age 30, especially women 15-19, women living in the Urban Goveruorates and Lower Egypt, women with a secondary or higher education, and women from households in the two highest quintiles on the wealth index. 60 J Maternal Health Table 5.7 Coverage of safe Dreffnancv messazes Percentage of ever-married women age 15-49 reporting they had received information about danger signs women must be aware of to have a sa~ pregnancy during the six months prior to the survey and, among women receiving information, the percent distribution by the last source from which they received information, according to background characteristics, Egypt 2003 Background characteristic Percentage Number receiving Source of information of inlbrmation Med- women on Number ical Other Frierids/ Total receiving pregnancy of News- Pamph- pro- Hus- rela- neigh- per- informa danger signs women TV Radio papers let Poster vider band tives bors Other cent tion Antenatal care Had birth 56.3 4,574 70.9 0.2 0.3 0.3 0.3 20.7 0.3 4.1 2.8 0.1 100.0 2,575 ANC 59.4 3,326 69.1 0.1 0.2 0.4 0.3 22.4 0.3 4.1 3.0 0.1 100.0 1,974 NoANC 48.1 1,248 77.0 0.2 0.5 0.3 0.4 15.3 0.2 4.0 2.0 0.0 " 100.0 601 No birth 47.8 4,585 70:4 0.2 0.3 0.4 0.4 18.4 0.2 5.5 3.8 0.3 100.0 2,192 Age 15-19 59.2 343 51.7 0.6 0.0 0.0 0.0 34.3 0.4 9.0 4.0 0.0 100.0 203 20-24 58.7 1,372 61.8 0.4 0.4 0.3 0.3 28.6 0.2 5.2 2.9 0.0 100.0 806 25-29 59.0 1,782 68.6 0.2 0.1 0.4 0.5 24.7 0.1 3.2 1.8 0.2 100.0 1,052 30-34 56.2 1,415 71.7 0.0 0.3 0.2 0.6 19.0 0.5 4.0 3.6 0.0 100.0 795 35-39 49.6 1,588 75.7 0.0 0.8 0.2 0.3 14.2 0A 4.6 3.9 0.3 100.0 788 40-44 43.7 1,380 78.9 0.3 0.0 0.6 0.1 9.8 0.1 5.4 4.2 0.7 100.0 604 45-49 40.6 1,279 77.3 0.2 0.5 0.5 0.3 10.6 0.6 5.9 4.0 0A 100.0 519 Urban-rural residence Urban 53.9 3,908 68.6 0.1 0.5 0.6 0.5 22.3 0.3 3.8 2.9 0.4 100.0 2,106 Rural 50.7 5,251 72.3 0.3 0.2 0.2 0.2 17.6 0.2 5.5 3.6 0.0 100.0 2,662 Place of residence Urban Governorates 49.7 1,666 65.8 0.0 1.1 0.3 0.5 24,1 0.4 2.8 4.2 0.7 100.0 827 Lower Egypt 50.9 4,105 61.8 0.4 0.3 0.5 0.6 24.3 0.2 7.2 4.7 0.0 100.0 2,088 Urban 57.3 1,181 62,8 0.4 0.3 0.9 1.0 25.3 0.3 6.2 2.9 0.0 100.0 677 Rural 48.2 2,924 61,3 0.4 0.3 0.3 0.4 23.8 0.1 7.7 5.6 0.0 100.0 1,411 Upper Egypt 54.7 3,388 82.9 0.1 0.0 0.2 0.0 12.5 0.3 2.8 1.2 0.1 100.0 1,852 Urban 56.7 1,061 79.1 0.0 0.0 0.5 0.0 16.4 0.2 2.4 1.[ 0,3 100.0 602 Rural 53.8 2,327 84.7 0.1 0.0 0.0 0.0 10.6 0.3 3.0 1.3 0.0 100.0 1,251 Education No education 43.2 3,452 77.9 0.1 0.0 0.1 0.1 14.3 0.1 4.0 3.4 0.0 100.0 1,492 Some primary 44.1 1,167 69.5 0.0 0.0 0.3 0.2 17.8 0.0 7.3 4.8 0.0 100.0 515 Prim. comp./ sorne secondary 57.6 1,270 72.6 0.5 0.0 0.2 0.3 19.3 0.1 4.4 2.5 0.0 100.0 732 Secondary complete/higher 62.0 3,270 64.9 0.2 0.8 0.6 0.5 24.2 0.5 4.7 3.0 0.4 100.0 2,029 Work status Working for cash 55.4 1,455 68.0 0.2 0.6 0.7 1.5 19.4 0.3 4.6 3.9 1.0 100.0 806 Not working for cash 51.4 7,704 71.2 0.2 0.3 0.3 0.1 19.7 0.3 4.8 3.1 0.0 100.0 3,961 Wealth index Lowest quintile 40.4 1,699 77.4 0.I 0.0 0.0 0.0 14.5 0.2 5.4 2.4 0.0 100.0 686 Second quintile 50.6 1,769 72.9 0.0 0.3 0.2 0.3 17.7 0.1 4.6 3.8 0.0 100.0 895 Middle quintile 54.9 1,874 71.1 0.3 0.0 0.3 0.2 19.1 0.0 5.3 3.4 0.2 100.0 1,029 Fourth quintile 56.8 1,937 68.6 0.5 0.1 0.5 0.5 22.3 0.2 3.8 3.5 0.0 100.0 1,101 Highest quintile 56.2 1,879 66.2 0.0 1.1 0.5 0.6 22.5 0.7 4.8 2.9 0.6 100.0 1,056 Total 52.1 9,159 70.7 0.2 0.3 0.3 0.3 19.7 0.3 4.7 3.3 0.2 100.0 4,767 Maternal Health ] 6l 5.5 Delivery Care Hygienic conditions and proper medical assistance at the time of delivery can reduce the risk of complications and infection for both the mother and the new born baby. For all births in the five- year period before the survey, the 2003 EIDHS collected information on whether the mother was assisted by medical personnel or not and on the place of delivery. These results are presented in Table 5.8. In the majority of the births (69 percent) during the five-year period preceding the survey, the mother was assisted at delivery by a doctor or a trained nurse/midwife. Most of the remaining births were assisted by dayas (traditional birth attendant). With respect to the place of delivery, around 6 in 10 births are delivered in a health facility, with women being more likely to deliver in a private than in a public sector facility (36 percent and 24 percent, respectively). Table 5.9 presents differentials in the percentage of medically- assisted births and in the percentage of births taking place in a Table 5.8 Delivery characteristics_ Percent distribution of births in the five year period before the survey by the type of person assisting at the delivery and the place o['delivery+ Egypt 2003 [otal Assistance dur ing delivery Doctor 63.8 Trained nursc/midwii~ 56 Daya 282 Relative/other 2. I No care/missing 0.~ Place of deliver) Health ihcility 59.0 Public sector 23.4 Private sector 35.7 At home 40.9 Don't know/tnissing 0 I ['otal 100.0 N um bet 6,314 health facility. As expected, women who saw a medical provider for antenatal care during the pregnancy, especially those who received regular antenatal care, were more likely to have been assisted at delivery by a doctor or trained nurse/midwife and to have delivercd in a health facility. The mother's age is only very slightly associated with the type and place of delivery. The child's birth order is negatively associated with both of the delivery indicators; for example, the proportion of medically assisted deliveries births ranges from 82 percent among first births to 47 percent among births of order 6 or higher. Looking at other characteristics, both the likelihood that a birth will be assisted by medical personnel or that it will take place in health facility is greater among urban households, especially those living m the Urban Governorates, than among rural households. The proportions increase with the woman's education level, are higher llsr women who work than those who do not, and rise with the wealth index. With respect to the latter variable, women whose bousehold ranked in the bottom quintile on the wealth index were less than half as likely women whose household was ranked in thc lowest quintile (95 percent and 43 percent, respectively). 5.6 Postnatal Care Care following the delivery is very important for thc mother and her child, particularly when the birth is not assisted by medical personnel. It is generally recommended that mothers receive the first postnatal checkup within two days of delivery in order to detect problems that may lead to maternal death. Care for the Mother Table 5.10 looks at whether or not mothers received postnatal care following delivery |br all births during the five-year period before the 2003 EIDHS. Births are classified according to whether a medical provider assisted at the delivery or not and by the place of delivery (in a health facility or clse,,yhcre). Where a medical provider was present at thc delivery, the postnatal care refers to any checkup the woman may have received other than that which may have taken place at the time of the 62 J Malermd Hea/th Table 5.9 Medically assisted deliveries by background characteristics Among birlhs in the five-year period before the survey, percentage whose mothers were assisted at delivery by medical provider and whose mother delivered in a health facility according to selected background characteristics, Egypt 2003 Percentage Percentage assisted by delivered medical in health provider facility All births Medical care during pregnancy Had ANC 81.0 70.2 4,338 Four or more visits 84.6 74.5 3,51 I Fewer than 4 visits 65.9 51.6 827 No ANC 43.8 34.6 1,976 TT or other care 46.5 37.6 1,496 No medical care 35.2 25. I 479 Age at birth < 21") 67.5 57,2 735 20-34 69.8 59.3 4,905 35 49 68.0 59.2 674 Birth order 1 82.1 71.7 1,858 2-3 69.6 59.7 2,816 4 5 58.8 46.8 1,038 6+ 47.2 37.9 602 Urban-rural residence Urban 86.7 78.0 2,362 Rural 59.0 47.7 3,952 Place of residence Urban Governorates 90.2 82.5 91 I Lower Egypt 76.5 65.7 2,688 Urban 91.0 81.0 751 Rural 70.9 59.8 1,937 Upper Egypt 55.3 44.5 2,715 Urban 77.4 69.1 700 Rural 47.6 36.0 2.015 Education No education 47.8 38.5 2,142 Primary incomplete 62.9 52.2 638 Primary complete/some secondary 71.4 59.5 1,023 Secondary complete/higher 88.6 78,0 2.51 I Work status Working tot" cash 83.4 74.3 755 Not working lhr cash 6"/.5 57.0 5.559 Wealth index Lowest quintile 43.2 33.8 1,366 Second quintile 55.5 45.0 1.279 Middle quintile 73.1 61.2 1,323 Fourth quintile 86.2 74.5 1,319 ttighest quintile 95.0 87.3 1,029 Total 69.4 59.0 6,314 Maternal Health I 63 Del ivery care. For births assisted by dayas, re lat ives or other indiv iduals wi thout medical training, the postnatal care refers to any checkup from a medical prov ider occurr ing after the del ivery. Overa l l , mothers reported rece iv ing a postnatal checkup in the case o f around 4 in 10 births dur ing the f ive-year per iod before the survey. Among the mothers who had any postnatal care, around 70 percent had a checkup with in two days o f the del ivery. Table 5.1 ft Postnatal care tbr mother Percent distribution of births during the five-year period belbre lhe sur~ey, by timing, type oI provider and location of the first postnatal checkup for mother, according to the type of assistance at delivery and place of delivery. E~wt 2003 Type of assistance at delivery Place of delivery Delivery Medically assisted by Within Outside assisted daya/ health health Postnatal care delivery I other li~eility [ileility All births Timing of first postnatal checkup Within 2 days of birth 38.8 7.2 430 9 1 29.1 3-7 days of birth 9.6 5.1 100 5.7 8.2 8 27 days of birth 2.5 1,9 2.6 2.0 2.3 4+ weeks after birth 3.2 2 4 3.1 27 2 9 No care 45,8 83.4 41.4 805 57.3 Don't know/missing 0 1 0. I 0. I tl I 0. I Provider for first postnatal care checkup Doctor 51.3 80 56.9 10.7 38.0 Trained nurse/midwife 2.8 1.4 1.7 3.3 2.4 Daya 0. I 7.2 0.0 5.s 2 2 No care 45.8 834 41.4 80.5 573 Source for first postnatal checkup Public sector 16.2 1.2 20.7 2.9 I I.h Hospital 14 1.8 18.9 1.0 15 ttealth unit 0.5 0.1 1.3 1.8 0.3 MCtl center 31.3 3.5 0.5 0. I 22.8 Private doclor/clinic 4.4 9.6 3q.5 4.4 60 Home 0.3 04 24 I 1.1 0.3 Other location 0.2 00 /hO I. 1 0. I No care 45.8 83 4 41 4 80.5 57.3 Total percent 100.0 100.0 100.0 I/){h0 i 00.(l Number of births 4.380 1,914 3,732 2,582 6.314 Delivery ~as assisted by doctor or trained nurse/midwaY. Postnatal care checkups were much more common in births in which the mother was assisted by medica l personnel (54 percent) than among other births (17 percent). V ir tual ly all mothers who had a medica l ly -ass is ted del ivery also saw a medical prov ider for the first postnatal care checkup, and thc checkup took p lace in a health faci l i ty. Mothers who del ivered without medical assistance were seen a lmost as often by a daya as by a medica l prov ider for the first postnatal checkup, and the checkups frequent ly occurred at home. 1"able 5.10 also shows the patterns o f postnatal care for the mother accord ing to the place o f del ivery. As expected, postnatal care was more common for mothers who de l ivered in a health faci l i ty (59 percent) than for mothers who de l ivered outs ide a health Facility (19 percent). As expected a lmost all mothers who.de l ivered in a health faci l i ty saw a medical prov ider for the first postnatal care checkup, and the checkup genera l ly took p lace in a health Facility. Among mothers who del ivered outside a health faci l i ty and had a postnatal checkup, the major i ty saw a medica l provider for the first checkup, but many o f the checkups occurred in the home. 64 J Maternal Health Table 5.11 controls for the type of assistance at delivery in looking at differentials in the likelihood that the mother received postnatal care from a medical provider] The mother's age is not consistently related to the postnatal care indicators presented in the table. Although not uniform, the association between the child's birth order and the likelihood the mother will receive postnatal care is generally negative. Table 5.11 Postnatal care for mother by background characteristics Percentage of births in the five-year period belbre the survey for which the mother received at least one postnatal care checkup from a medical provider and for which the mother had the first checkup within two days of the delivery by type of delivery assistance, according to selected background characteristics, Egypt 2003 Medically-assisted Delivery assisted by delivery I daya/other All births Postnatal Postnatal Postnatal checkup checkup checkup within two Any within two Any within two Any Number Background days of postnatal days of postnatal days of postnatal of characteristics delivery care delivery care delivery care births Age at birth < 20 33.3 50.3 5.8 16.8 24.4 39.4 735 20-34 39.2 54.7 7,4 16.6 29.6 43.2 4,905 35-49 41.9 55.0 6.7 14.8 30.6 42.1 674 Birth order I 41.6 60.2 6.0 14.8 35.2 52.0 1,858 2-3 38,6 53.7 6.5 15.2 28.8 42.0 2,816 4-5 36.5 47.2 9.9 21.7 25.6 36.7 1,038 6+ 30.6 41.1 6.2 14.3 17.7 27,0 602 Urban-rural residence Urban 43.0 59.3 7.7 18.7 38.3 53.9 2,362 Rural 35.1 49.8 7.0 16.0 23.6 35.9 3,952 Place of residence Urban Governorates 46.0 63.4 7.9 22.8 42.3 59.4 91 I Lower Egypt 39.8 55.4 7.2 20.6 32.2 47.2 2,688 Urban 41.2 57.1 8.7 17.0 38.2 53.5 751 Rural 39.2 54.5 7.0 21.0 29.8 44.8 1,937 Upper Egypt 33.5 47.6 7.0 13.8 21.6 32.5 2,715 Urban 40.7 55.9 7. I 17.1 33,1 47.2 700 Rural 29.4 42.9 7.0 13.3 17.7 27.4 2,015 Education No education 35.6 4~,. I 6.6 15.2 20.4 30.9 2,142 Primary incomplete 40.8 51.8 7.5 17.6 28.5 39.1 638 Primary comp./some sec. 37.3 50.5 7.6 16.7 28.8 40.8 1,023 Secondary complete/higher 40.4 58.7 8.4 19.8 36.8 54.3 2,51 I Work status Working tbr cash 42.5 60.3 5.1 16.3 36.3 53.0 755 Not working for cash 38.2 53.2 7.2 16.4 28.1 41.2 5,559 WeaLth index Lowest quintile 28.2 41.3 4.3 13.0 14.7 25.2 1,366 Second quintile 36.6 48.6 8.7 17.2 24.2 34.6 1,279 Middle quintile 37.8 52.6 9.8 21.9 30.3 44.3 1,323 Fourth quintile 36.2 53.2 6.8 16.1 32.2 48. I 1,319 Highest quintile 50.8 69.0 13.3 23.4 49.0 66.7 1,029 Total 38.8 54.2 7.1 16.4 29.1 42.7 6,314 Delivery was assisted by doctor or trained nurse/midwife. 7Differentials in postnatal care levels by place of delivery are similar to those presented in Table 5.11 and, thus, are not shown separately in the report. Maternal Health ] 65 Urban mothers are more l ikely to rece ive postnatal care than rural mothers. Mothers in rural Upper Egypt have the lowest percentage report ing any postnatal care (27 percent) and women in the Urban Governorates have the h ighest percentage (59 percent). The percentage rece iv ing postnatal care increases wi th both the woman's educat ional level and with household wealth. It is also h igher in this group for women who work tbr cash than for other women. Care for Ch i ld Tab le 5.12 looks at whether or not the chi ld rece ived any postnatal care fo l lowing del ivery for the last birth dur ing the f ive-year per iod before the 2003 E IDHS. Aga in as was done in looking at care for the mother, births are c lass i f ied accord ing to whether a medical prov ider assisted at the del ivery or not and by whether the de l ivery took p lace in a health faci l i ty or not. Where a medica l prov ider was present at the del ivery, the postnatal care refers to any checkup a chi ld may have rece ived other than that wh ich may have taken p lace at the t ime o f the de l ivery care. For births de l ivered without medica l assistance, postnatal care also refers to any checkup from a medical prov ider that occurred after the del ivery. Table 5.12 Postnatal care for child Percent distribution of births during the five year period before the survey, by timing and location of the first postnatal checkup for child and mother's report as to whether sample of blood was taken from baby's heel during the first 2 weeks fi~llowing delivery, according to the type of assistance at delivery and place of delivery, Egypt 2003 Postnatalcare Type of assistance Place of at delivery delivery Delivery Medically- assisted by Within Outside assisted daya/ health health delivery ~ other facility 15cility All births Timing of first postnatal checkup Within 2 days of birth 30.3 6.9 33.4 8, [ 23.5 3-7 days of birth 20.2 16. I 20. I 17.3 19.0 8-27 days of birth 7.2 7.4 6.7 8.2 73 4+ weeks after birth 5.9 7.7 5.7 7.6 6.4 No care 36. I 61.7 33.9 58.6 43.5 Don't know/missing 0.3 0.0 0,3 0. I 0.2 Total 100,0 100.0 100.0 100.0 100.0 Number of births 3,257 1.306 2,793 1.781 4,574 Source for postnatal care provider Public sector 384 47 4 39.1 42.9 40.1 Hospital 21.4 8.7 23.5 7.5 18.9 ttealth unit 14.8 37.3 13.5 33.3 19. I MCH center 2.2 1.4 2.1 2 1 2 I Private doctor/clinic 52.7 34.3 54.6 35.7 49.2 Home 8.4 17.2 6.3 19.6 t 0. I Own home 7.7 16.7 6.0 18.1 9.5 Other home 0.7 0.5 0.3 15 0.6 Other 0.3 0.'~ 0.0 1.0 0.3 Don't know/missing 0.2 09 0, I 0.8 0.3 Total 100.0 100,0 I OthO 100.0 100.0 Number of births with checkup 2,083 500 2.083 sO0 2,584 Blood sample from child's heel Sample taken 26. I 15.5 27.0 16.7 23.0 Sample not taken 69.9 82.6 68.9 81.0 73 6 Don't know/Missing 40 1.9 4.1 24 3.4 Total 100 100 100.0 100.0 100 Number of last births 3,257 1,306 2,793 1,781 4,574 I Delivery was assisted by doctor or trained nurse/midwife. 66 I Maternal ftealth Overall, 56 percent of last births during the five-year period before the survey had a postnatal checkup from a medical provider. The checkup took place within two days of the delivery for around 40 percent of the births who had a checkup (24 percent of all births). For most of the babies, the checkup took place in a health facility; mothers reported that it occurred at home for only one in ten births for which a postnatal checkup was reported. With regard to the blood sample, 23 percent of all last births were reported to have had a blood sample taken from the heel during the two-week period following delivery. Postnatal care checkups for the child were more common if the mother had a medically-assisted delivery (64 percent) than among the mother not assisted by a medical provider (38 percent) and among births taking place in a health facility (66 percent) than among births outside a health facility (41 percent). Children whose mothers were assisted at delivery by a medical provider were more likely to have had a heel sample taken than were other children (26 percent and 16 percent, respectively). Similarly children whose mothers gave birth in a health facility were more likely to have had a heel sample taken than children whose mothers gave birth elsewhere (27 percent and 17 percent, respectively). Table 5.13 controls for the type of delivery assistance in presenting the differentials in the likelihood that a child will be seen by a medical provider for a checkup immediately after birth and in the percentages who had a blood sample taken from the heel. The highest percentages of infants receiving any care are found in the Urban Governorates (77 percent) and among households in the highest quintile on the wealth index (79 percent). The lowest proportions are observed for children of birth order 6 or higher (39 percent) and children living in households ranked in the lowest quintile on the wealth index (39 percent). Infants in rural Upper Egypt also are less likely to have postnatal care than children living in other areas. Looking specifically at the proportions of children for whom a blood sample was reported to have been taken from the child's heel, the differentials are generally similar to those observed with respect to any care. Overall, the proportion having the blood sample drawn is highest in the Urban Governorates (44 percent) and lowest in rural Upper Egypt (11 percent). Maternal Health I 67 Table 5.13 Postnatal care for child by background characteristics Percentage of last births in tbe five-year period belbre Ihe survey tbr which the child received postnatal care checkup and li)r which the mother reported a blood sample was taken fiom the child's leg by type of delivery assistance, according to selected background characteristics, Egypt 2003 Medically-assisted delivery I Delivery assisted by daya/other All births Blood Blood Blood sample Post- sample [)(>st- sal~lplc taken natal taken natal taken Ii"om check- [horn check- from Any Posmatal heel Any up hecl Any up hccl post- Num- check up within post withhl within post within within natal ber Background "~ ithin two two natal two two natal two two check- of characteristics days weeks checkup days weeks check-up days y weeks up births Age at birth < 2(I 26.3 21.6 63.3 7.7 17.0 387 208 20.2 560 387 20-34 30.4 27.6 63.9 7.3 158 40.0 23.8 2+3 57.1 3,606 35 49 32.4 19.3 647 4.0 116 26.6 23.8 16,9 53,1 581 Birth order I 33.5 30.7 70.2 6.0 22.6 46.3 294 29.5 66.6 1.071 2-3 31,0 26.7 04.5 79 16.7 40.2 24.9 24.0 58.0 2.165 4-5 25.4 20.0 57.4 7,2 13.5 37.3 18.4 17.5 49.6 848 6- 23.4 17.7 504 4 7 10.2 29.0 139 138 39.4 489 Urban-rural residence Urban 38.5 30,7 71.6 10.0 20.2 415 35.1 29.5 68.0 1.792 Rural 22.5 21.7 56.7 6.3 14,4 374 16.1 188 493) 2.782 Place of residence Urban Governorates 47.9 45. I 80.0 5.8 314 36,7 44.5 44.0 76.5 710 Lower Egypt 23,5 26.7 60.6 3.3 24,6 45.0 19.4 26.2 57.1 2.013 Urban 26.9 25.5 63.3 12,5 30.3 44.3 236 259 61.6 578 Rural 21.7 27.3 59.2 4.4 23.9 451 16.9 26.3 55.3 1.435 Upper Egypt 29.4 13.4 58.9 7.9 9 0 34.2 21)(I I 1.5 48.2 1,85 I Urban 38.5 14.1 69.0 l l.2 90 42.8 32.8 130 635 503 Rural 23.8 12.9 527 7.4 9.1) 32.9 153 10.9 42.4 1,347 Education No education 22.0 19.5 54.9 6.0 12.7 330 140 16 1 439 1,499 I'rimal3~ incomplete 29.1 21.1 60.5 4.4 168 4~8 201 195 544 469 Primary comp./some sec. 33.1 286 65.5 114 17.8 47.5 27.1 256 605 725 Sec. comp./higher 333 29 1 68.0 77 22.0 430 30 7 284 654 1.881 Work status Working for cash 38.8 265 690 8. I 21. I 40.7 33.9 25.7 64.5 582 Not working for cash 28.8 26.0 63/) 6.8 14.9 37.9 22.0 22.6 55.3 3.992 Wealth index Lowest quintile 16.0 16.1 48.1 3,6 10.4 30.9 9.1 12.9 38.5 904 Second quinlile 19.8 21.I 54.0 9.0 16.7 39.3 15.1 19.2 47.7 913 Middle quintile 27.4 25.6 60.1 8.6 19.3 46.1 225 24.0 56.4 955 Fourth quintile 28.5 27.7 65.8 108 19.7 41.7 26.2 26.7 62.7 983 Highest quintile 49.2 33.2 80.2 4.5 261 54.g 46.9 329 789 818 Total 30.3 26.1 63.9 6.9 154 38.1 23.5 23.0 565 4,574 I Delivel~ was assisted by doctor or trained nurse/midwife 68 J Maternal Health 5.7 Trends in Maternal Health Indicators Tab le 5 .14 presents the t rend in key materna l heal th ind icators by res idence for the per iod between the 1988 and 2003 DHS surveys . Overa l l , there has been a s teady upward t rend in al l o f the indicators . Focus ing on the recent per iod (i .e., between the 2000 and 2003 surveys , the increase in antenata l care coverage was par t i cu la r ly notable . The percentage o f b i r ths in wh ich the mother repor ted rece iv ing any antenata l care rose f rom 53 percent in 2000 to 69 percent in 2003, and the percentage o f b i r ths hav ing regu lar antenata l care (i .e., at least four v is i ts) rose f rom 37 percent in 2000 to 56 percent in 2003. The percentage o f b i r ths in wh ich the mother rece ived a TT in ject ion a lso increased, f rom 72 percent in 2000 to 78 percent in 2003. S ix ty -n ine percent o f de l iver ies were ass is ted by med ica l personne l (a lmost a lways a doctor ) in 2003 compared to 6 l percent in 2000. A l l res ident ia l ca tegor ies shared in the improvements in materna l heal th ind icators between the 2000 and 2003 surveys . Rura l areas, however , cont inue to lag beh ind urban areas in both antenata l care coverage and in med ica l ly -ass i s ted de l iver ies . Wi th in rural Egypt , the abso lu te increase in antenata l care coverage were somewhat greater in Upper Egypt than in Lower Egypt wh i le the abso lu te increase in med ica l ly -ass i s ted de l iver ies was greater in Lower Egypt than in Upper Egypt . Table 5.14 Trends in maternal health indicators Percentag of births in the fi',e years preceding the survey whose mothers had at least one tetanus toxoid injection, antenatal care from a doctor or trained nurse-midwife, and four or more antenatal care visits, and percentage whose mothers were assisted at delivery by a medical provider, by urban-rural residence and place of residence, Egypt, 1988-2003 Place ofresidence Urban Maternal health Residence Gover- Lower Egypt Upper Egypt indicator Urban Rural norates Total Urban Rural Total Urban Rural Total Antenatal care A~X 1988 u u u u u u u u u u 1992 u u u u u u u u u u 1995 58.3 27.2 59.2 41.9 65.2 34.5 28.6 51.2 20.8 39.1 2000 70.4 41.9 74.1 53.5 71.2 47.2 44.3 65.1 36.9 52.9 2003 82.9 60.4 83.9 75.2 86.3 70.9 57.4 77.8 50.3 68.8 Regular 1988 u u u u u u u u u u 1992 u u u u u u u u u u 1995 50.0 14.9 55.1 27.9 52 20.2 17.9 40.6 I 0. I 28.3 2000 53.9 25.9 56.0 38.9 56.2 32.8 27.2 49.8 19.2 36.7 2003 73.5 44.9 75.4 61.1 76.4 55.2 43.5 68.0 35.0 55.6 Tetanus toxoid injection 1988 12.6 10.6 8.8 13.1 14.8 12.5 II.I [7.3 8.6 11.4 1992 56.9 57.5 52 64 67.8 62.7 53.3 55.3 52.8 57.8 1995 66.7 71.2 64.2 75.6 70.2 77.4 66.3 67.6 65.9 69.5 2000 70. I 73.9 62.4 79.1 75.3 80.4 70.0 75.4 68. I 72.4 2003 71.1 82.1 66.2 83.6 75.0 86.9 76.5 73.5 77.5 78.0 Medically- assisted deliveries 1988 57.0 19.1 64.9 31.1 54.4 23.3 23.9 46.9 14.4 34.6 1992 62.5 27.5 68.3 39.7 62.9 32.5 29.7 51.8 23.0 40.7 1995 67.9 32.8 69.2 51.4 75.1 43.9 32.2 59.6 22.9 46.3 2000 81.4 48.0 83.7 65.1 84.7 58.1 47.8 74.7 38.2 60.9 2003 86.7 59.0 90.2 76.5 91.0 70.9 55.3 77.4 47.6 69.4 u = unknown (not available) Maternal Health ] 69 6 CHILD HEALTH AND NUTRITIONAL STATUS OF CHILDREN AND WOMEN Increasing the proportion of children who are vaccinated against the major preventable diseases of childhood is a cornerstone of Egypt's child survival programs. This chapter presents information from the 2003 EIDHS on the level of immunization among young children. The chapter also considers information from the EIDHS on the prevalence and treatment of diarrhea and acute respiratory infections, illnesses that are among the most common causes of childhood deaths in Egypt. Finally, the chapter also looks at several important aspects of the nutritional status of Egyptian children and their mothers. 6.1 Immunizations The World Health Organization guidelines for childhood immunizations call for all children to receive during the first year of life a BCG vaccination against tuberculosis, three doses of the DPT vaccine (DPT 1, DPT 2 and DPT 3) to prevent diphtheria, pertussis and tetanus, three doses of polio vaccine (Polio 1, Polio 2 and Polio 3), and a measles vaccination. In addition to these standard immunizations, Egypt's childhood immunization program recommends that children receive three doses of the hepatitis vaccine, booster doses for DPT and polio, and the MMR vaccine against measles, mumps and rubella. Immunization Levels Immunization information from the 2003 EIDHS is presented in Table 6.1 for children 12-23 months. The age range was chosen in order to assess the current situation with respect to immunization coverage. The table shows that birth records and/or health cards were available in the case of 74 percent of these children. For children who did not have a record, the information on vaccinations was based on the mother's report, s Virtually all children 12-23 months have received at least some of the recommended vaccinations. Coverage levels for BCG are nearly universal, and 96 percent have received a measles vaccination. Ninety-three percent of the children have received the recommended three doses of the DPT and polio vaccines (DPT 1-3 and Polio 1-3). Overall, 88 percent of children are considered as immunized against all major preventable childhood diseases, i.e., they have received a BCG and measles vaccination and the three DPT and three polio immunizations. Looking at the other vaccines for which data is shown in Table 6.1, coverage levels are relatively high for the hepatitis vaccine, with 79 percent of children reported as having received the third dose of the hepatitis vaccine. Levels are lower for the other vaccines shown in the table (15 percent for Polio 0; 33 percent for Activated DPT; 34 percent for Activated Polio and 32 percent for MMR). The low coverage levels for the latter vaccines are not unexpected in view of the fact that the vaccines have only recently been introduced into the immunization schedule. Differentials in Vaccination Coverage Table 6.1 also presents differentials in vaccination coverage. Looking at the differences in the proportions considered as fully immunized, girls are slightly less likely to be fully immunized than boys (89 percent versus 86 percent). By residence, the percentages fully immunized vary from 86 Sin Egypt, immunizations may be recorded on a child's birth record (certificate) or on a special health card. In collecting data on immunization coverage in the 2003 EIDHS, mothers were asked to show the interviewer the birth record and/or health card for each child born since Janua~ T 1998. When the mother was able to show the birth record and/or health card, the dates of vaccinations were copied from the document(s) to the questionnaire. If neither a birth record nor a health card was available (or a vaccination was not recorded), mothers were asked a series of questions to determine whether the child had ever received specific vaccines and, if so, the number of doses. Child Health and Nutritional Status of Children and Women I 71 "~ II able 6.1 Vaccinations by background characteristics m 2a~ \mong children 12-23 months, perccntagc ~ho had vaccination records seen and percentage "aho received each ~accinc (according to the ~ accination cards or the mother's report) and. pcrcentage ~ith a \ accination card. b~ selected background characteristics, Egypt 2003 3' Background Record characteristic seen Vaccinations Fully Number Hepa- Hepa- Hepa- immu- of BCG DPT 1 DPT 2 DPT 3 ADPT Polio 0 Polio 1 Polio 2 Polio 3 Polio 4 AP tiffs 1 tiffs 2 titis 3 Measles MMR nized ~ None children 8ex Male 74.6 99.0 99.7 95.8 92.9 33.2 15.3 99.6 95.9 93.5 69.4 36A 93.0 84.6 793 96.4 303 88,5 0.0 648 Female 730 993 99.4 93.3 92.3 33.4 13,5 99.8 94.0 93.1 609 329 94.3 83.2 78.6 94.6 34.1 86.3 0.2 544 1 Urban-rural residence Urban 71.1 I000 1000 96.3 93.9 34.9 13.8 10/)0 965 94.6 65.5 34.4 92.8 84.6 79,4 96.0 37,4 88,8 0,0 449 Rural 75.5 98.6 99.3 93.6 918 32.3 14,9 99.4 942 92.5 65.5 348 94.1 83.5 78.8 95.3 28.8 86.7 0.1 742 PLace o f residence Urban Govemorates 61.4 1000 100.0 97.9 93.4 35.3 140 100,0 981 955 63.9 33.8 93.3 82.9 78.4 947 34.5 87.2 0.0 185 Lower Egypt 73.0 99.0 100.0 937 91.9 32.4 15.1 997 92.9 90.8 64.5 33.9 93.7 82.7 770 96.8 34.4 N7.0 0.0 514 Urban 760 100.0 100.0 92,1 911 339 14.6 100.0 91.1 88.8 71.5 356 91.6 80.7 73.6 976 369 865 0.0 140 Rural 718 98.6 100.0 94.2 92.2 31.9 15.2 996 93.6 91.5 61.9 33.3 94.6 83.5 783 965 33.4 87.2 00 374 Upper Egypt 79.4 98.9 99.0 94.4 93.1 33.4 14.1 99.5 96.1 95.1 67.1 35.7 93.5 85.6 81.3 94.6 28.7 88.1 02 493 , Urban 81hl 100.0 100.0 987 98.0 35.5 12.6 100.0 100.0 99,6 61.1 339 934 91.4 87.4 96.2 42,2 937 0.0 125 Rural 79.2 98.5 986 93.0 91.5 32.7 146 993 94.8 93.6 69.2 36.4 93.6 83.6 79.2 941 24.2 86.3 0.3 368 Educat ion No education 76.8 98.9 98.8 91.9 90.2 333 /43 98.9 91.5 896 64.5 34.6 92.9 81.9 775 94.0 30.5 82.8 03 375 i primary incomplete 76.0 976 998 899 874 28.3 25.0 100.0 90.2 884 63.6 32./I 88.5 74.3 695 960 26.5 85.1 /1.0 116 i Prima W complete'some secondary 7931 98.1 100.0 96.3 92,0 300 11.9 100.0 97.2 943 69.4 32.6 95.0 82.7 75.(I 961 24.7 86.3 00 199 Secondary comp higher 691 100.0 100.0 97.1 95.9 357 132 100,0 97,9 968 652 36.1 947 88.1 83.9 96.4 37.4 92.0 00 502 V~ork status Working for cash 71,5 100,0 1000 97.1 94.9 38.5 18.9 1000 965 94,1 62.7 388 962 839 80.7 94.8 43.9 898 00 135 Not working for cash 74.1 990 995 943 924 32.6 13,9 99.6 948 932 659 34.1 93.3 83.9 788 957 30.5 87.2 01 1,057 Weal th index Lowest quintde 71.3 974 987 90.1 88.6 31.3 13.3 995 914 896 588 31.9 919 78.7 724 93.7 301 80 I 00 244 Second quintile 75.8 984 993 92,9 89,4 30.4 160 98.7 93.8 907 64.9 34.5 92.5 82.1 764 955 24.7 86.5 0.5 221 Middle quintile 823 99.8 99.9 97.3 96.0 383 161 100,0 978 971 730 391 942 86.8 82,9 95,4 297 919 00 256 Fourth quintile 72.8 100.0 100.0 95.4 94.5 33.6 140 1000 951 93.6 694 36.6 05.0 85.2 81.6 96.0 36.2 88.3 0.0 281 ttighest quintile 65.(I 100.0 100.0 978 94.3 318 12.7 1000 972 957 58,9 295 94.2 87 I 816 976 40.1 91.2 0.0 190 Total 2003 EIDtlS 73.8 99.1 99.6 94.6 92.6 33.3 14,5 997 950 93.3 655 34.7 93.6 83.9 79.0 95.6 32.1 87.5 0.l 1,192 Total 2000 EDHS 725 993 992 971 940 NA NA 996 97.7 94.9 NA N a, 987 963 930 969 NA 922 0.2 2,170 ADPT Activated DPT AP Activated polio MMR Measles, mumps, and rubella Children are considered fully immunized have received the BCG vaccine, the DPI 1, DPT 2 and DP I 3 vaccines, the Polio 1, Polio 2. and Polio 3 vaccines, and tile measles vaccines. Percent in rural Upper Egypt to 94 percent in urban areas in the same region. Looking at mother's education, the percentage fully immunized ranges from a low of 83 percent for children whose mother never attended school to 92 percent among children whose mothers completed the secondary level or higher. The lowest coverage shown in the table is found among children living in households in the bottom rank on the wealth index; 2 in 10 children in this group have not received all of the basic immunizations required to be fully immunized against the six preventable childhood illnesses. Trends in Vaccination Coverage Table 6.1 also shows the trend in the proportion of children fully immunized against the six preventable childhood illnesses between the 2000 and 2003 DHS surveys. The level found in the 2003 EIDHS is slightly lower than the level reported in the 2000 EDHS, reflecting small drops in the proportions receiving the DPT 1-3 immunizations (from 94 percent in 2000 to 93 percent in 2003), the Polio 1-3 immunizations (95 percent in 2000 to 93 percent in 2003) and the measles vaccine (97 percent in 2000 to 96 percent 2003). Some caution should be exercised in interpreting the trend between the 2000 DHS and the 2003 EIDHS since the sampling variability is greater in the 2003 EIDHS than in the 2000 survey due to the EIDHS's smaller sample. 6.2 Diarrhea Dehydration caused by severe diarrhea is a major cause of illness and death among young children. A simple and effective response to dehydration is a prompt increase in the child's fluid intake through some form of oral rehydration therapy (ORT). ORT may include the use of a solution prepared from commercially produced packets of oral rehydration salts (ORS) or a homemade mixture usually prepared from sugar, salt and water. Increasing the amount of any other liquids given a child during a diarrheal episode is another means of preventing dehydration. In the 2003 EIDHS, mothers of children under five years of age were asked about whether any of their children under five years of age had had diarrhea at any time during the two-week period. 9 If the child had had diarrhea, the mother was asked about feeding practices during the diarrheal episode and about what actions were taken to treat the diarrhea. Table 6.2 shows the percentages of children under five years of age who had had diarrhea at some time during the two-week period before lhe survey and, among children ill with diarrhea, the percentages receiving medical care, oral rehydration therapy (ORT), or other treatments. Overall, 19 percent of children were reported as having had diarrhea in the two-week period prior to the survey. The age pattern shows the typical peak in diarrhea prevalence among children age 6-23 months. The results in Table 6.2 indicate that some effort is made to treat the diarrhea in most episodes in young children; mothers reported that nothing was done in only 16 percent of the cases. With regard to specific actions taken when a child was ill with diarrhea, mothers sought advice or treatment at a health facility in 46 percent of the diarrheal episodes. Among those receiving medical advice, private health care providers were consulted more often than providers at public sector facilities. As discussed earlier, increasing a child's fluid intake during a diarrheal episode is important to prevent or treat dehydration. Table 6.2 indicates that ORT was used in treating around one-third of the children who suffered from diarrhea. Around one-quarter of mothers reported that ORS packets were used in treating the diarrhea compared to nine percent who used recommended home fluids. Mothers reported that the child was given more fluids in a total of 31 percent of the cases. Altogether some form of ORT or increased fluids was used to treat a little more than half of the diarrheal episodes. '~Since there are seasonal variations in the pattern of diarrheal illnesses, it should be remembered that the percentages in Table 6.2 represent the prevalence of diarrhea at the time of the 2003 EIDHS (i,c,, May June 2003) and not the situation at other times of the year in Egypt. Child Health and Nutritional Status of Children and Women I 73 Xx ~a % Table 62 Prevalence and lrcatment of diarrhea Percentage o f children under five years ill with diarrhea in the two weeks before the sur~ey and, among ill children, percentage receiving medical care. oral rchydration therapy tORY), other treatment and no treatment, scleeled background characteristics, i g.?'pt 2003 Percentage of Medical care from: Oral rehydration therapy Other treatments chi ldren il l with Any health PuNic Private ORS Background RHSat E i therORS Increased ORT/Increase characterislic diarrhea provider provider provider packel home or RHS fluids d fluids Child's age Under6monlhs 201 469 159 31.2 271 6.6 31 I 169 41.4 6 II months 377 542 212 331 389 101 45.1 269 59.3 12 23 months 280 47,5 187 29 1 32,9 101 38.5 36.1 61.6 24-35 months 175 498 20,6 294 22,8 105 293 340 q7.6 36-47 months 11.6 244 I 0,7 137 14.5 7.1 194 298 479 48 59 months 72 365 86 280 151 4.9 18.3 31.7 44.6 Sex Male 199 507 17.6 334 28.6 106 351 316 56.6 Female 177 396 175 22.1 276 71 318 293 537 Birth order 1 221 485 14.5 343 27.0 6.7 311 327 q36 2-3 182 443 177 268 27.8 82 332 293 ~46 4-5 18.5 443 214 22.8 29.6 130 376 242 536 6+ 13.0 441 237 20.3 32,7 151 394 434 724 Urban-rural residence Urban 16.8 46.2 154 31 I 208 70 252 333 509 Rural 20.2 45.5 /87 269 318 101 379 292 s75 Place of residence Urban Govemorates 17.8 398 134 269 225 0s 23 1 425 56 I Lower Egypt 191 41 9 /3 / 289 240 38 269 294 475 Urban 160 457 104 356 I I 3 82 170 25.3 36~ Rural 203 408 /39 268 279 24 300 30.7 508 Upper Egypl 191 5 /4 235 281 341 170 437 27.9 628 Urban 16,3 562 238 32.4 28.5 152 370 285 587 Rural 20.0 501 23.X 269 357 176 455 27.7 640 Education No education 16.9 467 233 23.4 363 126 428 26.4 596 Primar'r incomplete 2(15 438 M.3 287 34.8 59 372 28.6 560 Prim.comp.isome sec 233 476 195 283 234 94 302 28.7 512 Secondarycomp/h igher /84 446 129 320 224 70 273 35.3 538 %gork status Working for cash 14.(I 46g 107 360 19.0 67 217 30.5 462 Not working for cash 19.6 457 18.3 275 29.0 93 348 30.6 561 Wealth index Lowest quinti le 21.9 425 22.3 204 37.3 13.2 450 30.5 647 Second quinti le I8.fl 47.3 Iq5 279 34.5 84 401 22.8 535 Middle quintilc 19.0 50.5 19.7 309 26.4 95 3 /2 275 502 Fourth quinl i le 179 44.6 136 314 21.8 72 256 328 518 Highest quimile 162 43.3 9.0 343 14.8 48 194 435 541 Total 189 45.7 176 283 282 91 336 30.6 553 Number of Home children with Antibiotics Otherp i l l IV remedy/Olher None diarrhea 22.2 32.5 5 5 85 204 122 23.5 36.3 66 4 7 125 248 25.9 346 74 3.9 98 334 18.5 347 50 83 18.9 218 14.1 31.7 56 98 22.8 138 13.0 367 q 5 4,5 18.5 83 19.7 380 71 62 13.4 630 23./ 303 5.2 b.l 17.9 514 22.8 378 85 4.2 152 392 22.6 349 4.4 7.7 15.6 494 153 31.6 4.9 69 171 183 179 22.1 10.1 5.0 117 74 226 405 42 9.2 157 383 205 31.6 72 4.6 153 760 238 44.4 18 93 160 159 250 353 60 74 17.1 492 221 412 41 13.9 19.2 116 259 33.3 66 54 16.4 376 166 30 7 79 39 13.7 493 216 342 79 43 11.6 109 152 297 79 38 14.2 384 153 271 81 40 18.3 344 210 381 48 128 94 127 257 314 58 6,1 19.3 226 235 409 54 60 131 447 170 467 ~5 11.5 131 101 216 334 6.3 57 157 1,043 176 257 106 4.2 14.3 280 231 33.9 4.7 4.3 155 233 195 35.1 6.3 7.3 186 243 216 42.5 4.2 6.2 135 226 265 391 3.5 10.7 M4 162 212 346 6.2 6.2 155 I , /44 qote: Oral rehvdrat[otl therapy fl)R] ) includes use of solutions prepared from oral rehydrafion salt (ORS) packets and ol recommended home fluids (RHS }, ¢g , sugar-salt-water so/ulions Increased fluids includes increased frequency of breastl~eding ~ublic sector providers include government hospitals and health unit~ Pri~ ate secI(ir pro~ider~ include private hospila/s c/ini s and privale doc[or~ The pereenlage cons/J]Iing a pub/i seelor provider and lhe percentage consulting a prll ale secIor Irm ider do not sun! to the tolal percentage col!su khlg any heahh plo%ider because , ill a small proportion of cases, more Ihan one lyp¢ ofpru~ ider ~t as consulted. IV relel s to intravenous fluids Antibiotics and other antidiarrheal medications are generally not recommended for treating diarrhea in young children. However, Table 6.2 shows that antibiotics were given to 21 percent of the children with diarrhea and around one-third of the children received some other type of medication. Considering the differentials in Table 6.2, there are marked differences in the age patterns for most treatment indicators. For example, children under age 3 are more likely than older children to be taken to a health provider when they are ill with diarrhea, and they are also more likely to be treated with ORT. Looking at sex differentials, boys are markedly more likely than girls to be taken to a provider for treatment (particularly private providers), and girls are more likely than boys not to receive any treatment. ORT therapy is a more common treatment for diarrhea in rural than urban areas while urban mothers, particularly those in the Urban Governorates, are more likely than rural mothers to report increasing general fluids than to employ ORT. Both the educational level of the mother and the wealth index are inversely related to the use of ORT. Reliance on antibiotics or other medications to treat diarrhea is somewhat more common in urban than rural areas. 6.3 Acute Respiratory Infection Along with diarrhea, acute respiratory infection (ARI), particularly pneumonia, is a common cause of death among infants and young children. Early diagnosis and treatment with antibiotics can prevent a large proportion of the deaths due to pneumonia. The 2003 EIDHS collected information on the prevalence of symptoms of ARI and on the treatment children with AR1 symptoms received. As in earlier DHS surveys, the prevalence of ARI was estimated in the 2003 EIDHS by asking mothers if their children under five years of age had been ill with coughing accompanied by short rapid breathing in the two weeks before the survey. Cough and short, rapid breathing are signs and symptoms of pneumonia, and thus, the EIDHS results are less appropriate for use in assessing the presence of other ARI-related conditions (coughs and colds, wheezing, ear infection, and streptococcal sore throat). The mother's report is also subjective, reflecting her perception of the symptoms the child had. The E1DHS results indicate that the prevalence of cough with short, rapid breathing during the two- week period before the survey was 10 percent among children under five years of age (Table 6.3). Differentials in the proportions of children with ARI symptoms are small. The largest differences are by the child's age, with children 6-11 months having the highest rate of illness followed by children 12-35 months. Women whose children had ARI symptoms were asked whether they had sought advice or treatment for the illness. The mothers reported that advice or treatment was sought from a health provider for 70 percent of the children who were ill. Private providers were consulted more often than government health facilities (48 percent and 23 percent, respectively). Differences in the likelihood of seeking medical advice are quite evident. Medical advice was sought more often in cases when the child was less than one-year old than when the child is 12 months and older or when the child is a boy rather than a girl. Children from Upper Egypt were more likely to be taken to a provider than children from Lower Egypt or from the Urban Govemorates. Mothers with at least a primary education were more likely to seek medical advice than less-educated mothers. The percentage seeking medical advice also increased with the household's ranking on the wealth index. Table 6.3 also shows the percentage of children who were given antibiotics to treat respiratory illness. According to the mother, 73 percent of children who had a cough and short, rapid breathing were treated with an antibiotic. Those who were most likely to receive antibiotics included children 6-11 Child Health and Nutritional Status of Children and Women I 75 months, urban children, especially from urban Lower Egypt, children whose mothers had a secondary or higher education, and children falling in the top three quintiles on the wealth index. Table 6.3 Prevalence and treatment of acute respiratory disease Percentage of children under five ill with ARI symptoms in the two weeks before the survey and. among ill children, percentage receiving medical care, antibiotics, and no Ireatment by selected background characteristics, Egypt 2003 Percentage Among ch0dren with AR[ symptoms, percentage of receiving: children Medical care from: ill with cough and Any Number Background short, rapid health Public Private Anti- No of characteristic breathing provider provider provider biotics treatment children Child's age Under 6 Months 7.3 76.4 26.3 50.6 73.7 I 7 5 6 l O 6-I I Months 15 5 799 26.(I 54.5 81 4 8 4 658 12-23 Months I 1.4 72 4 20.2 53.2 74.4 16. I I, 192 24-35 Months I 1.5 63.9 20.0 455 70.5 22.9 1,243 36-47 Months 8. I 63.4 21 7 41.7 63,6 20.6 I, 195 48-59 Mouths 8.3 7l) 0 302 40.3 76.9 16.9 I, 158 Sex Male 10.6 75.9 23. I 53. I 79 7 12.0 3,16 I Female 9.9 63.5 23.6 41.3 65,9 23.6 2,895 Birth order I 9. I 71. I 19.6 52,6 75.5 15.0 1,777 2 3 I 1.3 74.0 23.4 51.3 74.4 16.9 2319 4-5 10.6 6(i,2 24.6 36.4 67.5 22.6 993 6- 78 644 338 306 71.6 16.7 567 Urban-rural residence Urban I I. I 68.2 21,2 47.0 77.3 18.0 2.284 Rural 9.7 71.6 24.8 48.0 70.6 16.9 3372 Place of residence Urban Govemorates 12.5 69.8 22.7 47.1 76.3 23.4 892 Lower Egypt 12.3 66.0 16 8 49.9 68.7 19.6 2,579 Urban 12.3 62.8 15.7 475 70.7 19.9 725 Rural 12.3 67.2 17.2 50.9 67.9 19.5 1,853 Upper Egypt 7.3 77.5 34.7 44. I 79.2 10.0 2,585 Urban 7.7 73,9 27,8 46, I 9l).7 3. I 667 Rural 7.2 78.9 37.3 43.4 75.0 12.5 1,918 Education No education 10.5 64.7 33.3 33. I 63 5 21.6 2,03 I Primal2¢ incomplete 12. I 64.9 19.3 46.0 70.9 18.5 620 Primary complete/some secondary 11.4 75.5 t9.6 55.9 76.4 14.0 972 Secondary comp,/higher 9, I 746 17.0 58.0 82(1 14.5 2,433 Work status Working for cash 10.6 71.9 21.0 51.6 64.6 17 6 724.0 Not ,~ orking tbr cash 10.2 70.0 23.7 47. I 74.5 17.3 5.332.0 Wealth index Lowest quintile 10.5 58.2 28.8 29.6 55.6 25.6 1,278 Second quintile 8.4 68.8 25. I 46.0 69.6 182 1,233 Middle quintile 12.0 73.2 33.8 4th7 78.9 13.0 1,280 Fourth quinti[e 10.4 76.t 17.8 58.6 83 0 14 3 1,265 ltighest quintile 9.5 75.6 4.6 71.0 79.9 16.11 1,000 Total 10.2 70.2 23.3 47.6 73 3 17.3 6~056 76 [ Child Health and Nutrilional Status. o/' Children and ~)mwn 6.4 Breastfeeding and Supplementation The pattern of infant feeding has an important influence on the health of children. Feeding practices are the principal determinant of a young child's nutritional status, and poor nutritional status has been shown to increase the risk of illness and death among children. Breastfeeding practices also have an effect on the mother's fertility. Frequent breastfeeding for long durations is associated with longer periods of postpartum amenorrhea and thus longer birth intervals and lower fertility. Initiation of Breastfeeding Early initiation of breastfeeding is beneficial for a number of reasons. For the mother, early suckling promotes the release of a hormone that helps the uterus achieve a contracted state and reduces the risk of postpartum hemorrhage. For the child, it is important to receive the colostrnm, which is contained in the first breast milk after delivery and is rich in antibodies. Table 6.4 shows that more than 9 in l0 children in every subgroup were reported as ever breastfed. Among the children who were ever breastfed, the majority began breastfeeding soon after birth; 52 percent of the children were put to the breast within an hour after delivery, and 87 percent were breastfed within the first day. Both medical assistance at delivery and delivery at a health facility are associated with lower proportions of children for whom breastfeeding was initiated within an hour of birth. Even among children in these subgroups, however, breastfeeding was initiated for more than eight in ten children within 24 hours of birth. In general, the characteristics associated with facility deliveries or medical assistance at delivery (e.g., urban residence and higher educational levels) are also associated with somewhat later initiation of breastfeeding. Prelacteal feeding is the practice of giving other liquids to a child during the period after birth before the mother's milk is flowing freely. Overall, according to Table 6.4, slightly more than half of all children born in the five years prior to the survey received prelacteal feeds during the first three days after birth. In general, differentials in the level of prelacteal feeds are comparatively small, with the greatest variation observed by place of residence. Introduction of Complementary Feeding The Ministry of Health and Population has adopted the recommendation from UNICEF, WHO and other international agencies that during the first six months of life, children should be exclusively breastfed; that is, they should be given only breast milk and not receive other complementary liquids (including plain water) or solids. Early complementary feeding is discouraged because the early introduction of other liquids or foods may increase the exposure of an infant to pathogens that may cause diarrheal disease. Malnutrition is another risk. The complementary foods given to a child may not provide all of the calories that the infant needs, particularly if they are watered down. Since the production of breast milk is influenced by the intensity and frequency of suckling, early complementary feeding may reduce breast milk output, further increasing the risk of malnutrition. To obtain information on feeding patterns, mothers were asked about the breastfeeding status of all children under the age of five in the 24-hour period before the interview and about what other (if any) liquids or solids had been given to the child during the period. These data are used in Table 6.5 to explore patterns of breastfeeding and supplementation among children under age 3. The table shows that breastfeeding continues for the majority of Egyptian children beyond the first year of life, with around half of the children 18-19 months continuing to be breastfed. Weaning takes place rapidly'after this age, with just 13 percent children age 24-25 months still breastfed. Child Health and Nutritional Status of Children and Women ] 77 Exclusive breastfeeding is common but not universal among very young infants. Table 6.5 shows that, among infants under two months of age, 67 percent received only breast milk. The proportion exclusively breastl?d then drops off to 30 percent among children 2-3 months of age, and to less than 10 percent among children 4-5 months of age. It is important to introduce complementary foods around age six months since at that stage the mother's breast milk no longer provides adequate nutrition for the child. Table 6.5 indicates that are some problems with the timely introduction of complementary foods. For example, around I in I I children ages 8-I 1 months were not being given solid or mushy food or other milk in addition to breast milk. Table 6.4 Initial breastfeeding Among children born in the five years preceding the survey, percentage who were ever breastli~d, percentage who started breast feeding within one hour and within one day of birth, and percentage who received prelacteal feeding, by selected background characteristics, Egypt 2003 Percentage who started Percentage brcastllzeding: who Start Start received Number Background llver Within Within prelacteal of characteristic breastfed I hour I day feeding children Assistance at deliver) Medically trained provider 94.5 45.7 85.2 56. I 4,380 Daya 96.7 669 91.2 53.3 1,780 Other or None 95. I 69.9 87.0 56.3 154 Place of delivery Public health facility 94.6 49.5 84.8 53.6 1,474 Private health facility 94.0 39.7 83.9 58.9 2,252 Home/other 96.5 64.8 909 53. I 2.587 Sex Male 95.3 51.6 87. I 55.5 3.305 Female 95.0 53.2 86.9 55. I 3.009 Urban-rural residence Urban 94.3 45 9 87.3 54.7 2,362 Rural 95.7 56.2 86.8 55.7 3.952 Place of residence Urban Governorates 94.7 39,5 85.8 49.6 91 I Lower Egypt 94.0 43.5 84.2 54.4 2,688 Urban 92.2 42.6 84.9 55. I 75 I Rural 94.7 43 9 83.9 54.2 I,t,~37 Upper Egypt 96.5 65. I 90. ] 58. I 2.7 ] 5 Urban 96. I 57.3 91.8 60.9 700 Rural 96.6 67.8 89.5 57. I 2.015 Education No education 95.2 62.6 87.9 53 3 2,142 Primary incomplete 97 1 50 1 86.7 62.5 638 Primary complete/some secondary 93.4 539 87.5 56. I 1,023 Secondary comp./higher 95.3 43.7 86. I 54.8 2,51 I Work status Working for cash 92.9 47.6 87.4 53.7 755 Not working for cash 955 53.0 86.9 55.5 5,559 Wealth index Lowest quintile 94,9 60.7 84.8 54.8 1.366 Second quintile 965 56.5 88.8 55.4 1,279 Middle quintile 94.8 55.5 874 55.3 1,323 Fourth quindle 94.4 45.4 88.4 ~4.0 1,319 Highest quintilc 95.3 40.9 853 57.4 1,029 Total 95.2 52A 87.0 55.3 6,314 78 Child ltealth and Nutritional Status ~?/Children and Women Table 6.5 Breastfeeding status Percent distribution of children by breastfeeding status, by selected background characteristics, Egypt 2003 Breastl~d and given Water- Comple- Not Exclusively Plain based mentary Number Months breast- breast water liquids/ toods/ Total of living since birth feeding fed only juices milk percent children <2 1.8 67.4 9.0 12.6 9.2 100.0 153 2-3 2.6 29.7 23.6 26.7 17.3 100.0 208 4-5 4.4 7.8 22.2 11.5 54.0 100.0 248 6-7 10.8 2.1 14.4 7.5 65.3 100.0 206 8-9 12.1 0.5 5.0 3.4 79.0 100.0 217 10-11 10.5 0.0 5.7 3.3 80.5 100.0 235 12-13 16.9 0.0 0.3 3.8 79.0 100.0 155 14-15 15.7 1.1 0.5 1.4 81.3 100.0 165 16-17 30.0 0.1 2.7 0.2 67.1 100.0 247 18 19 47.4 0.0 0.0 0.0 52.6 100.0 189 20-21 62.3 0.0 0.0 0.0 37.7 100.0 234 22-23 77.9 0.0 0.1 0.0 22.0 100.0 202 24-25 86.6 0.0 0.6 0.0 12.8 100.0 198 26-27 93.5 0.0 0.0 0.1 6.4 100.0 221 28-29 96.7 0.0 0.0 0.0 3.3 100.0 227 30-31 98.3 0.0 0.0 0.0 1.7 100.0 203 32-33 99.5 0.0 0.0 0.0 0.5 100.0 206 34-35 99.2 0.0 0.0 0.0 0.8 100.0 187 0-3 months 2.3 45.7 17.4 20.7 13.9 I00.0 361 4-6 months 5.0 6.6 19.3 10.8 58.3 100.0 357 7 9 months 13.2 0.4 8.5 4.1 73.8 100.0 3[4 Total 48.6 . 52 4.9 3.9 37.4 I00.0 3,703 Differentials in the Duration and Frequency of Breastfeeding and Bottle-feeding Differentials in the median duration of breastfeeding and in the prevalence of bottle-feeding are presented in Table 6.6. The median duration of breastfeeding is 18.8 months. Children are exclusively breastfed or predominantly breastfed for an average of 1.5 months and 2.4 months, respectively. Children born in health facilities are breastfed for a somewhat shorter period on average than those born at home; moreover, there is a difference of around 1 month in the average duration of breastfeeding among children born in public and private facilities. A similar pattern is observed in looking at the relationship between assistance at delivery and breastfeeding durations; children whose mothers were assisted at delivery by a medical provider are breastfed for an average of 18.1 months, 1.8 months less than children whose mothers received assistance at delivery from a daya. Looking at other characteristics, males tend to be breastfed on average for a somewhat longer period than females. The average breastfeeding duration is somewhat longer for rural children than for urban children. By place of residence, the median duration ranges from a low of 18 months in urban Lower Egypt to 19.4 months in rural Upper Egypt. Children bona to mothers with less than a primary education are breastfed slightly longer than children born to more educated mothers. Table 6.6 also provides information on the differentials in the percentage of children under age two who are being bottlefed. Overall, a bottle with a nipple was used in feeding only 17 percent of these children during the 24 hours before the survey. Bottlefeeding is more common among children whose mothers delivered in a health facility and/or received assistance at delivery from a doctor or trained nurse/midwife. Bottlefeeding rates are notably higher among babies in urban areas, babies whose Child Health and Nutritional Status of Children and Women I 79 mothers have some education, and babies whose mothers work for cash. Even in these groups, however, less than one-quarter of babies are bottlefed. Table 6.6 Median duration and frequency of breastfeedint~ Median duration of any breastfeeding, exclusive breastlEedmg, and lull brcastti~eding among children under age 3 and percentage of children under age 2 who were boulefed, by background characteristics, Egypt 2003 Background characteristic Among children under age three, Percen- median duration in months Number rage Number o[ tlndet of An) Exclusive Full children age two chihlren breast- breast- bmasl- tinder age who arc under [?eding lbeding leeding I three buttle led age 2 Place of delivery Public health fitcility 18,7 Private health Ihcility 17.8 Home/other 195 Assistance at delivery Medical provider 18. I Daya 19.9 Other/none 21 7 Sex Male 19.2 Felnale 18 1 Urban-rural residence Urban 184 1 3 Rural 19.tt 1.6 Place of residence Urban Govemorates IS.3 1.5 Lower Egypt 18.4 1.7 Urban 18.0 1.7 Rural 18.5 1.7 tipper Egypt 19.3 1,4 Urban 19.1 0.5 Rural 19.4 1.6 Education No education 19.5 1.5 Primary incomplete 19.2 0.9 PrimaiT complete/some secondary 18.9 1.8 Secondary comp./higher l 8,0 15 Work status Working lbr cash Not working tor cash Total I 2 22 929 18.5 619 15 2,1 1,445 209 948 1.8 3.1 1,477 I 1.9 892 1.5 2.3 2,772 19.1 1,805 1.8 3. I 990 I I.~ 602 0.4 17 88 10.7 52 1.5 24 1.998 164 1.289 1.6 2.4 1,852 177 1.171 21 1,385 213 901 2.6 2.465 146 1,558 2.0 548 2 I. I 365 2.4 1.663 I q,7 1,053 2 1 430 26.9 277 2.4 1,233 17. I 775 2,6 1.640 13.0 1,042 0.7 407 15,5 259 2.7 1,233 12 1 782 3 I 1,259 13.3 77(1 22 357 221 231 2.9 628 19.2 405 2. I 1.606 17.8 1.054 16.9 1.3 2.3 414 21.I 249 18.9 16 24 3,436 16.6 2,210 18.8 1.5 2.4 3,850 17,0 2,459 ]Either exclusively breasttEd or received plain wmer only in addition to breastfeeding 80 I Child t tealth and Nutritional Status qf Children and ~men 6.5 Nutritional Status of Children Measurement of Nutritional Status Nutritional status is a primary determinant of a child's health and well-being. To assess nutritional status, the 2003 EIDHS obtained measurements of height ~° and weight for all children living in the household who were under age 6. Using these anthropometric measurements as well as information on the ages of the children, three standard indices of physical growth describing the nutritional status of children were constructed: (1) height-for-age; (2) weight-for height; and (3) weight-for-age. As recommended by the World Health Organization (WHO), evaluation of nutritional status in this report is based on the compar!son of the three indices for the population of children in the survey with those reported for a reference population of well-nourished children. One of the most commonly used reference populations, and the one used for this study, is the international reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by WHO and the U.S. Centers for Disease Control. Each of the indices measures somewhat different aspects of nutritional status. The height-for-age index provides an indicator of linear growth retardation. Children whose height-for-age is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age, or stunted. Children who are below minus three standard deviations (-3 SD) from the reference population are considered severely stunted. Stunting of a child's growth may be the result of a Failure to receive adequate nutrition over a long period of time or of the effects of recurrent or chronic illness. The weight-for-height index measures body mass in relation to body length. Children whose weight- for-height measures are below minus two standard deviations (-2 SD) from the median of the reference population are too thin for their height, or wasted, while those whose measures are below minus three standard deviations (-3 SD) from the reference population median are severely wasted. Wasting represents the failure to receive adequate nutrition during the period immediately before the survey. It may be the result of recent episodes of illness or acute food shortages. Weight-for-age is a composite index of height-for-age and weight-for-height. Children whose weight- for-age measures are below minus two standard deviations (-2 SD) from the median of the reference population are underweight for their age, while those whose measures are below minus three standard deviations (-3 SD) from the reference population median are severely underweight. A child can be underweight for his age, because he is stunted, he is wasted, or he is both stunted and wasted. Levels of Child Malnutrition Table 6.7 shows the proportions of children born to EIDHS respondents and under age five who are classified as malnourished according to three measures of nutritional status, i.e., height-for-age, weight-for-height, and weight-for-age, by selected background characteristics of the child. The data on height-for-age in Table 6.7 indicates that there is considerable chronic malnutrition among Egyptian children. Sixteen percent of children under age five are stunted, and 6 percent are severely stunted. A child's age is associated with the likelihood of stunting. Stunting increases from only 16 percent among children under six months of age to 23 percent among children 12-23 months, ~CPAIthough the term "height" is used, children younger than 24 months were measured lying on a measuring hoard, while standing height was measured for older children, Weight data were obtained using a digital scale with an accuracy of 100 grams~ Child H~'alth and Nutritional Status of Children and Women I 81 before falling to 10 percent among children age four and older. Levels of stunting are slightly higher for male children than for female children. Table 6.7 Nutritional status of children Percentage of children under five years who are classified as malnourished according to three anthropometric indices of nutritional status: height-for-~ge, weight-for-height, and weight-for age. by selected background characteristics. Egypt 2003 Background Below characteristic 3 SD Height-tbr-age Weight-for-height Weight-tBr-age Number Below Below Below Below Below of -2 SD I -3 SD -2 SD I -3 SD -2 SD I children Child's age Under 6 months 3.9 15.8 0.8 4.6 0.2 64 546 6 11 months 6.3 17.3 /).0 4.4 0.5 I 1 0 619 12 23 months 9.7 23.0 0.5 4.0 19 11.2 I,I 18 24-35 months 6.2 13.6 1,5 4.2 2,5 9.3 1,191 36-47 months 4.2 14.8 14 47 1. I 8.7 1,159 48-59 months 2.4 10.3 0.0 2 5 0.4 4.6 l,128 Sex Male 6.3 16.9 0.8 4.3 14 9.4 3,1) 14 Female 4.7 14.2 0.8 3.7 I 1 7.6 2,748 Birth order I 5.5 I4.8 1.0 4.0 1.4 8.6 1,678 2-3 5.2 15.2 0.8 4.0 I.I 8.5 2,593 4-5 5.8 17.6 0.5 4.2 I. I 8.2 942 6+ 6.5 17.0 0.8 3.8 1.8 9 1 549 Birth interval First birth 5.6 t 5.0 0.9 3.9 1.5 8.8 1.706 Under 24 months 6.1 16.9 0.7 5.3 1.2 10. I 823 24-47 months 5.7 15.9 0.9 4. I I. I 8.8 2,033 48~ months 4.7 15.3 0.5 3.1 1.0 6.7 1,199 Urban-rural residence Urban 4.9 14. I 1.0 3.8 1.2 6.8 2,177 Rural 59 16.6 {).6 4 [ 1,3 96 3,584 Place of residence Urban Governorates 6.1 15.6 0,7 3. I 15 5.7 837 Lower Egypt 3.0 10.9 0.3 3. I 08 6.2 2,483 Urban 2.2 10.0 0.4 2.2 0.4 4.8 700 Rural 33 I 1.3 0.2 3.4 1.0 6.8 1,783 Upper Egypt 7.9 20.4 1.3 5.3 1.5 119 2,442 Urban 6.3 [67 2.0 6.3 1.5 10.5 641 Rural 8.5 21.8 1.0 4.9 1.5 12.4 1.801 Education No education 6.9 [ 7.2 0.9 4.0 1.4 9.7 1,925 Primary incomplete 4.4 16.6 0.7 4.6 1.5 I 0.0 596 Primary comp./some secondary 36 14.2 0.9 3.2 l 2 73 920 Secondary comp./higher 5.5 146 0.7 4. I 1.0 7.7 2,32 I Work status Working for cash 5. I 14. I 0.4 4. I 0,7 7.9 691 Not working for cash 5,6 15.8 0.8 4.l) 1,3 8.6 5,070 Wealth index Lowest quintile 7.0 18.2 1.0 4.3 2.1 10.8 1,205 Second quintile 5.4 16.7 0.4 3.7 1.0 9.5 1,174 Middle quintile 4.8 15.3 0.6 3.8 0.6 6.9 1,213 Fourth quintile 4.3 138 0.7 4.9 1.0 8.0 1,21 I Highest quintile 6.3 13.7 1.2 3.0 IS 7.3 958 Total 5.5 15.6 0.8 40 1 2 8.6 5,761 Note: Figures are for children ol EIDHS respondents under age five. Each index is expressed in terms of the number o[" standard deviation (SD) units from the median of the NCBS/CDC/WHO international reference population. Chihlrcn arc classified as undernourished if their z-scores are below minus two or minus three standard deviations (SD) from the median. ~Includes children who are below -3 SD 82 I Child Health and Nutritional Status o['Children anal Women Rural children are more likely to be stunted than urban children (17percent and 14percent, respectively). The percentage stunted varies by place of residence, from 10 percent in urban Lower Egypt to 22 percent in rural Upper Egypt. The educational level of the mother is inversely related to the level of stunting. Children of mothers who work for cash are somewhat less likely to be stunted than other children. Household wealth also is associated with stunting levels; the proportion stunted declines from 18 percent among children living in households in the lowest quintile on the wealth index to 14 percent among children in households in the two highest quintiles. The weight-for-height index provides a measure of wasting, or acute malnutrition. Overall, four percent of Egyptian children are wasted. Differences in wasting levels are generally minor across the subgroups in Table 6.7. Reflecting the effects of both chronic and short-term malnutrition, nine percent of children under age five are underweight for their age. Low weight-for-age is more common among children 6-23 months than among older or younger children. Other differentials in the proportions of children who are underweight generally parallel the patterns seen for stunting. Trends in Child Nutrition Table 6.8 looks at recent trends in the nutritional status of children in Egypt using anthropometric data from EDHS surveys undertaken between 1992 and 2003. There are a number of factors that should be kept in mind in looking at the trends in the indicators. First, the trends may be influenced by differences in the quality of the anthropometric data collected in the surveys or in the reporting of children's ages. Particularly where they are small, the differences in the indicators may be simply a result of sampling variability rather than of a genuine change in children's nutritional status. Table 6.8 Trends in nutritional status of children Percentage of children under five classified as malnourished according to selected indices of nutritional status: height-for-age, weight-fbr-height, and weight-for-age, Egypt 1992-2003 1997 1998 Index of 1992 1995 Interim Interim 2000 2003 nutritional status EDHS EDHS EDHS EDHS EDHS EIDHS Height-for-age 26.(I 29.8 24.9 20.6 18.7 15.6 Weight-for height 3.4 4.6 6.1 5. I 2.5 4.0 Weight for age 9.9 12.5 I 1.7 10.7 4.0 8.6 Note: Figures are based on children of respondents under age five. Source: E1-Zanat~, and Associates and Macro International Inc., 1999, Table 9.7 The trends in the nutritional status indicators suggest that the nutritional status of young children in Egypt has improved since the early 1990s. Looking at the height-for-age measures, for example, there was a decrease in the percentage of children who were considered stunted, from 26 percent at the time of the 1992 EDHS to 16 percent in the 2003 EIDHS. The weight-for-height and weight-for-age measures also show declines, with the levels observed for the 2003 EIDHS being for the most part lower than the levels in earlier surveys. 6.6 Nutritional Status of Women Besides measures for children under age five, the 2003 E1DHS obtained information on the height and weight of women interviewed in the survey. These measures are used to calculate the body mass index (BMI), an indicator combining height and weight data. In looking at the nutritional indicators for women, it is important to recognize that the anthropometric data are not representative of all women age 15-49 in Egypt. In particular, height and weight measures were not obtained for women who were Child Health and Nutritional Status of Children and Women [ 83 not married. Women who were pregnant or less than two months postpartum are also excluded fi-om the analysts of women s body mass. Table 6.9 presents height and BMI measures for ever-married women. Maternal height is an outcome of nutrition during childhood and adolescence. It is useful in predicting the risk of difficult delivery, since small stature is frequently associated with small pelvis size. The risk of low birth weight babies is also higher for short women. The cutoff point, i.e., the height below which a woman is considered to be at nutritional risk, is in the range of 140-150 centimeters. The mean height of mothers measured in the 2003 EIDHS was 159 centimeters. Less than one percent were shorter than 145 centimeters. In looking at BMI levels, a cutoff of 18.5 has been recommended for assessing chronic energy deficiency among nonpregnant women. Excluding those who are pregnant or less than two months postpartum, the mean BMI of ever-married Egyptian women is 28.6. Less than 1 percent have a BMI below 18.5, the level indicating chronic energy deficiency. Table 6,9 Nutritional status of women by background characteristics Among ever-married women age 15-49. mean height and percentage under 145 cm, mean body mass index (BM) and percentage whose BMI is below 8 5, by selected background characteristics. E~ypt 2003 Height Number BMI Number Background Height percent < of percent < ol characteristic mean 145 women i BM[ mean 18.5 ~olnen I Age 15-19 157.2 0.5 340 23.9 2.0 227 20-24 158 4 0.3 1.357 25.5 1 3 I ~024 25-29 159.2 0.2 1.763 27. I 0.8 1.434 30-34 159.5 0.4 1,401 28. I (/.4 1.260 35 39 159.8 0.5 1.577 29.0 0.7 1.5111 40-44 159.9 05 1.367 30.7 0.3 1.355 45-49 160.0 0.9 1.273 31 3 0.2 1.269 Urban-rural residence Urban 159.6 0.4 3,876 29.6 0.3 3,484 Rural 159,2 0.5 5,201 27.9 0.9 4+594 Place of residence Urban Governorates 159.0 0.2 1,647 30. I 0.1 1,500 Lower Egypt 160.6 0.2 4,073 29.0 0.2 3,643 Urban 160.8 0.2 1,174 29.5 0.3 1 ,I)47 Rural 160.5 0. I 2,899 28,8 0.2 2~597 Upper Egypt 158. I 0.9 3.357 27.3 1.5 2~934 Urban 159.4 0.8 1,054 28.7 0.7 937 Rural 157.5 0.9 2.303 26.6 1.9 1.997 Education No education 159 1 0.7 3~422 28,5 0.8 3 174 Primary incomplete 159.0 0.7 1,162 29.2 0.4 1.069 Primary complete/some secondary 159 1 05 1,257 28.5 0.8 1.090 Secondary comp,fbighel 160.0 0.1 3,236 28.4 0 4 2.745 Work status Working tbr cash 160.7 0.0 1,440 29.5 0.3 1.350 Not working for cash 159.1 0.5 7.637 28,4 0.7 6,728 159.4 0.4 9,077 28.6 0.6 8,078 Total Table 6.9 also presents di f ferentials in the nutr i t ional indicators for women. There is little variat ion in women's mean height. The mean body mass index varies direct ly with the woman's age and is somewhat h igher among urban women than among rural women• By place of residence, the mean body mass index ranges from a low o f 26.6 among ever-marr ied women in rural Upper Egypt to a high 84 I Child Health and Nutritional Status qf Children and 14~men of 30.1 in the Urban Governorates. 6.7 Micronutrient Supplementation Vi tamin A Supp lementat ion Egypt has a program of vitamin A supplemen- tation for new mothers and young children. Vitamin A is a micronutrient found in very small quantities in some foods. It is considered essential for normal sight, growth, and devel- opment. Vitamin A is important in protecting the body against some infectious illnesses such as measles and diarrheal disease. Severe vita- min A deficiency is associated with total loss of vision or with other vision impairments in- cluding night blindness. Supp lementat ion amon~ Women As part of the supplementation program, a vi- tamin A capsule is given to new mothers within the first two months after delivery, with the goal that the infant will receive an adequate quantity of the micronutrient through the mother's breast milk to ensure healthy devel- opment. To collect information to assess the effect of the maternal supplementation pro- gram, women who had given birth during the five-year period prior to the DHS were shown a vitamin A capsule and asked whether they had been given the capsule during the two-month period after the child's birth. Table 6.10 presents the level and differentials in vitamin A supplementation among women for the 2003 EIDHS. The table also includes information on the levels observed in the 2000 EDHS in order to assess the trend since that survey. According to the 2003 results, mothers reported receiving a vitamin A capsule for one in three births. The largest differentials in the proportions of mothers reporting they received a vitamin A capsule are observed by residence and the household's wealth status. A comparison of the 2000 EDHS and the 2003 EIDHS levels shows threefold increase in the proportion of mothers who received a vitamin A capsule during the two-month period after they gave birth (from 11 percent to 34 percent). Table 6.10 Vitamin A supplementation among postpartum mothers Percentage ofbiflhs in the five years preceding the 2003 EIDHS for which mothers received vitamin A dnring the two-month period immediately following delivery, by selected background characteristics, and percentage of births in the five years preceding the 2000 EDHS for which mothers received vitamin A during the two-month period immediately lbl[owing delivery, Egypt 2000-2003 Mother Background received Number of characteristic vitamin A births Mother's age at birth < 20 35.5 735 20 34 34.5 4,905 35 49 26.1 674 Birth order 1 36A 1,858 2-3 34.8 2,816 4-5 31.2 1,038 6+ 24.8 602 Urban-rural residence Urban 31.2 2,362 Rural 35.2 3,952 Place of residence Urban Governorates 33.8 911 Lower Egypt 39.4 2,688 Urban 31.2 75 I Rural 42.6 1.937 Upper Egypt 28.0 2,715 Urban 27.7 7110 Rural 28. I 2,015 Education No education 3 I. I 2,142 Primary incomplete 31.3 638 Primary comp./some seconda~ 35.2 1.023 Secondary, comp./higher 36.(I 2.51 I Work status Working for cash 32.8 755 Not working for cash 33.8 5,559 Wealth index Lowest quintile 28.5 [,366 Second quintile 32.5 1,279 Middle quintile 40.6 1,323 Fourth quintile 33.3 1,319 Highest quintilc 33.9 1,029 Total 2003 EIDHS 33.7 6,314 Total 2000 EDHS 10.9 I 1,361 ('him ttealth and Nutritional Status of Children and Women I 85 Supp lementat ion among Ch i ld ren The second component of the supplementation program is directed at children. Beginning at age nine months (typically at the time the child receives the measles vaccination), young children are given one vitamin A capsule (100,000 international units). Two additional capsules (200,000 units) are given to children at age 18 months with the acti- vated polio dose. Table 6.11 looks at the coverage of vitamin A supplementation among children age 12-23 months. The rate is based on information from the vaccination record that the child had received a capsule during the six-month period before the survey or on the mother's recall that the child received a capsule when a vaccination record was not available. About 65 percent of children age 12- 23 months have received a vitamin A capsule. This is nearly three times the coverage recorded in the 2000 EDHS (23 percent). Differentials across subgroups do not show con- sistent patterns. Overall, children of birth order 6 or higher have the lowest level of supplementation (54 percent) and children living in urban Upper Egypt have the highest level (75 percent). Use o f Iod ized Sa l t Iodine is another important micronutrient. Low levels of iodine in the diet are associated with a number of problems including miscarriages and, among children, retarded mental development. Egypt has adopted a program of fortifying salt with iodine to prevent iodine deficiency. In the 2003 EIDHS, the iodine content of the salt used in the household was measured using a rapid- test kit provided by UNICEF. The test kit consisted of ampoules of a stabilized starch solution and a weak acid-based solution. A drop of the starch so- lution was squeezed onto a salt sample obtained in Table 6. I I Vitamin A supplementation among children 12- 23 months Percentage of children 12-23 months who were reported in the 2003 EIDHS to have received vitamin A capsule, by selected background characteristics, and percentage of children 12-23 months who were reported in the 2000 EOHS to have received vitamin A capsule. Egypt 2000- 2003 Child Background received Number of characteristic vitamin A births Sex Mate 65.0 648 Female 64.6 544 Birth order 1 67.9 381 2-3 (13.4 524 4 5 67.4 197 61 54.1 91 Urban-rural residence Urban 68.3 449 Rural 62.7 742 Place of residence Urban Governorates 68.6 185 Lower Egypt 59.0 514 Urban 62. I 140 Rural 579 374 Upper Egypt 69.4 403 Urban 74.7 125 Rural 67.6 368 Education No education 64.4 375 Primary incomplete 56.4 I lt~ Prhnary comp./some secondary 67.2 199 Secondary comp/higher 66.0 502 Work status Working ibr cash 68.8 135 Not working for cash 643 1,057 Wealtb index Lowest quintile 65.2 244 Second quintile 67.4 221 Middle quintile 60J) 256 [:ourth qumtile 66.2 28 I Highest qumtde 656 190 Total 2003 EIDtlS 64.8 I. 192 Fota12000 EDHS 227 2, [ 70 the household, causing the salt to change color. The EIDHS interviewer conducting the test matched the color of the salt to a color chart included with the test kit to determine the level of iodization. Table 6.12 shows the percentage of households using iodized salt. Ovcrall, the iodine content of the salt was 25 ppm (parts per million) or higher in 56 percent of households. This is more than twice the percentage of households in this category at the time of the 2000 EDHS. In turn, the percentagc of households using noniodized salt has dropped sharply since 2000, from 44 percent to 21 percent. 86 I Child ltealth and Nutritional Status ~?f Children and Women Table 6.12 Iodized salt Percentage of households in which salt was tested for iodine, and, among those tested, percent distribution by iodine content, by selected background characteristics, Egypt 2003, and percentage of households in which salt ~as tested tbr iodine, and, among those tested, percent distribution by iodine content. Egypt 2000-2003 Percentage of Iodine content households 0 ppm Number Background in which salt (no Total of characteristic was tested iodine) < 25 ppm 26 ppm+ percent households Urban-rural residence Urban 99.5 7.9 15.6 76.5 100.0 5,047 Rural 99.7 33.9 30,0 36.2 100.0 5,042 Place of residence Urban Governorates 99.3 3.3 9.1 87.6 100.0 2,319 Lower Egypt 99.6 28,7 23.5 47.8 100.0 4,259 Urban 99.6 13.3 18.6 68.1 100.0 1,451 Rural 99.7 36.7 26.1 37.3 100.0 2,808 Upper Egypt 99.8 23.0 30.9 46,1 100.0 3,511 Urban 99.7 I 0,0 24.0 66.0 100.0 1,278 Rural 99.8 30.4 34.8 34.8 100.0 2,233 Total 2003 EIDHS 99.6 20.9 22.8 56.3 100.0 10,089 Total 2000 EDHS 99.9 44.1 28.4 27.5 100.0 16,957 Tab le 6 .12 also shows that there are marked res ident ia l d i f ferences in the use o f iod ized salt. Urban households were much more l ikely than rural households to be us ing salt cons idered to be adequately iodized; the salt was not iod ized at al l in one-third o f rural households compared to 8 percent o f urban households. By p lace o f res idence, the proport ion o f households us ing non iod ized salt ranged from 3 percent in the Urban Governorates to 37 percent in rural Lower Egypt. Child Health and Nutritional Status of Children and Women ] 87 7 EARLY CHILDHOOD MORTALITY This chapter presents information on the levels and trends, and differentials in neonatal, post-neonatal, infant and child mortality among children less than five years of age in Egypt. The 2003 EIDHS mortality estimates are calculated from information that was collected in the birth history section of the individual questionnaire. The birth history section began with questions about respondent's experience with childbearing (i.e., the number of sons and daughters living with the mother, the number who live elsewhere, and the number who have died). These questions were followed by a retrospective birth history in which the respondent was asked to list each of her births, starting with the first birth. Data were obtained in the birth history on the sex, month and year of birth, survivorship status, and current age, or age at death, of each of the respondent's live births. This information is used to directly estimate the following mortality rates: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the difference between infant and neonatal mortality Infant mortality: the probability of dying during the first year of life Child mortality: the probability of dying between the first and fifth birthday Under-five mortality: the probability of dying before the fifth birthday. 7.1 Levels of Early Childhood Mortality Neonatal, postneonatal, infant, child and under-five mortality rates are shown in Table 7. I for the 20 years preceding the 2003 EIDHS. It is important to remember that these rates are derived from retrospective data and are, thus, subject to errors of omission and misreporting of dates of birth and ages at death. These errors are usually more common for events further back in time. Therefore, the results in Table 7.1 are more likely to underestimate rather than overestimate the size of the decline in mortality over time in Egypt. Table 7.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality for five-year periods preceding the survey, Egypt 2003 Approximate Mortality rate Years midpoint of preceding calendar the survey period Neonatal Post- Infant Childhood Under-5 neonatal (Iq0) (4ql) (5q0) 0-4 2001 22.9 15.1 38.0 7.9 45.7 5-9 1996 27.0 24.7 51.7 14.1 65.1 I o- 14 1991 27.4 30.3 57.7 18.6 75.2 15-19 1986 33.1 35.7 68.8 33.2 99.7 The 2003 EIDHS mortality estimates show that childhood mortality is becoming increasingly concentrated in early infancy. For the five-year period before the survey, the under-five mortality rate is 46 deaths per 1000 births while the infant mortality rate is 38 per 1,000; this indicates that more than 80 percent of early childhood deaths in Egypt are occurring before the child reaches his first birthday. In turn, an examination of the neonatal and posmeonatal rates (23 per 1,000 and 15 per 1,000, respectively) show that three-fifths of infant deaths take place within the first month of life. 7.2 Trends in Early Childhood Mortality Table 7.2 presents the trend in infant and under-five mortality rates for successive five-year periods before the three rounds of the Egypt DHS surveys and the 1980 EFS. Together the estimates cover a Early Childhood Mortality I 89 thirty-year period from the late 1960s through the beginning of the current decade. They show that childhood mortality levels decreased substantially over the period. Overall, the probability of dying before age five has fallen by around 80 percent from a level of 243 deaths per 1,000 births in the 1960s. The infant mortality rate is now only around one-fourth of the level observed in the mid-1960s. Table 7.2 also allows for an examination of the trend in childhood mortality since the 2000 EDHS. The comparison suggests that mortality continued to decline at a relatively steady pace during the approximately three- year period between the two surveys. 7.3 Socio-Economic Differentials Table 7.3 looks at how the survival of young children is related to a number of socio- economic conditions including residence, the mother's educational level, and household wealth. For these comparisons, the mortality estimates are calculated for a ten-year period before the survey so that that the rates are based on a sufficient number of cases in each category to ensure statistical significance. Urban children have a lower probability of dying both in infancy and in the later stages of early childhood than rural children. The under-five mortality in rural areas is 63 deaths per 1,000 births, nearly 50 percent higher than the urban level of 43 per 1,000. Looking at rural mortality patterns in more detail, children in rural Upper Egypt havc a Table 7.2 Trends in early childhood mortality in Egypt, 1965-2(11)3 Trends in neonatal, infant, and under-five mortality Ihom selected surveys, Egypt 1964-2003 Approxi- Approximate mate Inthnt Under-five reference period midpoint Survey mortality mortality 1998-2003 2001 2003 EDHS 38 46 1995 2000 1998 2000 EDHS 44 54 1993-1998 1996 2003 EDHS 52 65 1990-1995 1993 2000 EDHS 66 84 1990-1995 1993 1995 EDHS 63 81 1988 1993 1991 2003 EDtlS 58 75 1987 1992 1990 1992 EDHS 62 85 1985-199(/ I988 2000 EDHS 74 11)3 1985-1990 1988 1995 EDHS 82 110 1983-1988 1986 1988 EDITS 73 102 1982-1987 1985 1992 EDttS 97 130 1980-1985 1983 2000 EDtlS 98 140 1980-1985 1983 1995 EDHS 97 I39 1978-1983 1981 1988 EDHS 120 167 1977-1982 1980 1992 EDHS 1(18 157 1974 1979 1977 1980 EFS 132 191 1973-1978 1976 1988 EDHS 124 203 1969-1974 1972 1980 EFS 146 238 1964-1969 1967 t980 EFS 141 243 Note: For the 2003 EIDHS. the fieldwork took place principally during May Thus, the five-year relerenee periods lbr this sul~ey can be considered to approximately rcprcsent periods starting in May of the year in which the period begins and ending in April of the year in which the period terminates. For the 2g00 EDHS and the 19811 EFS. the fieldwork for the survey took place principally during February and March of the survey years. Thus. the five-yeal rel~rence periods fi~r the mortality rates nora these surveys can be considered to approximately represent periods starting in March orthe year in which the period begins and ending in Februal2¢ of the year in which the period terminates (e.g., March 1995-February 2000 ft~r the five-year period immediately prior to the 20011 DIIS). For all other DHS surveys, fieldwork took place principally during October to December of the survey years, r[ bUS, thc five-year reference periods used in calculating the mortality rates [br the 1988, 1992 and 1995 D]IS su~eys can be considered to approximately represent periods starting in November of the year bl which the period begins and ending in October ol'the year in which the period terminates (e.g., November 1990-October 1995) Source: EI-Zanaty et aL,1996, Table 9.2 much greater likelihood of dying than children in rural Lower Egypt. The under-five mortality rate in rural Upper Egypt is 73 deaths per 1,000 compared to 53 per 1,000 in rural Lower Egypt. Urban children also have a higher probability of dying in infancy if they live in Upper Egypt (45 deaths per 1,000) than if they live in Lower Egypt or in the Urban Governorates (41 per 1,000 and 26 per 1,000, respectively). As expected, mortality levels are inversely associated with the mother's educational level. For ex- ample, the under-five mortality rate among children born to women with no education is 73 deaths per 1,000 births compared with 32 deaths per 1,000 births among children born to women who have completed secondary school or higher Finally, as Table 7.3 shows, there is a strong negative association between household wealth and early childhood mortality rates. Children from households ranked in the bottom 20 percent on the wealth 90 I Early Childhood Mortalio, index are more than two and one-half times as likely to die before reaching age five as children from households ranked in the highest quintile on the index. Overall, at current levels, around 1 in 12 children in the poorest households will die before the fifth birthday compared to around 1 in 31 children from the wealthiest households. 7.4 Demographic Differentials Table 7.4 shows the relationship between early childhood mortality and various demographic variables including the sex of child, mother's age at birth, the child's birth order, and the length of the previous birth interval. Both infant and under-five mortality levels are slightly higher for girls than for boys. The effect of young maternal age at birth on mortality is quite evident in Table 7.4. Children born to mothers who were under age 20 or age 40 and older are significantly more likely to die during both infancy and early childhood than children born to mothers in the 20-39 age cohort. The relationship between mortality and birth order does not exhibit the expected pattern of markedly higher mortality among first births. However, mortality rises as expected with birth order among second-order and higher births, with very high order births (i.e., seventh order and higher) experiencing much higher mortality than other children. For example, under-five mortality for births of orders seven or higher is 107 per 1,000 compared to 49 per 1,000 for first-order births. Short birth intervals are strongly associated with mortality levels. For example, the under-five mortality rate among children born less than two years after a previous birth is 85 deaths per 1,000 births, nearly 90 percent higher than the level among children born four or more years after a previous birth. 7.5 High-Risk Fertility Behavior There is a strong relationship between maternal fertility patterns and children's survival risks. Typically, the risk of early childhood death is higher among children born to mothers who are too Table 7.3 Early childhood mortality by socio-economic characteristics Infant and under-five mortality for the ten-year period preceding the survey, by selected socio-economic background characteristics, Egypt 2003 Background Infant Under-5 characteristics mortality mortality Urban-rural residence Urban 34.0 42,5 Rural 51.4 63.1 Place of residence Urban Govemorates 26.3 33.5 Lower Egypt 41.3 49.2 Urban 33.4 40.8 Rural 44.3 52.5 Upper Egypt 54.8 68.8 Urban 45.1 56.3 Rural 58.3 73.4 Education No education 57.3 73.4 Some primary 52.6 62.2 Primary complete/some secondary 43.6 53.3 Secondary compLete/higher 28.6 32,2 Wealth index Lowest quinlile 65.0 83.8 Second quintile 45.3 56.9 Middle quinlile 43. I 50.7 Fourth quintile 37.1 44.4 Highest quintile 27.6 32.0 Total 44.7 55. I Table 7.4 Early childhood mortality by demographic characteristics In0ant and under-five mortality by selected demographic background characteristics thr the ten-year period preceding the survey, Egypt 2003 Background Infant Under 5 characteristics mortality mortality Sex of child Male 43.0 53.1 Female 46.5 57.4 Mother's age at birth Less than 20 60.4 67.7 20-29 41.0 51.1 30-39 45.1 57.7 40-49 52.4 64.9 Birth order I 43.4 48.9 2-3 37.2 45.3 4-6 48.2 63.4 7+ 82.0 107.1 Previous birth interval < 2 years 65.0 84.8 2-3 years 37.6 48.3 4 years or more 37.4 45.1 Early Childhood Mortality [ 91 young or too old, children born after too short birth interval and among children of high birth order, than among other children. For purposes of the analysis that follows, a mother is classified as "too young" i f she is less than 18 years of age, and "too old" if she is over 34 years at the time of the birth. A "short birth interval" is defined by a birth occurring less than 24 months after the previous birth, and a child is of "high birth order," i f the mother had previously given birth to three or more children (i.e., the child is of birth order four or higher). The data presented in the first two columns of Table 7.5 address the issue of high-risk fertility behavior from the perspective of the child. The first column shows the percentage of births in the five- year period before the survey that falls into one or more of the categories where the risk of dying is elevated. The second column presents the ratio of the proportion dead in each high-risk category to the proportion dead among children not in any high-risk category. Categories in which this risk ratio exceeds 1.0 are considered to have an elevated risk of dying. FinalIy, in looking at Table 7.5, it should be noted that first births, although they often at increased risk of dying, are included in the not at high- risk category. This is because it is not an avoidable fertility behavior. Thc table shows that 41 percent of the births in the five-year period before the survey were in at least one of the high-risk categories, and 12 percent had two or more risk factors. A short birth interval and high birth order were the most common risks. Considering the risk ratios in the second column, a child in any of the risk categories is 1.57 times as likely to die a child not in any of the categories. Among the single- risk categories, older maternal age places children at the highest risk. Risk ratios are higher for children in multiple risk categories than children in any single risk category. With regard to the specific combination of risk factors, the highest risks are found for births to older mothers after a short interval and higher order births after a short interval. Finally, Column 3 of Table 7.5 shows the potential for high-risk births from the per- Table 7.5 Hi~h-risk t'eltilitv behavior Percentage of children born in the five years prior to die survey who are al elevated risk of mortality and percentage o['currently married women at risk of conceiving a child with an elevated lisk of mortality, according to categol2/of increased risk, Egypt 2003 __ Births in the five years preceding the Percen survey rage of Percen currently tage ol Risk married Risk category births ratio women' Not in any high-risk category 325 1.00 19.0 ~' Unavoidable risk category First births, mother age 18 to 24 26.5 I 40 75 Single high-risk category Mothcr'sage 18 29 1.77 0.3 Mother Age 34 2 1 1.98 7.S Birth interval 241nonths 97 1.30 9.3 Birth order > 3 14.2 1 34 12.9 Subtotal 28.9 142 30.0 Multiple high-risk eategor) Age<l 8 & birth interval <24 months ~ 02 0.00 0 1 Age>34 & birth interval <24 0.2 5.06 0.3 Age>34 & birth order >3 7.> 167 35 I Age>34 birth interval <24 months & birth order :>3 1.0 1.86 2 3 Birth interval <24 months & birtb order >3 3.3 248 5.8 Subtotal 12 1 1.92 4~.6 In any avoidable high-risk categoI?~ 41.t) 1.37 736 l'otal 100.0 na IO0.O Number of birtbs 6.314 na 8,445 Note: Risk ratio is the ratio of the p, oportion dead of births in a specific high risk categot2¢ to the proportion dead of births not in any high risk category Women were assigned to risk categories according to the status they would have at the biith of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 months ago. and latest birth of order 3 or higher b Includes sterilized women • Includes the combined categories age • 18 and birth order >3 spective of the woman, i.e., the proportion of currently married women who if they had become pregnant would give birth to a child who would be at elevated risk of dying. A woman's current agc, time elapsed since the last birth, and parity are used to determine the risk category in which any birth a woman conceived at the time of the survey would fall. For example, i f a respondent age 40 who had 92 ] Early Childhood MortaliOJ four births with the last birth 18 months before the survey were to become pregnant, she would fall in a multiple-risk category of being too old, too high parity (four or more births) and giving birth too soon (less than 24 months after a previous birth). Overall, the majority of currently married women in Egypt have the potential of giving birth to a child at elevated risk of mortality (74 percent). Thirty percent of women have the potential of having a birth in a single high-risk category (mainly high birth order), while more than 40 percent have the potential for having a birth in a multiple high-risk category (mainly old maternal age and high birth order). Early Childhood Mortality ] 93 8 KNOWLEDGE OF AIDS, HEPATITIS C, AND SAFE INJECTION PRACTICES The 2003 EIDHS is the first DHS survey conducted in Egypt to collect information on the levels of knowledge of AIDS and of hepatitis C. The survey also included questions relating on the awareness of safe injection practices. Efforts are being directed at increasing awareness of AIDS and hepatitis C and of the importance of safe injection practices; these data will be useful in shaping these efforts by both assessing women's current knowledge and providing information on the channels through which they are obtaining information. 8.1 Knowledge of AIDS The 2003 EIDHS obtained information on three aspects of AIDS knowledge: the overall level of awareness of AIDS, the source from which information on AIDS had most recently been obtained, and knowledge of the avenues through which AIDS might be contracted. Tables 8.1 and 8.2 present these findings. Table 8.1 shows that around 9 in l0 ever-married women in Egypt have heard about AIDS. Knowledge levels are almost universal among urban and highly educated women. Although knowledge was still widespread, notably lower levels of knowledge were found among women who never attended school (79 percent) and among women living in households ranking at the bottom of the wealth index (72 percent). Women in the youngest and oldest age cohorts and rural women are also less likely to know about AIDS than women in other groups. Table 8.1 also shows that television was the most recent source of information on AIDS for the great majority of women in all subgroups. Less than five percent of women named another information source. Table 8.2 presents information on the avenues of transmission of the virus causing AIDS named by women who had heard about AIDS. The percentages naming various transmission routes add to more than 100 percent because women were asked to name at least two ways in which an individual might contract the virus. The results in Table 8.2 indicate that most women who know about AIDS can name a way in which the virus that causes AIDS is transmitted; 76 percent of women who had heard about AIDS--68 percent of all wome~were able to name a way an individual may be exposed to the virus causing AIDS. Three-quarters of the women knowing an avenue of transmission said that the virus causing AIDS could be contracted through a blood transfusion, and 55 percent said an individual could get the virus through heterosexual relations. Similar percentages named homosexual sex and contact with an unclean needle as potential ways to get the virus (41 percent and 40 percent, respectively). Less than 15 percent of the women mentioned any of the other transmission routes. Although the levels vary, most subgroups have similar patterns of responses with regard to the routes through which the virus causing AIDS is contracted, e.g., transfusion is the avenue most commonly cited and mosquito or other insect bites and mother to child transmission cited least often in all groups. Knowledge of A1DS, Hepatitis C, and Safe In/ection Practices ] 95 1able 8.1 Knowledge of AID=S Percentage of all ever-married women age 15 49 who kno~ about AII)S and percent distribution of women knowing about AIDS by the source of in lbnnat ion fi-om which the woman last saw or heard about I[IV/AIDS. according to selected background characteristics. Egypl 20/)3 Percen Number tage of Source fioln which women last saw/heard about o['cver- ever- I I IV/AIDS married married Number ~omen women of who had knowing ever- Husband, heard Background about married Other Medical other Other/ Total aboo{ characteristic AIDS v, omen TV media pro~,ider relafve missing percent AIDS Age 15-19 83.4 343 909 ().0 1.5 I.I 65 100.0 286 20-24 93.2 1.372 959 0.2 0,9 1.4 1.6 100.0 1,279 25 29 926 1382 !)6.9 0.7 02 0.9 1.3 100.0 1,651 30 34 921 1.415 96.2 0.8 07 0.8 1.5 100.0 1,303 35-39 88.5 1,588 95.5 0.7 09 0.9 19 t00.0 1.400 40-44 88.1 1380 94.0 I 4 l.I 1,3 2.1 100.0 1,215 45-49 83.6 1.279 94.8 07 0.3 11 3.1 1000 1.069 Urban-rural residence Urban 97.3 3,908 95.7 1. I 0.8 13) 1.4 100.0 3,802 Rural 83.9 5.251 95.3 0.4 0.7 I I 2.5 100,0 4.407 Place of residence LIrban Govemorates 97.9 1,666 96. I 05 (I.9 1.2 1.3 100.0 1,631 Lower Egypt 87.6 4,105 94.6 1. I L0 1.3 2.0 100.0 3,596 Urban 96.6 1,181 94.3 2.1 1.0 I.I 15 100.0 1,141 Rural 83.9 2.924 94.8 0.6 I.I 1.3 2.2 100.0 2,455 Upper Egypt 88.0 3,388 96.2 04 (1.3 0.7 2.5 100.0 2,983 Urban 97.1 1.061 96.8 (1.8 0.4 0.6 15 100.0 1,031 Rural 83.9 2,327 95.9 0.2 0.2 0.8 3.0 1000 1.952 Education No educa0on 78.9 3,452 945 0.4 0.4 1.3 3.4 t00.0 2,722 Some primal2/ 88.1 1,167 956 0.2 02 1.9 2.1 100.0 1,029 Primary complete/ some secondary 94.7 1,27(/ 96.7 0.3 0.6 0.8 1.6 100.0 1,203 Secondary complete/higher 99.5 3,270 95.8 1.3 12 0.7 10 100.t) 3,254 Work status Working for cash 95.1 1.455 92.9 1.7 2.6 10 1.9 100.0 1,384 Not working for cash 88.6 7,7()f 96.0 0.5 0.4 I.I 2.0 100.0 6,822 Wealth index Lowest quintile 72,0 1,699 91.2 0.5 0.7 2.0 5.6 I00.0 1.223 Second quintile 85./) 1,769 96.4 0.2 0.5 0.9 2.0 100.0 1,503 Middle quintile 92.4 1,874 96,5 0.7 0.6 0.7 1.6 100.0 1.731 Fourth quintiie 97,4 1,937 96.3 0.6 0.9 1.1) 12 100.0 1.887 Highest quintile 99.2 1,879 95.9 I 4 0.9 0.9 0.9 100.0 1,865 Total 89.6 9.159 95.5 0.7 0.7 1.1 2.0 1003) 8,209 96 I Knowledge of AIDS, Hepatitis (, and Sq/L, h?/ection Practices Table 8.2 Kngwledge of ways a person can contract AIDS Percentage o['ever-married women age 15-49 kno,aing about AIDS who can name at least one way in which an individual can contract the virus causing AIDS and percentage of women knowing a way in which the virus causing AIDS can be contracted who named various routes of transmission, according to selected background characteristics, Egypt 2003 Pcrcen~ rage of Percentage of women naming various routes of transmission ever - married women knowing Number about of ever- AIDS married xs ho Call women name one Number who know way the ol evcr Casual one way virus married Other physical Mos the virus AIDS women contact contact Mothcrto quito/ causing can be knowing Hetcro- Homo- Blood Un- with with child other AIDS can [:lackground con- about sexual sexual trans- clean infected infected trans- insect be con- characteristic tracted AIDS relations sex thsion needle person person mission bites Other tracted Age 15-19 61.7 286 50.1 31.3 65.6 35,9 18.6 I 1.2 58 3.4 50 177 20-24 77.6 1.279 49.8 40.8 73.6 397 13.7 14.5 6.4 1.1 3.4 992 25 29 81.8 1.651 54.0 42,9 75.9 39.5 12.2 98 5.4 18 29 1,350 30-34 80.3 1,303 56,9 43.0 79.7 40,9 12.8 8.8 37 1.3 1.9 1,047 35-39 76.4 1,406 58.0 39.3 73,8 41.0 12.9 8,1 5.5 1.3 1,9 1,075 40-44 72,8 1,215 57.9 397 77.7 4 l l 12,7 7.9 5.3 I I 2.1 884 45-49 68.5 1,069 52 I 43.4 75.4 40.3 128 9.3 4.7 2.1 1.4 732 Urban-rural residence Urban 86.7 3,802 61.4 41,0 81.2 42.4 10.1 8,6 5.3 0.8 17 3,295 Rural 672 4,407 47.4 41.5 69.6 37.9 16.2 11.0 5.2 2.3 32 2,961 Place of residence Urban Gover norates 86.2 1,631 76.4 30.7 81.0 38.2 5.4 88 5.8 0.6 1.9 1,406 Lower Egypt 74.8 3,596 54.0 42.0 695 40.6 18.5 9.3 5.3 2.2 36 2,689 Urban 86.4 1,141 54.0 48.8 77.3 45.1 16.6 8.6 5.4 L2 2.3 985 Rural 69.4 2,455 540 38.1 65.0 38.0 19.6 9.7 5.2 28 43 1,704 Upper Egypt 72.5 2,983 41.5 47.2 80.0 41.2 11.0 11.0 4.8 1.2 13 2,161 Urban 87.7 1,031 45.9 48.7 85.7 45.9 10.3 8.4 4.3 0.8 0.6 904 Rural 64.4 1,952 38.4 46. l 759 37.8 I I.b 12.9 52 1.5 1.8 1,258 Education No education 57.0 2.722 46.6 37.3 65.7 34,7 14,9 I 1.3 2.1 1 7 2 I 1,55 I Some prim, 66.9 1,029 495 40 1 707 35.8 11.3 107 4.2 2.0 3. I 688 Prim. comp./ some sec. 80.2 1.203 57.4 418 71.8 34.8 11.4 10.8 4.6 2 1 2.4 965 Sec, comp./higher 93.8 3,254 5tl.2 43.3 83.2 45.8 12.9 85 7.2 1.1 25 3.052 Work status Working for cash 88.9 1,384 55.1 48,1 84.7 50.2 14.0 7.5 8,2 1.4 1.9 1,23l Not working lor cash 73.6 6,822 54,6 39.6 73.5 37.8 12.7 10.3 4,5 1.5 2.5 5,022 Wealth index Lowest 47.1 1.223 41,0 38.7 623 32.3 14.5 14.8 2.0 35 4.2 576 Second 65,4 1,503 46.8 40.5 68.3 36.0 17.4 I 1.0 2.8 1.0 2.9 982 Middle 76.2 1,731 50.0 43.7 677 37.5 16.4 11,9 4.4 2.0 2.4 1.319 Fourth 85.8 1,887 585 406 78.7 4[.8 11.0 9.[ 5.9 15 2.4 1.619 Highest 943 1.865 63.7 412 875 45,9 9.2 6,5 77 0.8 1.6 1,759 Total 76.2 8,209 54.7 41.2 75.7 40.3 13.0 9.8 5.2 1.5 2,4 6,256 Knowledge of AIDS, Hepatitis C and SaJe Injection Practices ] 97 8.2 Knowledge of Hepatitis C The information that was collected in the 2003 EIDHS on hepatitis C parallels that obtained with respect to AIDS: ever-married women were asked if they knew about hepatitis C, and, if so, the source from which information on hepatitis C had most recently been obtained and the avenues through which hepatitis C might be contracted. Tables 8.3 and 8.4 present these findings. Table 8.3 shows that 65 percent of ever-married women said that they had heard about hepatitis C; this is considerably lower than the proportion who knew about AIDS. Women were most likely to say they knew about hepatitis C if they lived in an urban area, especially one of the Urban Govemorates, if they had a secondary or higher education, and if they were in the highest wealth quintile. Women in the latter category were the most likely to know about hepatitis C, with 92 percent saying they had heard of the disease. As was the case with AIDS, notably lower levels of knowledge were found among women who never attended school (45 percent), women in the youngest and oldest age cohorts, and rural women. Women living in households ranked in the bottom quintile on the wealth index were the least likely to know about hepatitis C; fewer than 2 in 5 women in this subgroup said they had heard of the disease. Table 8.3 shows that television was again a primary most recent source of health information; slightly more than 80 percent of the women knowing about hepatitis C said that they had heard about the illness most recently on television. Table 8.4 presents information on the avenues of transmission named by women who had heard about hepatitis C. The percentages naming various transmission routes add to more than 100 percent because women were asked to name at least two ways in which an individual might contract hepatitis C. The results in Table 8.4 indicate, again as was the case with AIDS, most women who know about hepatitis C, can name a way in the illness is transmitted; 56 percent of the women who had heard about hepatitis C 36 percent of all ever-married women~ere able to name a way an individual may be exposed to the illness. Almost three-quarters of the women able to name an avenue of transmission for hepatitis C said that it could be contracted through a blood transfusion (73 percent), and 46 percent said that contact with an unclean needle could expose an individual. Other commonly mentioned avenues of transmission lbr the illness included heterosexual sex (19 percent), casual physical contacts with an infected person (e.g., shaking hands) (25 percent) and other types of contact with infected persons (31 percent). As was the case with AIDS, subgroups share similar patterns of responses with regard to the routes of transmission for the hepatitis C although the proportions citing a specific avenue vary. 98 I Knowledge of AIDX Hepatitis C. and Sql~" Injection Practices Table 8.3 Knowledge of hepatitis C Percentage of ever-married women age 15-49 kno'~ing about hepatitis C and percent distribution of women knowing about hepatitis C by the source of information from which the woman last sam' or heard about hepatitis C, according to selected background characteristics, Egypt 2003 Percentage of Number of ever-married ever-married women Number Source from which women last saw/heard about women who knowing of ever- hepatitis C had heard Background about married Other Medical Husband/ Other/ Total about characteristic hepatitis C women TV media provider other relative missing percent hepatitis C Age 15-19 55.2 343 81.6 1.8 1.5 7.7 7.4 100.0 189 20-24 62.7 1,372 84.3 11.9 4.4 5.5 4.9 100.0 861 25-29 68.9 1.782 83.0 1.6 4.2 5.7 5.5 100.0 1,229 30-34 69.6 1.415 83.9 0.9 5.0 4.9 5.4 100.0 984 35-39 66.2 1.588 79.7 1.7 4.3 7.4 6.9 100.0 1,051 4(/-44 65.7 1.380 80.7 I.I 4.6 6.7 6.8 100.0 907 45 49 59.0 1.279 76.4 1.9 3.9 9.4 8.5 100.0 754 Urban- rura l res idence Urban 81.6 3.9(/8 82.2 1.4 5.2 5.8 5.4 100.0 3,188 Rural 53.1 5,251 80.8 1.3 3.3 7.3 7.3 100.0 2,788 P lace o f res idence Urban Governorates 86.0 1,666 85.6 0,7 5.4 4.0 4.3 100.0 1,433 Lower Egypt 60.4 4.105 75.4 1.8 4.7 9.7 8.4 100.0 2,481 Urban 76.9 1.181 75.4 2,8 4.9 8.4 8.5 100.0 908 Rural 53.8 2.924 75.4 1.3 4.5 10.4 8.4 100.0 1,573 Upper Egypt 60.8 3.388 86.0 1.3 3.1 4.5 5,0 100.0 2,061 Urban 79.8 1.061 83.7 1.2 5.0 6.2 4,0 100.0 847 Rural 52.2 2.327 87.7 1,4 1,8 3.3 5.8 100.0 1,215 Educat ion No education 44.5 3,452 81.9 0.7 2.8 6.7 7.8 100.0 1,536 Some primary 57.8 1.167 79.9 0.8 3.7 7.3 8.2 100,0 675 Primary comp./some secondary 69.0 1,270 84.6 1.4 2.7 5.7 5.6 100.0 876 Secondary comp./higher 88.3 3.270 80.7 1.9 5.7 6,5 5.2 100.0 2,888 Work s ta tus Working lbr cash 81.3 1,455 75.0 1.8 7.3 7.5 8.4 100.0 1,183 Not working for cash 62.2 7.701 83.1 1.3 3.6 6.3 5.8 100.0 4,790 Weal th index . Lowest quintile 38.2 1.699 80.2 0,9 2. I 8.3 8.5 100.0 649 Second quintile 50.2 1,769 80.4 0,9 4.2 6.2 8,3 100.0 889 Middle quintile 63.7 1.874 81.3 1.4 4.7 6.4 6.3 100.0 1,193 Fourth quintile 78.5 1,937 85.0 0.9 3.8 5,3 5.1 100.0 1,520 t lighest quintile 91.8 1.879 79.7 2,2 5,4 7.2 5.5 100.0 1,725 Total 65.2 9,159 81.5 1.4 4.3 6.5 6.3 100.0 5,975 Knowledge ~?f A1DS, Hepatitis (2, and Safe Injection Practices ] 99 Table 8.4 Knowledfle of ways a person can contract hepatitis C Percentage of eye.married women age 15 49 knowing about hepatitis C who can name at least one way ht which an individual can contracl hepatitis C and percentage of women knowing about a way hepatitis C can be contracted who nanlcd ~arious routes of transmission, according to selected background characteristics, Egypt 2003 Background characteristic Percentage OI" ever - married women Number knowing of ever about married hepatitis C womcn who can having name one knowl- way edge hepatitis C about Hetero- Homo Blood can bc hepa sexual sexual trans- UncIean in~cted inl~cted trans- contracted titis C relations sex filsion needle Percentage ol'women naming various routes of transmission Number o f ever - married women who ( asual know one Other phys-ical way contact contact Motber hcpati0s with with to child Mosqmto/ C can be other con person person mission insect bites Other tracted Age 15-19 350 189 176 9.7 725 478 33.7 220 65 8.9 49 66 20-24 526 861 232 135 715 458 324 22.3 41 6.3 10.5 453 25 29 54.3 1,229 19.0 13~ 763 464 295 236 49 42 99 667 30-34 60.2 984 20.8 10.4 74.3 46~ 34.5 21.9 68 3.7 87 592 35 39 577 1,051 18 8 8.7 73.6 44.1 30.7 235 48 5,1 I4.6 607 40-44 605 907 17.5 9.5 716 47I 30l 296 55 59 139 549 45 49 53.9 754 159 81 69.3 48.9 30.1 301 46 76 12.3 407 Urban-rural residence Urban 64.0 3,188 193 100 76.8 46.9 31.1 27.5 5.3 Rmal 46.7 2,788 19.1 11.8 673 455 315 20.7 5.2 b. 1 I 1.5 2,(139 5.8 115 1,302 Place of residence Urban Governorates 62.8 1,433 20.6 7.9 759 416 31.5 33.3 6.2 6.4 12.2 900 Lower Egypt 564 2.481 23.6 7. I 676 45.2 365 19.0 38 60 169 1,400 Urban 656 908 230 73 71.4 485 367 19.5 38 57 170 596 Rural 51.1 1.573 241 69 647 428 363 186 3.8 6.2 16.8 804 Upper Egypt 50.5 2,061 121 18.0 78.1 520 24.1 25.4 6.3 36 36 1,040 Urban 64.1 847 130 163 84 2 53 9 24.4 266 53 22 4.2 543 Rural 41 0 1,215 11.0 198 71 5 500 237 24.2 73 50 29 497 Education No education 32.3 1,536 154 8 6 61.3 42.9 294 255 4.9 49 9.3 496 Some primary 40.9 675 16.2 9.3 65,5 45 0 25.4 250 44 64 136 276 Primary comp./ some sec. 48.6 876 17.8 13.1 60.6 42.4 26.9 23.0 5.6 6.4 12.3 426 Secondary comp./higher 74.2 2,888 208 10.9 77.5 48.1 33.3 24.8 5.3 5.1 11.5 2.142 Work status Working for cash 762 1,183 159 1(12 783 528 31.7 284 61 4.5 13.4 901 Not working for cash 50.9 4,790 20.4 10.tt 713 44.0 31.1 23.5 4.9 57 10.7 2,438 Wealth index Lowest quintilc 29.3 649 7.8 14.3 57.0 38.6 27.5 30.3 4.4 45 116 190 Second qumtde 37.5 889 20.2 12.0 64.2 42.6 30.9 22.0 4.4 58 89 333 Middle quintile 50.0 1,193 21.2 I I . I 68.0 47.0 30.7 22.9 4.4 4.9 9.7 596 Pourthquintilc 587 1,520 20.5 107 71 I 445 324 22.6 6.1) 5.4 127 893 Highest quintile 77.0 1,725 188 9.6 81.3 494 31.4 27.2 5.4 5.6 121 1,328 Total 55,9 5,975 19.2 [ 0.7 73. [ 46.4 31.3 24.8 5.2 5.4 [ 1.5 3,340 100 I Knowledge of AIDS, Hepatitis C, and SafL, Injection Practices 8.3 Knowledge of Safe Injection Practices In order to assess the extent to which efforts to inform Egyptians about safe injection practices are succeeding, ever-married women were asked if they had heard anything in the six month period before the EIDHS about how to be sure an injection is given safely. If they indicated that they had heard something about safe injection practices they were asked about what they had heard and about the source from which they had last gotten information. Tables 8.5 and 8.6 present the results of these questions. Table 8.5 Knowledge about safe injection practices Percentage of ever-married women age 15-49 who had heard something about what people should do to ensure injections are given sa|~ly and percent distribution of women knowing about sal~ injection practices according to the source of inlbrmation from which the woman last saw or heard about sate injection practices in the six month period before the survey, according to selected background characteristics, Egypt 2003 Background characteristic Percentage of ever- Number married Source from which women last saw/ &ever- women heard about safe in)ection practices married having women heard who bad something Number heard about safe of ever- Husband/ about safe injection married Other Medical other Other/ Total injection practices women TV media provider relative missing percent practice Age 15 19 55.7 343 55.3 0.0 28.2 11.6 4.9 100.0 191 20-24 59.9 1,372 58.3 1.4 27.4 8.8 4.2 100.0 822 25-29 64.5 1,782 58.1 2.1 27.0 8.7 4.2 100.0 1,150 30-34 65.0 1,415 54.7 2.0 28.0 10.6 4.8 100.0 920 35-39 62.7 1,588 55.4 2.1 26.4 10.0 6.1 100.0 995 40-44 59.4 1,380 58.4 1.4 27.0 8.2 5.0 100.0 819 45 49 58.7 1,279 55.1 1.2 26.3 10.4 7.0 100.0 750 Urban-rural residence Urban 63.8 3,908 59.1 1.9 27.2 7.6 4.2 100.0 2,494 Rural 60E 5,251 54.7 1.5 26.9 I L0 5.9 100.0 3,153 Place of residence Urban Governorates 52.2 1,666 62.3 2.0 22.7 7.9 5.2 100.0 870 Lower Egypt 60.8 4,105 49.7 2.1 29.2 12.7 6.2 100.0 2,497 Urban 70.3 1,181 53.4 2.8 30.0 9.1 4.7 100.0 830 Rural 57.0 2,924 47.9 1.8 28.8 14.5 7.0 100.0 1,667 Upper Egypt 67.3 3.388 62.1 1.0 26.3 6.6 3.9 100.0 2,28 I Urban 74.8 1,061 61.5 0.8 29.2 5.8 2.7 100.0 794 Rural 63.9 2,327 62.5 1.2 24.8 7.0 4.6 100.0 1,487 Education No education 53.6 3,452 56.6 0.7 26.5 10.1 6.1 100.0 1,849 Some primary 57.6 1.167 50.3 0.4 28.6 13.1 7.5 100.0 672 Primary complete/some secondary 64.8 1,270 62.5 1.0 23.7 9.3 3.7 100.0 823 Secondary complete/higher 70.4 3~270 56.5 3. I 28.2 8.0 4.2 100.0 2,303 Work status Working for cash 66.4 1,455 50.4 3.4 31.6 8.9 5.7 100.0 966 Not working for cash 60.8 7J01 58.0 1.3 26.1 9.6 5.0 100.0 4,680 Wealth index Lowest quinti[e 51.0 1,699 51.9 I. I 30.7 [0.0 6.3 100.0 867 Second quintile 59.4 1,769 53.8 1.4 27.7 l 1.0 6.1 100.0 1,052 Middle quintile 65.1 1,874 58.9 1.1 25.1 I 1.0 3.8 100.0 1,220 Fourth quintile 65.0 1,937 62.3 1.6 23.7 7.9 4.5 100.0 1,259 Highest quintile 66.5 1,879 54.4 2.9 29.2 8.0 5.4 100.0 [,251 Total 61.7 9,159 56.7 1.7 27.0 9.5 5.1 100.0 5,648 Knowledge of A1DS, Hepatitis C, and Sa/e lnjection Practices ] 101 Table 8.5 shows that slightly more than 60 percent of cver-marricd women said that they had recently heard about how injections should be given to ensure safety, i.e., to avoid transmitting infection. Among the women who said they had heard about safe injection practices, television (57 percent) was cited most often as the source from which information had been received most recently followed by a medical provider (27 percent) and the husband or other relative (10 percent). Di f ferent ia ls in the propor t ions say ing they had heard about sa le in ject ions are not as large as the d i f ferent ia ls observed w i th respect to awareness o f A IDS or o f hepat i t i s C. In genera l the d i f ferent ia ls fo l low expected patterns; however , somewhat surpr i s ing ly , women in the Urban Governorates were the least l ike ly to say they had heard anyth ing recent ly ( in the s ix -month per iod be lbre the survey) about sa le in ject ion pract ices. For women who sa id they had recent ly heard about safe in ject ion pract ices, Tab le 8.6 prov ides in fo rmat ion on what they repor ted they had heard. They were encouraged by the in terv iewers to g ive more than one response i f they had heard about more than one way to ensure in jcc t ions wcrc g iven safely. Thus , the percentages in Tab le 8.6 add to more than 100 percent. Table 8.6 Sat? injection practices Percentage of ever married women age 15 49 who know about safe injection practices naming vm ious praclices, according to selected background characteristics, Egypt 2003 Number of Use syringe/ Do not share Boil/sterilize ever-man-ied women needle Ibom syringe/ needle bcIbrc having heard ofsai? Background characteristic sealed packet needle reusing Other injection practices Age 15-19 77.4 60.5 14.7 0,8 191 20 24 81.5 65.5 14.3 0.3 822 25-29 82.3 63 4 14.6 0.9 I ,I 50 30-34 84.2 63,3 15 6 I+ 1 920 35-39 85.2 602 13+8 I+ 1 995 40 44 82.6 65.8 I 6.3 1.3 819 45-49 83 1 59.1 15.1 I 5 750 Urban-rural residence Urban 87.3 66.4 16.5 1.2 2,494 Rural 79.6 59.9 13+6 0+9 3.153 Place of residence Urban Govemorates 91 +3 68.7 20.3 0.3 870 Lower Egypt 88.4 54+6 10. l 2.0 2.497 Urban 91.6 56.0 10+5 3 2 830 Rural 86.9 53.9 9.8 1 4 1,667 Upper Egypt 73+9 69.5 18 1 0.2 2,28 I Urban 78+3 74.8 18.7 00 794 Rural 71.5 66.7 17.9 (1.3 1,487 Education No education 78.8 553 13.5 0.5 1,849 Some primat3, 80.2 h 1.6 15(1 1 +3 672 Primary complete/some secondary 83.5 61.5 11.9 0.9 823 SecondmT complete/higher 87.0 69.6 17. I 1.4 2,303 Work status Working t~r cash 87.2 68.3 l S.0 2.5 966 Not working for cash 82. I 61.7 14.3 0.7 4.680 Wealth index Lowest quintile 77.2 57 6 12.9 0.6 867 Second quintilc 80+5 55.6 12+7 0.') 1,052 Middle quintile 82+5 59.3 137 I. I 1,220 Fourth quintile 86.0 63 9 13.7 I 0 1,259 llighest quintile 86.7 74.8 20.4 1.2 1,25 I Total 83.0 62.8 [ 4.9 1.0 5,648 102 I Knowledge q]AIDS, tlepatitis C, and Sq[i~ Irz/cction Practice,~ With respect to safe injection practices, women were most likely to say that they had heard that the syringe and needle should come from a sealed packet; 83 percent mentioned this practice. Slightly more than 60 percent had heard that needles or syringes should not be shared while 15 percent had heard that needles should be boiled or otherwise sterilized before they were used again. Knowledge of AIDS, Hepatitis C, and Sa[~ ~ Injection Practices J 103 9 FEMALE CIRCUMCISION Female circumcision is a widespread practice in Egypt. The 2003 EIDHS collected information on the prevalence of female circumcision and attitudes about the practice in order to monitor the changes, particularly in the attitudes about female circumcision, among Egyptian women. 9.1 Prevalence of Female Circumcision The practice of female circumcision is virtually universal among women of reproductive age in Egypt. Table 9.1 shows that 97 percent of the ever-married women interviewed in the 2003 EIDHS reported that they had been circumcised. This is the same proportion as reported in the 2000 EDHS. This is not surprising since the majority of circumcisions occur when girls are between the ages of 7 and 12; consequently, it will take a number of years before the results of the current campaign to eliminate the practice will be evident in the rates among the ever-married women age 15-49 who are DHS respondents. To obtain insight into whether changes may be occurring in the likelihood that young girls will be circumcised, ever-married women who had living daughters were asked questions about the circumcision experience of their daughters. Overall, 6,587 EIDHS respondents had at least one living daughter. Table 9.1 shows that slightly fewer than 8 in 10 women reported that at least one of their daughters had already been circumcised (47 percent) or that they intended to have a daughter circumcised in the future (31 percent). Comparing these results to those reported in earlier DHS surveys, there have small declines since 1995 in the proportion of women reporting that their daughter had been circumcised (from 50 percent in the 1995 and 2000 surveys to 47 percent in 2003) as well as in the proportion of women intending to circumcise a daughter in the future (from 38 percent in 1995 to 31 percent in the 2000 and 2003 surveys). Looking at the differentials, place of residence is strongly associated with the likelihood a daughter will be circumcised. The percentage of women who have at least one daughter who had been circumcised or who intend to have their daughter circumcised in the future varies from a low of 57 percent among women in the Urban Governorates to a high of 91 percent among women in rural Upper Egypt. As expected, women with no education are the most likely to have at least one circumcised daughter or to plan to have their daughter(s) circumcised while women with a secondary or higher education are the least likely to have or to consider having their daughter(s) circumcised. Even among highly educated women, however, more than half report that they have at least one daughter who has been circumcised (20 percent) or that they plan for their daughter(s) to be circumcised in the future (33 percent). The likelihood a daughter will be circumcised also decreases with the household's rank on the wealth index. As is the case with education, however, even in households ranked in the highest wealth quintile, about half of the women have a daughter who has already been circumcised or say they plan to have a daughter circumcised in the future. The EIDHS obtained information from women who said their daughters would not be circumcised about the reasons for their attitude. Women could give more than one reason in response to the question. The majority (61 percent) simply said that they did not believe in the practice (data not shown in table). A substantial proportion of the women expressed concern about potential health complications (42 percent) while 20 percent saw the practice as against religion. Other reasons women mentioned included the beliefs that a girl who was not circumcised would have a better marriage prospect (8 percent) and that sexual relations with a woman who was not circumcised afforded greater pleasure for the husband (5 percent). Female Circumcision I 105 Table 9.1 Prevalence of female circumcision Percentage of ever-married women age 15-49 who have been circumcised and, among ever-married women with daughters, percentage with at least one daughter circumcised or who say they intend to have their daughter(s) circumcised, according to selected background characteristics, Egypt 2003 Background characteristic Percentage Percentage with of ever-manied no daughters women Percentage with circumcised who who at least one plan to have Number of have been Number of ever daughter daughter women with circumcised married women circumcised circumcised daughter(s) Age 15-19 96.8 343 1.3 79.9 99 20-24 97.4 1.372 1.9 67.2 672 25-29 97.3 1 382 10.5 58.9 [,189 30-34 96.5 1,415 31.3 41 6 1.06 I 35-39 96.4 1,588 61.7 18.9 1,30 I 40-44 96.5 1,380 76.0 6.8 1,142 45-49 98.0 1,279 86.9 2.2 l, 123 Urban-rural residence Urban 94.6 3,908 39.8 25, I 2,802 Rural 98.8 5,251 52.9 34.8 3,785 Place of residence Urban Governorates 91.3 1,666 37.6 19.3 I. 174 Lower Egypt 98.3 4,105 47.8 32.4 2,943 Urban 96.3 1,181 39.3 28.8 856 Rural 99.1 2,924 51.2 33.9 2.087 Upper Egypt 98.3 3,388 51.4 340 2,470 Urban 97.8 1,061 43.6 30.0 772 Rural 98.6 2,327 55.0 35.9 1,698 Education No education 99.1 3,452 66.6 27.2 2,726 Some primary 98.9 I, 167 61 5 26.7 889 Primary complete/some secondary 98.1 1,270 39.1 40.6 885 Secondary complete/higher 93.7 3,270 19.7 32~7 2,088 Work status Working for cash 94.3 1,455 42.3 22.4 1,051 Not working tbr cash 97.5 7,701 48.3 32.3 5,533 Wealth index Lowest quindle 99.0 1,699 57.5 35. I t,310 Second quintile 99.2 1769 55.4 34.4 1,332 Middle quintile 98.9 1,874 50.9 34.4 1.297 Fourth quintile 97.5 1,937 42.9 29. I 1.360 Highest quintde 90.8 1,879 29.7 20.2 1,288 Total 2003 EIDHS 97.0 9,159 47.3 30.7 6,587 Total 2000 EDHS 97.3 15,573 49.5 31.4 I 1,540 Total 1995 EDHS 97.0 14,779 49.7 37.6 10,847 9.2 Support for Female C i rcumcis ion The 2000 EIDHS obtained additional information about women's attitudes about whether the practice of circumcision should be continued. Table 9.2 shows continuing widespread support for the practice of circumcision among women in Egypt. Overall, 71 percent of EIDHS respondents feel that the practice of circumcision should continue. This is slightly lower than the percentage of 2000 EDHS respondents who supported continuation of female circumcision (75 percent). 106 ] Female Circumcision Table 9.2 Attitude about continuation of female circumcision Percent distribution of ever-married women age 15-49 by the attitude toward the continuation of the practice of female circumcision, according to selected background characteristics, Egypt 2003 Background characteristic Female circumcision should: Number of ever- Be Other/ Total married Continue discontinued not sure percent women Age 15-19 78.5 14.7 6.8 100.0 343 20-24 70.9 16.4 12.7 100.0 1,372 25-29 68.3 18.4 13.3 100.0 1.782 30-34 68. I 19.4 12.5 100.0 1,415 35-39 72.7 17.3 10.0 100.0 1,588 40-44 69.7 19. I l 1.2 100.0 1,380 45-49 75.8 15.9 8.3 100.0 1,279 Urban-rural residence Urban 56.7 28.2 15.1 100.0 3,908 Rural 81.8 9.8 8.4 100.0 5,251 Place of residence Urban Governorates 50.5 33.7 15.8 100.0 1,666 Lower Egypt 73.0 15.1 11.9 100.0 4,105 Urban 58.2 25.4 16.4 100.0 1,181 Rural 79.0 10.9 I 0.0 100.0 2,924 Upper Egypt 78.8 13.0 8.2 100.0 3,388 Urban 64.8 22.8 12.4 100.0 1,061 Rural 85.2 8.5 6.3 100.0 2,327 Education No education 87.4 5.4 7.2 100.0 3,452 Some primary 78.4 11.5 10.1 100.0 I, 167 Primary complete/some secondary 73.2 16.0 10.8 100.0 1,270 Secondary complete/higher 50.5 33.5 16.0 100.0 3,270 Work status Working for cash 55.7 31.4 13.0 100.0 1,455 Not working for cash 74.0 15.1 10.9 100.0 7,701 Wealth index Lowest quintile 87.1 5.3 7.6 100.0 1,699 Second quintile 84.3 7.4 8.3 100.0 1,769 Middle quintile 78.2 11.6 10.3 100.0 1,874 Fourth quintile 63.6 21.8 14.6 100.0 1,937 Highest quintile 44.8 40.4 14.8 100.0 1,879 Total 71.1 17.7 11.2 100.0 9,159 Marked d i f ferences in att i tudes about the desirabi l i ty o f cont inu ing the pract ice o f female c i rcumcis ion are ev ident accord ing to the woman's background character ist ics. Urban residents are much less l ikely than rural residents to be l ieve c i rcumcis ion should be cont inued. On ly around ha l f o f women in the Urban Governorates support cont inu ing wi th the pract ice compared to more than 8 in 10 women in rural Upper Egypt. There also is a marked negat ive re lat ionship between a woman's educat ional level and the l ike l ihood that she supports the cont inuat ion o f the pract ice o f c i rcumcis ion. Look ing at the re lat ionship wi th the weal th index, women in the lowest weal th quint i le are a lmost tw ice as l ikely to support cont inuat ion o f the pract ice as women in the h ighest wea l th quint i le (87 percent and 45 percent, respect ively) . Female Circumcision ] 107 9.3 Communicat ion about Female Circumcision To obtain information on the communication challenges through which women receive information on about female circumcision, women were asked about whether they had heard or seen anything about the practice during the year before the survey from the following sources: television, radio, newspaper/ magazine, community meeting, and mosque or church. They also were asked if they had discussed the subject with relatives, friends or neighbors at any time during the year. Table 9.3 presents the results from these questions. Table 9.3 Communication about female circumcision Percentage of ever-married women age 15-49 who have heard or seen information about temale circumcision through various information channels and who have discussed the practice witb relatives, family or I?iends during the year before the survey, according to selected background characteristics, Egypt 2003 Discussed with Number News- lhmily/ of ever- Background paper/ Community Mosque/ friends/ married characteristic Television Radio magazine meeting church neighbors women Age 15-19 80.3 21.0 6.6 3.0 4.7 50. I 343 20-24 84.8 22.1 9.5 2. I 3.4 55.6 1,372 25 29 89.4 19.7" 12.2 1.5 3.5 56.9 1.782 30 34 86.8 22.5 14.3 2.6 3.8 59.6 1,415 35-39 87.4 18.9 12~9 2.4 3.7 59.0 1,588 40-44 85.6 21.0 12.5 2.7 4.6 57.1 1,380 45-49 83.7 18.2 8.3 1.9 3.4 53.5 1,279 Urban-rural residence Urban 93.7 21.6 19.0 2.2 5.1 60.0 3,908 Rural 80.8 19.5 6.0 2.2 2.7 54.4 5,25 I Place of residence Urban Governorates 97.3 16.6 22.0 1.5 4.8 62. I I ~666 Lower Egypt 81.6 21.0 9.8 3.4 3.0 51.7 4,105 Urban 89.2 26.4 17.1 3.4 5.0 56.2 1,181 Rural 78.6 18.9 6.8 3.4 2.1 49.9 2,924 Upper Egypt 86.5 21.4 8.6 I. I 4.2 60.4 3,388 Urban 92.9 23.9 16.4 1 8 5.8 61.2 1,061 Rural 83.5 20.3 5d) 0.7 3.5 61)./I 2,327 Education No education 78.7 13.8 0.6 1.2 2.6 52.5 3,452 Some primary 83.4 17.0 2.0 2.2 3.4 52.5 1,167 Primary complete/some secondary 90. I 23.6 7.4 1.8 3.4 59.6 1,270 Secondary complete/higher 93.8 27.3 28.1 3.4 5.3 61.7 3,270 Work status Working for cash 90.7 24.0 26.7 4.3 5.0 59.7 1,455 Not working for cash 85.4 19.7 8.7 1.8 3.5 56.2 7,701 Wealth index Lowest quintile 70.7 14.2 1. I 1.9 1.9 51.0 1,699 Second quintile 81.8 19.0 31 1.5 3.4 51.4 1,769 Middle quintile 89.0 20.5 7.6 2.0 4. I 57.4 1,874 Fourth quintile 92.9 22.7 13.6 2.3 3.9 59.9 1,937 Highest qu!ntile 94.9 24.9 30.7 3.2 5.3 63.2 1,879 Total 2003 EIDHS 86.3 20.4 11.5 2.2 3.8 56.8 9,159 Total 2000 EDHS 72.7 36.8 20.4 3.3 3.9 33.0 15,559 108 [ Female Circumcision The majority of women had heard or seen something about female circumcision during the year before the survey. With respect to the specific communication channels, television was the most commonly mentioned source of the information women had received; 86 percent of women said they had heard about female circumcision on TV. Radio was the second most common source (20 percent) followed by newspaper or magazines (12 percent). Comparatively few women reported that the topic had been discussed in a community meeting (2 percent) or at the mosque or church (4 percent). Table 9.3 shows that 57 percent of EIDHS respondents had discussed female circumcision with a family member, friend or neighbor in the year prior to the survey. There was some variation in the percentage reporting discussion across subgroups. Women age 15-19 and women in rural Lower Egypt were least likely to say they had talked about circumcision (50 percent) and women in the highest wealth quintile (63 percent) were most likely to report talking about it. Finally, the responses for the communication questions are compared with the results of the same questions in the 2000 EDHS at the bottom of the panel. The comparison indicates that substantially more women saw something on television about female circumcision on television prior to the E1DHS than prior to the 2000 EDHS (86 percent and 73 percent, respectively). On the other hand, the percentages reporting they had seen or heard information through the other media channels were uniformly somewhat lower in the EIDHS than in the 2000 EDHS. With regard to discussion of the topic, the trend is quite positive. At the time of the 2000 EDHS, one- third of the women said they had talked about the subject with family, friends or neighbors. In the 2003 survey, this percentage was 56 percent, a more than 70 percent increase in the likelihood that the topic was discussed. 9.4 Beliefs about Circumcision In the 2003 EIDHS, respondents were asked about whether they agreed or disagreed with a number of statements various beliefs about the practice Table 9.4 shows the proportion of women agreeing with each belief in the 2003 EIDHS and the 2000 EDHS. Table 9.4 shows that, at the time of the EIDHS, 72 percent of ever-married women agreed that circumcision is an important part of religious tradition. Around two-thirds of the women feel that the husband prefers the wife to be circumcised. Somewhat less than half of the women agree that circumcision prevents adultery. With regard to the potential adverse consequences of the practice for women, around one-third of the women believe that circumcision lessens sexual satisfaction for a couple, and 28 percent agreed with the statement that circumcision can cause severe complications that may lead to a girl's death. On the other hand, only small proportions believe that circumcision causes infertility or makes childbirth difficult. Looking at the differentials, there are significant variations in the proportions who agree with many of the beliefs. In general, the variations follow expected patterns: rural, less educated and poorer women express more conservative views than other women. For example, the proportion who consider circumcision to be an important religious tradition is higher among rural than urban women (78 percent and 64 percent, respectively) and varies from a high of 82 percent among women who never attended school to 59 percent among women with a secondary or higher education. Female Circumcision I 109 Table 9.4 Beliefs about lbmale circumcision Percentage of ever-married women age 15 49 wbo agree with various statements about lbmalc circumcision, according to selected background characteristics, Egypt 2003 Background characteristic Number of Important Can lead Causes Makes Lessens ever- religious Husbands Prevents to girl's infer childbirth sexual married tradition prefer adultery death tility difficult satisfaction women Age 15-19 74.1 68.9 41.1 25.7 8.6 4.0 251 343 20-24 70.2 65.5 42.7 27.8 7.3 6,3 28.0 1.372 25-29 70.9 65.1 48.1t 27.8 6.9 6.11 35.9 1,782 30-34 71.5 615 46.2 29.6 79 5.5 33,1 1.415 35-39 73.4 65.1 47.7 28.8 7.8 6.3 33,I) 1,588 40-44 72.6 62.9 47.1 29.4 8.8 6.6 35.6 1,380 45-49 74.9 64.4 49.7 25.7 6.0 5.3 29.4 1,279 Urban-rural residence Urban 64.2 55.3 46.6 38.5 9./) 6.8 41.7 3.908 Rural 78.2 71.0 46.9 20.4 6.4 53 25.5 5,251 Place of residence Urban Governorates 59.0 5 I. I 46.6 45.6 8.2 5. I 45.6 1.666 Lower Egypt 75.0 64.0 43.9 21 5 63 3.9 32.0 4~105 Urban 65.6 55.6 44.3 28.5 79 4.8 40.5 1,181 Rural 78.8 67.3 43.7 18.7 5.7 3.5 28.6 2,924 Upper Egypt 75.4 71.3 50.2 27.6 8.6 8.8 264 3,388 Urban 70.7 61.6 49.0 38.5 I 1,5 I I.h 37.1 13161 Rural 77.5 75.7 50.8 226 7.3 7.6 21.6 2,327 Education No education 82. I 754 49.8 17.3 4.7 3.6 20.4 3,452 Some prbnary 78.7 70.1 49.4 24.6 6.0 55 27.9 1.167 Primary complete/ some secondary 73. I 687 49.7 25.7 64 6.3 32.4 1.270 Secondary complete/ higher 59.2 48,9 41.3 41.8 I 1.4 8.4 46.7 3.27tt Work status Working lbr cash 62.4 51.4 44.7 38.9 I 1.0 8. I 48.4 1,455 Not working Ibr cash 74 1 66.8 47. I 26.1 6.8 5.5 29.4 7,701 Wealth index Lowest quintile 78. I 75.5 44.2 174 5.2 3.9 18.0 1,699 Second quintilc 82.3 73.0 49.3 18.3 5.5 5.5 24.3 1.769 Middle quintilc 78.1 71.5 50.1 236 6.6 5.5 28.8 1.874 Fourth quin01e 70.2 60.4 50.4 32.2 7.4 5. I 38. I 1.937 Highest quintile 53.7 43.11 39.4 47.5 12.5 9.4 50.9 1.879 Total 2003 EIDHS 72.2 64.3 46.7 28 1 7.5 5.9 32.4 9.159 Total 2000 EDHS 72.6 67. I 51.4 29. I 7.8 7.5 37.0 15,559 A comparison of the E1DHS results with the 2000 EDHS findings indicates that women's beliet~ about circumcision remained relatively constant during the period. In particular, Table 9.4 shows there was very little change between 2000 and 2003 in the proportions of women agreeing with two beliefs that are important to the continuing support for the practice the belief that circumcision is a religious tradition and that husbands prefer their wives to be circumcised. I 10 [ Female Cireumcision REFERENCES EI-Zanaty, Fatma and Ann A. Way. 2001. Egypt Demographic and Health Survey 2000. Calverton, Maryland: Ministry of Health and Population [Arab Republic of Egypt], National Population Council [Arab Republic of Egypt], and ORC Macro. EI-Zanaty and Associates and Macro International Inc. 1999. Egypt Demographic and Health Survey 1998. Cairo Egypt: E1-Zanaty and Associates [Arab Republic of Egypt] and Macro International Inc. E1-Zanaty and Associates and Macro International lnc. 1998. Egypt Demographic and Health Survey 1997. Cairo Egypt: EI-Zanaty and Associates [Arab Republic of Egypt] and Macro International Inc. E1-Zanaty, F., Enas M. Hussein, Gihan A. Shawky, Ann Way, and Sunita Kishor. 1996. Egypt Demographic and Health Survey 1995. Calverton, Maryland: National Population Council [Arab Republic of Egypt] and Macro International Inc. EI-Zanaty, F., H. A. A. Sayed, H. Zaky, and Ann Way. 1993. Egypt Demographic and Health Survey 1992. Calverton, Maryland: National Population Council [Arab Republic of Egypt] and Macro International Inc. Filmer, Deon and Lant Pritchett. 1998. Estimating Wealth Effects without Expenditure Data-or Tears: An Application to Educational Enrollments in States of lndia. World Bank Policy Research Working Paper No. 1994. Washington, DC: Development Economics Research Group (DECRG), The World Bank. Rutstein, Shea. 1999. Wealth versus Expenditure: Comparison between the DHS Wealth Index and Household Expenditures in Four Departments of Guatemala. Unpublished. Sayed, H. A. A., M. Osman, F. EI-Zanaty, and Ann Way. 1989. Egypt Demographic and Health Survey 1988. Columbia, Maryland: National Population Council [Arab Republic of Egypt] and Institute for Resource Development/Macro Systems, Inc. References ] 111 APPENDIX A SAMPLING ERRORS The estimates from a survey are affected by two types of error: (1) nonsampling errors and (2) sampling errors. Nonsampling errors are the result of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct households, misunderstanding of the questions on the part of the interviewer or the respondent, and data entry errors. Quality control measures during the implementation of the 2003 EIDHS were designed to minimize this type of error; however, nonsampling errors are impossible to avoid and the extent of the impact of this type of error on the survey results is difficult to evaluate statistically. Unlike nonsampling error, sampling error can be evaluated statistically. The sample of respondents selected in the 2000 EIDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of the samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. Sampling error is usually assessed in terms of the standard error for a particular statistic. The standard error is calculated by taking the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for a population can reasonably be assumed to lie. Typically, 95 percent confidence intervals will be calculated, i.e., the range within which there is 95 percent confidence that the true value of the statistic lies. This upper boundary of this interval is calculated by adding the standard error to the statistic and the lower boundary is calculated by subtracting the standard error from the statistic. Sampling errors are presented in Table A.I for the key indicators from the 2003 EIDHS. For each indicator, Table A.I presents the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard (SE/R), and the 95 percent confidence intervals (R_+2SE). Appcm/ix A Sam/ding Errol:s I 113 Table I Sampling errors lor selected variables: National sample, 2003 Egypt Interim Demographic and Health Survey Number of cases Confidence limits Standard Un Design Relative Value error weighted Weighted c fl~ct errol Variables (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE No education 0.377 0.010 9159 9159 1.921 0.026 0.357 0.396 Ever used any contraceptive method 0.810 0.006 8430 8445 1.416 0.007 0.798 0.822 Currently using any contraceptivc method 0.600 0.007 8430 8445 1.390 0.012 11.585 0,615 Currently using a modem method 0.566 0.007 8430 8445 1.383 0.013 11.551 0.581 Currently using pill 0.093 0,004 8430 8445 L217 0.041 0.085 0. 110 Currently using IUD {).367 0.008 843{) 8445 1.499 0.021 0.351 0.382 Currently using injection 0.079 0.004 8430 8445 1.267 0.047 0.072 0.087 Want no more children 0.630 0.1106 8430 8445 I. 192 0.010 0.617 0.642 Want to delay at least 2 years 0.153 0.005 8430 8445 1192 0.031 0.144 0.162 Mothers received tetanus injection 0.780 0.009 6661 6314 1.422 0.01 I 0.763 0.798 Mothers received antenatal care 0.687 0.010 6661 6314 1.484 0.015 0.666 0.7{/8 Mothers received regular antenatal care 0.556 0.012 6661 6314 1.622 0,022 0.532 0.580 Mothers received medical care at delivery 0.694 0.012 6661 6314 1.694 0.017 0.670 {I.718 Had diarrhea in last 2 weeks 0.189 0.006 6348 6056 I. 195 0.033 11.176 0.201 Treated with ORS packets 0.282 0.017 1335 1144 1.212 0.061 1/.247 0.316 Consulted medical personal about d iar rhea 0.457 0.018 1335 1144 1.192 0.040 0.421 /I.494 Having immunization record 0.738 0.015 12311 1192 1.172 0.020 0.708 0.768 Received BCG vaccination 0.991 0.004 1230 1192 1.153 0.004 0.984 /I.998 Received DPT vaccination (3 doses) 0.926 0.009 1230 1192 I 122 0.009 1/.909 0.943 Received polio vaccination 13 doses) 0.933 0.009 123{I 1192 1.191 0.009 0.916 {/.950 Received measles vaccination 0.956 0.006 1230 1192 1.087 0.007 0.943 0.969 Received hepatitis vaccination (3 doses) 0.790 0.014 1230 1192 1.160 0.017 0.763 0.8[8 Fully immunized 0.875 0.012 1230 1192 1.236 0.014 0.851 0.899 Weight4br-height I1156 0.007 6106 5766 1.292 0.042 0.143 {).169 tteight-lbr-agc 0.040 0.003 6106 5766 1.286 {),085 0.033 0.046 Weight-lbr-age 0.086 0.005 6065 5761 I 21 I 0.054 0.076 0.095 Total fertility rate (0 3 years) 3.183 0.055 NA 265502 1.182 0.017 3.073 3.292 Mortality rates (0-9 years) Neonatal 24.858 1.792 12912 12309 1.130 0.072 21.274 28.442 Postneonatal 19812 1.431 12926 123211 1.085 0.072 16.950 22.674 Inlhnt 44.6711 2.398 12929 12322 1.131 0.052 40.035 49.3116 Child 10.928 1416 12953 12343 1.096 0.102 8.696 13.160 Under-five 55.110 2.649 12937 12357 1.149 0.048 49.811 60.409 i i i i i i i i i i i i i i i i 114 I Appendix A Sampling Errors APPENDIX B 2003 EGYPT INTERIM DEMOGRAPHIC AND HEALTH SURVEY QUESTIONNAIRES ARAB REPUBLIC OF EGYPT MINISTRY OF HEALTH AND POPULATION NATIONAL POPULATION COUNCIL INTERIM EDHS 2003 HOUSEHOLD QUESTIONNAIRE DATA COLLECTED FROM THIS STUDY IS CONFIDENTIAL AND WILL BE USED FOR SCIENTIFIC PURPOSES ONLY Appendix B Questionnaires [ 115 EGYPT INTERIM DEMOGRAPHIC AND HEALTH SURVEY 2003 HOUSEHOLD QUESTIONNAIRE GOVERNORATE KISM/MARQAZ. SHIAKtlA/VILLAGE HOUSEHOLD NO. INSIDE SEGMENT. PSU/SEGMENT NO BUILDING NO. HOUSING UNIT NO. I I GOVERNORATE PSU/SEGMEN1 NO r I I I I I URBAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I RURAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 LARGE C ITY . . . . . . . I SMAI , I , C I ' ]Y . . . . . . . 2 TOWN . . . . . . . . . . . . . . . 3 V [LLAGE . . . . . . . . . . . . . 4 ~O' I 'SLuM AREA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I SLUM AREA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~AME OF" HOUSEHOLD HEAD ~-DDRESS IN I)E fAIL HOUSEItOLD NO URBAN/RURAL ~LI r I,FICAL[TY NOT SLUM/SEIJM ELATE I EAM NTERYIEWER ~UPERYISOR ASSISTANT iUPERVISOR ~ESULT ~EXT VISIT: DATE TIME RESULT CODES: I COMPLETED INTERVIEWER VISITS I 2 DAY 5 REFUSED 2 NOT HOUSEHOLD MEMBERAI IIOME/ NO COMPETENT PERSON AT HOME 3 ENTIRE HOUSEHOIJ) ADSEN F EOR AN EXTENDED PERIOD 4 POSTPONED 9 OTHER ADDRESS ( HECKED NAME I)A I'E SIGNATURE 6 DWELLING VAGANT/ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 D'@ELLING NOT FOUND (SPECIFY) YES . I BY NO . 2 t t ~ F IELD EDITOR / / 2003 FU~ REINTERVIEW OFFICE EDITOR / / 2003 r ~ wsr r MONTH YEAR I Ilol 112rolol3 I EAM INTERVIEWER SUPERVISOR ASSIS IANT SUPERVISOR RESULT TOTAL NUMBEROFVISITS I I TOTAl, IN ROUSF, HOIA) TOTAL EIAGIBLE ~OMEN LINE NO. OF RESPONI)ENT FROM I l l l Q. YES . I NO . 2 CODER / / 2003 UF~ DV KEVER / / 2003 UF~ 116 t AppendL~ B Questionnaires HOUSEHOLD SCHEDULE We would like some information about LINE USUAL RESIDENTS AND RELATIONSHIP NO, VISITORS ~1) IlI l l I , i i l tT t ! Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. AFTER LISTING NAMES, ASK QUESTIONS 003-005 TO BE SURE THAT THE LISTING IS COMPLETE. THEN GO ON TO QUESTION 006. What is the Does relationship of (NAME) (NAME) to the usually head of the live here? last night? female? household? (SEE CODES BELOW). 01 HEAD 02 MARrI:AL - RESIDENCE SEX AGE STATUS IF AGE 15 OR WOMEN OLDER 009 010 011 012 Did Is How old What is CIRCLE LINE (NAME) NAME) was NAME'S) NUMBER OF sleep here male or (NAME) current WOMEN at his/ marital ELIGIBLE FOR her last status? INDIVIDUAL birthday? INTERVIEW (i.e., MARRIED EVER-MARRIED 2 WIDOWED RECORD WOMEN AGE 15- 3 DIVORCED IN 49 YEARS WHO COMPLET- 4 SEPARATED ARE USUAL ED YEARS. 5 NEVER RESIDENTS OR MARRIED/ STAYED THERE SIGNED ON THE NIGHT CONTRACT BEFORE INTERVIEW) YES NO YES NO M F IN YEARS LINE NO. 1 2 1 2 1 2 [ - -~ [ ] 01 03 04 rN , 2 , 2 , 2 ~ [ ] ELIGIBILITY CHILDREi~ 013 CIRCLE LINE NUMBER OF CHILD UNDER AGE 6 02 t 2 , 2 , 2 r e [ ] o2 LINE NO. 01 02 03 04 05 . ~ , 2 , 2 , 2 l -n [ ] 05 05 06 N-] , 2 , 2 , 21 - ~ [ ] 06 06 07 08 09 1 2 1 2 1 2 ~ [ ] 07 07 ~ ] 1 2 1 21 2 ~ [ ] 08 08 ~I~ 1 2 1 2 t 2 ~ [ ] 09 09 10 I l l 1 2 ' Just to make sure that I have a complete listing: 303 Are there any other persons such as small children or infants who are not listed? YES N .ADDTO002 NO D 304 In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends who usually live here? YES [~- -~ADDTOOO2 NO [ ] 305 Do you have any guests or temporary visitors staying here, or anyone else who slept here last night? YES I~ '~ADDTOO02 NO D 2 1 2 ~ [ ] 10 10 CODES FOR G006 RELATIONSHIP TO HOUSEHOLD HEAD: 01 = HEAD 06 = BROTHER / SISTER 02 = WIFE / HUSBAND 09 -- BROTHER-IN-LAW I SISTER-IN-LAW 03 = SON / DAUGHTER 10 = OTHER RELATIVE 04 = SON-IN-LAW / DAUGHTER-IN- 11 = ADOPTED I FOSTER CHILD LAW 12 = STEP CHILD 05 = GRANDCHILD 13 -- NOT RELATED 06 = PARENT 98 = DON'T KNOW 07 = PARENT-IN-LAW Appendix B Questionnaires I 117 LINE ATTENDANCE DURING THE 2001-2002 SCHOOL NO. EDUCATION ATTENDANCE DURING THE 2002-2003 SCHOOL YEAR YEAR IF AGE 6 YEARS OR OLDER IF AGE 3 - 24 YEARS IF AGE 3 - 24 YEARS 001 014 015 016 Has IF ATTENDED SCHOOL (NAME) What is the ever been hlohest level to school? of school IF YES: NAME) attended7 ASK QUESTION 1 PRIMARY IS 015"022 2 PREPARATORY AS APPRO- 3 SECONDARY PRIATE, 4 UPPER INTERMEDIATE IF NO: 5 UNIVERSITY GO TO 006 6 MORE THAN FOR NEXT UNIVERSITY PERSON 017 018 019 020 021 022 Has (NAME) IF ATTENDED SCHOOL Did (NAME) IF ATTENDED SCHOOL What is the attended school During this What grade attend school What level of What highest at any time school year, is he/she at any time school did grade grade hc/sh= during the 2002- what level is attending? during the (NAME) did successfully 2003 school (NAME) bccn 2001-2002 attend during he/she completed ,ear, thai is attending? school year, the 2(/01- 2002 attend at that since September that is the level'? 2002 current NURSERY/ school year school year'? during the (school year)'? KINDERGARTEN beginning in 0 NURSERYt 2001- 1 PRIMARY September KINDERGARTE 2002 IF YES: 2 PREPARATORY 2001 (the N school 3elWiOUS 1 PRIMARY ASK QUESTIONS 3 SECONDARY schoo l year)'~ 2 PREPARATORY year? 018-019, 4 UPPER 3 SECONDARY GO TO 006 FOR NEXT IF NO: INTERMEDIATE IF YES: ASK 4 UPPER PERSON GO TO 020 5 UNIVERSITY QUESTIONS INTERMEDIATE 6 MORE THAN 021-022. 5 UNIVERSITY UNIVERSITY IF NO: 6 MORE THAN GO TO 000 UNIVERSITY YES NO LEVEL GRADE YES NO LEVEL GRADE YES NO LEVEL GRADE 01 1 2 [ ] N ~ 2 [ ] N , 2 [ ] [ ] 02 1 2 [ ] I I " 2 [ ] N , 2 [ ] [ ] 03 1 2 [ ] 04 1 2 [ ] I I ' = [ ] I I 1 2 [ ] [ ] I I ' 2 [ ] I I , 2 [ ] [ ] 05 06 07 2 2 [ ] [ ] , 2 [ ] I I [ ] [ ] 1 2 [ ] I I , 2 [ ] [ ] 1 2 [ ] [ ] , 2 [ ] [ ] 2 [ ] [ ] 1 2 [ ] I I o0 , 2 [ ] [ ] 1 2 [ ] I I 1 2 [ ] [ ] DO , 2 [ ] [ ] 1 2 [ ] [ ] 1 2 [ ] [ ] ,0 1 2 [ ] [ ] , 2 [ ] 023 CHECK O12 AND ENTER THE TOTAL NUMBER OF ELIGIBLE WOMEN 024 CHECK 013 AND ENTER THE TOTAL NUMBER OF ELIGIBLE CHILDREN 025 TICK IF AN ADDITIONAL HOUSEHOLD QUESTIONNAIRE USED [ ] 1 2 [] [] [ 1 8 ] Appendix B Questionnaires NO. QUEST IONS AND F ILTERS 026 What type o f dwell ing does your household live in? 027 CODING CATEGORIES SK IP TO APARTMENT . 1 FREE STANDING HOUSE 2 OTHER 6 (SPECIFY) Is your dwell ing owned by your OWNED . 1 L household or not? OWNED JOINTLY . 2 030 RENTED . 3 IF OWNED: IS it owned solely by your OTHER 6 household or jointly with someone else'? (SPECIFY) 028 Is there a possibility that you could be YES l evicted from this dwelling? NO . 2 - DON'T KNOW . 8 - - " 030 029 How likely is it that you could be L IKELY . 1 evicted, would you say very likely, SOMEWHATUKELY 2 somewhat likely or very little likely? VERY LITTLE LIKELY . 3 DON'T KNOW . 8 030 MAIN MATERIAL OF THE FLOOR. RECORD YOUR OBSERVATIONS. NATURAL FLOOR EARTH/SAND 1 l RUDIMENTARY FLOOR WOOD PLANKS 2 | FINISHED FLOOR PARQUET OR POLISHED WOOD 3 | CERAMIC/MARBLE TILES . . . . . . . . . . . . . . . . . . . . . 32 CEMENT TILES . 33 CEMENT . 34 WALL-TO-WALL CARPET . . . . . . . . . . . . . . . . . . . . . . . 35 VINYL . . . . . . . . . . . . . . . . . . . 36 OTHER 96 (SPECIFY) 031 ; How many rooms does your household use for l iving (excluding the bathrooms kitchens and stairway areas)? 032 What is the main source of drinking water for members of your household? ROOMS UVq PIPED WATER PIPED INTO RESIDENCE 11 - - -~ 034 PIPED INTO YARD/PLOT . 12 - "-~ 034 PUBLIC TAP 13 WATER FROM OPEN WELL OPEN WELL IN RESIDENCE 21 - - - * 034 OPENWELLINYARD/PLOT 22 - - -~ 034 OPEN PUBLIC WELL . . . . . . . . . . . . 23 WATER FROM PROTECTED WELL PROTECTEDWELLINRESIDENCE . 3 l - - -~ 034 PROTECTED WELLIN YARD/PLOT . 32 - - - , - 034 PROTECTED PUBLIC WELL . 33 SURFACE WATER NILE/CANALS 4 l BOTFLED WATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 - - - -~ 034 OTHER 96 (SPECIFY) 033 How long does it take to go there, get MINUTES water, and come back? Append ix B Quest ionnaires I I 19 NO. 034 OUES ONS AND rILX During the last two weeks, has there been any time when water was not available from (source in 032)7 CODING CATEGORIES SKIP TO YES I NO 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ -~ 036 035 Did this happen on a daily or almost daily basis, only a few times per week, or less frequently'? DAILY/ALMOST DAILY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 FEW TIMES PER WEEK.• 2 LESS FREQUENTLY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DON'T KNOW . 036 Do you store water in the household? YES 1 NO. 2 I DON'T KNOW ~-~ 039 037 038 039 ASK TO SEE THE CONTAINER(S) IN WHICH ALL COVERED WATER IS STORED Could you show me in which container(s) you store water? OBSERVE: Are the containerfs ) covered? OBSERVE: Do(es) the container(s) have a narrow or wide mouth (s)? I SOMECOVERED . . . . . . . . . . . 2 NONE COVERED . . . . . . . . . . . . . . . . . 3 NOTABLETO OBSERVE . 8 - - What kind of toilet facility do most members of your household use? ---* 039 NARROW MOUTH(S) ] WIDE MOUTH(S) 2 . BOTH TYPES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 MODERN FLUSH TOILET . . . . . . . . . . . . . . . . . 1 l TRADITIONAL WITH TANK FLUSH 1 2 TRADITIONAL WITH BUCKET FLUSH . 13 PIT TOILET/LATRINE 2 [ NO FACILITY 31 - - - " 045 OTHER 96 (SPECIFY) 040 Is this toilet in working condition at this time? YES I NO 2 • BON'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . 041 Into where does this facility drain'? PUBLIC SEWER 01 ---~ 043 VAULT (BAYARA) 02 SEPTIC SYSTEM . 03 PIPE CONNECTED TO CANAL . . . . . . . . . . . . . . 04 PIPE CONNECTED TO GROUND WATER 05 EMPTIED (NO CONNECTION) 06 | OTHER 96 k~ 043 (SPECIFY) 042 Are you or your neighbors currently experiencing any problems with this drainage system'? IF YES: What type of problems? POOLING AROUND OWN DWELLING POOLING AROUND NEIGHBOR'S DWELLING . COST OF EVACUATION . OTHER (SPECIFY) NO PROBLEM (S) A B C X Y DON'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z 043 Do you share this facility with other households'? IF YES: How many other households sharing this facility? 044 ASK TO SEE THE TOILET FACILITY USED BY MOST HOUSEHOLD MEMBERS. OBSERVE WHETHER THERE IS FECAL MATTER INSIDE THE FACILITY ON THE FLOOR OR WALLS. NUMBER OF OTHER HOUSEHOLDS SHARING TOILET FACILITY " I [ -~ NOT SURE HOW MANY SHARING 9~ . TOILET NOT SHARED . . . . . . . . . . . . . . . . . . 00 YES, MAT[ER PRESENT . I NO, NO MATTER . . . . . . . . . . . . . 2 NOT ABLE TO DETERMINE . 3 • NOT ABLE TO OBSERVE TOILET . 8 " 120 ] Appendix B Questionnaires NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO i i 045 Does your household have any place YES . . . . 1 used for hand washing? NO . 2 "-* 048 046 047 ASK TO SEE THE PLACE USED MOST OFTEN FOR HANDWASHING. INDICATEIF PLACEIS IN SAME ROOM/IN ROOM ADJACENT TO THE TOILET FACILITY USED BY HOUSEHOLD MEMBERS. IN SAME/ADJACENT ROOM . . . . . . . . . . . . . . . . . . . . . . . . . . . : l NOT NEAR TOILET FACILITY 2 NOT ABLE TO DETERMINE/NO TOILET FACILITY . 3 NOT ABLE TO OBSERVE HANDWASHING AREA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 - "--~ 048 OBSERVE IF THE FOLLOWING ITEMS ARE PRESENT IN THE AREA USED FOR HANDWASHING. YES NO Water/tap? WATER/TAP l 2 Soap, ash or other cleansing agent? SOAP/ASH/OTHER 1 2 Towel or cloth'? TOWEL/CLOTH . 1 2 Bas in? BASIN . . . . . . . . . . . . . . . . . l 2 048 How does this household primarily COLLECTED dispose of kitchen waste and trash? FROM HOME 11 FROM CONTAINER IN THE STREET . . . . . . . . . . 12 RECORD MAIN METHOD OF DISPOSAL ONLY. IF ~NO OR MORE METHODS ARE USED DUMPED EQUALLY, RECORD THE HIGHEST METHOD ON INTO STREET/EMPTY PLOT . 21 THE LIST• INTO CANAL/DRAINAGE . 22 BURNED 31 FED TO ANIMALS 4 l OTHER 96 (SPECIFY) • DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 049 What type of fuel does your household use for cooking? ELECTRICITY . 01 LPGINATURAL GAS 02 KEROSENE . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03 COAUIGNITE . 04 CHARCOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 FIREWOOD/STRAW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 DUNG . . . . . . . . . . . . . . . . . . . . . . . . . . 07 OTHER 96 (SPECIFY) 050 05l Does your household have: Electricity? A radio with cassette recorder? A television? A video? A telephone? A Mobile? A personal home computer? Does your household have: An electric fan? A water heater? A refrigerator? A freezer? A sewing machine? An automatic washing machine? Any other washing machine? A Gas/electric cooking stove? An air condition? A dish washer? A satallite dish? YES NO ELECTRICITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 RADIO WITH CASSETTE . l 2 TELEVISION . 1 2 VIDEO l 2 TELEPHONE . 1 2 MOBILE l 2 COMPUTER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l 2 YES NO ELECTRIC FAN l 2 WATER HEATER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 2 REFRIGERATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l 2 FREEZER . l 2 SEWING MACHINE . ] 2 AUTOMATIC WASHING MACHINE . 1 2 OTHER WASHING MACHINE . . . . . . . . . . . . . . . l 2 GAS/ELECTRIC COOKING STOVE . 1 2 AIR CONDITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 2 DISH WASHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 SATALLITE DISH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 2 Appendix B Questionnaires [ 121 NO. QUESTIONS AND FILTERS 052 Do you or any member of your household own: A bicycle? A motorcycle or motor scooter'? A car/van/truck? Farm or other land? Livestock (donkeys, horses, cows, sheep, etc.)/poultry? 053 How much on average does your household pay in month for the electric bill? 054 ASK RESPONDENT FOR A TEASPON OF SALT. TEST SALT FOR IODINE RECORD PPM (PARTS PER MILLION). CODING CATEGORIES i YES BICYCLE . l MOTORCYCLE OR MOTOR . CAR/VAN/TRUCK . [ FARM/OTHER LAND., l LIVESTOCK/POULTRY . ] NO 2 2 2 2 SKIP TO i IN POUNES . . . . . . . . . . . . . . . . . . . . . . . . . . . [ ~ I NO ELECTRICITY . 997 DON'T KNOW . 998 0 PPM (NO IODINE) . I 1-25 PPM . 2 26-50 PPM 3 51-75 PPM . 4 76-100 PPM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 122 I Appendix B Questionnaires HEIGHT AND WEIGHT 055 CHECK QUESTIONS 012 AND 013 AND IDENTIFY ALL ELIGIBLE EVER-MARRIED WOMEN 1549 AND CHILDREN UNDER AGE 6. RECORD THE LINE NUMBERS, NAMES AND AGES OF THE WOMEN AND CHILDREN FROM THE HOUSEHOLD SCHEDULE IN THE APPROPRIATE GRID BELOW. USE AN ADDITIONAL QUESTIONNAIRE IF THERE ARE NOT SUFFICIENT LINES TO RECORD ALL OF THE ELIGIBLE WOMEN AND CHILDREN. LINE ELIGIBLE WOMEN 15 -49 NAME AGE HEIGHT AND WEIGHT MEASUREMENT OF ELIGIBLE WOMEN 15 49 RESULT: NO CHECK COLUMN 001 056 -]-1 --i-i - -n CHECK COLUMN 002 057 CHECK COLUMN 010 058 TT] 059 WEIGHT (KILOGRAMS) HEIGHT (CENTIMETERS) 060 061 -F~- I I FT--n.n -T-T].I I ~-F-].[] ~T- I .D 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER 062 063 ELIGIBLE CHILDREN UNDER AGE 6 LINE NO. CHECK COLUMN 001 O56 HEIGHT AND WEIGHT MEASUREMENT OF CHILDREN UNDER AGE 6 RESULT: MEASURED 1 MEASURE[ WEIGHT HEIGHT 1 LYING 2 NOT (KILOGRAMS) (CENTIMETERS) DOWN PRESENT 2 STANDING 3 REFUSED 6 OTHER 060 061 062 063 NAME AGE DATE OF BIRTH CHECK CHECK What is (NAME'S) date of COLUMN COLUMN 002 010 birth? 057 058 059 DAY MONTH YEAR --r-i I I .D ' I I I .E , 2 I I -1--I r -1 -1~I -T I I - FT -F lo l I I .D I l l .E , 2 I I I~ZZ] I - -F -11- -1 -3~o l I I .D I l l .D , 2 I I F I~[Z~~ol I I .E II1.1 1 2 I I r-T-] ~CFTT] lol I I.E 064 TICK IF ADDITIONAL QUESTONNAIRE USED TO RECORD MEASUREMENTS FOR: WOMENI I C"'LDREN I I 065 NAME OF MEASURER ~ NAME OF ASS ISTANT I I 1 .1 1 2 I I FT] Appendix B Questionnaires I 123 OBSERVATIONS THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 066 - 067 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNIARE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD. POOR 1 066 DEGREE OF COOPERATION. FAIR 2 GOOD 3 • VERY GOOD . . . . . . . . . . . . . . . . . . . 4 - 067 INTERVIEWER'S COMMENTS: 068 FIELD EDITOR'S COMMENTS: 069 SUPERVISOR'S COMMENTS: 070 OFFICE EDITOR'S COMMENTS: 124 I Appendix B Questionnaires ARAB REPUBLIC OF EGYPT MINISTRY OF HEALTH AND POPULATION NATIONAL POPULATION COUNCIL INTERIM EDHS 2003 WOMAN'S QUESTIONNAIRE DATA COLLECTED FROM THIS STUDY IS CONFIDENTIAL AND WILL BE USED FOR SCIENTIFIC PURPOSES ONLY Appendix B Questionnaires [ 125 EGYPT INTERIM DEMOGRAPHIC AND HEALTH SURVEY 2003 WOMAN'S QUESTIONNAIRE GOVERNORA1 I,; PSU/SEGMENT NO. SHIAKHA/YILLAGI' ItOUSEHOLD NO. INSIDE SEGMEN I. URBAN . LARGE~FI'Y. . . . . .1 SMALL CITY NOI SLUM AREA . ~AME OF HOUSEHOLD HEAD 4.DDRESS IN DE'FAIL NAME DE WOMAN L[NE NUMBER OF WOMAN IDENTIFICATION KISM/MARQAZ BUILDING NO. HOUSING UNIT NO. I RURAl . 2 2 ['OWN . 3 VH3,AGE . 4 I SLUM AREA . 2 GOVERNORA I E PSU/SEGMENT NO I_r I I I I_j HOUSEHOLI) NO URBAN/RURAL I I I U~ I,OCALITY NOT SLU "¢I/SIAJM lANE NUMBER INTERVIEWER VISITS FINAL VISIT DATE fEAM [NTERVI E'vVER ~*UPERVISOR ASSISTANT ~UPERVISOR ~,ESUI, I' '~EXT x,' ISI I': I)A I'E RIME I 2 3 ~,ESU LT CODES: I (OMPI ,E I ED [ NOT AT HOME POSI PONED REFUSED PART IALLY COMPLETED i [NCAPACITATED/NO] ELIGIBLE 7 OTHER ,(SPECIFY) DAY MONTH TEA~¢I INTERYI E~,V ER SIJPER'~ ISOR ASSIS I ANT SUPERVISOR RESULT YEAR [21olol3 TO+I AL "v ISF] S [ [ NAME DATE SIGNATURE FIELD EDITOR / / 2003 I ] ] OFF ICE EDITOR / / 2003 r r r CODER / / 2003 [ ] ] KEYER / / 2003 126 [ Appendix B Questionnaires i NO. SECTION I : RESPONDENT'S BACKGROUND My name is and I am working with Ministry of Health and Population. We are conducting a national survey about the health of women and children, We would very much appreciate your participation in the survey. This information will help the government to plan health services, The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. We also may return later to interview you or other members of your household again, Participation in the survey is voluntary and you can choose not to answer any of the questions, However, we hope that you will participate in the survey since your views are important, At this time, do you want to ask me anything about the survey. May I begin the interview now? SIGNATURE OF INTERVIEWER: RESPONDENT AGREE ? RESPONDENT DOES NOT [ ] TO INTERVIEW AGREE TO INTERVIEW QUEST IONS AND F ILTERS CODING CATEGORIES ----'1102 SKIP TO 101 102 RECORD THE TIME HOUR . . . . . . . . . . . . . . . . . . . . . . . . . . . MINUTES . First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Cairo, Giza, Alexandria, another city or town or in a village? (NAME OF LOCALITY AND GOVERNORATE) 103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR RECORD "O0", 104 Just before you moved here, did you live in Cairo, Giza, Alexandria, another city or town or in a village? (NAME OF LOCALITY AND GOVERNORATE) 105 In what month and year were you born? CAIRO / GIZA . l ALEXANDRIA . 2 OTHER CITY I TOWN 3 VILLAGE 4 OUTSIDE EGYPT 5 (SPECIFY) OFFICE: GOVERNORATE'S CODE YEARS . ~- -~ ALWAYS . 95 - ----* 105 VISITO~ TEMPORARILY STAYING. 96_ CAIRO / GIZA . l ALEXANDRIA . 2 OTHER CITY i TOWN 3 VILLAGE . 4 OUTSIDE EGYPT 5 (SPECIFY) OFFICE: GOVERNORATE'S CODE MONTH . DON'T KNOW MONTH . 98 YEAN . t 1 1 1 1 . DON'T KNOW YEAR . . . . . . . . . . . . . . . . 9998 Appendix B Questionnaires I 127 NO. QUESTIONS AND FILTERS 106 How o d were you at your last birthday'? COMPARE AND CORRECT t05 AND I OR 106 IF INCONSISTENT 107 What is your current marital status? 108 Now 1 would like to ask you some questions about your marriage (s). How many times have you been married'? 109 110 I l l CHECK 108: MARRIED ONCE [~ In what month and year did you enter into a marriage contract with your husband? CODING CATEGORIES AGE IN COMPLETED YEARS MARRIED 1 WIDOWED 2 DIVORCED . 3 SEPARATED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 NUMBER OF TIMES MARRIED . I J SKIP TO MARRIED MORE THAN [~1 ONE TIME Now we would like to ask about your first husband. In what month and year did you enter into a marriage contract with your first husband? How old were you when you entered into a marriage contract with your (first) husband? CHECK 108: MARRIED ONCE ~ oNEMARRIEDTIME MORE THAN ~ In what month and year in what month and year did you start living with did you start living with your husband? your first husband? MONTH . ~] l DON'T KNOW MONTH 98 YEAR I J I I k DON'T KNOW YEAR . 9998 AGE IN COMPLETED YEARS. ~ ] MONTH DON'T KNOW MONTH . . . . . . . . 98 I l l YEAR . I [ I I t--- ' l l3 DON'T KNOW YEAR . 9998 112 113 114 115 116 How old were you when you started living together with your (first) husband? AGE IN COMPLETED YEARS. I I J DETERMINE MONTHS MARRIED SINCE JANUARY 1998, ENTER "X" IN COLUMN 1 OF THE CALENDAR FOR EACH MONTH MARRIED, AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE JANUARY ~998, FOR WOMEN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PROBE FOR DATE WIDOWED, DIVORCED, OR SEPARATED, AND FOR STARTING DATE OF ANY SUBSEQUENT MARRIAGE SINCE JANUARY t998. Have you ever attended school? What is the highest level of school you attended? What is the highest grade which you successfully completed at that level'? YES 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2---.----.201 PRIMARY ] PREPARATORY . 2 SECONDARY . 3 UPPER INTERMIDIATE ~ UNIVERSITY . . . . . . . . . . . . . . . . . . . . . . 5 MORE THAN UNIVERSITY . (3 " GRADE "J I 128 I Appendix B Questionnaires NO. 201 SECT ION 2 : REPRODUCTION QUEST IONS AND F ILTERS CODING CATEGORIES SKIP TO Now 1 would like to ask about all the births you have YES 1 had during your life. Have you ever given birth? NO 2"-- ~ 206 202 Do you have any sons or daughters to whom you have YES given birth who are now living with you? NO 1 2- - ~ 204 203 204 How many sons live with you? And how many daughters live with you? IF NONE RECORD "00" SONS AT HOME DAUGHTERS AT HOME Do you have any sons or daughters to whom you have YES given birth who are alive but do not live with you? NO 1 2~ ~ 206 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE RECORD "00" SONS ELSEWHERE . . . . . . . . . . . . . . . . . . . DAUGHTERS ELSEWHERE . 206 Have you ever given birth to a boy or a girl who was born alive but later died? IF NO PROBE: Any baby who cried or showed any sign of life but only survived a few hours or days? YES NO 1 2---- ~ 208 207 In all, how many boys have died'? And how many girls have died'? IF NONE RECORD "00" BOYS DEAD . . . . . . . . . . . . . . . . . . . . . . . GIRLS DEAD . 208 209 210 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE RECORD "00" TOTAL . . . . . . . . . . . . . . VTq CHECK 208: Just to make sure that 1 have this right: you have had in TOTAL your life. Is that correct? YES NOD births during (Number) PROBE AND CORRECT201-200 AS NECESSARY CHECK 208: ONE OR MORE BIRTHS NO BIRTHS [ ] 226 Appendix B Questionnaires I 129 211 NOW I WOULD LIKE TO RECORD THE NAMES OF ALL YOUR BIRTHS, WHETHER STILL ALIVE OR NOT, STARTING WITH THE FIRST ONE YOU HAD RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES AND MARK WITH A BRACKET. COMPLETE 213- 221 FOR EACH BIRTH. USE ADDITIONAL FORMS IF THERE ARE MORE THAN TEN BIRTHS. AFTER COMPLETING ALL BIRTHS. GO TO 222. 219 Is In what month boyor a girl'? (NAME) bm~]? PROBE: What is his/her birthday'? OR: In what I season w3s he/she born? 213 RECORD SINGLE OR MULTIPLE STATUS. 216 Is (NAME) still alive? birthday'? RECORD AGEIN I COMPLET- ED YEARS. BOY . I MONTH YES . I AGE IN YES . I NO . YEARS NO . . . . . . . . 2 YEAR 9 :D SING . , MULT . 2 GIRL . 2 SING . . . . . . . . . BOY . l ~IULT . 2 ,GIRL . . . . . . . . 2 SING . BOY . I ~ULT . 2 GIRL . 2 Go to 220 2 / 8~, , , , , , , ,~ 220 221 IF ALIVE IF DEAD: Were there any Is (NAME) [ RECORD How old was (NAME) other live births living with / HOUSEHOLD when he/she died? between (WHEN you? LINE NUMBER IF '1 YR.' PROBE: Itow YOU FIRST many months old was MARRIED OF CHILD (NAME)'? /NAME OF PREVIOUS (RECORD "00" RECORD DAYS IF LESS BIRTH)and IF CHILD NOT rHAN 1 MONTH; (NAME),~ LISTED IN THE MONTHS IF LESS THAN HOUSEHOLD TWO YEARS; OR CORRECT IF ~ = ~ , ~ ~ ~ , ~ = = S C H E D U L E ) . YEARS. NECESSARY HOUSEHOLD ~ YES . I - LINE NUMBER BAYS . ] NO . 2- "ONTHS ,L YEARS.3 NEXT BIRTH GO to 221 MONTH YES ] AGE IN YES I ~ IDAYS . I ~ ' ~ . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD IYES I - ~ r ~ LINE NUMBER NO . 2 YEARS NO . . . . . . . . "~ NO . 2 - YEAR ~ I ~ ] MONTHS.2 ~ - - Go to 220 ~'EARS. 3 NEXT BIRTH Go to 22t MONTH YES . I AGE IN YES . i HOUSEHOLD NO . YEARS NO . 2 LINE NUMBER Go to 220 Go to 221 !SING . BOY . MULT . 2 GIRL . MONTH YES . I AGE IN YES . . . . . [ HOUSEHOLD NO . YEARS NO . 2 LINE NUMBER GO to 220 Go to 221 SING . BOY . I ~ULT . 2 GIRL . 2 MONTH YES . . . . . I AGE IN YES . I HOUSEHOLD NO . YEARS NO . . . . . . . . 2 LINE NUMBER YEAR ~ T ~ Go to 220 Go to 221 DAYS . I ~ YES I . I - NO . 2 - ~QNTHS.2 ~EARS. . .3 NEXT BIRTH DAYS . ] ~ YES" "" I I - NO . 2 - MONTHS.2 fEARS,.3 NEXT BIRTH DAYS . I ~ YES . . . . I - NO . 2 - MONTHS.2 YEARS. . . .3 NEXT BIRTH SING . BOY . I MULT . ? GIRL . MONTH YES . . . . . . . I AGE IN YES . I HOUSEHOLD NO . YEARS NO . . . . . . . . 2 LINE NUMBER Go to 220 Go to 221 SING . ,BOY . I MULT . 2 GIRL . 2 MONTH YES . ~ 1 AGE IN YES . . . . . . I HOUSEHOLD[~ NO YEARS LINE NUMBER . . . . . . . . 2 - NO . . . . . . . . . 2 YEAR [ ~ Go to 220 Go to 221 DAYS . ] I l l YES . I - NO . . . . . . . . 2 - MONTHS.2 YEARS. . .3 NEXT BIRTH DAYS . l I I I YES . I - NO • 2 - MONTHS,.2 YEARS. . .3 NEXT BIRTH 130 [ Appendix B Questionnaires 213 214 215 216 RECORD Is In what month Is SINGLE OR (NAME) a andyear was (NAME) MULTIPLE boy or a girl'? (NAME) born'? still alive? STATUS. PROBE: What is his/her birthday'? OR: In what season was he/she born? SING . ] BOY . ] I MONTH YES . I MULT . 2 GIRL . 2 I I ] NO . 2- YEAR V-- Goto220 MONTH SING . I BOY . I YES . l MULT . 2 GIRL . 2 I I I NO . 2- YEAR r--- Goto 220 SING . I BOY . ~ MONTH YES . l MULT . 2 GIRL . 2 [ J I NO . YEAR Go to 220 How old Have you had any live births since the birth of (NAME OF LAST BIRTH)? CORRECT THE BIRTH HISTORY IF NECESSARY. 218 IF ALIVE --1 Is (NAME) living with you? 219 220 221 IF DEAD: Were there any RECORD How old was (NAME) other live births when he/she died? between (WHEN HOUSEHOLD YOU FIRST LINE NUMBER IF'I YR,' PROBE: HOW MARRIED/NAME OF CHILD many months old was OF PREVIOUS (RECORD "OO" (NAME)? BIRTH) and IF CHILD NOT RECORD DAYS IF LESS (NAME)? LISTED IN THE THAN 1 MONTH; HOUSEHOLD MONTHS IF LESS THAN SCHEDULE). TWO YEARS; OR YEARS. CORRECTIF NECESSARY YES . I NO . . . . . . . . 2 YES . l NO . 2 i YES I NO . 9 HOUSEHOLD ~ YES . I - Ll R DAYS . 1 NO . . . . . . . . . . . . 2- MONTHS.2 YEARS.3 NEXT BIRTH GO to 221 HOUSEHOLD ~ YES . I - LINE NUMBER DAYS . ] :NO . 2- MONTHS 2 YEARS.3 NEXT BIRTH Go to 221 HOUSEHOLD I ~ YES . I - LINE NUMBER DAYS . . . . . . . . ] U MONTHS.2 EARS.,.3 Gq to 221 = YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADD TO NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 TABLE COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS ARE SAME ~ NUMBERS ARE DIFFERENT I I = (PROBE AND RECONCILE) ¢ CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - I~- ] U FOR EACH BIRTH SINCE JANUARY 1998: MONTH AND YEAR OF BIRTH IS RECORDED . FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED . FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS . CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1998. I-"-'1 I I IF NONE, RECORD "0" AND GO TO 226. FOR EACH BIRTH SINCE JANUARY 1998, ENTER "B" IN THE MONTH OF BIRTH IN COLUMN 2 OF THE CALENDAR. FOR EACH BIRTH ENTERED IN THE CALENDAR, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "P" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE RIGHT OF THE "B" CODE. ALSO ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 1998 (IF ANY) AT THE BOTTOM OF THE CALENDAR 0201) . Are you pregnant now? UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Appendix B Questionnaires J 131 When did your last menstrual period start? QUESTIONS AND FILTERS :t CODING CATEGORIES[~.~ How many months pregnant are you? M O N T H S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RECORD IN COMPLETED MONTHS RECORD MONTHS PREGNANT IN COMPLETED MONTHS. ENTER "P" IN COLUMN 2 OF CALENDAR FOR THE TOTAL NUMBER OF COMPLETED PREGNANCY MONTHS, BEGINNING WITH THE MONTH OF INTERVIEW. At the time you became pregnant, did you want to become THEN . 1 pregnant then, did you want to wait until later, or did you not LATER . 2 want to become pregnant at all? NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Unfortunately many women have pregnancies that do not end in a live birth. Sometimes a baby is still born, that is, the baby is born who does not breathe or show any life. Other times women have a miscarriage or abortion early during a pregnancy. It is very important in our study to know about such pregnancies so health programs can be developed fnr women. USING THE INFORMATION IN THE CALENDAR, PROBE TO DETERMINE IF THE WOMAN HAD ANY STILL BIRTHS, MISCARRIAGES, OR ABORTIONS BACK TO JANUARY 1998. IF THE WOMAN REPORTS A PREGNANCY THAT DID NOT END IN A LIVE BIRTH, ASK ABOUT THE MONTH AND YEAR IN WHICH THE PREGNANCY ENDED. RECORD THE APPROPRIATE CODE FOR THE PREGNANCY OUTCOME ON THAT DATE IN COLUMN 2 IN THE CALENDAR: ( "B" FOR STILL BIRTH, "M" FOR MISCARRIAGE AND "A" FOR ABORTION). THEN ASK ABOUT THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "P" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: SINCE THE OUTCOME OF THE PREGNANCY IS RECORDED IN THE MONTH THAT PREGNANCY ENDED, THE NUMBER OF P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) ILLUSTRATIVE QUESTIONS TO IDENTIFY NON-LIVE BIRTH PREGNANCIES, ASK: • INTERVAL BETWEEN CURRENT PREGNANCY AND PRIOR BIRTH (LAST BIRTH): Did you have any pregnancy that ended in a still birth after the birth of (NAME OF LAST BIRTH) and belbre your current pregnancy'? Or any pregnancy that ended in a miscarriage or abortion? • INTERVAL BETWEEN LAST AND PRIOR BIRTH Did you Jaave any pregnancy that ended in a still birth between (NAME OF LAST BIRTH) and (NAME OF PRIOR BIRTH)? Or any pregnancy that ended in a miscarriage or abortion'? • INTERVAL BETWEEN NEXT-TO-LAST BIRTH AND PRIOR BIRTH: Did you have any pregnancy that ended in a still birth between (NAME OF NEXI TO LAST BIRTH) and (NAME OF PRIOR BIRTH)'? Or any pregnancy that ended in a miscarriage or abort'on ? • WOMEN WITH NO LIVE BIRTHS BUT WITH CURRENT PREGNANCY Before your current pregnancy, did you ever have any other pregnancy that ended in a still berth'? Or any other pregnancy that ended in a miscarriage or abortion? • WOMEN WITH NO LIVE BIRTHS AND NOT CURRENTLY PREGNANT Have you ever had a still birth? if YES: When did the last still birth occur? Have you ever had a miscarriage or abortion? If YEs: When did the last miscarriage or abortion occur'? FOR EACH PREGNANCY TERMINATION, ASK: How many months pregnant were you when the pregnancy ended? DAYS AGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I I WEEKS AGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 MONTHS AGO . 3 YEARS AGO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 IN MENOPAUSE/HAD HYSTERECTOMY . 994 BEFORE LAST BIRTH . 095 NEVER MENSTRUATED . . . . . . . . . . . . . . . 996 SKIP TO 132 I Appendix B Questionnaires NO. 301 Oll o31 o41 o51 o6 o71 SECT ION 3: CONTRACEPT IVE KNOWLEDGE AND USE qUEST IONS AND F ILTERS CODING CATEGORIES SK IP TO Now 1 would like to talk about family planning: the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about? CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 302, ASK 303 BEFORE PROCEEDING TO THE NEXT METHOD. METHOD PILL A woman can take a pill every day. IUD A woman can have a loop or coil placed inside her by a doctor or a nurse. INJECTABLES A woman can have an injection by a doctor or a nurse which stops her from becoming pregnant for several months. IMPLANT A woman can have small rod(s) placed m her arm by a doctor which stops her from becoming pregnant for several years. DIAPHRAGM, FOAM, JELLY A woman can place a sponge, suppository, diaphragm, je l ly or cream inside her vagina before intercourse. CONDOM A man can use a rubber covering during sexual intercourse. FEMALE STERILIZATION A woman can have an operation to avoid having any more children. MALE STERILIZATION A man can have an operation YES to avoid having any more children. NO 302 Have you ever heard of (METHOD)? 303 Have you ever used READ DESCRIPTION OF EACH METHOD fMETHOD) ? YES . . . . . . . . . . . . . 1 YES 1 .NO . 2~.NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 • £ YES l v YES I .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2~.NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 • YES l ~ YES l .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - ] .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . / YES 1 ~, YES l NO. . 2 - NO 2 YES 1 YES l NO 2- NO 2 YES I YES l .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- - .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . YES ] Have you e~er had an NO 2- operation to avoid having any more children'? YES 1 .NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ] Have you ever had a husband 2- who had an operation to avoid having children? YES l .NO . 2 RHYTHM OR PERIODIC ABSTINENCE A couple can YES 1 YES l avoid having sexual intercourse on certain days of the month when the woman is more likely to NO 2- NO 2 become pregnant. y WITHDRAWAL A man can be careful and pull out YES 1 YES 1 before ejaculation. . NO . 2 . NO . 2 ] l ~ PROLONGED BREASTFEEDING A woman can YES l I YES l prolong the t ime that she breastfeeds her baby to delay the next pregnancy. NO 2_ I NO 2 12 1 YES NO Have you heard of any other ways or methods that a woman or a man can use to avoid pregnancy? 1 (SPECIFY) 2 2- YES . . . . . . . . . . . . . . . . . . . . . . . . . . . ] NO 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . ] NO 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ,NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , (SPECIFY) 3 (SPECIFY I Appendix B Questionnaires I 133 NO. QUESTIONS AND FILTERS SKIP TO 304 CHECK 303: NOT A SINGLE "YES" I~] "--~ 308 l (NEVER USED) 305 Have you ever used anything or tried in any way to YES 1-----* 307 delay or avoid getting pregnant'? . NO . 2 , 306 ENTER "0" IN COLUMN 2 OF CALENDAR IN EACH BLANK MONTH ---~ 344 307 What have you used or done? CORRECT 303-304 (AND 302 IF NECESSARY) 308 309 310 311 312 Now l would like to ask you about the first time you did something or used a method to avoid getting pregnant. ltow many living children did you have at that time if CODING CATEGORIES AT LEAST ONE "YES" I t (EVER USED) any'? IF NONE RECORD IO0 I CHECK 303 (FEMALE STERILIZATION): WOMAN NOT STERILIZED CHECK 107: CHECK 226: CURRENTLY [ ~ MARRIED OZN%?NT[ Are you currently doing something or using any method to delay or avoid getting pregnant? (SPECIFY) • NUMBER OF CHILDREN I I I WOMAN STERILIZED ] --~ 313A I t -.34 WIDOWED/DIVORCED/ SEPARATED PREGNANT I t -----~ 343 YES l NO . 2 - - - - -~343 313 Which method are you using'? 313A 314 314A (IF THE RESPONDENT MENTIONED MORE THAN ONE METHOD RECORD THE HIGHEST CODE) CIRCLE "7" FOR FEMALE STERILIZATION. CHECK 313: In what month and year did you start using (CURRENT METHOD) continuously this time? PROBE: For how long have yon been using (CURRENT METHOD) now without stopping'? In what month and year was the sterilization performed? PILL ] IUD 2 INJECTABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 IMPLANT. 4 DIAPHRAGM/FOAM/ JELLY . . . . . . . . . . . . . . . . . . . 5 CONDOM 6 FEMALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . . 7 - - ---~ 3 14A MALE STERILIZATION . . . . . . . . . . . . . . . . . . . . . . . . . PERIODIC ABSTINENCE 9 WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [ PROLONGED BREASTFEEDIHG . . . . . . . . . . . . . G OTHER X MONTH YEAR ISPECIFY~ I I I I I 134 I Appendix B Questionnaires NO. QUEST IONS AND F ILTERS CODING CATEGORIES 3[5 IN CURRENT MONTH IN COLUMN 2 IN CALENDAR, ENTER CODE THE METHOD CIRCLED IN Q.3t3. THEN ENTER METHOD CODE IN EACH MONTH OF USE BACK TO THE DATE THE WOMAN BEGAN THE CURRENT SEGMENT OR TO JANUARY 1998 IF THE CURRENT SEGMENT OF USE BEGAN BEFORE JANUARY 1998, 3 16 CHECK 313: MINISTRY OF HEALTH FACILITY (MOH) USING PILL II Where did you obtain the packet of pills you are using now (you used most recently)? USING INJECTABLESI I Where did you go for your last injection? USINGCONDOM, I I DIAPHRAGM, FOAM OR JELLY USING ,UD l ] USINGIMPLANT ] I SHE/HE STERILIZED I I USINGPER'ODIC I I ABSTINENCE, WITHDRAWAL, PROLONGED BREASTFEEDING OR OTHER METHOD From where did you obtain your most recent supply of(METHOD)? ~Where did you have the IUD inse~ed? Where did you have the Implant inserted? ~' Where did the sterilization take place'? Did you get advice from anyone about how to use (METHOD) at the time you began this cun'ent period of use? WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE METHOD. PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) URBAN HOSPITAL I URBAN HEALTH UNIT 2 RURAL HOSPITAl 3 RURAL HEALTH UNIT . 4 MCH CENTER , 5 MOBILE UNIT . 6 OTHER MOH UNITS 7 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL 8 HEALTH INSURANCE ORGANIZATION . 9 CURATIVE CARE ORGANIZATION A OTHER GOVERNMENTAL . B NON-GOVERNMENTAL ORGANIZATIONS (NGO's) EGYPT FAMILY PLANNING ASSOCIATION . C CSI PROJECT . . . . . . . . . . . D OTHER NON-GOVERNMENTAt E MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC F PRIVATE DOCTOR G PHARMACY . . . . . . . . . . . . . H OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT ) CHURCH HEALTH UNIT j OTHER VENDOR (SHOP, KIOSK, ETC.,). K FRIENDS I RELATIVES L OTHER X (SPECIFY) NO ONE Y OFFICE: SOURCE CODE . SKIP TO Appendix B Questionnaires ] 135 NO. 317 QUESTIONS AND FILTERS CHECK 313 AND CALENDAR: CURRENTLY USING IUD [ ~ CURRENTLY USING PILL CURRENTLY USING INJECTABLE CURRENTLY USING IMPLANT CODING CATEGORIES SKIP TO b 323 I ~ 327 , 330 CURRENTLY USING OTHER MODERN METHOD(5-8) • 332 CURRENTLY USING OTHER TRADITIONAL METHOD (9, L, G, X) 318 I would like to ask about when you began using the YES, SAME PLACE IUD during this current period of use. NO, SOMEWHERE ELSE First of all did you get the IUD at (SOURCE IN 316) or did you buy it from somewhere else'? 319 From where did you buy the It Jr)? 320 WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT OBTAINED THE IUD, PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN CIRCLE THE APPROPRIATE CODE, (NAME AND ADDRESS OF pLACE) OFFICE: CODE SOURCE '"'"t I l l I J J J J MINISTRY OF HEALTH FACILITY (MOH) URBAN HOSPITAL . . . . . . . . . . . . . . . . . . . . . l URBAN HEALTH UNIT 2 RURAL HOSPITAL 3 RURAL HEALTH UNIT 4 MCH CENTER . 5 MOBILE UNIT . . . . . . . . . . . . . . . 6 OTHER MOH UNITS 7 OTHER GOVERNMENTAL FACILITY TEACHING HOSPITAL . HEALTH INSURANCE ORGANIZATION . 9 CURATIVE CARE ORGANIZATION A OTHER GOVERNMENTAL . NON-GOVERNMENTAL ORGANIZATIONS (NGO's) EGYPT FAMILY PLANNING ASSOCIATION Q' CSI PROJECT D OTHER NON-GOVERNMENTA[ E MEDICAL PRIVATE SECTOR PRIVATE HOSPITAL/CLINIC F PRIVATE DOCTOR G PHARMACY 1 [ OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT ] CHURCH HEALTH UNIT J OTHER VENDOR (SHOP, KIOSK, ETC.,) . K FRIENDS / RELATIVES L OTHER X , 343 ] - - - - -~ 321 2 (SPECIFY) DON'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . How much did it cost to buy the IUD from that place'? COST (IN POUNDS) .] ] ] I I I FREE 95 ' i DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 ] 36 I Appendi~ B Questionnaires NO. QUESTIONS AND FILTERS I 321 How much did it cost to have the IUD inserted (including all fees)? CODING CATEGORIES I COST(INPOUNDS) . ] ] FREE 995 DON'TKNOW . 998 SKIP TO 322 Would you be willing to pay the following for an IUD ( including all costs)? (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 338• FOR AMOUNT MORE THAN 200 POUNDS, RECORD YES OR NO AND GO TO 338,) 5 pounds? 10 pounds? 25 pounds? 50 pounds? 100 pounds? 150 pounds? 200 pounds'? More than 200 pounds? YES NO 5POUNDS . 1 2 - 10POUNDS 1 2 25POUNDS l 2 POUNDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 338 100POUNDS . . . . . . . . . . . . . . . . . . 1 2 t~ POUNDS l 2 200POUNDS. l 2 - MORETHAN2OOPOUNDS ] 7 2 - ,338 323 May I see the package of pills you are using now? RECORD NAME OF BRAND PACKAGESEEN l - - BRAND NAME ~ _ ----*325 i i i (SPECIFY) • PACKAGE NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 324 Do you know the brand name of the pill which you are using now? RECORD NAME OF BRAND BRAND NAME [ ~ (SPECIFY) DON'TKNOW 98 325 How much does one cycle of pills cost? POUNDS PLASTERS COST I - - [ - - ] FREE 9995 • DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9998 326 Would you be willing to pay the following for a cycle of pills? (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 333. AFTER ASKING ABOUT AMOUNT MORE THAN 5 POUNDS, RECORD YES OR NO AND GO TO 333.) 50 piasters? 75 piasters? 1 pound? 2 pounds? 5 pounds? More than 5 pounds? 50PIASTERS . 75PIASTERS 1POUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2POUNDS . 5POUNDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MORETHAN5POUNDS . YES 1 1 1 1 1 1-1 NO 2_ 2 2 2 - '~ 333 2_ 2--[_,+ 333 327 How frequently do you take the injection you are using now? EVERYMONTH . i . 1 EVERY TWO MONTHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 EVERYTHREE MONTHS . 3 328 How much did you pay the last time you got the injection at (source in 316)? POUNDS PT. COST I----[--1 " I----I--1 FREE 9995 • DON'T KNOW . 9998 Appendix B Questionnaires I 137 NO. CODING CATEGORIES SKIP TO 329 [ QUESTIONS AND FILTERS Would you be willing to pay the following for the injcctables (including all costs)? (IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 333. AFTER ASKING ABOUT AMOUNT MORE THAN 20, RECORD YES OR NO AND GO TO 333.) 2 pounds'? 5 pounds'? 10 pounds? 15 pounds? 20 pounds? More than 20 pounds? YES NO 2 POUNDS . ] 2-- 5 POUNDS l 2 lo POUNDS I 2 __~ 333 15 POUND S I 2 20 POUNDS . ] 2-- ' MORE THAN 20 POUNDS . ] -7 2~_,_,. 333 330 How many implant rods were inserted? 331 332 How much did it cost you to get the implant rod(s) inserted? • ONE IMPLANT ROD . I SIX IMPLANT RODS . 2 OTHER 6 (SPECIFY~ I POUNDS PT. COST . I I I I I[__L J FREE 999995 • DON'T KNOW . 999998 How much did it cost you to obtain/get advice about POUNDS PT. the (METHOD IN 313) AT (SOURCE IN 316)? COST t I [ I II I I FREE 999995 . DON'T KNOW . . . . . . . . . . . . . . . . . . 999998 333 CHECK 316 AND RECORD SOURCE WHERE METHOD WAS OBTAINED• PHARMACY ~ SOURCES 1-9, ~ K I L / X / Y Y A-G, I-J GO TO 338 334 At any time when you went to the pharmacy during this current period of use, were you told about side effects or health problems you might have with the (METHOD IN 313)? 338 I t ---* 343 YES [ NO . . . . . . . . . . . . . . . . . . . . 2 - -~ 336 NEVER WENT TO PHARMACY . 8 - --* 343 335 Were you told at the pharmacy what to do if you YES 1 experienced side effects or health problems'? . NO . 2 336 Were you told at the pharmacy about other methods of YES I family planning which you could use? NO . 2 337 338 Were you told at the pharmacy how to use the (METHOD IN 313)? YES 1 I - --~ 343 . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~ You obtained (METHOD IN 313 ) from (SOURCE IN 316). YES When you got the (METHOD) were you told about other NO methods of family planning which you could use? I - - * 340 2 339 At any other time, did a family planning or health YES worker tell you about other methods of family NO planning which you could use? When you got the (METHOD IN 313) this time, were you YES I - - -+ 342 told about side effects or problems you might have NO 2 with the /METHOD)? 340 138 I Appendix B Questionnaires NO. 341 342 343 344 345 346 347 348 QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO At any other time, did a family planning or health worker tell YES 1 yOU about side effects or problems you might have with NO 2- ~ 343 (METHOD IN 313)? Were you told what to do if you experienced side effects or YES 1 health problems? . NO . 2 I would like to ask some questions about all of the (other) periods in the last few years during which you or your husband used i~ method to avoid getting pregnant. COLUMN 2 - SEGMENTS OF CONTRACEPTIVE USE SINCE JANUARY t998 PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 1998. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. RECORD PERIODS OF USE AND NONUSE IN COLUMN 2 OF THE CALENDAR. FOR EACH MONTH IN WHICH A METHOD WAS USED, ENTER THE CODE FOR THE METHOD; ENTER "O" IN THOSE MONTHS WHEN NO METHOD WAS USED. ILLUSTRATIVE QUESTIONS FOR COLUMN 2 : When was the last time you used a method? Which method was that? When did you start using that method? How long atter the birth Of(NAME)? How long did you use the method then? IF THERE ARE NO PRIOR SEGMENTS OF USE, GO TO 344. COLUMN 3 -REASON FOR DISCONTINUATION FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD AND RECORD THE REASON FOR DISCONTINUATION IN COLUMN 3 OF THE CALENDAR IN THE MONTH IN WHICH THE SEGMENT OF USE WAS TERMINATED. IF A PREGNANCY FOLLOWED, ASK IF SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR WHETHER SHE DELIBERATELY STOPPED USING THE METHOD TO GET PREGNANT. ILLUSTRATIVE QUESTIONS FOR COLUMN 3 Why did you stop using the (method)? Did you become pregnant while using (method),or did you stop to get pregnant, or stop for some other reason'? IF DELIBERATELY STOPPED TO BECOME PREGNANT,ASK: "'How many months did it take you to get pregnant after you stopped using (method)"? ENTER "9" IN EACH SUCH MONTH IN COLUMN 2. NUMBER OF CODES ENTERED IN COLUMN 3 MUST BE THE SAME AS THE NUMBER OF COMPLETE SEGMENTS OF CONTRACEPTIVE USE IN COLUMN2. Have you ever heard (know) of "premarital examination" YES that is a consultation with a doctor or other staff as part of NO the preparation for marriage? Before you married (for the first time) did you have a YES premarital examination? Was family planning discussed during the premarital consultation? In the last 6 months have you heard seen, or received any information about family planning? What was the last source you got information from? 1 2- ----*347 1 . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2----*347 YES 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES 1 . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - . -~ , - 401 : TELEVISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 , RADIO 02 NEWSPAPER/MAGAZINE - 03 PAMPHLET/BROCHURE . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 POSTER 05 MEDICAL PROVIDER . 06 HUSBAND 07 i OTHER RELATIVES 08 FRIENDS/NEIGHBORS . 09 OTHER 96 (SPECIFY) Appendix B Questionnaires I 139 SECTION 4: FERTIL ITY PREFERENCES AND ATTITUDES ABOUT FAMILY PLANNING NO, 401 402 403 CHECK 107: CHECK313: QUESTIONS AND FILTERS CURRENTLY [~ MARRIED NEITHER [~ STERILIZED CHECK 226: NOT PREGNANT [~ OR UNSURE Now 1 have some qucslions about the future: Would you like to have (a / another) child or would you prelkr not to have any (more) children'? PREGNANT E3 Now 1 have S()lllg questions about the future: After the child you are expecting, would you like to have another child or would you prelL'r not to havc any more children? CODING CATEGORIES SKIP TO DIVORCED/WIDOWED/ I } -.416 SEPARATED SHEORHE I t - "416 STERILIZED HAVE A (ANOTHER) CHILD I NO MORE / NONE . . . . . . . 2 ~405 SHE CAN'T GET PREGNANT . 3 -- "--* 416 UNDECIDED OR DON'T KNOW ~ - - ---*405 404 405 406 407 408 CHECK 226: NOT PREGNANT E3 OR UNSURE How IDng would you like to wait from now heibre the birth of(a / another) child? PREGNANT E~ How long wDuld yon like to wait alter the birth of the child you arc expecting belbre the birth another child'? CHECK 226: CHECK312: CHECK 403: NOTPREGNANT OR UNSURE NOT CURRENTLY 7 USING/NOT ASKED w, . , s ANOTHER SOON CHECK 404: 7; % OR 02 OR MORE YEARS MONTHS 1 YEARS 2 SOON/NOW . . . . . . . . . . . . . . . . . . . . . 994- - '416 SHE CAN'TGETPREGNANT . 995- OF OTHER 996- (SPECIFY) - - - .410 DON'TKNOW . . . . . 998- PREGNANT [ k "--"411 CURRENTLYUSING ] ] --+416 WANTS ~ 409 NO MORE UNDECIDED/ b 410 UNSURE WANTS WITHIN 00-23 MONTHS OR 00 - 01 YEAR ' 411 [ 40 I AppendLr B Questionnairex NO. 409 QUESTIONS AND FILTERS CHECK 403: WANTS E--1 A I ANOTHER CHILD You have said that you do not want (a / another) child soon, but you are not using any method to delay a pregnancy. Can you tell me why? PROBE: Are there any other reasons? WANTS NO MORE CHILDREN You have said that you do not want any (more) children, but you are not using any method to avoid a pregnancy• Can you tell me why? PROBE: Are there any other reasons? (RECORD ANSWER IN DETAIL) CODING CATEGORIES SKIP TO FERTILITY-RELATED REASONS NOT HAVING SEX., A • INFREQUENT SEX . . . . . . . . . . . . . . . . . . . . . . . . . . . B MENOPAUSAL I HYSTERECTOMY . C SUBFECUND . . . . . . . . . D INFECUND . E POSTPARTUM AMENORRHEIC F BREASTFEEDING G FATALISTIC H OPPOSITION TO USE RESPONDENT OPPOSED I HUSBAND OPPOSED . j OTHER OPPOSED . K RELIGIOUS PROHIBITION [. LACK OF KNOWLEDGE KNOWS NO METHOD M KNOWS NO SOURCE N METHOD RELATED REASONS HEALTH CONCERNS . . . . . . . . . . . . . . . . . . . . . . . O FEAR OF SIDE EFFECTS p LACK OF ACCESS / TOO FAR Q COST TOO MUCH . . . . . . . . . . . . . . . . . . . . . . . . R INCONVENIENT TO USE S INTERFERES WITH BODY'S NORMAL PROCESSES . OTHER (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 CHECK 312: NOT CURRENTLY I [ CURRENTLY USING/NOT ASKED V USING 411 Do you know of a place where you can obtain a method of family YES planning? NO I I ----'416 1 2-----~ 413 Appendix B Questionnaires [ 141 NO. 412 QUESTIONS AND FILTERS Where is that? WRITE THE NAME AND ADDRESS OF THE SOURCE FROM WHICH THE RESPONDENT WOULD GETTHE METHOD, PROBE IF NECESSARY TO IDENTIFY THE TYPE OF SOURCE AND THEN C IRCLETHE APPROPRIATE CODE. (NAME AND ADDRESS OF PLACE) CODING CATEGORIES MINISTRY OF HEALTH FACIL ITY (MOH) URBAN HOSPITAl ] URBAN HEALTH UNIT . . . . . . . . . . . . . . . . . . . . . . 2 RURAL HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . . 3 RURAL HEALTH UNIT . . . . . . . 4 MCH CENTER . . . . . . . . 5 MOBILE UNIT 6 OTHER MOH UNITS 7 OTHER GOVERNMENTAL FACIL ITY TEACHING HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . HEALTH INSURANCE ORGANIZAT ION . 9 CURATIVE CARE ORGANIZAT ION . . . . . . . . . . . . A OTHER GOVERNMENTAL . . . . . . . . . . . . . B NON-GOVERNMENTAL ORGANIZAT IONS (NGO's} EGYPT FAMILY PLANNING ASSOCIAT ION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (~ CSI PROJECT D OTHER NGO's . . . . . . . . . . . . . . . . . . . . . . . . . . . . E MEDICAL PRIVATE SECTOR PRIVATE HOSP ITAL /CL IN(C . . . . . . . . . . . ~2 PRIVATE DOCTOR G PHARMACY n OTHER PRIVATE SECTOR MOSQUE HEALTH UNIT . . . . . . . . . . . . . . . . . . . l CHURCH HEALTH UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . J OTHER VENDOR (SHOP, K IOSK, ETC.,I . . . . . . . K FRIENDS / RELATWES . . . . . . . . . . . . . . . . . L OTHER X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z SKIP TC 413 Do you think you will use a method at any time in YES 1 j the future'? NO. 2 DON'T KNOW 8 ~" ~] 5 414 Which method would you prefer to use'? PILL [ - - I IUD 2 IN JECTABLES 3 IMRPLANT . . . . . 4 DIAPHRAGM/FOAM/ JELLY 5 CONDOM 6 = 416 FEMALE STERtLIZATION . . . . . . . . . . . . . . . . . . . . . . 7 MALE STERIL IZATION . . . . . . . . . . . . . . . . . . . . . . . . . PERIODIC ABSTINENCE 9 WITHDRAWAL L PROLONGED BREASTFEEDING G OTHER X (SPECIFY) . UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z - 142 I Appendix B Questionnaires NO. QUESTIONS AND FILTERS 415 What is the main reason that you think that you will not use a method at any time in the future? (RECORD ANSWER IN DETAIL) CODING CATEGORIES FERTILITY-RELATED REASONS NOT HAVING SEX . . . . . . . . . . . . . . . . . . 2 l INFREQUENT SEX 22 MENOPAUSAL I HYSTERECTOMY 23 SUBFECUND . 24 INFECUND . . . . . . . . . . . . . . . . . . . . . . . . . . 25 WANTS AS MANY CHILDREN AS POSSIBLE 26 OPPOSITION TO USE RESPONDENT OPPOSED 31 HUSBAND OPPOSED . 32 OTHER OPPOSED . . . . . . . . . . . 33 RELIGIOUS PROHIBITION " 34 LACK OF KNOWLEDGE KNOWS NO METHOD 41 KNOWS NO SOURCE 42 METHOD RELATED REASONS HEALTH CONCERNS 51 FEAR OF SIDE EFFECTS 52 LACK OF ACCESS / TOO FAR 53 COST TOO MUCH 54 INCONVENIENT TO USE 55 INTERFERES WITH BODY'S NORMAL PROCESSES . 56 OTHER 96 (SPECIFY) . DON'T KNOW . 98 S~PTO 416 CHECK 203 AND 205: HAS LIVING E - - ] CHILD (REN) If you could go back to the time you did not have any children and could choose NO LIVING CHILD (REN) i f you could choose NUMBER . . . . . . . . . . . . . . . . . . . . . . . . [ exactly the number of I children to have in your OTHER ANSWER exactly the number of whole life, how many children to have in your would that be? whole life how many would that be? (RECORD SINGLE NUMBER OR OTHER ANSWER) 96 (SPECIFY) DON'T KNOW . 98 -÷418 417 How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter to be a boy or a girl? BOYS NUMBER WANTED GIRLS NUMBERWANTED [ - - -71 D~S NOT MA~ER, EITHER SEX OTHZ =: TED . I (SPECIFY) 96 418 Would you say that you approve or disapprove of APPROVE . . . . . . . . . . . . 1 couples using a method to avoid getting pregnant? DISAPPROVE . 2 - - "-*" 421 , NOT SURE / DON'T KNOW . 8 Appendix B Questionnaires ] 143 NO. QUEST IONS AND F ILTERS 419 Would you consider it appropriate for a couple to use family planning after the first birth? CODING CATEGORIES SK IP T ( YES 1 NO 2 DON'T KNOW . 8 420 Would you consider it appropriate tbr a newly married YES I couple to use family planning before the first NO 2 pregnancy'? DON'T KNOW 8 421 Now 1 would like to ask about your opinion about family planning. Would you say that most, some, very few, or none of the couples use family planning in the reproductive ages living in this area? 422 Do you think the number of couples using family planning in this area is increasing, decreasing or staying about the same'? 422A CHECK 107: 423 CURRENTLY 9 MARRIED In the past six months did a health worker, a raida rifia, or anyone else visit you to talk about family planning'? IF YES: Who visited you'? MOST 1 SOME 2 I VERY FEW 3 NONE . 4 NOT SURE . INCREASING ] DECREASING . 2 STAY ADOUTTHESAME . 3 NGTSURE . g DIVORCED/WIDOWED/ ] t SEPARATED - -*428 VISITED BY: HEALTH WORKER A RAIDA t~ OTHER X (SPECIFY) NO ONE VISITED . . . . . . . . . . . . . . . . . . y 424 Have you visited any governmental health facility fDr YES [ any reason during the past six months'? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - -* 426 425 Did any staff member at this health facility speak to you YES about family planning methods? NO 426 Have you visited a private doctor or clinic for any reason YES . during the past six months'? NO I 2- - ' - "428 427 Did the doctor or any staff person there speak to you YES I about family planning methods? NO 2 428 CHECK 302: KNOWS PILL [~] DOESN'T KNOW PILL Are you aware there is a special brand of pill that is appropriate for a woman to use while breastfccding? =F YES: What brand is that? 429 I t ~ 501 YES, KNOW BRAND . l YES, BUT CAN'T NAME BRAND . . . . . . . . . . . . 2 NOT AWARE 8 (MENTIONED HER EXACT WORDS) 144 I Appendix B Questionnaires NO. 501 502 503 504 505 h i • i CHECK 224: SECTION 5: PREGNANCY AND BREASTFEEDING T,ONS ONE OR MORE BIRTHS ~ ] SINCE JANUARY 1998 CODING CATE~ SKIP i i NO BIRTHS SINCE I b 635 I JANUARY 1998 ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998 IN THE TABLE. BEGIN WITH THE LAST BIRTH AND RECORD "RNINS OR TRIPLETS IN SEPARATE COLUMNS. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS). Now 1 would like to ask you some questions about the health of all your children born in the past 5 years. (We will talk about one child at a time.) L,NENUMSEB 77--1 7Yq [--1--1 FROM Q. 2t2 I LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH FROM Q. 212 NAME NAME NAME ANDQ. 216 ALIVE [~ DEAD[~, ALIVE [~ DEAD ~ ALIVE ~ DEAD[~ At the time you became THEN I THEN I THEN I pregnant with (NAME). did you (SKmTOSO7) , ~ (SK,P TO 507) .¢ ~ (SKmTOnO7) . _ " 1 want to become pregnant then, LATER LATER LATER . 2 did you want to wait until later 2 2 or did not want (more) children NO MORE 3 7 NO MORE 3 -] NO MORE . 3 ._7 at all? (SKIP TO 507) q (SKIP TO 507) -4- (SKIP TO 507) .~- 506 How much longer would you like to have waited? MONTHS . 1 YEARS 2 DON'T KNOW . 998 MONTHS 1 MONTHS . . . . . . . t YEARS 2 YEARS . 2 DON'T KNOW . 998 DON'T KNOW . 998 507 When you were pregnant with HEALTH PROFESSIONAL HEALTH PROFESSIONAL HEALTH PROFESSIONAL (NAME), did you see anyone for DOCTOR A DOCTOR . A DOCTOR . A antenatal care fo r this NURSE I MIDWIFE B NURSE / MIDWIFE . B NURSE / MIDWIFE . B pregnancy'? OTHER PERSON OTHER PERSON OTHER PERSON IF YES: Whom did you see'? DAYA C DAYA C DAYA C Anyone else? OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) RECORD ALL PERSONS SEEN NOONE . Y--I NOONE . y_ NOONE . . . . . . . . Y -3 / / (SKIP TO 5t3) .o (SKIP TO 5t3) q (SKIP TO 513) ~- 508 Where did you receive the antenatal care? RECORDALLPLACES PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B MCH CENTER . C PRIVATE SECTOR pVT. HOSPITAL/CLINIC. D pVT. DOCTOR . E OTHER X (SPECIFY) PUBLIC SECTOR PUBLIC SECTOR GVT. HOSPITAL A GVT. HOSPITAI A GVT. HEALTH UNIT . B GV'I'. HEALTH UNIT . B MCH CENTER . C MCH CENTER. C PRIVATE SECTOR PRIVATE SECTOR PVT. HOSPITAL/CLINIC. D PVT. HOSPITAL/CLINIC. D PVT. DOCTOR . E PVT. DOCTOR . E OTHER X OTHER X (SPECIFY) (SPECIFY) 509 How many months pregnant MONTHS . . . . . . . . . . . . . . . . . [ ~ MONTHS. [ ~ MONTHS . ~ ] were you when you first saw someone for an antenatal care DON'T KNOW . 98 DON'T KNOW DON'T KNOW for this pregnancy? , 98 98 510 How many times did you receive antenatal care during this pregnancy? NO. OF VISITS ~ 1 NO. OF VISITS . ~ NO. OF VISITS ~ 1 , DON'T KNOW . . . . . . . . . . . . . . . . . . . 98 • DON'T KNOW . 98 DON'T KNOW . 98 " Appendix B Questionnaires [ 145 511 512 513 514 515 516 517 518 519 CHECK510: NUMBER OF RECEIVED ANTENATAL CARE How many months pregnant were you when you last saw someone for an antcnatal care for this pregnancy'? LAST BIRTH NAME MORETHAN ONCE ONCE/DK (SKIP~IO 513) ? MONTHS . ~-- DON'T KNOW . NEXT-TO-LAST BIRTH S ECON D-FROM-LASTBIRTH NAME NAME MORE THAN MORE THAN ONCE ONCE / DK ONCE ONCE / DK (SKIP TO 513) i (SKIP TO 513) MONTHS . [ - ' -7 ] MONTHS . . . . . . ~ I 98 DON'T KNOw 98 DON'T KNOW 98 When you wcrc pregnant with i YES YES I (NAME), were you given any lN o NO injection in the ann to prevent 2- the baby fi-om getting tetanus, DON'T KNOW DON'T KNOW . . . . . . . . . . 8- that is, convulsion after birth? (SKIP TO 518) • (SKIP TO 518) , During this pregnancy, How TIMES . r [ TIMES . [ ] many times did you get this injectioff? DON'T KNOW . 8 DON'T KNOW . 8 Where did you receive the PUBLIC SECTOR tetanus injection (s)? GVT. HOSPITAL A GVT. HEALTH UNIT B MCHCENTER. . C PRIVATE SECTOR RECORD ALL PLACES PVT. HOSPITAL/CLINIC . . D PVT. DOCTOR . [ OTHER X (SPECIFY) When you received the tetanus YES . I toxoid reJection, did anyone tell NO . . . . . . . . . . . . 2 PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . B MCH CENTER (i PRIVATE SECTOR PVT. HOSPITAUCLINIC. i) pVT. DOCTOR. E OTHER X (SPECIFY) (SKIP TO 515) YES . I NO . . . . . . . . . . . . . 2 - DON'TKNOW 8- (SKIP TO 515) T,MES . . . . I I DON'T KNOW . 8 PUBLIC SECTOR GVT. HOSPITAL A GVT. HEALTH UNIT B MCHCENTER . . . . . . ( PRIVATE SECTOR PVT. HOSPITAUCLINIC D PVT. DOCTOR [( OTHER X (SPECIFY) (SKIP TO 518) you that you should go for (other) antenatal care? At that time, did anyone talk to you about family planning? When you were pregnant with (NAME), did you see a doctor, nurse or other health worker for any other reason (OTHER THAN FOR AN ANTENATAL CHECKUP OR A TETANUS INJECTION}'(' IF YES: Whom did you see'? Anyone else? RECORD ALL PERSONS SEEN DON'TKNOW 8 YES I NO 2 DON'T KNOW . 8 HEALTH PROFESSIONAL DOCTOR A NURSE/MIDWIFE . 13 OTHER PERSON DAYA . ( i OTHER X (SPECIFY) NO ONE y- (SKIP TO 524) "~- HEALTH PROFESSIONAL HEALTH PROFESSIONAL DOCTOR A DOCTOR A NURSE/MIDWIFE H NURSE/MIDWIFE B OTHER PERSON OTHER PERSON DAYA C DAYA . ( OTHER OTHER X X (SPECIFY) (SPECIFY) NO ONE NO ONE . (SKIP TO 524) = y | 7 (SKIP TO 524) q y - Where did you go to see the doctor (nurse and / or health worker)? RECORD ALL PLACES PUBLIC SECTOR GVT. HOSPITAL . . . . A GVT. HEALTH UNIT B MCH CENTER (' PRIVATE SECTOR PVT. HOSPITAL/CLINIC. D PVT. DOCTOR . . . . . . . . 1 OTHER X (SPECIFY) PUBLIC SECTOR PUBLIC SECTOR GVT. HOSPITAL A GVT. HOSPITAL . A GVT. HEALTH UNIT H GVT, HEALTH UNIT . H MCH CENTER L MCH CENTER (' PRIVATE SECTOR PRIVATE SECTOR pVT. HOSPITAL/CLINIC. D PVT. HOSPITAL/CLINIC D PVT. DOCTOR K PVT. DOCTOR . . . . . . . . . . . . E OTHER OTHER X X (SPECIFY) (SPECIFY) 146 I Appendix B Questionnaires 520 CHECK Q 507: HAD ANTENATAL CARE 521 522 Did you seek this care because you thought there was a problem with the pregnancy? How many times during this pregnancy, did you see a doctor, nurse, midwife or other health worker? LAST BIRTH NAME NO HAD ANTENATAL ANTENATAL CARE? CAREI + I (SKIP TO 5261 YES [ NO 2- DON'T KNOW 8- (SKIP TO 524) I TIMES , [~ DON'TKNOW . 8 NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NAME NAME NO H~ NO HAD ANTENATAL ANTENATAL ANTENATAL ANTENATAL (SKIP TO 526) (SKIP TO 526) YES ] YES . . . . . . . . . . . . . . . . . . . 1 NO NO DON'TKNOW . DON'TKNOW . 8 (sK IPTO524) i (SKIPTO524) . TIMES [ ' - - '1 TIMES DON'TKNOW 8 DON'TKNOW . . . . . . . . . . . . . . . . g 523 How many months pregnant MONTHS . ~ MONTHS . ~ MONTHS ~T~ were you when you last saw a I I I I I I I I I health worker dur ing th i s DON'T KNOW . . . . . . . . . . . . 98 DON'T KNOW . . . . . . . . . . . . . . . . 98 DON'T KNOW 98 pregnancy? CHECK IF THE RESPONDENT HAD: 524 525 526 Q 507: ANY ANTENATAL CARE Q 513: TETANUS INJECTION Q 518: OTHER CARE CHECK Q 524: During the time that you were pregnant with (NAME), were any of the following done: Were you given a maternal card? Were you weighed? Was your height measured? Was your blood pressure measured? Did you give a urine sample? Did you give a blood sample? 527 Were you told about the signs of pregnancy complications? 528 Were you told about where to go if you had any of those complications? 529 During this pregnancy were you given or did you buy iron tablets or iron syrup? 530 During the whole pregnancy, for how many days did you take the tablets or syrup? YES NO YES NO YES NC ANYANTENATALCARE, , , ] 2 ANY ANTENATALCARE. ] 2 ANYANTENATAL CARE,., I 2 TETANUSINJECTION . 1 2 TETANUSlNJECTION . 1 2 TETANUSINJECTION . l 2 OTHER CARE . 1 2 OTHERCARE . . . . . . . . . . . . I 2 .OTHER CARE . ] 2 AT LEAST ALL AT LEAST ALL AT LEAST ALL ONE"YES" RESPONSES ONE"YES" RESPONSES ONE"YES" RESPONSES RESPONSE "NO" RESPONSE "NO" RESPONSE "NO" (SKIP TO 5291 (SKIP TO 529) (SKIP TO 529) YES NO YES NO YES NC MATERNALCARD . . . . . . ] 2 MATERNALCARD . ] 2 MATERNALCARD . ] 2 WEIGHT . I 2 WEIGHT I 2 WEIGHT . ] 2 HEIGHT . . . . . . . . . . . . . . . . . . . . ] 2 HEIGHT . | 2 HEIGHT . . . . . . . . . . . . . . . . . . ] 2 BLOOD PRESSURE . l 2 BLOOD PRESSURE. URINE SAMPLE | 2 URINE SAMPLE . BLOOD SAMPLE . 1 2 BLOOD SAMPLE . l 2 BLOODPRESSURE . | 2 URINESAMPLE . l 2 BLOODSAMPLE . . . . . . . . l 2 1 2 l 2 YES ] YES I YES ] NO 2 -NO 2_NO 27 8-] DON'T KNOW . . . . . . . . . . . . . . . . 8 - DON'T KNOW . . . . . . . . . . . . . . . . 8 - - DON'T KNOW (SKIP TO 529) q (SKIP TO 529) q (SKIP TO 529) t YES ] YES I YES [ NO 2 NO 2 NO , 2 DON'T KNOW . . . . . . . . . . . . . . . . 8 DON'T KNOW . . . . . . . . . . . . . . . 8 DON'T KNOW . . . . . . . . . . . . . . . . . . . 8 YES ] YES I YES l DON'T KNOW . . . . . . . . . . . . . . . . 8 - DON'T KNOW DON'T KNOW . . . . . . . . . . . . . . . . (SKIP TO 531) t (SKIP TO 53t) q (SKIP TO 531) I DAYS . I DON'T KNOW . . . . . . . . . . . . . . . . 998 DAYS . . . . . . . . . . . . . . ~ DAYS . . . . . . . . . . . . . DON'T KNOW . . . . . . . . . . . 998 . DON'TKNOW . . . . . . . . . . . 998 Appendix B Questionnaires I 147 531 532 533 534 Where did you give birth to (NAME)? Who assisted with the delivery Of(NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. Was (NAME) delivered normal or caeserean? LAST BIRTH NAME HOME YOUR HOME I] OTHER HOME ]2 PUBLIC SECTOR GVT. HOSPITAL . 2] GVT. HEALTH UNIT . 22 MCHCENTER . 23 PRIVATESECTOR PVT. HOSPITAL/CLINIC 3 ] OTHER 96 (SPECIFY) HEALTH PROFESSIONAL DOCTOR A NURSE/MIDWIFE . H OTHERPERSON DAYA C RELAT IVES/FR IENDS. D OTHER X (SPECIFY) NO ONE Y7 (SKIP TO 534) q NEXT-TO-LAST BIRTH • NAME . . . . HOME YOURHOME ]1 OTHER HOME . 12 PUBLIC SECTOR GVT, HOSPITAL . 2] GVT. HEALTH UNIT• 22 MCHCENTER . 23 PRIVATE SECTOR PVT, HOSPITAMCLINIC. 31 OTHER 96 (SPECIFY) SECOND-F•OM-LASTBIRTH NAME HOME YOUR HOME . I I OTHER HOME . 12 PUBLIC SECTOR GVT. HOSPITAL . 21 GVT. HEALTH UNIT 22 MCH CENTER . . . . 23 PRIVATE SECTOR PVT. HOSPITAL/CLINIC 3 ] OTHER 96 (SPECIFY) HEALTH PROFESSIONAL DOCTOR A NURSE/MIDWIFE B OTHER PERSON DAYA C RELATIVES/FRIENDS D OTHER X (SPECIFY) NO ONE y - (SKIP TO 534) 4 - - HEALTH PROFESSIONAL DOCTOR A NURSE / MIDWIFE . . . . . . . H OTHER PERSON DAYA . . . . . . . . . . . . C RELATIVES/FRIENDS . . . . . D OTHER X (SPECIFY) NO ONE y - (SKIP TO 534) • NORMAL I NORMAl ] NORMAL . . . . . . . . . . . . . . . . . ] CAESEREAN . . . . . . . . . . . . . . . . . . 2 CAESEREAN . . . . . . . . . . 2 CAESEREAN . . . . . . . . . . . . 2 In the first two months after YES I YES I YES . . . . . . l (NAME) was born, did a doctor, NO 2-, NO 2- NO 2 - nurse or other health worker or the daya check on DON'T KNOW 8- ] DON'T KNOW g- DON'T KNOW . 8 - your health'? (SKIP TO 538) , L (SKIP TO 538) .~. (SKIP TO 538) q 535 How many days or weeks after the delivery did the first check take place'? DAYS 1 - - - -1 WEEKS . 2 - - 7 DON'T KNOW . . . . . . . 998 DAYS 1 ~ DAYS . 1 ~ ] WEEKS 2 ~ WEEKS 2 [ ~ • DON'T KNOW . 998 DON'T KNOW . . . . . . . . . . . 998 536 Who checked on your health for the first time? HEALTH PROFESSIONAL HEALTH PROFESSIONAL HEALTH PROFESSIONAL DOCTOR I DOCTOR DOCTOR ] NURSE / MIDWIFE . 2 NURSE I MIDWIFE . 2 NURSE / MIDWIFE . . . . . 2 OTHER PERSON OTHER PERSON OTHER PERSON DAYA . 3 DAYA . 3 DAYA 3 RELATIVES/ FRIENDS 3 RELATIVES/ FRIENDS . 4 RELATIVES/ FRIENDS 4 OTHER OTHER OTHER _ 6 6 6 (SPECIFY) (SPECIFY) (SPECIFY) 148 [ Appendix B Questionnaires 537 538 LAST BIRTH NAME NEXT-TO-LAST BIRTH SECON D-FROM-LASTBIRTH NAME NAME Where did this first check take place'? HOME YOUR HOME . OTHER HOME . PUBLIC SECTOR OVT. HOSPITAL . GVT. HEALTH UNIT . . . . . . . MCH CENTER . PRIVATE SECTOR PVT. HOSPITAL/CLINIC. OTHER (SPECIFY) HOME HOME I 1 YOUR HOME . . . . . . . . . . . . I I YOUR HOME 1 ] 12 OTHER HOME . . . . . . . . . . . . . . 12 OTHER HOME 12 PUBLIC SECTOR PUBLIC SECTOR 21 GVT, HOSPITAL . . . . . 2 ] GVT. HOSPITAL . 2 ] 22 GVT. HEALTH UNIT . . . . . . . 22 GVT. HEALTH UNIT . 22 23 MCH CENTER . 23 MCH CENTER 23 PRIVATE SECTOR PRIVATE SECTOR 31 PVT. HOSPITAL/CLINIC. 3 I PVT. HOSPITAL/CLINIC. 3 ] 96 OTHER 96 OTHER 96 (SPECIFY) (SPECIFY) In the first two months after delivery, did you receive a Vitamin A dose (red/blue copsule)? SHOW CAPSULE. YES NO DON'TKNOW . . . . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I YES ] 2 NO 2 NO 2 8 DON'TKNOW 8 DON'TKNOW 8 539 In the first two months after (NAME) is delivery, did a doctor, nurse or other health worker check on his / her health? YES NO DON'T KNOW . . . . . . . . . . . . . . . . (SKIP TO 541A) I l YES l YES l 2 7 NO ~ ~ NO ' • 2 - 8 -1 DON'T KNOW . . . . . . . . . . . 6 7 DON'T KNOW . . . . . . . . . . . . . . . 8 - / (SKIP TO 544) q (SKIP TO 544) 4 540 541 541A 541B How many days or weeks after the delivery did the first check take place'? DAYS 1 WEEKS . 2 ~ [ ~ DON'T KNOW 998 Where did this first check take place'? HOME YOUR HOME . I 1 OTHER HOME . . . . . . . . . . . 12 PUBLIC SECTOR GVT, HOSPITAL . 2 ] GVT, HEALTH UNIT . 22 MCH CENTER . _93 PRIVATE SECTOR PVT, HOSPITAL/CLINIC . 31 OTHER 96 (SPECIFY) During the two weeks after the YES I birth was a sample of blood NO 2 taken from the baby's heel? DON'T KNOW g Where did this first check take HOME place? YOUR HOME . I [ OTHER HOME 12 PUBLIC SECTOR GVT, HOSPITAL . 2 I GVT, HEALTH UNIT . 22 MCH CENTER . . . . . . . . . . 23 PRIVATE SECTOR PVT, HOSPITAL/CLINIC . 3 l OTHER 96 (SPECIFY) DAYS 1 ~ [ ~ DAYS . 1 [ - - -~ WEEKS . 2 ~ ] WEEKS . 2 [ - - ~ DON'T KNOW . 998 , DON'T KNOW . . . . . 998 (SKIP TO 544) (SKIP TO 544) NN Appendix B Questionnaires I 149 LAST BIRTH NEXT-TO-LAST BIRTH NAME NAME SECON D-FROM-LASTBIRTH NAME Has your period returned since ] YES . [ 7 the birth of (NAME)? [ (SKIP TO 544) I / NO . . . . . . . . 2 ENTER "X" IN COL,4 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH, (OR TO CURRENT PREGNANCY) For how many months after the birth of(NAME) did you not have a period'? CHECK 226: RESPONDENT PREGNANT? ENTER "X" IN COL.4 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS WITHOUT A PERIOD (OR UP TO THE NEXT PREGNANCY, STARTING IN THE MONTH AFTER BIRTH, IF LESS THAN ONE MONTH WITHOUT A PERIOD, ENTER "O" IN COL.4 IN MONTH AFTER BIRTH. NOT PREGNANT PREGNANT OR UNSURE t lave you resnmed sexual relations since the birth o1" (NAME)'? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] NO . . . . . . . . . . . . . . . 2 7 (SKIP TO 548) 9 How long after birth Of(NAMF) did you not have sexual relations? Record Period In Days If Less Than Month And In Months Otherwise DAYS . . . . . . . . . . . . . . . . . . . 1 l~ ~ MONTHS . 2 l ' - - - ~ DON'T KNOW . 998 DAYS . . . . . . . . . . . . . . . 1 ~ ] MONTHS . . . . . . . . . . . . . 2 l~7- - - " 7 DON'T KNOW . . . . . . . . . . . . . . 998 DAYS 1 ~ ] MONTHS . . . . . . . . . . . . 2 ~ ] DON'T KNOW . . . . . . . . . . . . . . . . . 998 At the time you were pregnant with (NAME) or after you delivered, did anyone give you advice about breastfeeding? YES . . . . . . . . . . . . } NO 2 7 (SKIP TO 550) q YES . . . . . . . . I 2 NO . . . . . . . . 7 (SKIP TO 550) ~ YES . . . . . I NO 2~ (SKIP TO 650) + Who gave you this advice? RECORD ALL MENTIONED HEALTH PROVIDER A SOCIAL WORKER . . . . . . . . . . . . . . . B DAYA . . . . . . . . . . . . . . . (" RELIGOUS LEADERS . . . . . . . ]) NEIGHBORS/FRIENDS I HOUSEHOLD MEMBER . F OTHER RELATIVES (; OTHER X (SPECIFY) HEALTH PROVIDER . A SOCIAL WORKER B DAYA . . . . . . . . . . . . . . . . . . . . . . . . . . (' RELIGOUS LEADERS D NEIGHBORS/FRIENDS l i HOUSEHOLD MEMBER 1 OTHER RELATIVES ( i OTHER X (SPECIFY) HEALTH PROVIDER . . . . . . . . . . . . \ SOCIAL WORKER 14 DAYA . ( RELIGOUS LEADERS D NEIGHBORS/FRIENDS . . . . . 1 HOUSEHOLD MEMBER I' OTHER RELATIVES . ( i OTHER X (SPECIFY) At the time you were pregnant with (NAME) or after you delivered, did anyone give you advice about Family planning? YES . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . • 7 (SKIP TO 552) • [ YES ] NO 2 -I (SKIP TO 552) YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . ? - ' 7 (SKIP TO 552) Who gave you this advice'? RECORD ALL MENTIONED HEALTH PROVIDER . . . . . . . . . . A SOCIAL WORKER . . . . . . . . . . . B DAYA . . . . . . . . . . . . . . . . . . ( RELIGOUS LEADERS ]) NEIGHBORS/FRIENDS E HOUSEHOLD MEMBER F OTHER RELATIVES . . . . . . ( ; OTHER X (SPECIFY) HEALTH PROVIDER . . . . . . . . . A SOCIAL WORKER B DAYA . . . . . . . C RELIGOUS LEADERS D NEIGHBORS/FRIENDS E HOUSEHOLD MEMBER I OTHER RELATIVES . G OTHER X (SPECIFY) HEALTH PROVIDER. ~\ SOCIAL WORKER . . . . . . . . . . . . . H DAYA . . . . . . . . . . . . . . . . . . . . . . . . ( RELIGOUS LEADERS . . . . . I) NEIGHBORS/FRIENDS . HOUSEHOLD MEMBER . 1 OTHER RELATIVES . . . . . . . . ( i OTHER X (SPECIFY) 150 [ Append&/3 Questionnaires LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME SECOND-FROM-LASTBIRTH NAME 552 553 554 Did you ever breast~ed (NAME)? YES . (SKIPTO554) q NO . 2 NO ENTER "N" IN COL,5 OF CALENDAR IN MONTH AFTER BIRTH. THEN GO TO 560 How long after birth did you first put (NAME) to the breast'? IF LESS THAN 1 HOUR, RECORD '0O' HOURS, IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. I ~ YES ] - (SKIP TO 554)t 2 NO 2 IMMEDIATELY . 000 HOURS 1 I ~ DAYS . 2 I ~ l YES , (SKIP TO 554) ÷ IMMEDIATELY . . . . . 000 HOURS 1 I ~ DAYS . 2 IMMEDIATELY . . . . . 000 HOURS 1 ~ [ ~ DAYS 2 ~ ] 555 Within the first three days after YES delivery, before your milk began NO . . . . . flowing regularly was (NAME) given anything to drink other (SKIP TO 557) than breast milk? I YES. 2 -I NO (SKIP TO 557) q ] YES ] 2- NO 2- (SKIP TO 557) q 556 557 558 559 What was (NAME) given to drink before your milk began flowing regularly'? Anything else'? RECORD ALL MENTIONED CHECK 504 OR 216: CHILD ALIVE? Are you still breastfeeding (NAME)'? For how many months did yon breastfeed (NAME)? MILK (OTHER THAN BREAST MILK) A B PLAIN WATER . SUGARE OR GLUCOSE C WATER D GRIPE WATER SALT AND SUGAR E SOLUTION F FRUIT JUICE G INFANT FORMULA . H TEAl INFUSIONS . ] HONEY X OTHER (SPECIFY) ALIVE DEAD (SKIP TO 559 I YES ]7 (SKIP TO 562 I NO 2 MILK (OTHER THAN BREAST MILK) A B PLAIN WATER . SUGARE OR GLUCOSE C WATER D GRIPE WATER E SALT AND SUGAR F SOLUTION . G FRUIT JUICE . . . . . . H INFANT FORMULA . ] TEA/ INFUSIONS X HONEY OTHER (SPECIFY) ALIVE DEAD (SKIP TO 559) YES (SKIP TO 5621 q NO 2 MILK (OTHER THAN BREAST MILK) A PLAIN WATER B SUGARE OR GLUCOSE WATER C GRIPE WATER . D SALT AND SUGAR SOLUTION . E FRUIT JUICE F INFANT FORMULA. G TEAl INFUSIONS . H HONEY I OTHER X (SPECIFY) ALIVE DEAD (SKIP TO 559 I YES I~ (SKIP TO 562) , t - - NO 2 ENTER "X" IN COL.5 OF CALENDAR FOR THE NUMBER OF SPECIFIED MONTHS OF BREASTFEEDING, STARTING IN THE MONTH AFTER BIRTH. THEN GO TO 560, IF LESS THAN A MONTH ENTER "O" IN THE MONTH AFTER BIRTH, Appendix B Questionnaires ] 151 560 56 [ CHECK 504 OR 216: 562 563 Why did you (never / stop) breastfeeding (NAME)'? 564 LAST BIRTH NAME MOTHER ILL/WEAK . . . . . . . CHILD ILL/VVEAK . CHILD DIED . NIPPLE/BREAST PROBLEM. INSUFFICIENT MILK . . . . . . . MOTHER WORKING CHILD REFUSED . WEANING AGE 08 BECAME PREGNANT . . . . . . . 09 STARTED USING CONTRACEPTIVE . ] 0 OTHER 9E (SPECIFY) NEXT-TO-LAST BIRTH NAME 0 ] MOTHER ILL/WEAK . . . . . . 0 I 02 CHILD ILL/WEAK . 02 03 CHILD DIED . . . . . . . . 03 1)4 NIPPLE/BREAST PROBLEM (14 05 INSUFFICIENT MILK . 05 06 MOTHER WORKING 06 07 CHILD REFUSED . 07 WEANING AGE " 08 BECAME PREGNANT " 09 STARTED USING CONTRACEPTIVE ] 0 OTHER I)( 1 (SPECIFY I SECOND-FROM-LASTBIRTH NAME MOTHER ILL/WEAK . 0 I CHILD ILL/WEAK . . . . . . . . . . . . 02 CHILD D IED (13 NIPPLE/BREAST PROBLEM 04 INSUFFICIENT MILK . 05 MOTHER WORKING 06 CHILD REFUSED . 07 WEANING AGE . 0g BECAME PREGNANT O0 STARTED USING CONTRACEPTIVE . I 0 OTHER 96 (SPECIFY) ALIVE DEAD ALIVE DEAD ALIVE DEAD (SKIP TO 5651 (SKIP TO 5701 (SKIP TO 5651 (SKIP TO 5701 (SKIP TO 565) (SKIP TO 570) NUMBER OF NUMBER OF NIGHTTIME FEEDINGS . . ~ ] NIGHTTIME FEEDINGS [ ~ ] ENTER "X" IN COL.5 OF CALENDAR IN MONTH AFTER BIRTH AND IN EACH MONTH TO CURRENT MONTH. How many times did you breastfeed (NAME) last night between sunset and sunrise? IF ANSWER IS HOT NUMERIC, PROBE FOR APPROXIMATE NUMBER How many times did you breast fced (NAME) yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER NUMBER OF NUMBER OF DAYLIGHT FEEDINGS. . .~]~ DAYLIGHT FEEDINGS. [~] NUMBER OF NIGHTTIME FEEBINGS. [~ NUMBER OF DAYLIGHT FEEDINGS [ ~ 565 Did (NAML) drink anything from a bottle with a nipple yesterday or last night'? I YES I YES 1 NO 2 NO 2 DON'TKNOW: . . . . . . . . . . . . . . . ~ DON'TKNOW . YES I NO DON'TKNOW . 8 152 I Appendi~ B Questionnaires LAST BIRTH NAME 566 At any time yesterday or last night was (NAMe;), given any of the following: YES Plain water? PLAIN WATER l Sugar water? SUGAR WATER . I Juice'? ! JUICE I t lerba l tea? HERBAL TEA l Baby formula? BABY FORMULA . . . . I Fresh mi lk? FRESH MILK . I Tinned or powdered milk'? TINNED/ POWDERED MILK . . l 2 Any other liquid? OTHER LIQUID . 1 2 Fruit? FRUIT 1 2 Porridge, bread, rice, macaroni, FOOD MADE FROM or other food made from grains? GRAIN 1 2 Sweet potatoes or other food FOOD MADE FROM made from tubers'? TUBERS I 2 Eggs, fish, or poultry'? EGGS/FISH/ POULTRY . I 2 Meat'? MEAT I 2 Any other solid or semi-solid OTHER SOLID/ food'? SEMI-SOLID FOOD. l 2 567 CHECK 566: "YES" TO "NO" ONE OR MORE TO ALL FOOD OR LIQUID GIVEN ? 9 YESTERDAY? (SKIP TO 569) 568 (Aside from breastfeeding and NUMBER OF TIMES . . . . . . . . . I~ other liquids), how many times I I did (NAME) eat yesterday, DON'T KNOW 8 (INCLUDING BOTH MEALS AND SNACKS)? IF 7 OR MORE TIMES, RECORD 'T. NEXT-TO-LAST BIRTH NAME NO YES NO 2 PLAIN WATER . I 2 2 SUGAR WATER I 2 2 JUICE I 2 2 HERBAL TEA . . . l 2 2 BABY FORMULA l 2 2 FRESH MILK . . . . . . . . I 2 TINNED/ POWDERED MILK . . 1 2 OTHER LIQUID . [ 2 FRUIT l 2 FOOD MADE FROM GRAIN . I 2 FOOD MADE FROM TUBERS ] 2 EGGS/FISH/ POULTRY l 2 MEAT l 2 OTHER SOLID/ SEMI-SOLID FOOD., l 2 "YES" TO "NO" ONE OR MORE TO ALL ISKIP T~O 5691 NUMBER OF TIMES I DON'T KNOW . 8 SECOND-FROM-LAST BIRTH NAME YES NO PLAIN WATER . I 2 SUGAR WATER . I 2 JUICE [ 2 HERBAL TEA . ] 2 BABY FORMULA . ] 2 FRESH MILK . . . l 2 TINNED/ POWDERED MILK l 2 OTHER LIQUID [ 2 FRUIT 1 2 FOOD MADE FROM GRAIN I 2 FOOD MADE FROM TUBERS ] 2 EGGS/FISH/ POULTRY . l 2 MEAT 1 2 OTHER SOLID/ SEMI-SOLID FOOD . I 2 "YES" TO "NO" ONE OR MORE TO ALL ? ISK,pTO[~569, NUMBER OF TIMES . [ ] DON'T KNOW . 8 Appendix B Questionnaires ] 153 569 LAST BIRTH NAME On how many days during the past seven days was (NAME) given any of the following: Plain water'? Any kind of milk (other than breastmilk)? Liquids other than plain water or milk'? Food made from gains like porridge, bread, rice and macaroni? Sweet potatoes or other foods tubers'? Eggs, fish, or poultry'? Meat'? Fruit? Any other solid or semi-solid food'? RECORD THE NUMBER OF DAYS PLAIN WATER . [ ] MILK [ ] OTHER LIQUID [ ] FOODS FROM GRAINS [ ] FOODS FROM TUBERS [ ] EGGS/FISH/POULTRY . [ ] MEAT [ ] ERU,T 11 OTHER SOLID/ SEMI SOLID FOOD . ~] 5 70 RETURN TO 505 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 601. NEXT-TO-LAST BIRTH NAME RECORD THE NUMBER OF DAYS PLAIN WATER MILK OTHER LIQUID I I FOODS FROM GRAINS ,~ FOODS FROM TUBERS I~ EGGS/FISH/POULTRY ~] MEAT FRUIT I OTHER SOLID/ SEMI SOLID FOOD . J~ SECOND-FROM-LAST BIRTH NAME RECORD THE NUMBER OF DAYS PLAIN WATER . [ ] MILK [ ] OTHER LIQUID . [ ] FOODS FROM GRAINS [ ] FOODS FROM TUBERS [ ] EGGS/FISH/POULTRY [ ] MEAT [ ] FRUIT [ ] OTHER SOLID/ SEMI SOLID FOOD [ ] 154 I Appendix B Questionnaires SECTION 6: IMMUNIZATION AND HEALTH CODING CATEGORIES SKIP TO THAN 3 BIRTHS, USE ADDITIONAL FORMS). UNENDMBER FF1 FF1 FROM Q. 212 LAST BIRTH I NEXT-TO-LAST BIRTH I SECOND-FROM-LAST BIRTH NAME I NAME I NAME FROM Q. 212 ALIVE DEAD ALIVE GO TO 603 FOR NEXT BIRTH. IF NO OTHER BIRTH, GO TO 635 DEAD ALIVE DEAD GO TO 603 FOR NEXT GO TO 603 FOR NEXT BIRTH. IF NO OTHER BIRTH. IF NO OTHER BIRTH, GO TO 634 BIRTH, GO TO 634 Do you have a bir th certif icate for YES, SEEN AND YES, SEEN AND (NAME)? VACCINATION DATES VACCINATION DATES RECORDED RECORDED IF YES: May ) $cc i t? . . . . . . . . . . . . . . . . . . . . . . . . . 1 -1 (SKIP TO 606) 4 = (SKIP TO 606) 4 CHECK THE CERTIFICATE AND INDICATE WHETHER VACCINATION DATES ARE YES, SEEN BUT NO YES, SEEN BUT NO RECORDED ON THE CERTIFICATE OR VACCINATION DATES VACCINATION DATES NOT YES, SEEN AND VACCINATION DATES (SKIP TO 606) 4 1~ RECORDED . . . . . . . . . . . . . . . . . . . . . . . . . 1 - YES, SEEN BUT NO VACCINATION DATES RECORDED . 2 - RECORDED . 2 - ] RECORDED . . . . . . . . . . . . . . . . . . . . . . . . . 2 " YES, BUT NOT SEEN. . 3-] YES, BUT NOT SEEN . 3- YES, BUT NOT SEEN . 3- ' CERTIFICATE . 4 I NO CERTIFICATE . . . . . . . . . . . . . . . 4 I NO CERTIFICATE . . . . . . . . . . . . . . . 4 Did you ever have a birth certificate for (NAME)? IFYES: Did the ce~ificate include a vaccination record? (t) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CERTIFICATE. (2) WRITE '44' IN 'DAY* COLUMN IF CERTIFICATE SHOWS A VACCINATION WAS GIVEN BUT NO DATE WAS RECORDED. BeG POLIO 1 POLIO 2 POLIO 3 ACTIVATED POLIO DPT 1 DPT 2 DPT 3 ACTIVATED OPT MEASLES HEPATITS B1 HEPATITS B2 HEPATITS B3 VITAMIN A POLIO 0 (ZERO) POLIO 4 MMR OTHER (SPECIFY) YES, HAD CERTIFICATE YES, HAD CERTIFICATE YES, HAD CERTIFICATE WITH RECORD . 1 - WITH RECORD . 1- WITH RECORD . . . . . . . . . 1- YES, CERTIFICATE, BUTNO t YES, CERTIFICATE, BUTNO ] YES, CERTIFICATE, BUTNO RECORD . 2 - RECORD . 2 - RECORD . . . . . . . . . . . . . 2 - NO CERTIFICATE . 3 - NO CERTIFICATE . . . . . . . 3 - NO CERTIFICATE . 3 - (SKIPTO608~ (SKIPTO608~ (SKIPTO608)~- DAY MO. YEAR I DAY MO. YEAR I DAY MO. YEAR Appendix B Questionnaires I 155 I &S I 'B IR IH NAME 607 Has (NAME) received any vaccination that is not recorded on the certificate? YES 1 7 PROSE FOR i / IACCINATIONS AND WRITE "66" IN CORRESPONDING DAY COLUMN IN 606), NO 2 DON'T KNOW . . . . . . . . . . . . 8 YES, SEEN 17 (SKIP TO 610) q YES, NOT SEEN 2 7 SKIP TO 612) 4 IO HEALTH CARD . 3 RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT, POLIO, MEASLES, HEPATITIS B1-B3 AND MMR. (IN CASE OF POLIO, DPT, HEPATITIS PROBE CAREFALLY TO BE SURE THAT THE CHULD RECEIVED THE VACCINATIONS IN FRONT OF THE VACCINATIONS WITH NO RECORD) 608 Do you have a health card whcrc (NAME'S) vaccinations are written down? IF YES[ May l scc it, please? 609 Did you ever have a health card for (NAME)'.' 0 ] 0 (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS A VACCINATION WAS GIVEN BUT NO DATE WAS RECORDED. BCG POLIO 1 DPT 1 HEPATITIS B1 POLIO 2 DPT 2 HEPATITIS B2 POLIO 3 DPT 3 HEPATITIS B 3 POLIO 4 MEASLES ACTIVATED POLIO ACTIVATED DPT VITAMIN A POLIO 0 (ZERO) MMR OTHER (SPECIFY) SKIP TO 612) i YES NO . I NEX I- I O-I . ~,S I B IR I ' l l NAME D~.~ MO. BCG PI D1 H1 P2 D2 H2 P3 D3 H3 P4 MEA AP AD VA P0 MMF OTH YES 1 7 PROBE FOR q | tACCINATIONS AND WRITE "66" IN CORRESPONDING DAY COLUMN IN 606). NO 2 DON'T KNOW . 8 YES, SEEN . . . . . . . . . . . . . . . . . . . 17 (SKIP TO 610) YES, NOT SEEN . . . . . . . . . . . . . 2 - SKIP TO 612) I IO HEALTH CARD 3 YES 1 NO . . . . . . . . . . . . . . . . . . . . 2 SKIP TO 6121 q YEAR DA~ MO. YEAR NE('()N I)-I ROM-I,A~%I BI R r l l NAME YES 1 7 PROSE FOR q / CACCINATIONS AND WRITE "66" IN CORRESPONDING DAY COLUMN IN 606). NO . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . 8 YES, SEEN 1- (SKIP TO 6101 YES, NOT SEEN 21 (SKIP TO 6121 4 NO HEALTH CARD . 3 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . 2 SKIP TO 6121 I DAY MO, P I I D1 I Ht I P2 I D2 I H2 I P3 I D31 H3 I P4 I MEAl AP I VA I POl MMRI OTH I YEAR t 156 n Appendir B Questionnaires LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NAME NAME NAME 611 612 613 614 Has (NAME) received any vaccinations that are not recorded on this health card'? RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT, POLIO, MEASLES, HEPATITIS B1-B3 AND MMR. IN CASE OF POLIO, DPT, HEPATITIS PROBE CAREFALLY TO BE SURE THAT THE CHULD RECEIVED THE VACCINATIONS IN FRONT OF THE VACCINATIONS WITH NO RECORD) CHECK 604 AND 608: Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases? Please tell me i f (NAME) (has) received any of the following vaccinations: A BCG vaccination against Tuberculosis, that is, injection in YES 17 YES I '~ YES 17 PROBE FOR q (PROBE FOR I (PROBE FOR q VACCINATIONS AND WRITE VACCINATIONS AND WRITE VACCINATIONS AND WRITE "66" IN CORRESPONDING "66" IN CORRESPONDING "66" IN CORRESPONDING DAY COLUMN IN 610. THEN DAY COLUMN IN 610. THEN DAY COLUMN IN 610. THEN SKIP TO 615) ~. SKIP TO 615) ~. SKIP TO 615) ~[ NO 2 - NO 2 - NO 2 - DON'T KNOW 8 - DON'T KNOW 8 - DON'T KNOW . 8 - SKIP TO 615) q (SKIP TO 615) i (SKIP TO 615) q NEITHER CERTIFICATE NEITHER CERTIFICATE NEITHER CERTIFICATE CERTIFICATE OR HEALTH CERTIFICATE OR HEALTH CERTIFICATE OR HEALTH NOR HEALTH CARD SEEN NOR HEALTH CARD SEEN NOR HEALTH CARD SEEN CARD (THAT CARD (THAT CARD (THAT HAS VACCINE ~ HAS VACCINE ~ HAS VACCINE RECORDED) RECORDED) RECORDED) I I YES 1 YES 1 YES 1 NO 2 NO 2 NO 2" DON'T KNOW ~ I DON'T KNOW 8 DON'T KNOW SKIP TO 618) q n (SKIP TO 6t8) a 8 n (SKIP TO 618) t 8- YES 1 YES 1 YES 1 NO 2 NO 2 NO 2 DON'T KNOW . 8 DON'T KNOW . 8 DON'T KNOW . 8 the left shoulder that caused a scar? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Polio vaccine, that is drops in the YES YES YES 1 1 1 month? NO NO NO IF YES: DON'T KNOW 2 DON'T KNOW 2 DON'T KNOW . 2 How many times'? 0 0 5 IF DON'T KNOW NUMBER OF T,MES, NUMBER OF TIMES . [ ~ NUMBER OF TIMES ~ NUMBER OF TIMES I I I I I I RECORD 8 IN BOX. A DPT injection? YES 1 YES 1 YES 1 IF YES: NO 2 NO 2 NO 2 How many times? DON'T KNOW 8 DON'TKNOW 8 DON'TKNOW . 8 IF DON'T KNOW NUMBER OF TIMES, NUMBER OF TIMES . ~- -~ NUMBER OF TIMES . ~ NUMBER OF TIMES I RECORD 8 IN BOX. An injection against measles at ,YES . . . . . . . . . . . . . . . . . . . . . . . 1 ' YES . . . . . . . . . . . . . . . . . . . . . . . 1 'YES . 1 nine months'? NO 2 NO 2 NO 2 DON'T KNOW 8 iDONTKNOW . 8 ~DONTKNOW . 8 YES 1 YES 1 YES 1 NO 2 NO 2 NO 2 DON'T KNOW . 6 DON'T KNOW . . . . . . . . . 8 DON'T KNOW . 6 An injection against hepatitis'? IF YES: How many times'? IF DON'T KNOW NUMBER OF TIMES, RECORD 8 IN BOX. NUMBER OF TIMES . An MMR injection, that is an injection against measles, memps and rubella and taken at one-half /ear? I NUMBER OF TIMES ~- '~ NUMBER OF TIMES I YES 1 ! YES 1 YES 1 NO 2 NO . 2 NO 2 DON'T KNOW . 8 DON'T KNOW . 8 DON'T KNOW 0 Appendix B Questionnaires I 157 LASTBIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LASTBIRTH NAME NAME NAME 615 Did (NAME) receive a vitamin A blue capsule that is taken at 9 and 18 months ? SHOW CAPSULE• 616 At anytime when you took your child for these immunizations, did anyone talk to you abou( Family planning'? YES 1 YES 1- YES 1 - NO 2 NO 2= NO 2 - DON'T KNOW 8 DON'T KNOW 8- DON'T KNOW 8-- SKIP TO 618) , (SKIP TO 618) YES I . ,\,~,\.~.,~,,,,~ ~.~'~ ,-.,,~.@.,-s,~-. ? STILL YOUNG/DIDN'T GO . ~:4g,~:~: . '~ ; ~i: DON'T KNOW/UNSURE . 8 ~.%\×~ ¢~.~N ~ ~ a ~'~",~ ~.~,~ 617 Did anyone talk to you about any other health services (nutrition / antenatal care)'? YES I . ~ :~ ~'~" @~ ~~:~: ,~; '~k~'~'~%5~. '~: . . . ~ . ~"~' : : -~ .~\ . . . . . . . . . . . . . . . . . I YES I YES I 2 NO 2 NO 2 618 Has (NAME) been ill with a fever at YES any time in the last two weeks? NO ]DON'TKNOW N DON'TKNOW . 8 DON'TKNOW 8 " 619 ttas (NAME) bccn ill with a cough at any time in the last two weeks'? 620 When (NAME) had the illness with a cough, did he/she breathe faster than usual with short, rapid 621 YES I YES I YES ] NO =~ NO 2q NO 2- DON'TKNOW 8~ DON'TKNOW ~ DON'TKNOW SKIP TO 624) 4 / SKIP TO 624) q (SKIP TO 624) q YES I YES I YES I NO ~ NO 2 NO breaths'? Did you seek advice or treatment Ibr the cough? DON'TKNOW ~ DON'TKNOW DON'TKNOW YES i YES I YES , NG NO NO SKIP TO 623) 4 SKIP TO 623) q (SKIP TO 623) ÷ PUBLIC SECTOR 622 Where did you seek advice or treatment? Anywhere else'? RECORD ALL MENTIONED. PUBLIC SECTOR GVT. HOSPITAL . A GVT. HEALTH UNIT . . . . . . . . [3 MCH CENTER . ( MEDICAL PRIVATE SECTOR PVT. HOSPiTAL/CLINIC D PVT. DOCTOR . . . . . . . . . . . . . . . I PHARMACY . . . . . . . . . . . . . . . . . . . PUBLIC SECTOR GVT. HOSPITAL . A GVT. HOSPITAL • A GVT. HEALTH UNIT . . . . 13 GVT. HEALTH UNIT I~ MCH CENTER . . . . . . . . . . . . . . . . C MCH CENTER . . . . . . . . . . . . . . C MEDICAL PRIVATE SECTOR MEDICAL PRIVATE SECTOR PVT, HOSPITAL/CLINIC PVT, HOSPITAL/CL IN IC I ) l ) PVT. DOCTOR . . . . . . . . PVT. DOCTOR . . . . . E I PHARMACY . . . . . . . . . PHARMACY F I ~ F OTHER PRIVATE SECTOR OTHER PRIVATE SECTOR OTHER PRIVATE SECTOR TRADITIONAL TRADITIONAL TRADITIONAL PRACTITIONER (j PRACTITIONER (i PRACTITIONER . . . . . . (i RELATIVES/FRIENDS H RELATIVES/FRIENDS FI RELATIVES/FRIENDS . . . . . . . I I OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) I YES I 2 NO 2 8 DON'T KNOW N 623 Was (NAME) given antibiotic to treat YES 1 YES the cough? NO 2 NO DON'T KNOW . . . . . . . . . . . 8 DON'T KNOW 158 I Appendix B Questionnaires 624 625 t las (NAME) had diarrhea in the last two wecks'? Now 1 would like to know how much (NAME) was offered to drink during the diarrhea, was he/she offered less than usual to drink, about the same amounl or more than usual to drink'? l IF LESS, PROBE: Was he/ she offered much Jess than usual to drink or somewhat less'? LAST BIRTH NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NAME NAME NAME YES I YES ] YES I NO 28 ~ NO 21 NO DON'T KNOW DON'T KNOW DON'T KNOW . SKIP TO 633) ~- SKIP TO 633) q SKIP TO 633) t MUCH LESS . I MUCH LESS . I MUCH LESS . . . . . . . . . . . . . . . I SOMEWHAT LESS 2 SOMEWHAT LESS 2 SOMEWHAT LESS . 2 ABOUT THE SAME 3 ABOUT THE SAME 3 ABOUT THE SAME 3 MORE 4 MORE 4 MORE 4 NOTHING TO DRINK . 5 NOTHING TO DRINK . 5 NOTHING TO DRINK . 5 DON'T KNOW 8 DON'T KNOW 8 DON'T KNOW 8 626 When (NAME) had diarrhea, was MUCH LESS . . . . . . . . . . . . . . . . . I MUCH LESS . I MUCH LESS . ] he/ she offered less than usual SOMEWHAT LESS . 2 SOMEWHAT LESS 2 SOMEWHAT LESS 2 to eat, about the same amount ABOUT THE SAME 3 ABOUT THE SAME 3 ABOUT THE SAME 3 more than usual, or nothing to MORE 4 MORE 4 MORE 4 eat? STOPPED FOOD . 5 STOPPED FOOD 5 STOPPED FOOD 5 IF LESS, PROBE: Was he/ she NEVER GAVE FOOD 6 NEVER GAVE FOOD . 6 NEVER GAVE FOOD . 6 of fered much ]ess than usual to DON'T KNOW . 8 DON'T KNOW 8 DON'T KNOW . . . . . 8 i eat or somewhat less'? 627 ~ Was (NAME) given a fluid made YES I YES I YES I from a special packet called NO 2 NO 2 NO 2 : mah lou l moalget el-gaffaf to DON'T KNOW 8 DON'T KNOW 8 DON'T KNOW . . . . . . . . . . . . . . . 8 i drink'? 628 Did anyone advice you to give ! (NAME) mahloul moalget el gafaf when (he/she) had diarrhea that time? IF YES: Who? RECORD ALL MENTIONED. 629 Was he/she given anything (clsc) to treat the diarrhea? 630 What was given to treat the diarrhea'? Anything else'? RECORD ALL MENTIONED. PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR DOCTOR/HEALTH WORKER A DOCTOR/HEALTHWORKER A DOCTOR/HEALTH WORKER A PRIVATE SECTOR PRIVATE SECTOR PRIVATE SECTOR DOCTOR/HEALTH WORKER B DOCTOR/HEALTH WORKER B DOCTOR/HEALTH WORKER B PHARMACY WORKER . (, PHARMACY WORKER . U PHARMACY WORKER . (2 TRADITIONAL TRADITIONAL TRADITIONAL PRACTITIONER . D PRACTITIONER . . . . . . . . . . . . . . . . . D PRACTITIONER . D HUSBAND E HUSBAND E HUSBAND . E OTHER RELATIVE/FRIEND F OTHER RELATWE/FR/END. F OTHER RELATIVE/FRIEND . F OTHER X OTHER X OTHER X (SPECIFY) (SPECIFY) (SPECIFY) NO ONE . y NO ONE . y NO ONE . y_ YES [ YES ] YES ] NO . 2_ NO 2~ NO 2- DON'T KNOW . . . . . . . . . . . . . . g_ DON'T KNOW 84 DON'T KNOW g_ SKIP TO 631) ~" SKIP TO 631) 4 SKIP TO 631) t HOMEMADE SUGAR, SALT HOMEMADE SUGAR, SALT HOMEMADE SUGAR, SALT AND WATER SOLUTION . A AND WATER SOLUTION . A AND WATER SOLUTION . A ANTIBIOTIC ANTIBIOTIC ANTIBIOTIC (PILL OR SYRUP) B (PILL OR SYRUP) B (PILL OR SYRUP) B OTHER PILL OR SYRUP . (2 OTHER PILL OR SYRUP . C OTHER PILL OR SYRUP . C INJECTION INJECTION INJECTION (I.V.) INTRAVENOUS D (I.V.) INTRAVENOUS . D (LV.) INTRAVENOUS . I) HOME REMEDIES/ HOME REMEDIES/ HOME REMEDIES/ HERBAL MEDICINES . E HERBAL MEDICINES E HERBAL MEDICINES E OTHER OTHER OTHER X X X (SPECIFY) (SPECIFY) (SPECIFY) Appendix B Questionnaires I 159 LAST BIRTH NAME 631 Did you seek advice or YES treatment for the diarrhea'? NO (SKIP TO 633) ,I 632 Where did you seek advice or PUBLIC SECTOR treatment? 633 634 635 636 NEXT-TO-LAST BIRTH SECOND-FROM-LAST BIRTH NAME NAME 637 Anywhere else? RECORD ALL MENTIONED. l YES 1 YES I 2- NO 21 NO 2- (SKIP TO 6331 I | (SKIP TO 633) GVT. HOSPITAL A GVT. HEALTH UNIT B MCH CENTER . ( MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . I) PVT. DOCTOR K PHARMACY F OTHER PRIVATE SECTOR TRADITIONAL PRACTITIONER (i PUBLIC SECTOR PUBLIC SECTOR GVT. HOSPITAL A GVT. HOSPITAL A GVT. HEALTH UNIT . B GVT. HEALTH UNIT U MCH CENTER ( MCH CENTER (, MEDICAL PRIVATE SECTOR MEDICAL PRIVATE SECTOR PVT. HOSPITAL/CLINIC . PVT. HOSPITAL/CLINIC I) I) PVT. DOCTOR PVT. DOCTOR I I PHARMACY . . . . . PHARMACY . F OTHER PRIVATE SECTOR OTHER PRIVATE SECTOR TRADITIONAL TRADITIONAL PRACTITIONER G PRACTITIONER (; RELATIVES/FRIENDS OTHER X OTHER (SPECIFY) GO BACK TO 603 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 634. CHECK 627, ALL COLUMNS: NO CHILD ~] ANY CHILD RECEIVED ORS L~J RECEIVED ORS l] RELATIVES/FRIENDS H RELATIVES/FRIENDS II X OTHER X (SPECIFY) (SPECIFY) ] --~636 Have you ever heard of a special product called mahloul moalget el-gaffaf yDU can get for the treatment of diarrhea? Now 1 would like to ask about your opinion about how many pregnant women living in this area receive antenatal care. Would you say that most, some,very few, or none of pregnant women go for anteratal care'? Do you think the number of women in this area receiving antenatal care is increasing, decreasing or staying about the same? 638 In the last 6 months have you heard,seen, or received any infbrmation about the warning or danger signs women should be aware of in order to have a safe pregnancy'? 639 What was the last source you got information from? YES I NO 2 MOST ] SOME 2 VERY FEW 3 NONE 4 NOR SURE INCREASING 1 DECREASING 2 STAY ABOUT THE SAME 3 NOR SURE YES ] NO 2- - -+ 701 TELEVISION 0 I RADIO 02 NEWSPAPER/MAGAZINE 03 PAMPHLET/BROCHURE 04 POSTER 05 MEDICAL PROVIDER . 00 HUSBAND 07 OTHER RELATIVE . ()~ FRIENDS/NEIGHBORS 09 OTHER ~)() (SPECIFY) 160 I Appendix B Questionnaires SECT ION 7 INFECT IOUS D ISEASES NO. QUEST IONS AND F ILTERS 701 Now 1 would like to talk about something else. Have you ever heard about AIDS disease? CODING CATEGORIES SK IP TO YES 1 NO 2- - ~ 705 702 703 704 From where did you last see or hear about H IV /A IDS? Do you know of ways in which a person can be infected with the virus causing A IDS? Please name me at least two ways in which a person can be infected with AIDS. RECORD ALL WAYS OF INFECTION THE RESPONDENT NAMES 705 Have you ever heard about Hepatitis C? TELEVISION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O1 RADIO 02 NEWSPAPER/MAGAZINE 03 MEDICAL PROVIDER . 04 HUSBAND 05 OTHER RELATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FRIENDS/NEIGHBORS 07 OTHER 96 (SPECIFY) YES I NO 2- - ~ 705 SEXUAL RELATIONS . . . . . . A HOMOSEXUAL SEX . . . . . . . . . . . . . . . . . . . . . . B CONTACT WITH BLOOD FROM INFECTED PERSON THROUGH: TRANSFUSION. C UNCLEAN NEEDLES . . . . . . . . . . . . . . . . . . D OTHER (E.G. RAZORS) F; CASUAL PHYSICAL CONTACT WITH INFECTED PERSON (E.G., SHAKING HANDS/SHARING FOOD/DRINK)• F MOTHER-TO-CHILD TRANSMISSION. (j MOSQUITO/OTHER INSECT BITE . Et OTHER X (SPECIFY) YES ] • NO . 2 - - - ' * 709 706 From where did you last see or hear about the Hepatitis C virus? TELEVIS ION 01 RADIO 02 NEWSPAPER/MAGAZINE . 03 MEDICAL PROVIDER . 04 HUSBAND . 05 OTHER RELATIVES . 06 FRIENDS/NEIGHBORS . 07 OTHER 96 (SPECIFY) 707 Do you know of ways in which a person can be infected YES 1 with the Hepatitis C vires? . NO . 2 - -~- -* 709 Appendix B Questionnaires I 161 NO. QUESTIONS AND FILTERS 708 Please name me at least two ways in which a person can be infected with the Hepatitis C virus. RECORD ALL WAYS OF INFECTION THE RESPONDENT NAMES. CODING CATEGORIES SKIP TO SEXUAL RELATIONS A HOMOSEXUAL SEX . . . . . . . . . . . . . . . . . . . . . B CONTACT WITH BLOOD FROM INFECTED PERSON THROUGH: TRANSFUSION . . . . . . . . . . . . . . . . . . . . . . C UNCLEAN NEEDLES . . . . . . . . . . . . . . . . . I) OTHER (E.G. RAZORS) E CASUAL PHYSICAL CONTACT WITH INFECTED PERSON (E.G., SNAKING HANDS/SHARING FOOD/DRINK) F MOTHER*TO-CHILD TRANSMISSION . . . . . . . . . . . . . . . . . G MOSQUITO/OTHER INSECT BITE . H OTHER X (SPECIFY) 709 In the last 6 months have you heard,seen, or received any information about what people should do to be sure that injection are given safely? 710 What did you hear? YES 1 NO 2~- -~ 801 USE ONLY SURING (NEEDLE) IN SEALED PACKET A DO NOT SHARE SYRINGE (NEEDLE) B BOIL/STERILIZE SYRINGE (NEEDLE) BEFORE EUSING (, OTHER X (SPECIFY) 711 What was the last source you got information from? TELEVISION. 0 ] RADIO 02 NEWSPAPER/MAGAZINE . . . . . . . . . . . . . . . . . . 03 PAMPHLET/BROCHURE 04 POSTER 05 MEDICAL PROVIDER . 06 HUSBAND . . . . . . . . . . . 07 OTHER RELATIVES . 08 FRIENDS/NEIGHBORS . . . . . . . . . . . . . . . . . . . . . . . . 09 OTHER 90 (SPECIFY) 162 [ Appendix B Questionnaires NO. 801 SECTION 8: FEMALE CIRCUMCISION QUESTIONS AND FILTERS CODING CATEGORIES SKIP TO Did you ever hear about female circumcision? YES . 1 , NO . 2--,"* 901 802 Are you yourself circumcised? 803 804 CHECK 214 AND 216: HAS ONE [ ~ LIVING DAUGHTERS IGO TO 804 I Has your daughter been circumcised? IF YES, RECORD 01 IN THE BOXES. IF NO, CIRCLE 95. YES . 1 , NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , IGO TO 804A I 804A How many of your daughters have been circumcised,? RECORD NUMBER IN THE BOXES. IF NONE, CIRCLE 95. 805 Do you intend to have your daughter/any (other) of your daughters circumcised? Why don't you intend to have your daughter (s) circumcised? Any other reasons? 806 RECORD ALL REASONS MENTIONED 807 i Do you think that this practice should be continued or should it be discontinued? ""*807 NUMBER CIRCUMISEB . I I I 95 NO DAUGHTERS ClRCUMISEO . YES l - - - -* 807 NO 2 ALL HER DAUGHTERS CIRCUMCISED. ~ . DON'T KNOW . J~84 - -~ 807 DON'T BELIEVE IN / ACCEPT IT . A AFRAID OF COMPLICATIONS B AGAINST RELIGION C BETTER MARRIAGE PROSPECTS IF NOT CIRCUMCISED D GREATER PLEASURE FOR HUSBAND. E OTHER X (SPECIFY) CONTINUED . 1 DISCONTINUED . OTHER 6 (SPECIFY) DON'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . . 808 During the past year, have you heard or seen anything about female circumcision: On television? On radio? In a newspaper or magazine? At a community meeting? At tile mosque or church? YES NO TELEVISION 1 2 RADIO 1 2 NEWSPAPER I MAGAZINE . 1 2 COMMUNITY MEETING . 1 2 MOSQUE / CHURCH 1 2 809 During the past year have you discussed female YES circumcision with your relatives, friends or neighbours? NO 1 2 Appendix B Questionnaires I 163 NO. QUEST IONS AND F ILTERS 810 I will read you some statements. Please te]l me if you agree or disagree: Circumcision Is an important part o f religious tradition A husband will prefer his wi le to bc circumcised Circumcision can cause severe complications, which may lead to the gir l 's death Circumcision prevents adultery Circumcision may cause a woman to have problems in becoming pregnant Circumcision lessens sexual satisfaction for a couple Childbirth is more difficult for a woman who has been Circumcised CODING CATEGORIES IMPORTANT PART OF RELIGIOUS TRADITION HUSBAND PREFER . SKIP TO DIS- AGREE AGREE DK 1 2 8 1 2 8 CAN LEAD TO GIRL 'S DEATH 1 2 8 PREVENTS ADULTERY . . . . . . . 1 2 8 CAUSE PROBLEMS IN GETTING PREGNANT 1 2 8 LESSENS SEXUAL SATISFACTION . 1 2 8 CHILDBIRTH MORE DIFFICULT . . . . . . . . . 1 2 8 164 J Appendix B Questionnaires NO. 901 902 SECTION 9: HUSBAND'S BACKGROUND QUESTIONS AND FILTERS CHECK107: CURRENTLY [~ MARRIED St'ET;%I I (SKIP TO 903) CODING CATEGORIES WIDOWED I t RECORD THE LINE NUMBER OF THE WOMAN'S HUSBAND FROM HOUSEHOLD QUESTIONNAIRE. IF THE HUSBAND IS NOT PRESENT IN THE HOUSEHOLD, RECORD " O0 " , SKIP TO --~ 904 HUSBAND'S LINE NUMBER t ~ ] 903 Now I would like to ask some questions about your (last) husband. [~] ] How old was your (last) husband on his most recent AGEIN COMPLETED YEARS birthday? 904 In what month and year was your (last) husband born? MONTH . ~ COMPARE AND CORRECT 903 AND / OR 904 IF INCONSISTENT. DON'T KNOW MONTH 98 905 Before you got married was ),our (last) husband related to you in anyway through blood or marriage? 906 What type of relationship was it'? YEAR . 907 Did your (last) husband ever attend school? 908 What was the highest level of school he attended'? 909 910 DON'T KNOW YEAR . 9998 YES l NO 2-- ~ 907 FIRST COUSIN ON FATHER'S SIDE . l FIRST COUSIN ON MOTHER'S SiDE . . . 2 SECOND COUSIN ON FATHER'S SIDE 3 SECOND COUSIN ON MOTHER'S SIDE 4 OTHER BLOOD RELATIVE . . . . . . . . . . . 5 OTHER RELATIVE BY MARRIAGE . 6 YES NO 1 2------* 910 PRIMARY l PREPARATORY . 2 SECONDARY . 3 UPPER INTERMIDIATE . . . . . . . . . . . . . . 4 UNIVERSITY . 5 MORE THAN UNIVERSITY . . . . . . . . . . . . . 6 . DGN'TKNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 -.----~ 910 What was the highest grade which he completed at that GRADE 1 [ level? I I . DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 CHECK 107: CURRENTLY [ ~ WIDOWEDI i i MARRIED DIVORCED I -~ 100 l SEPARATED Appendix B Questionnaires I 165 NO. QUESTIONS AND FILTERS 911 Is your husband currently employed? 912 913 IF NO: Is he retired or unemployed? CHECK911: HUSBAND [~ CURRENTLY EMPLOYED What kind of work does your husband mainly do? HUSBAND [~ RETIRED OR UNEMPLOYED In the last job he had, what kind of work did your husband mainly do? Does (did) your (last) husband work for a member of his family, fbr someone else, or is (was) he self employed? CODING CATEGORIES YES NO, RETIRED NO, UNEMPLOYED SKIP TO I 2 3 RECORD ANWSER IN DETAIL FOR FAMILY MEMBER . ] FOR SOMEONE ELSE . 2 FOR HIMSELF . . . . . . . . . . . . . . . . . 3- - - - - - * 915 914 915 916 Does (did) he earn a regular wage or salary'? YES . . . . . 1 NO 2 CHECK 912: WORKS (WORKED) 7 DOES (DID) NOTWORK I I IN AGRICULTURE IN AGRICULTURE (Does / Did) your husband mainly work on his own land or family land, or (does / did) he rent land, or (does / HIS tFAMILYLAND did) he work on someone else's land'? RENTED LAND . . . . . . . . . . . . . . . . SOMEONE ELSE'S LAND I001 166 I Appendix B Questionnaires SECTION 101 WOMAN'S WORK NO. QUEST IONS AND F ILTERS 1001 As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Before you married (for the first time) did you ever do any of these things or any other work? 1002 Are you currently doing any of these things or any other work'? CODING CATEGORIES SK IP TO YES . l NO 2 YES 1-----1004 NO 2 1003 Have you done any work in the last 12 months? YES l NO 2- ~ 1010 1004 What is your occupation, that is, what kind of work do you mainly do? RECORD ANSWER IN DETAIL. [U] 1005 Do you do this work tbr a member o f your family, for someone else, or are you self-employed? FOR FAMILY MEMBER . 1 FOR SOMEONE ELSE . 2 SELF-EMPLOYED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1006 CHECK 1004: WORKS IN ~ DOES NOT WORK AGRICULTURE ~ IN AGRICULTURE 1007 Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land? 1008 Do you usually work throughout the year, or do you work seasonally, or only once in a while? I I 1008 OWN LAND 1 FAMILY LAND . 2 RENTED LAND . . . . . . . . . . . . . . . . . . . . . . . . . . 3 SOMEONE ELSE'S LAND . 4 THROUGHOUT THE YEAR 1 SEASONALLY/PART OF THE YEAR . 2 ONCE IN A WHILE . 3 1009 Are you paid in cash, in both cash and kind, in kind only or are you not paid at all? CASH 1 CASH AND KIND . 2 IN KIND ONLY . . . . . . . . . . . . . . . . . . . . . . . . . . 3 NOTPAID AT ALL . 4 [ --* 1013 ]010 CHECK 1t4 AND 115: PRIMARY [ ~ PREPARATORY OR LESS OR HIGHER 1011 Have you ever participated in a literacy program or any YES other program that involved learning to read or write NO (not including primary school)? 1012 Now 1 would like you to read out loudly as much of this card as you can. 1 2 CAN'T READ AT ALL . . . . . . . . . . . . . . . . . . ABLE TO READ ONLY PART OF SENTENCES ON CARD . . . . . . . . . . . . . . . SHOW CARD TO RESPONDENT. ABLE TO READ ALL OF CARD . Do you usually read a newspaper or magazine almost ALMOST EVERY DAY . . . . . . . . . . . . . . . . . . . l every day, at least once a week, less than once a week or AT LEAST ONCE A WEEK . . . . . . . . . . . . . . 2 not at a l l ? LESS THAN ONCE A WEEK . 3 NOT AT ALL . 4 Do you usually listen to the radio almost every day, at ALMOST EVERY DAY . . . . . . . . . . . . . . . . . . . . . . 1 least once a week, less than once a week or not at all? AT LEAST ONCE A WEEK . . . . . . . . . . . . . . 2 LESS THAN ONCE A WEEK . 3 NOT AT ALL . 4 1 - -+ 11114 2 3 1013 1014 Appendix B Questionnaires ] 167 NO, 1015 1016 1017 QUEST IONS AND F ILTERS Do you usually watch television almost every day, at least once a week, less than once a week or not at all'? CODING CATEGORIES ALMOST EVERY DAY 1 AT LEAST ONCE A WEEK . LESS THAN ONCE A WEEK . 2 3 NOT AT ALL . . . . . . . . . . . . . . . . . . . . 4 THANK YOU FOR TAKING THE TIME TO ANSWER THESE QUESTIONS. WE MAY RETURN TO INTERVIEW YOU HOUSEHOLD IN TH EFUTURE AND WE HOPE YOU WILL AGREE TO PARTIC PATE AGAIN AT THAT TIME, RECORD THE TIME. HOUR . . . . . . . . . . . . . . . . MINUTES . SKIP TO 168 [ Appendix B Queslionnaire,~ OBSERVATIONS THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY, COMPLETE QUESTIONS 1t01 - 1102 AS APPROPRIATE, BE SURE TO REVIEW THE QUEBTIONNIARE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD, POOR . 1 110| DEGREE OF COOPERATION, FAIR 2 GOOD 3 • VERY GOOD . 4 1102 INTERVIEWER'S COMMENTS: 1103 FIELD EDITOR'S COMMENTS: 1104 SUPERVISOR'S COMMENTS: ] ] 05 OFFICE EDITOR'S COMMENTS: Appendix B Questionnaires I 169 INSTRUCTIONS: 1. ONLY ONE CODE SHOULD APPEAR IN ANY BOX 2. FOR COLUMNS t AND 2 ALL MONTHS SHOULD 3. BE FILLED IN. INFORMATION TO BE CODED FOR EACH COLUMN COLUMN 1: MARRIAGE X MARRIED 0 NOT MARRIED COLUMN 2: BIRTHS, PREGNANCIES, CONTRACEPTIVE B BIRTHS P PREGNANCIES M MISCARRIAGE A ABORTION ~-~ S STILL BIRTH 0 NO METHOD 1 PILL 2 IUD 3 INJECTIONS 4 NORPLANT 5 DIAPHRAGM / FAOM I JELLY 6 CONDOM 7 FEMALE STERILIZATION 8 MALE STERILIZATION 9 PERIODIC ABSTINENCE L WITHDRAWAL G PROLONGED BREASTFEEDING X OTHER (SPECIFY) COLUMN 3: DISCONTINUATION OF CONTRACEPTIVE USE 1 BECAME PREGNANT WHILE USING 2 WANTED TO BECOME PREGNANT 3 HUSBAND DISAPPROVED 4 WANTED MORE EFFECTIVE METHOD 5 HEALTH CONCERNS 6 SIDE EFFECTS 7 LACK OF ACCESS I TOO FAR I 2 I 8 COST TOO MUCH 9 INCONVENIENT TO USE F FATALISTIC U UNABLE TO GET PREGNANT / MENOPAUSE D MARITAL DISSOLUTION I SEPARATION I INFREQUENT SEX I HUSBAND AWAY X OTHER (SPECIFY) Z DON'T KNOW COLUMN 4: POST PARTUM AMENORRHEA X PERIOD DID NOT RETURN [1 I 0 LESS THAN ONE MONTH COLUMN 5: BREAST FEEDING X BREAST FEEDING 0 LESS THAN ONE MONTH N NEVER BREASTFED CHILD'S NAME / METHOD 2 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 3 4 5 t201 LAST CHILD BORN PRIOR MONTH TO JANUARY 1998. YEAR NAME; . 170 [ Appendix B Questionnaires Front Matter Title Page Citation Page Table of Contents List of Tables and Figures Chapter 01 - Introduction Chapter 02 - Fertility Chapter 03 - Family Planning Chapter 04 - Family Planning Services Chapter 05 - Maternal Health Chapter 06 - Child Health and Nutritional Status of Children and Women Chapter 07 - Early Childhood Mortality Chapter 08 - Knowledge of AIDS, Hepatitis C and Safe Injection Practices Chapter 09 - Female Circumcision References Appendix A - Sampling Errors Appendix B - 2003 Egypt Interim Demographic and Health Survey Household Questionnaire Woman's Questionnaire

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