Egypt - Demographic and Health Survey - 2006

Publication date: 2006

'I[RV &GOQITCRJKE�CPF *GCNVJ�5WTXG[ ���� Egypt Demographic and Health Survey 2005 Fatma El-Zanaty Ann Way March 2006 Ministry of Health and Population National Population Council Ford Foundation El-Zanaty Associates The 2005 Egypt Demographic and Health Survey (2005 EDHS) was conducted on behalf of the Ministry of Health and Population and the National Population Council by El-Zanaty and Associates. The 2005 EDHS is part of the worldwide MEASURE DHS project which is funded by the United States Agency for International Development (USAID). USAID/Cairo was the main contributor of funding for the survey. Support for the survey was also provided by UNICEF and the Ford Foundation. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID, UNICEF, or the Ford Foundation. Additional information about the 2005 EDHS may be obtained from the National Population Council, P.O. Box 1036, Cairo, Egypt; Telephone: 20-2-5240504 or 20-2-5240505 and Fax: 20-2-5240219. Information about DHS surveys may be obtained from the MEASURE DHS Project, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: reports@orcmacro.com, Internet: http://www.measuredhs.com. Recommended citation: El-Zanaty, Fatma and Ann Way. 2006. Egypt Demographic and Health Survey 2005. Cairo, Egypt: Ministry of Health and Population, National Population Council, El-Zanaty and Associates, and ORC Macro. Contents | iii CONTENTS TABLES AND FIGURES . vii PREFACE . xv FOREWORD . xvii ACKNOWLEDGMENTS . xix SUMMARY OF FINDINGS . xxi MAP OF EGYPT .xxviii CHAPTER 1 INTRODUCTION 1.1 Geography .1 1.2 Socioeconomic Indicators .1 1.3 Population Size and Structure .1 1.4 Recent Rate of Natural Increase .2 1.5 Population Policy and Programs .3 1.6 Health Policies and Programs .4 1.7 Organization and Objectives of the 2005 EDHS.5 1.8 Survey Coverage .11 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS 2.1 Characteristics of the Household Population .13 2.2 Education of the Household Population .15 2.3 Housing Characteristics .18 2.4 Household Possessions.24 2.5 Household Wealth.25 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3.1 Background Characteristics .27 3.2 Educational Attainment by Background Characteristics.28 3.3 Literacy Assessment.29 3.4 Exposure to Mass Media .30 3.5 Employment Status .32 3.6 Disposal of Earnings .36 3.7 Household Decision-Making .40 CHAPTER 4 FERTILITY 4.1 Current Fertility Levels and Differentials .43 4.2 Fertility Trends .45 iv │ Contents 4.3 Children Ever Born and Living.49 4.4 Birth Intervals.50 4.5 Age at First Birth.52 4.6 Teenage Pregnancy and Motherhood.54 CHAPTER 5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING 5.1 Knowledge of Family Planning Methods .55 5.2 Exposure to Family Planning Messages .56 5.3 Attitude about Timing of Adoption of Contraception.58 5.4 Knowledge of Fertile Period .58 5.5 Ever Use of Family Planning .59 5.6 First Use of Family Planning .63 CHAPTER 6 CURRENT USE OF FAMILY PLANNING 6.1 Current Use of Family Planning .65 6.2 Differentials in Current Use of Family Planning .66 6.3 Trends in Current Use of Family Planning.69 6.4 Sources for Modern Family Planning Methods.74 6.5 Pill Brands.77 6.6 Cost and Willingness to Pay .78 6.7 Informed Choice.81 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE 7.1 Contraceptive Discontinuation Rates.83 7.2 Reasons for Discontinuation of Contraceptive Use .84 7.3 Intention to Use Contraception in the Future .86 7.4 Reasons for Nonuse .86 7.5 Preferred Method .87 7.6 Contact of Nonusers with Outreach Workers/Health Care Providers .88 CHAPTER 8 PROXIMATE DETERMINANTS OF FERTILITY 8.1 Marital Status .91 8.2 Consanguinity .92 8.3 Age at First Marriage .93 8.4 Postpartum Amenorrhea, Abstinence, and Insusceptibility.95 8. 5 Termination of Exposure to Pregnancy .97 CHAPTER 9 FERTILITY PREFERENCES 9.1 Desire for More Children .99 9.2 Need for Family Planning. 102 9.3 Ideal Number of Children . 104 9.4 Unplanned and Unwanted Fertility . 107 Contents | v CHAPTER 10 INFANT AND CHILD MORTALITY 10.1 Assessment of Data Quality . 109 10.2 Levels and Trends in Early Childhood Mortality . 110 10.3 Differentials in Mortality. 112 10.4 Perinatal Mortality. 115 10.5 High-Risk Fertility Behavior . 117 CHAPTER 11 MATERNAL HEALTH CARE 11.1 Pregnancy Care. 119 11.2 Content of Pregnancy Care . 123 11.3 Delivery Care. 125 11.4 Trends in Antenatal and Delivery Care Indicators . 130 11.5 Postnatal Care. 132 11.6 Family Planning and Breastfeeding Advice. 137 11.7 Exposure to Safe Pregnancy Messages . 137 CHAPTER 12 CHILD HEALTH 12.1 Immunization of Children . 139 12.2 Acute Respiratory Infection . 143 12.3 Diarrhea . 147 12.4 Disposal of Children’s Stools . 149 CHAPTER 13 FEEDING PRACTICES AND MICRONUTRIENT SUPPLEMENTATION 13.1 Breastfeeding and Supplementation . 151 13.2 Dietary Diversity among Children and Women . 156 13.3 Micronutrient Supplementation . 163 CHAPTER 14 NUTRITIONAL STATUS AND ANEMIA LEVELS 14.1 Collection of Anthropometric and Anemia Data. 169 14.2 Nutritional Status of Children . 169 14.3 Nutritional Status of Never-Married Youth and Young Adults. 175 14.4 Nutritional Status of Women. 178 14.5 Prevalence of Anemia . 180 CHAPTER 15 KNOWLEDGE OF INFECTIOUS DISEASES AND OTHER HEALTH ISSUES 15.1 HIV/AIDS Knowledge and Attitudes . 189 15.2 Reports of Recent Sexually Transmitted Infections . 195 15.3 Hepatitis C Knowledge. 197 15.4 Injections . 200 15.5 Smoking. 203 vi │ Contents 15.6 Tuberculosis. 205 15.7 Women’s Access to Health Care . 207 15.8 Health Insurance Coverage . 209 CHAPTER 16 FEMALE CIRCUMCISION 16.1 Prevalence of Female Circumcision. 211 16.2 Circumcision Experience of Daughters . 214 16.3 Support for Female Circumcision . 215 16.4 Reasons for Support of Female Circumcision. 217 16.5 Exposure to Information about Circumcision . 218 CHAPTER 17 DOMESTIC VIOLENCE 17.1 Introduction. 221 17.2 Physical Violence . 221 17.3 Marital Violence. 224 17.4 Women’s Attitudes towards Wife Beating. 229 CHAPTER 18 CHILD WELFARE 18.1 Orphanhood and Children’s Living Arrangments . 231 18.2 Current School Attendance . 232 18.3 Child Labor . 233 18.4 Child Disciplinary Activities . 237 REFERENCES .239 APPENDIX A PERSONS INVOLVED IN THE 2005 EGYPT DEMOGRAPHIC AND HEALTH SURVEY. 243 APPENDIX B SAMPLE DESIGN. 249 APPENDIX C ESTIMATES OF SAMPLING ERRORS. 261 APPENDIX D DATA QUALITY TABLES . 275 APPENDIX E QUESTIONNAIRES . 281 Tables and Figures | vii TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Population of Egypt, 1990-2004.2 Table 1.2 Life expectancy, Egypt 1960-2004 .3 Table 1.3 Survey timetable, 2005 Egypt DHS .6 Table 1.4 Sample results .12 Figure 1.1 Trend in rate of natural increase, Egypt 1991-2004 .2 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS Table 2.1 Household population by age, sex, and residence.13 Table 2.2 Trends in population distribution by age, 1988-2005 .14 Table 2.3 Household composition by residence.15 Table 2.4.1 Educational attainment of male household population by age and residence.16 Table 2.4.2 Educational attainment of female household population by age and residence.17 Table 2.5 Household drinking water access and treatment by residence .19 Table 2.6 Sanitation facilities by residence.20 Table 2.7 Cooking arrangements by residence .22 Table 2.8 Dwelling characteristics by residence .23 Table 2.9 Household possessions by residence .25 Table 2.10 Wealth quintiles by residence .26 Figure 2.1 Population pyramid.14 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .27 Table 3.2 Educational attainment by background characteristics .28 Table 3.3 Literacy by background characteristics.30 Table 3.4 Exposure to mass media by background characteristics .32 Table 3.5 Employment status by background characteristics.33 Table 3.6 Occupation by background characteristics .35 Table 3.7 Type of employment.36 Table 3.8 Relative magnitude of woman’s earnings by background characteristics .37 Table 3.9 Control over woman’s earnings by background characteristics.38 Table 3.10 Control over husband’s earnings by background characteristics .39 Table 3.11 Relative magnitude of earnings and control over woman’s and husband’s earnings .40 Table 3.12 Women's participation in decision-making .40 Table 3.13 Women's participation in decision-making by background characteristics.41 viii │ Tables and Figures Figure 3.1 Exposure to media .31 Figure 3.2 Occupation among working women .34 CHAPTER 4 FERTILITY Table 4.1 Current fertility by residence .44 Table 4.2 Fertility by background characteristics .46 Table 4.3 Trends in age-specific fertility rates.47 Table 4.4 Trends in fertility .48 Table 4.5 Trends in fertility by residence.48 Table 4.6 Children ever born and living .49 Table 4.7 Birth intervals by background characteristics.51 Table 4.8 Ideal birth interval by residence .52 Table 4.9 Age at first birth.53 Table 4.10 Median age at first birth by background characteristics .53 Table 4.11 Teenage pregnancy and motherhood by background characteristics.54 Figure 4.1 Total fertility rates by place of residence.45 CHAPTER 5 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING Table 5.1 Family planning knowledge.55 Table 5.2 Exposure to family planning messages by background characteristics .57 Table 5.3 Timing of use of family planning among newly married couples by background characteristics .58 Table 5.4 Knowledge of fertile period .59 Table 5.5 Ever use of family planning methods by age .60 Table 5.6 Trends in ever use of family planning method .61 Table 5.7 Ever use of family planning methods by background characteristics .62 Table 5.8 Number of living children at time of first use of family planning .63 Figure 5.1 Trends in family planning knowledge, Egypt 2000-2005.56 Figure 5.2 Trends in ever use of family planning, Egypt 1980-2005.61 CHAPTER 6 CURRENT USE OF FAMILY PLANNING Table 6.1 Current use of family planning methods by residence.65 Table 6.2 Current use of family planning methods by selected demographic and social characteristics .67 Table 6.3 Current use of family planning by governorate .68 Table 6.4 Trends in current use of family planning.70 Table 6.5 Trends in family planning method mix .70 Table 6.6 Trends in family planning use by residence .71 Table 6.7 Trends in current use of family planning methods by governorate .72 Table 6.8 Trends in current use of family planning by socio-demographic characteristics .73 Table 6.9 Source for modern family planning methods .75 Table 6.10 Sources of family planning methods by residence.76 Tables and Figures | ix Table 6.11 Trends in reliance on public sector source for contraceptive method by residence .77 Table 6.12 Brand of pill .77 Table 6.13 Knowledge of pill brand suitable for breastfeeding women.78 Table 6.14 Cost of method for pill users.78 Table 6.15 Amount users are willing to pay for the pill.79 Table 6.16 Cost of method for injectable users .79 Table 6.17 Amount users are willing to pay for injectables .79 Table 6.18 Cost of method for IUD users.80 Table 6.19 Amount users are willing to pay for IUD insertion.81 Table 6.20 Informed choice.82 Figure 6.1 Current use by method .66 Figure 6.2 Trends in current use, Egypt 1980-2005.69 CHAPTER 7 NONUSE OF FAMILY PLANNING AND INTENTION TO USE Table 7.1 Contraceptive discontinuation rates .84 Table 7.2 Reasons for discontinuation.85 Table 7.3 Future use of family planning .86 Table 7.4 Reason for not intending to use contraception .87 Table 7.5 Preferred family planning method .88 Table 7.6 Discussion of family planning in contacts with fieldworkers or health providers by background characteristics.89 CHAPTER 8 PROXIMATE DETERMINANTS OF FERTILITY Table 8.1 Current marital status .91 Table 8.2 Consanguinity by background characteristics.92 Table 8.3 Age at first marriage .93 Table 8.4 Median age at first marriage by background characteristics.94 Table 8.5 Postpartum amenorrhea, abstinence, and insusceptibility .95 Table 8.6 Median duration of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics.97 Table 8.7 Menopause.97 Figure 8.1 Percentage of births whose mothers are amenorrheic, abstaining, or insusceptible.96 CHAPTER 9 FERTILITY PREFERENCES Table 9.1 Fertility preferences by number of living children .99 Table 9.2 Fertility preferences by age. 100 Table 9.3 Desire to limit childbearing by background characteristics . 101 Table 9.4 Need for family planning by background characteristics . 103 Table 9.5 Reason for not intending to use contraception . 104 Table 9.6 Ideal number of children. 105 Table 9.7 Mean ideal number of children by background characteristics. 106 x │ Tables and Figures Table 9.8 Husband’s fertility preference by wife’s ideal number of children. 106 Table 9.9 Fertility planning status. 107 Table 9.10 Wanted fertility rates by background characteristics . 108 Figure 9.1 Desire for more children among currently married women . 100 CHAPTER 10 INFANT AND CHILD MORTALITY Table 10.1 Early childhood mortality rates . 111 Table 10.2 Trends in early childhood mortality . 111 Table 10.3 Early childhood mortality rates by socioeconomic characteristics . 113 Table 10.4 Early childhood mortality rates by demographic characteristics. 115 Table 10.5 Perinatal mortality by background characteristics. 116 Table 10.6 High-risk fertility behavior . 118 Figure 10.1 Trends in under-five mortality, Egypt 1967-2003. 112 Figure 10.2 Under-five mortality by place of residence . 114 CHAPTER 11 MATERNAL HEALTH CARE Table 11.1 Antenatal care. 119 Table 11.2 Tetanus toxoid coverage during pregnancy. 120 Table 11.3 Last birth protected against neonatal tetanus . 121 Table 11.4 Medical care other than visit for antenatal care or tetanus toxoid injection during pregnancy . 121 Table 11.5 Care during pregnancy by background characteristics . 122 Table 11.6 Content of pregnancy care by background characteristics. 124 Table 11.7 Place of delivery by background characteristics . 126 Table 11.8 Reason for not delivering last birth in health facility . 127 Table 11.9 Assistance during delivery by background characteristics . 128 Table 11.10 Caesarean deliveries by background characteristics . 129 Table 11.11 Child’s size at birth by background characteristics . 130 Table 11.12 Trends in maternal health indicators by residence . 131 Table 11.13 Postnatal care for mother . 133 Table 11.14 Postnatal care for mother by background characteristics. 134 Table 11.15 Postnatal care for child. 135 Table 11.16 Postnatal care for child by background characteristics . 136 Table 11.17 Exposure to family planning and breastfeeding information . 137 Table 11.18 Coverage of safe pregnancy messages by background characteristics . 138 Figure 11.1 Time spent in facility after delivery . 127 CHAPTER 12 CHILD HEALTH Table 12.1 Vaccinations by source of information. 140 Table 12.2 Differentials and trends in vaccination coverage by background characteristics. 142 Tables and Figures | xi Table 12.3 Number of times vaccinated in national immunization day campaigns by residence . 143 Table 12.4 Prevalence of ARI symptoms . 143 Table 12.5 Consultation for children ill with ARI symptoms . 144 Table 12.6 Treatment and feeding practices for children ill with ARI symptoms . 145 Table 12.7 Prevalence and treatment of ARI symptoms by background characteristics . 146 Table 12.8 Prevalence of diarrhea by background characteristics . 147 Table 12.9 Consultation about diarrheal episode . 148 Table 12.10 Treatment and feeding practices during diarrhea. 149 Table 12.11 Prevalence and treatment of diarrhea by background characteristics . 150 CHAPTER 13 FEEDING PRACTICES AND MICRONUTRIENT SUPPLEMENTATION Table 13.1 Initial breastfeeding by background characteristics . 152 Table 13.2 Breastfeeding status by age. 153 Table 13.3 Median duration and frequency of breastfeeding and prevalence of bottlefeeding by background characteristics . 155 Table 13.4 Foods and liquids consumed by children in the day or night preceding the interview. 158 Table 13.5 Infant and young child feeding (IYCF) practices in Egypt . 161 Table 13.6 Foods and liquids consumed by mothers in the day or night preceding the interview by background characteristics . 163 Table 13.7 Presence of iodized salt in household by background characteristics . 164 Table 13.8 Micronutrient intake among children by background characteristics . 166 Table 13.9 Micronutrient intake among mothers by background characteristics . 168 Figure 13.1 Breastfeeding status and child’s age. 154 Figure 13.2 Infant and Young Child Feeding (IYCF) Practices . 160 CHAPTER 14 NUTRITIONAL STATUS AND ANEMIA LEVELS Table 14.1 Nutritional status of children by children’s characteristics . 172 Table 14.2 Nutritional status of children by mother’s characteristics. 173 Table 14.3 Trends in nutritional status of children. 174 Table 14.4.1 Nutritional status of never-married male youth and young adults by background characteristics . 176 Table 14.4.2 Nutritional status of never-married female youth and young adults by background characteristics . 177 Table 14.5 Anthropometric indicators of nutritional status of adult women. 178 Table 14.6 Nutritional status of ever-married women by background characteristics . 179 Table 14.7 Prevalence of anemia in children by child’s characteristics . 181 Table 14.8 Prevalence of anemia in children by background characteristics . 182 Table 14.9.1 Prevalence of anemia in never-married male youth and young adults by background characteristics . 184 Table 14.9.2 Prevalence of anemia in never-married female youth and young adults by background characteristics . 185 Table 14.10 Prevalence of anemia in ever-married women by background characteristics . 187 xii │ Tables and Figures Figure 14.1 Anemia prevalencre among young children by wealth quintile . 183 CHAPTER 15 KNOWLEDGE OF INFECTIOUS DISEASES AND OTHER HEALTH ISSUES Table 15.1 Knowledge of AIDS by background characteristics. 190 Table 15.2 Knowledge of prevention of mother-to-child transmission of HIV by background characteristics . 191 Table 15.3 Accepting attitudes toward those living with HIV by background characteristics . 192 Table 15.4 Knowledge of a place where HIV testing available by background characteristics . 193 Table 15.5 Sources of information about AIDS by background characteristics . 194 Table 15.6 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms by background characteristics . 196 Table 15.7 Knowledge of hepatitis C by background characteristics . 198 Table 15.8 Knowledge of the ways a person can contract hepatitis C by background characteristics . 199 Table 15.9 Prevalence of injections . 200 Table 15.10 Injection prevalence by background characteristics . 201 Table 15.11 Exposure to information regarding injection safety. 202 Table 15.12 Prevalence of smoking and exposure to information about health effects of second-hand smoke by background characteristics. 204 Table 15.13 Awareness and attitudes about tuberculosis. 206 Table 15.14 Problems in accessing health care by background characteristics . 208 Table 15.15 Health insurance coverage by background characteristics. 209 CHAPTER 16 FEMALE CIRCUMCISION Table 16.1 Prevalence of female circumcision among ever-married women 15-49 by background characteristics . 211 Table 16.2 Current and expected prevalence of female circumcision among girls . 212 Table 16.3 Current and expected prevalence of female circumcision among girls by background characteristics . 213 Table 16.4 Age at circumcision among girls by residence . 214 Table 16.5 Person performing circumcisions among girls by residence . 215 Table 16.6 Attitude about continuation of female circumcision by background characteristics . 216 Table 16.7 Beliefs about female circumcision by background characteristics . 218 Table 16.8 Exposure to information regarding female circumcision. 219 Figure 16.1 Trends in attitudes toward female circumcision, Egypt 1995-2005 . 217 CHAPTER 17 DOMESTIC VIOLENCE Table 17.1 Experience of physical violence since age by background characteristics . 222 Table 17.2 Perpetrators of physical violence . 223 Table 17.3 Violence during pregnancy. 224 Table 17.4 Forms of marital violence . 225 Tables and Figures | xiii Table 17.5 Marital violence by background characteristics . 226 Table 17.6 Marital violence by spousal characteristics. 227 Table 17.7 Help-seeking behavior by women experiencing physical or sexual violence . 228 Table 17.8 Reason for not seeking assistance to prevent violence. 229 Table 17.9 Attitudes towards wife beating by background characteristics . 230 CHAPTER 18 CHILD WELFARE Table 18.1 Children's living arrangements and orphanhood by background characteristics . 231 Table 18.2 School attendance by residence . 232 Table 18.3 Children’s involvement in economic activities or domestic chores . 233 Table 18.4 Hours children engaged in economic activities or chores. 234 Table 18.5 Children's involvement in economic activities or domestic chores by background characteristics . 235 Table 18.6 Child labor by background characteristics . 236 Table 18.7 Child disciplinary practices by background characteristics . 238 APPENDIX B SAMPLE DESIGN Table B.1 Sample allocation for the 2005 Egypt DHS survey . 250 Table B.2 Sample implementation. 252 APPENDIX C ESTIMATES OF SAMPLING ERRORS Table C.1 List of selected variables for sampling errors, 2005 Egypt DHS . 262 Table C.2 Sampling errors for National sample . 263 Table C.3 Sampling errors for Urban sample. 264 Table C.4 Sampling errors for Rural sample . 265 Table C.5 Sampling errors for Urban Governorates . 266 Table C.6 Sampling errors for Lower Egypt . 267 Table C.7 Sampling errors for Lower Egypt Urban sample. 268 Table C.8 Sampling errors for Lower Egypt Rural sample . 269 Table C.9 Sampling errors for Upper Egypt . 270 Table C.10 Sampling errors for Upper Egypt Urban sample . 271 Table C.11 Sampling errors for Upper Egypt Rural sample . 272 Table C.12 Sampling errors for Frontier Governorates. 273 APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution . 275 Table D.2 Age distribution of eligible and interviewed women . 276 Table D.3 Completeness of reporting . 276 Table D.4 Births by calendar years . 277 Table D.5 Reporting of age at death in days . 278 Table D.6 Reporting of age at death in months. 279 Preface | xv PREFACE Health for all is the main health objective of the Egyptian government. The Ministry of Health and Population (MOHP) has given a high priority to implementing this objective, developing a national system of health facilities that provide services at all levels. As part of this effort, the MOHP is committed to increasing the quality and coverage of the health care system in Egypt, especially in rural areas. The MOHP also is emphasizing the importance of preventive care, particularly, the necessity of ensuring all children are fully immunized against preventable diseases like measles and polio. To monitor and evaluate the achievement of these objectives, reliable data are needed. These data can be obtained from service administration (service-based data) and collected directly from the community (household-based data). The two types of data complement each other in enhancing the information available to monitor progress in the health sector. Beginning in 1980, a number of surveys have been carried out in Egypt to obtain data from the community on the current health situation, including a series of Demographic and Health Surveys (DHS) in which 2005 EDHS is the most recent. The results of the 2005 EDHS show that the family planning program in Egypt continues to be successful in helping couples to plan their families. The survey also found that key maternal and child health indicators, including antenatal care coverage, medical assistance at delivery, and infant and child mortality have improved. The findings of the 2005 EDHS together with the service-based data are very important in measuring the achievements of family planning and health programs. To ensure understanding and use of these data, the results of the 2005 EDHS should be widely disseminated at different levels of health management, in the central offices as well as local governments, and to the community at large. Prof. Dr. Hatem El-Gabaly Minister of Health and Population Foreword | xvii FOREWORD The Egyptian family planning program has made substantial progress in supporting the efforts of Egyptian families to meet their reproductive goals. A reason for this success has been the considerable body of population research that has been undertaken over the past decades. This research has helped the program to monitor the impact of its effort and identify key areas for further intervention. The 2005 Egypt Demographic and Health Survey is the fifth full-scale survey implemented in Egypt as part of the worldwide DHS program. The purpose of the survey was to provide the Ministry of Health and Population (MOHP) of Egypt with information on fertility, reproductive practices of women, maternal care, child health and mortality, child nutrition practices, breastfeeding, and anemia. This infor- mation is important for understanding the factors that influence the reproductive health of women and the health and survival of infants and young children. This report summarizes the results of more than one year of continuous work preparing and carry- ing out different activities of the 2005 EDHS, including fieldwork, data processing, and analysis of the findings presented in this report. I would like to express my appreciation to all parties who assisted in the implementation of the 2005 EDHS. Their efforts resulted in the successful completion of the 2005 EDHS activities and the rapid issuance of this analysis of the survey results. Dr. Safaa El-Baz Assistant Minister of Health and Population for National Population Council Affairs Acknowledgments | xix ACKNOWLEDGMENTS The 2005 Egypt Demographic and Health Survey represents the continuing commitment and efforts in Egypt to obtain data on fertility and contraceptive practice. The survey also reflects the strong interest in obtaining information on key maternal health and child survival issues. The wealth of demographic and health data that the survey provides will be of great use in charting future directions for the population and health programs. This important survey could not have been implemented without the active support and dedicated efforts of a large number of institutions and individuals. The interest of H.E. Prof. Dr. Hatem El-Gabaly, Minister of Health and Population, has served to motivate the survey team. The support and approval of the previous Minister H.E. Prof. Dr. Awad Tag El-Din was instrumental in securing the implementation of the survey. Dr. Safaa El-Baz Assistant of Minister of Health and Population for National Population Council Affairs, provided strong continuing support to the project and has shown great interest in the survey results. I am deeply grateful to the Ministry of Health and Population staff who contributed to the successful completion of this project, especially Dr. Yehia El-Hadidi, Under-Secretary of the Ministry of health and Population and head of the Population Sector, and Dr. Essmat Mansour, Under-Secretary for Primary Health Care and Head of the Maternal and Child Health Project, for their continuous help during the survey implementation. Funding for the survey was principally provided by USAID/Cairo through its bilateral health and population projects with additional contributions from UNCIEF and Ford foundation. Technical assistance came from the international MEASURE DHS project. I also gratefully acknowledge the population and health office staff USAID/Cairo, especially Ms. Kathryn Panther, head of Health and Population Division, and Ms. Shadia Attia, Research and Monitoring Advisor, Population and Health Division, for their support and valuable comments throughout the survey activities. I also acknowledge with gratitude Ms. Roumiana Gantcheva, Monitoring and Evaluation Office, UNICEF, and Dr. Maha El-Adawy, Reproductive Health and Rights Program Officer, Ford Foundation for their support to facilitate and ensure the successful implementation of the survey. Dr. Ann Way of ORC Macro, who worked closely with us on all phases of EDHS, deserves special thanks for all her efforts throughout the survey and during the preparation of this report. My thanks also are extended to Dr. Alfredo Aliaga for his advice and guidance in designing the sample. Ms. Jeanne Cushing deserves my deepest thanks for her assistance in data processing and analysis required for this report. Dr. Jasbir Sangha provided invaluable assistance with the organization of the anemia-testing component of the survey I would like to express my appreciation for all the senior, administrative, and field staff at El- Zanaty & Associates for the dedication and skill in which they performed their tasks. Finally, I would like to express my appreciation to all households and women who responded in the survey; without their participation this survey would have been impossible. Fatma El-Zanaty, Ph.D Technical Director Summary of Findings | xxi SUMMARY OF FINDINGS The 2005 Egypt Demographic and Health Survey (2005 EDHS) interviewed a nationally representative sample of 19,474 ever-married women age 15-49. The survey is the eighth in a series of Demographic and Health Surveys con- ducted in Egypt. As in previous surveys, the main purpose of the 2005 EDHS was to provide de- tailed information on fertility, family planning, infant and child mortality, maternal and child health and nutrition. The survey also collected information on the levels of knowledge of infec- tious diseases including HIV/AIDS and hepatitis C. In addition, the 2005 EDHS included anemia testing and special modules on child labor, domes- tic violence, and female circumcision. FERTILITY BEHAVIOR Levels, Trends and Differentials. During the past 25 years, fertility in Egypt has decreased by more than two births, from 5.3 births at the time of the 1980 Egypt Fertility Survey to 3.1 births at the time of the 2005 EDHS. In rural ar- eas, the fertility rate is 3.4 births, around 25 per- cent higher than the rate in urban areas (2.7 births). Fertility levels are highest in Upper Egypt (3.7 births) and in the Frontier Governorates (3.3 births) and lowest in the Urban Governorates (2.5 births). Education is strongly associated with lower fertility as is wealth. The fertility rate de- creases from a level of 3.6 births among women in the lowest wealth quintile to 2.6 births among women in the highest quintile. Age at Marriage. One of the factors influ- encing the on-going fertility decline in Egypt has been the steady increase in the age at which women marry. Currently, the median age at first marriage among women age 25-29 is 21.3 years. One of the most important effects of the increase in the age at first marriage has been a reduction in adolescent fertility. Adolescent childbearing car- ries higher risks of morbidity and mortality for the mother and child, particularly when the mother is under age 18. At the time of the 2005 EDHS, nine percent of women age 15-19 had given birth or were pregnant with their first child. FAMILY PLANNING USE Family Planning Knowledge and Attitudes. Widespread awareness of family planning methods as well as nearly universal approval of family planning have been crucial elements in the expansion of family planning use. At the time of the 2005 EDHS, the aver- age currently married woman knew about seven methods. Family planning IEC efforts reach large numbers of women; nine in ten 2005 EDHS respon- dents had heard or seen a family planning message during the six months prior to the survey. Family planning has broad support among Egyp- tian couples. Most women (93 percent) consider it appropriate for a couple to begin family planning use after they have their first child. However, very few women who approve of family planning use (2 per- cent) think that a newly married couple should use contraception to delay the first pregnancy. Levels and Trends. The Egyptian government’s commitment to providing widely accessible family planning services has been a very important factor in the on-going fertility decline. Contraceptive use levels have more than doubled in Egypt between 1980 and 2005, from 24 percent to 59 percent. The IUD contin- ues to be by far the most widely used method; 37 per- cent of married women were relying on the IUD, 10 percent on the pill, and seven percent on injectables. Differentials in Use. Despite nearly universal family planning knowledge and approval, the 2005 EDHS found significant differentials in use. As ex- pected given the nearly universal disapproval of fam- ily planning use before the first birth, less than one percent of currently married women who had not yet had a child were using at the time of the survey. Use rates rise rapidly with family size; 46 percent of women with one child were using and use rates peak at 75 percent among women with 3 children. Use rates were 60 percent or higher in the Urban Governorates, in both urban and rural areas in Lower xxii | Summary of Findings Egypt, and in urban areas in Upper Egypt. In con- trast, 45 percent of currently married women were using in rural Upper Egypt and 51 percent in the Frontier Governorates. Among women who never attended school, 55 percent were using compared to 62 percent among women who com- pleted secondary school or higher. Use rates rose from 53 percent of women in the lowest wealth quintile to 63 percent among women in the high- est quintile. Discontinuation of Use. A key concern for the family planning program is the rate at which users discontinue use of contraception and their reasons for stopping. Overall, 32 percent of users in Egypt discontinue using a method within 12 months of starting use. The rate of discontinuation during the first year of use is much higher among pill users (50 percent) and injectable users (46 percent) than among IUD users (15 percent). With regard to the reasons for stopping use, users are more likely to discontinue during the first year of use because they wanted a more effective method. Overall, 12 percent of users who discontinued during the first 12 months of use switched to another method within two months of the time they discontinued. Provision of Services. Both government health facilities and private sector providers play an important role in the delivery of family plan- ning services. More than half of all users of mod- ern methods (57 percent) go to Ministry of Health or other governmental providers for their method. This represents an increase from the situation in 2000, when 49 percent of users relied on public sector facilities for their methods. Public sector providers are also the principal source for the IUD and injectables while more than seven in ten pill users obtain their method from a pharmacy. The 2005 EDHS results suggest that family planning providers are not routinely offering women the information necessary to make an in- formed choice about the method best suited to their contraceptive needs. In particular, more than four in ten users of modern methods are not pro- vided information about methods other than the one they adopt. Although side effects cause many users to discontinue, providers also are counsel- ling only around half of the users about potential side effects. NEED FOR FAMILY PLANNING Fertility Preferences. Many Egyptian women are having more births than they consider ideal. Over- all, seven percent of births in the five years prior to the survey were reported to be mistimed, that is, wanted later. and 12 percent were unwanted. If Egyp- tian women were to have the number of children they consider ideal, the total fertility rate would fall from 3.1 births to 2.3 births per woman. Unmet Need for Family Planning. Taking into account both their fertility desire at the time of the survey and their exposure to the risk of pregnancy, 10 percent of currently married women were consid- ered to have an immediate need for family planning. Unmet need is greatest among women in rural Upper Egypt, where 17 percent of women are in need of fam- ily planning to achieve their childbearing goals. INFANT AND CHILD MORTALITY Levels and Trends. At the mortality level pre- vailing in the five-year period before the 2005 EDHS, one in 24 Egyptian children will die before their fifth birthday. The level of early childhood mortality has fallen substantially since the mid-1960s, when around one in four children died before reaching age five. During the five-year period before the survey, the infant mortality rate was 33 deaths per 1,000 births, and the neonatal mortality rate was 20 deaths per 1,000 births. This indicates that around 80 percent of early childhood deaths in Egypt are taking place be- fore a child’s first birthday, with nearly half occurring during the first month of life. Socioeconomic Differentials. Mortality is higher in rural than urban areas. The highest level is found in rural Upper Egypt, where the rate of under-five mor- tality is more than double that in the Urban Gover- norates, which has the lowest mortality. Differentials are especially large across wealth quintiles; children born to women in the lowest wealth quintile are around three times more likely to die by their fifth birthday than children born to mothers in the highest quintile. Demographic Differentials. Mortality risks are especially high for births that occur within too short a period after a prior birth. The risk of dying before the Summary of Findings | xxiii fifth birthday is nearly tripled for births that are closely spaced, i.e., for children born less than two years after an elder sibling, compared to children born four or more years after a prior birth. During the five years prior to the 2005 EDHS, more than one-fifth of non-first births oc- curred within 24 months of a previous birth. Breastfeeding practices, especially the early intro- duction of supplemental foods, reduce the time a woman is amenorrheic following a birth and, thus contribute to short birth intervals. Half of Egyp- tian mothers become exposed to the risk of an- other pregnancy within four months of giving birth. MATERNAL HEALTH Care during Pregnancy. The care that a woman receives during pregnancy reduces the risks of illness and death for both the mother and the child. Overall, women saw a medical provider for at least some type of care during pregnancy in the case of 91 percent of all last births that oc- curred during the five-year period prior to the 2005 EDHS. Women reported that they had ante- natal care, i.e., care sought specifically to monitor the pregnancy, in the case of 70 percent of births. They saw a provider for the recommended mini- mum number of antenatal care visits (four) in the case of 59 percent of births. Tetanus toxoid injections are given during pregnancy for the prevention of neonatal tetanus, an important cause of death among newborns. Around 70 percent of last-born children during the five-year period prior to the 2005 EDHS were fully protected against neonatal tetanus. Content of Pregnancy Care. Women re- ported that they had been weighed and their blood pressure monitored during pregnancy in the case of more than nine in ten births in which a medical provider was seen for pregnancy care. Urine and blood samples were taken during pregnancy care in more than eight in ten births. Mothers were less likely to have been given advice about potential pregnancy complications; they reported being told about the signs of pregnancy complications in about one-third of the births and about where to seek assistance if they experienced problems in the case of 31 percent of the births. Delivery Care and Postnatal Care. Trained medical personnel assisted at 74 percent of births dur- ing the five-year period prior to the 2005 EDHS. Dayas (traditional birth attendants) assisted with most of the remaining deliveries. Sixty-five percent of de- liveries took place in a health facility, with delivery care provided somewhat more often at private than governmental facilities. Around two in ten deliveries were by Caesarean section. Care following delivery is very important for both the mother and her child, especially if the birth occurs in the home without medical assistance. In Egypt, mothers reported they were seen by a medical provider for postnatal care following 56 percent of all deliveries but in only eight percent of deliveries oc- curring outside a health facility. Slightly more than one-third of infants born during the five-year period prior to the EDHS were seen for postnatal care. How- ever, a recent campaign to encourage mothers to have a blood sample taken from the child’s heel for screen- ing within two weeks following delivery has been ef- fective; six in ten last-born children had a blood sam- ple taken from the heel. Differentials in Coverage. A woman’s residence and education status are strongly associated with the receipt of maternity care. For example, the percentage of births in which the mother received regular antena- tal care was 49 percent among rural births compared to 75 percent among urban births. Coverage of mater- nity care services is especially low in rural Upper Egypt, where regular antenatal care was received for 37 percent of births and 55 percent of deliveries were medically assisted, and among births in the lowest wealth quintile, where regular antenatal care was re- ceived for 31 percent of births and 51 percent of de- liveries were medically assisted. Trends in Coverage. Coverage of maternity care services has improved markedly in Egypt. Coverage of antenatal care services grew from 39 percent in 1995 to 70 percent in 2005. Medically assisted deliv- eries also increased over the period, from a level of 46 percent in 1995 to 74 percent in 2005. CHILD HEALTH Childhood Vaccination Coverage. One of the primary means for improving survival during child- hood is increasing the proportion of children vacci- xxiv | Summary of Findings nated against the major preventable diseases. The 2005 EDHS results show that 89 percent of chil- dren 12-23 months are fully immunized against the six major preventable childhood illnesses (tu- berculosis, diphtheria, whooping cough, tetanus, polio and measles). In addition, 80 percent of young children also have the recommended three doses of the hepatitis vaccine. Prevalence and Treatment of Childhood Illnesses. The 2005 EDHS provided data on the prevalence and treatment of two common child- hood illnesses, diarrhea and acute respiratory ill- ness. Eighteen percent of children under five were reported to have had diarrhea in the two weeks preceding the survey. Medical advice was sought in treating somewhat more than half of these cases. Use of ORS packets (34 percent) or a homemade solution of sugar, salt and water (3 percent) to combat the dehydration was common. Altogether 48 percent of children ill with diarrhea were treated with some form of ORT or increased fluids. A child was considered to have symptoms of an acute respiratory infection if he/she had a cough accompanied by short, rapid breathing that the mother described as related to a chest prob- lem. During the two weeks preceding the survey, nine percent of children had ARI symptoms. A provider was consulted about the illness in the case of 73 percent of children with these symp- toms, and mothers reported that antibiotics were given to slightly more than half of the children. NUTRITION INDICATORS FOR CHILDREN AND WOMEN Infant Feeding Practices. Breastfeeding is nearly universal in Egypt, and the average length of time that a child is breastfed is relatively long (18.6 months). However, breastfeeding practices for very young children are not optimal. More than half of infants receive prelacteal feeds (i.e., they are given some type of liquid until the mother’s breast milk flows freely). Less than one in six children are exclusively breastfed through- out the first 6 months of life. Exclusive breast- feeding (i.e., without any food or liquid) is rec- ommended because it provides all the necessary nutrients and avoids exposure to disease agents. Appropriate infant and young child feeding (IYCF) practices include timely initiation of feeding solid/semi-solid foods from age six months and in- creasing the amount of foods and frequency of feeding as the child gets older while maintaining frequent breastfeeding. Feeding practices for about one-third of children age 6-23 months met the minimum standard with respect to all three of these feeding practices. Nutritional Status of Children. The 2005 EDHS found that 18 percent of Egyptian children show evidence of chronic malnutrition or stunting, and four percent are acutely malnourished. The nutri- tional status of children under age five has improved from the situation prevailing during the first half of the 1990s, when 25-30 percent of children were found to be stunted. Large differentials in children’s nutri- tional status continue to be observed, however, par- ticularly by residence. For example, the percentage stunted among children in rural Upper Egypt is 23 percent compared to a level of 13 percent among chil- dren in rural Lower Egypt. Nutritional Status of Youth and Young Adults. Six percent of never-married males age 10-19 and eight percent of never-married females age 10-19 in Egypt are classified overweight, i.e., their BMI val- ues at or above the 95th percentile on age and sex- specific BMI growth charts. The BMI values for an additional 15 percent of males and 23 percent of fe- males fall between the 85th and 95th percentiles, indi- cating that they are at risk of becoming overweight. At the other end of the scale, three percent of males and two percent of females are considered to be under- weight, i.e., their BMI values fall below the 5th per- centile on the growth charts. Nutritional Status of Women. One indicator of the nutritional status of women is the body mass in- dex. Excluding those who are pregnant or less than two months postpartum, the mean BMI of ever- married women age 15-49 is 30.1. The majority of women have a BMI of 25.0 or higher and are consid- ered overweight (33 percent) or obese (47 percent). Less than one percent of women have a BMI below 18.5, the level indicating chronic energy deficiency. Anemia Levels. Anemia, a condition character- ized by a decrease in the concentration of hemoglobin in the blood, is associated with increased morbidity and mortality risks. The 2005 EDHS included hemo- Summary of Findings | xxv globin testing (the primary method of anemia di- agnosis) in a subsample of one-third of all EDHS households for three groups: ever-married women age 15-49, children under age five and never- married males and females 10-19 years old. Around four in ten EDHS respondents have some degree of anemia. Most of these women were found to be mildly anemic, five percent are moderately anemic and only a few women (less than one percent) were found to be severely ane- mic. Looking at the situation among young chil- dren, nearly half were considered to be at least mildly anemic, around one-fifth were moderately anemic, and less than one percent were severely anemic. The overall levels of anemia among never- married males and females age 10-19 years were 26 percent and 35 percent, respectively. Six per- cent of males and five percent of females were classified as moderately or severely anemic and less than one percent of both sexes were found to be severely anemic. Vitamin A Supplementation. Vitamin A is a micronutrient found in very small quantities in some foods. It is considered essential for normal sight, growth, and development. Information col- lected in the survey on the diet of young children and their mothers suggests that less than half of children under age 3 and slightly more than half of their mothers are consuming foods rich in vi- tamin A on a daily basis. Egypt has recently introduced a program of vitamin A supplementation for new mothers and for children beginning at age nine months. Moth- ers reported receiving a vitamin A capsule post- partum in the case of nearly half of all births in the five-year period before the survey. Around three in ten children 9-23 months had received a vitamin A capsule. Iodization of Salt. Iodine is another impor- tant micronutrient. Egypt has adopted a program of fortifying salt with iodine to prevent iodine de- ficiency. Overall, 78 percent of households were found to be using salt containing some iodine. KNOWLEDGE OF INFECTIOUS DISEASES AND OTHER HEALTH ISSUES Awareness of HIV/AIDS and Other Infectious Diseases. More than eight in ten ever-married women in Egypt have heard of AIDS. However, only six per- cent have comprehensive knowledge about the modes of transmission and prevention, and virtually all women express attitudes suggesting that there is a high degree of stigma associated with AIDS. Women were almost as likely to know about hepatitis C and tuberculosis as about AIDS. Two- thirds of the women knowing about hepatitis C were able to name a way the illness is transmitted, while around half of women knowing about tuberculosis understood that it is transmitted through the air when an infected person coughs or sneezes. Injection safety. Failure to follow safe injection practices increases the risk of transmission of blood- borne pathogens. The EDHS collected information from all respondents to assess the coverage of recent IEC efforts designed to increase population awareness about safe injection practices. About six in ten EDHS respondents had received information about injection safety. The EDHS also collected information on the prevalence of injections and on the degree of compli- ance with injection safety procedures. Around one in four respondents had received at least one injection in the six-month period prior to the survey, with most getting the last injection from a medical provider. Ninety-five percent indicated that the provider had taken the syringe and needle used for the injection from a new, unopened package. Smoking. Less than one percent of ever-married women age 15-49 themselves currently smoke or use any form of tobacco. However, 56 percent of the women report that at least one other household mem- ber smokes or uses another form of tobacco. Slightly more than three in four EDHS respondents had re- ceived information about the health effects of second- hand smoke during the six months prior to the survey. xxvi | Summary of Findings FEMALE CIRCUMCISION Level and Trends. Almost all ever-married women age 15-49 (96 percent) have been circum- cised. Among daughters under age 18, 28 percent were circumcised at the time of the survey. Girls age 9-10 are more than twice as likely as girls age 7-8 to have been circumcised (24 percent and 10 percent, respectively). The prevalence of circum- cision increases rapidly from age 9 onward to a peak of 77 percent among girls age 15-17. The percentage already circumcised can be combined with the percentage of girls whose mothers expressed an intention to circumcise their daughter(s) in the future to provide an estimate of the expected prevalence of circumcision at age 18 for each cohort of girls. The results suggest that the prevalence of circumcision will decline over the next 15-20 years, from the current levels of around 80 percent to around 60 percent. Attitudes and Beliefs. Attitudes about cir- cumcision appear to be changing. A smaller pro- portion of women supported continuation of the practice at the time of the 2005 EDHS (68 per- cent) than at the time of the 2000 EDHS (75 per- cent) or the 1995 survey (82 percent). Beliefs that support continuation of the prac- tice are shared by the majority of women. For ex- ample, six in ten ever-married women age 15-49 believe that circumcision is an important part of religious tradition. A similar proportion feel that the husband prefers the wife to be circumcised, and around half of women think that circumcision prevents adultery. Fewer women believe that the practice has any adverse consequences; for exam- ple, only around one-third thinks that a girl may die as a result of being circumcised. DOMESTIC VIOLENCE Violence since Age 15. A subsample of the 2005 EDHS respondents was asked if they had experienced violence since age 15. The data show that almost half of ever-married women in the reproductive ages in Egypt have experienced vio- lence at some point since they were 15 and around one in five reported experiencing violence in the 12 months preceding the survey. The main perpe- trators are husbands, and to a lesser extent, moth- ers, fathers and brothers. Marital Violence. Physical violence is the most common form of violence, with one-third of ever- married women subjected to some form of physical violence at least once by their current or most recent husband. Twenty percent reported that the most recent episodes of violence had taken place within the 12 months prior to the survey. Seven percent of women indicated that their spouse had ever physically forced them to have sex, and four percent reported that they had recently been forced to have sex by their spouse. Eighteen percent of ever-married women re- ported they had ever experienced emotional violence, and 11 percent experienced a recent episode of emo- tional violence. Virtually all women experiencing emotional violence indicated that their husbands had said or done something intended to humiliate them; however, six percent reported the husband had threat- ened them or someone close to them with physical harm. Attitudes towards Marital Violence. To gauge the acceptability of domestic violence, women in the 2005 EDHS were asked whether they thought a hus- band would be justified in hitting or beating his wife in each of the following five situations: if she burns the food; if she argues with him; if she goes out with- out telling him; if she neglects the children; and if she refuses to have sexual relations with him. Results show that half of the women agreed that at least one of these factors is sufficient justification for wife beating. Around one in six women believed that it is justified for all of the reasons mentioned in the question. Acceptance of wife beating was higher among rural women than urban women. Women living in rural Upper Egypt were most likely and women in the Urban Governorates were least likely to accept wife beating as justified. The differentials by wealth quin- tile are especially marked; for example, women in the lowest wealth quintile were more than three times as likely to consider wife beating to be justified for at least one of the reasons as women in the highest wealth quintile (74 percent and 23 percent, respec- tively). CHILDREN’S WELFARE School Attendance. Information contained in the EDHS on children’s education is useful in looking at several important aspects of school attendance among Summary of Findings | xxvii Egyptian children. Among children age 6-15, 91 percent were currently attending school. Boys in the age group were slightly more likely than girls to be currently attending school (93 percent and 90 percent, respectively). Residential differentials in school attendance are generally minor for children age 6-15. How- ever, among the population age 16-24, school at- tendance is higher among urban than rural resi- dents and in the Urban Governorates and Lower Egypt compared to Upper Egypt and the Frontier Governorates. Child Labor. Eight percent of children age 6-14 in the households sampled in the 2005 EDHS were engaged in child labor activities. Eleven per- cent of rural children are engaged in child labor compared to three percent of urban children. The percentage of children engaged in child labor activi- ties ranges from less than one percent among children in the highest wealth quintile to 17 percent among children in the lowest wealth quintile. Child Disciplinary Activities. Respondents in the 2005 EDHS who had children age 3-17 years were asked about the types of actions they took to teach their children the right behavior or to address behavior problems during the month before the survey. Nine in ten respondents with children age 3-17 years indicated that they had addressed behavior problems by explain- ing why the behavior was wrong. A similar proportion said that they had at times shouted, yelled or screamed at the child when there was a behavior problem. Around seven in ten women had hit or slapped a child on the body with a hard object, and four in ten had hit a child on the face, head or ear. xxviii | Map of Egypt Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY Egypt is located on the northeast corner of the African continent. It is bordered by Libya to the west, Sudan to the south, the Red Sea to the east, and the Mediterranean Sea to the north. Egypt has the largest, most densely settled population among the Arab countries. The total area of the country covers approximately one million square kilometers. However, much of the land is desert, and only 6 percent of Egypt’s area is inhabited. Recently, the Egyptian government adopted a policy of land reclamation and fostering of new settlements in the desert. Despite these efforts, the majority of Egyptians live either in the Nile Delta located in the north of the country or in the narrow Nile Valley south of Cairo. Administratively, Egypt is divided into 26 governorates (see map) and Luxor City. The four Urban Governorates (Cairo, Alexandria, Port Said, and Suez) have no rural population. Each of the other 22 governorates is subdivided into urban and rural areas. Nine of these governorates are located in the Nile Delta (Lower Egypt), eight are located in the Nile Valley (Upper Egypt), and the remaining five Frontier Governorates are located on the eastern and western boundaries of Egypt. 1.2 SOCIOECONOMIC INDICATORS Egypt’s economy expanded steadily during the 1990s. Reflecting that growth, the gross domestic product (GDP) per capita has achieved a level of US $1,380 (UNDP 2005). The country’s economic growth has been accompanied by improvements in a number of human development indicators, including: • The proportion of households with sustainable access to improved sanitation which was 87 percent in 1990 reached 98 percent by 2000 (UNDP 2004). • School enrolment levels have improved over time, and literacy levels have risen. For example, in 1990, the net enrolment ratio at the primary level was 84 and adult literacy was 47 percent; by 2003, the net enrolment ratio at the primary level had increased to 91 and adult literacy had risen to 56 percent (UNDP 2005). From a social perspective, the advances which have occurred over time in the education of women are of particular note. Female enrolment at the primary level rose from 57 percent in 1970 to 98 percent in 2002. At the secondary level, female enrolment also expanded rapidly, from 23 percent in 1970 to 70 percent in 1997 (UNDP 2004). Although indicators have improved over time, gaps remain evident for a number of subgroups, particularly women. For example, the adult literacy rate among females in 2003 was 44 percent compared to 65 percent for males. The net primary enrollment ratio in 2002/2003 was 90 for females compared to 96 for males (UNDP 2005). 1.3 POPULATION SIZE AND STRUCTURE The latest population census in Egypt was carried out in November 1996. According to the results, Egypt has a de facto population of 59.3 million. This number excluded the roughly 2.2 million Egyptians who were living abroad. By the beginning of 2005, it is estimated that population had increased by more than 10 million to 69.9 million (CAPMAS 2005). 2 | Introduction Table 1.1 presents the trend between 1990 and 2004 in the size of Egypt’s population and in the distribution of the population by urban-rural residence. The table shows that the total Egypt’s population increased during this period by around 30 percent. Despite the sizeable popula- tion expansion, the percentage of the Egyptian population living in areas classified as urban remained virtually un- changed during the period. 1.4 RECENT RATE OF NATURAL INCREASE The rate of natural increase represents the differ- ence between the level of births and deaths in a population. It indicates how fast a population will grow, taking into account these two natural events. Figure 1.1 shows that the rate of natural increase has been declining in Egypt since 1991.1 Most of the decline in the rate of natural increase since 1991 has been the result of changes in fertility behavior. The crude birth rate (CBR) dropped from a level of 30 per thousand population in 1991 to 28 per thousand by 1994. As Figure 1.1 shows, the decline leveled off in the mid-1990s, with the CBR fluctuating around a level of 27 births per thousand until the end of the decade. At that point, the CBR resumed declining although slowly reaching a level of 25.8 in 2004. The crude death rate (CDR), already at a comparably low level in 1990, also declined further in the period although the pace of decline was slow and erratic. 1 A third factor influencing population growth is migration, which is not taken into account in Figure 1.1. Table 1.1 Population of Egypt, 1990-2004 Total population in Egypt and the percentage living in urban and rural areas, 1990-2004 Place of residence Years Total population (millions)1 Urban Rural 1990 51,911 43.4 56.6 1991 52,985 43.2 56.8 1992 54,082 43.2 56.8 1993 55,201 43.1 56.9 1994 56,344 43.1 56.9 1995 57,510 42.9 57.1 1996 58,755 42.6 57.4 1997 60,080 42.6 57.4 1998 61,341 42.6 57.4 1999 62,639 42.4 57.6 2000 63,976 42.5 57.9 2001 65,298 43.1 56.9 2002 66,628 42.9 57.1 2003 67,965 42.9 57.1 2004* 69,330 42.5 57.5 1 Figures exclude Egyptians living abroad Source: CAPMAS 2005, Table 1.4 Figure 1.1 Trend in Rate of Natural Increase, Egypt 1991-2004 25.826.126.526.727.427.027.5 30.0 26.9 28.1 27.7 27.9 28.3 27.5 6.46.56.46.26.36.46.56.56.56.76.66.76.97.2 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Crude Birth Rate Crude Death Rate Source: CAPMAS 2005Note: Rates are per thousand population. Introduction | 3 As Table 1.2 shows, declines in mortality during the period 1960-2004 had a demonstrable effect on increasing the life expectancy of the Egyptian population. The life expectancy at birth represents the average number of years a child born in a specific year may be expected to live during his/her lifetime. Life expectancy increased by 19.0 years for females and 16.8 years for males during the period. 1.5 POPULATION POLICY AND PROGRAMS The government of Egypt is aware of the challenges that demographic problems pose to the attainment of the nation's devel- opment objectives. The country has adopted a national population policy which considers both quantitative and qualitative aspects of the population as important determinants of development. Slowing the growth rate of population has long been a goal of the Egyptian government policy. In the early 1960s the government made an explicit commitment on the population question when it stated in the National Charter that “high growth rates represent the most dangerous obstacle that hinders efforts to raise the standard of living of the Egyptian people” (Ibrahim 1995). Governmental concern about population issues was further demonstrated when the Supreme Council for Family Planning issued the first National Population Policy in 1973. A main objective of the policy was to reduce the CBR from 34 births per thousand population in 1973 to 24 per thousand in 1982. The policy emphasized that population growth was dependent, in part, on socioeconomic development and that the manipulation of socio- economic change should itself be an element in a comprehensive population policy. In 1977, family planning activities became more structured, organized and better managed, and the goals became more quantified at the national and sub-national levels. Information, Education, and Communication (IEC) activities were enhanced and synchronized in the late 1970s, when the Supreme Council for Population and Family Planning established high committees to coordinate IEC activities in support of the family planning activities. In 1980, a new National Strategic Framework for Population, Human Resource Development and the Family Planning Program was issued. This national strategy and its related documents set a specific timetable and explicit measures for assessing progress toward the achievement of the population and human development goals. Reflecting the continued commitment of the Egyptian government to addressing population issues, a national population conference was held in 1984. The National Population Council (NPC) was established shortly after the conference, replacing a succession of lower-level governmental bodies. In 1986, the third national population plan was formulated by the NPC, including quantifiable objectives. This plan came as response to the growing concern that previous efforts had failed to achieve real progress in reducing the population growth rate. The plan described the nature of the population problem of Egypt and re-emphasized the interaction between population and development factors. In October 1995, a modified population strategy was developed, based on the recommendations coming from the 1994 International Conference on Population and Development (ICDP). The program of action articulated a comprehensive approach to issues of population and development and identified a range of demographic and social goals to be achieved over a 20-year period. In January 1996, the Ministry of Health became the Ministry of Health and Population (MOHP), reflecting the Ministry’s increased responsibility for population sector activities. Responding to the Table 1.2 Life expectancy, Egypt 1960-2004 Life expectancy at birth by sex, Egypt 1960-2004 Year Male Female 1960 51.6 53.8 1976 52.7 57.7 1986 60.5 63.5 1991 62.8 66.4 1996 65.1 69.0 1999 66.3 70.5 2001 67.1 71.5 2002 67.5 71.9 2003 67.9 72.3 2004 68.4 72.8 Source: CAPMAS, 2005, Table 1.7 4 | Introduction concerns of the Cairo conference declaration, the MOHP has merged family planning, maternal health, and child health services into a broad-based women’s health program. It has expanded family planning services, particularly to low-income populations and to rural Upper Egypt. As part of these efforts, the MOHP has renovated most of its clinics and added more than 500 mobile family planning clinics to improve access to services. The most recent documents codifying the National Population Program were issued in 2002. These documents which articulate detailed population strategies are considered a constructive addition to the 1986 national population plan, which constitutes the only official document up to the present. 1.6 HEALTH POLICIES AND PROGRAMS The Egyptian health system faces multiple challenges in improving and ensuring the health and well-being of the Egyptian people. The system faces not only the burden of combating illnesses associated with poverty and lack of education, but it must also respond to emerging diseases and illnesses associated with a modern, urban lifestyle. Emerging access to global communications and commerce is raising the expectations of the population for more and better care and for advanced health care technology. To meet these challenges, the Egyptian health system has a strong infrastructure of physicians, clinics and hospitals, availability of technology and pharmaceuticals, and excellent physical access to care, with 95 percent of the population being within five kilometers of a medical facility. During the 1990s, the MOHP had the continuing objective of “health for all by the year 2000.” Within that broad mandate, the Government of Egypt placed a priority on meeting children’s health needs, with President Mubarak declaring that the 1989-1999 period would be a decade focused on the protection and development of the Egyptian child. A National Council for Childhood and Motherhood, co-chaired by the Prime Minister and the First Lady, was formed at that time to coordinate activities between ministries implementing programs affecting children and mothers. To improve child health, the MOHP has focused on national programs to control diarrhea and acute respiratory infections and an expanded childhood immunization program. Targets were set to eradicate poliomyelitis and to eliminate neonatal tetanus before the year 2000. The MOHP also directed attention to reducing neonatal mortality by improving the quality of care given to newborns at home and in health facilities through postnatal care. Following the merger of the health and population services described above, the MOHP also has stressed the importance of integrating family planning and maternal and child health. The government of Egypt has articulated as its long-term goal the achievement of universal coverage of basic health services for all of its citizens. It identified the extension of services to reach the most vulnerable population groups as a priority. As part of the policy reform agenda, health insurance is being expanded to cover more beneficiaries and efforts are being focused on enhancing the quality of health services. Attention also is being paid to improving health manpower distribution and the compensation provided to health workers. The importance of strengthening the information system to collect, analyze, and facilitate the use of health information at all levels was recognized, and steps have been taken to address this task. All these health reform plans are expected to have a positive effect on the health of women and children. Introduction | 5 1.7 ORGANIZATION OF THE 2005 EDHS The Egypt Demographic and Health Survey (2005 EDHS) is the latest in a series of a nationally representative population and health surveys conducted in Egypt.2 The 2005 EDHS was conducted under the auspices of the Ministry of Health and Population (MOHP) and National Population Council (NPC) and implemented by El-Zanaty & Associates. Technical support for the 2005 EDHS was provided by ORC Macro through the MEASURE DHS project. MEASURE DHS is sponsored by the U.S. Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators. USAID/Cairo is the main financial contributor to the survey. The United Nations Children’s Fund (UNICEF) and Ford Foundation also supported the survey financially. The 2005 EDHS was undertaken to provide estimates for key indicators such as fertility, contraceptive use, infant and child mortality, immunization levels, coverage of antenatal and delivery care, nutrition, and prevalence of anemia. In addition, the survey was designed to provide information on the prevalence of female circumcision, domestic violence, and children’s welfare. The survey results are intended to assist policymakers and planners in assessing the current health and population programs and in designing new strategies for improving reproductive health and health services in Egypt. 2005 EDHS TIMETABLE The 2005 EDHS was executed in four stages. The first stage involved preparatory activities, including designing the sample and updating the frame. At the same time, the survey questionnaires were developed, pretested, and finalized. The preparatory stage was initiated in September 2004, and all of the activities were completed by mid-February 2005. The second stage, which took place from March through July 2005, involved training field staff and interviewing eligible households and individual respondents. The third stage encompassed all of the data processing activities necessary to produce a clean data file, including editing, coding, entering and verifying the data as well as checking it for consistency. This stage started soon after the beginning of the fieldwork and lasted until early August 2005. The focus of the final stage of the survey was analyzing the data and preparing the report. This phase began in October 2005 with the publication of the preliminary report, which presented the main findings from the survey. The activities involved in each of the stages are described in more detail below. The survey timetable is presented in Table 1.3. 2 The 2005 EDHS is the fifth full-scale Demographic and Health Survey to be implemented in Egypt; the earlier surveys were conducted in 1988, 1992, 1995, and 2000. Three additional interim DHS surveys were carried out in 1997 and 1998 and 2003. Other national-level surveys for which results are shown in this report include the 1980 Egyptian Fertility Survey (EFS), the 1984 Egypt Contraceptive Prevalence Survey (ECPS), and the 1991 Egypt Maternal and Child Health Survey (EMCHS). 6 | Introduction Table 1.3 Survey timetable, 2005 Egypt DHS Activity Starting date Duration Updating the sample frame September 2004 1 month Mapping October 2004 7 weeks Quick-count operation October 2004 3 months Recruitment and training of listing staff January 2005 1 week Listing and re-listing January 2005 5 weeks Sample selection February 2005 6 weeks Questionnaire design December 2004 3 months Preparation of training materials January 2005 2 months Pretest January 2005 2 weeks Finalization of questionnaires February 2005 1 month Training of data collection staff March 2005 5 weeks Printing survey materials March 2005 2 weeks Fieldwork April 2005 2 months Reinterviews July 2005 2 weeks Office editing and coding April 2005 3 months Data entry May 2005 3 months Computer editing June 2005 3 months Preliminary report September 2005 1 month Detailed tabulations September 2005 2 months Final report preparation October 2005 4 months Sample Design The primary objective of the sample design for the 2005 EDHS was to provide estimates of key population and health indicators including fertility and child mortality rates for the country as a whole and for six major administrative regions (the Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and the Frontier Governorates). In addition, seven governorates targeted for special USAID-sponsored family planning and health initiatives were over sampled, namely: Fayoum, Beni-Suef, Menya, Qena, and Aswan in Upper Egypt, and Cairo and Alexandria. In the Urban Governorates, Lower Egypt, and Upper Egypt, the 2005 EDHS design allowed for governorate-level estimates of most of the key variables, with the exception of the fertility and mortality rates. In the Frontier Governorates, the sample size was not sufficiently large to provide separate estimates for the individual governorates. To meet the survey objectives, the number of households selected in the 2005 EDHS sample from each governorate was not proportional to the size of the population in the governorate. As a result, the 2005 EDHS sample is not self-weighting at the national level, and weights have to be applied to the data to obtain the national-level estimates presented in this report. A more detailed description of the 2005 EDHS sample design is included in Appendix B. Sampling errors for selected variables are presented in Appendix C. Introduction | 7 Sample Selection The sample for the 2005 EDHS was selected in three stages. The first stage included selecting the primary sampling units. The units of selection were shiakhas/towns in urban areas and villages in rural areas. A list of these units which was based on the 1996 census was updated to August 2004 using information obtained from CAPMAS, and this list was used in selecting the primary sampling units (PSUs). Prior to the selection of the PSUs, the frame was further reviewed to identify any administrative changes that had occurred after August 2004. The updating process included both office work and field visits during a one-month period. After it was completed, urban and rural units were separately stratified by geographical location in a serpentine order from the northwest corner to the southeast corner within each governorate. During this process, shiakhas or villages with a population less than 2,500 were grouped with contiguous shiakhas or villages (usually within the same kism or markaz) to form units with a population of at least 5,000. After the frame was ordered, a total of 682 primary sampling units (298 shiakhas/towns and 384 villages) were selected. The second stage of selection involved several steps. First, detailed maps of the PSUs chosen during the first stage were obtained and divided into parts of roughly equal population size (about 5,000). In shiakhas/towns or villages with a population of 20,000 or more, two parts were selected. In the remaining smaller shiakhas/towns or villages, only one part was selected. Overall, a total of 1,019 parts were selected from the shiakhas/towns and villages in the 2005 EDHS sample. A quick count was then carried out to provide an estimate of the number of households in each part. This information was needed to divide each part into standard segments of about 200 households. A group of 48 experienced field workers participated in the quick count operation. They were organized into 16 teams, each consisting of 1 supervisor, 1 cartographer and 1 counter. A one-week training course conducted prior to the quick count included both classroom sessions and two field practices in a shiakha/town and a village not covered in the survey. The quick-count operation took place between the end of October 2004 and January 2005. As a quality control measure, the quick count was repeated in 10 percent of the parts. If the difference between the results of the first and second quick count was less than 2 percent, then the first count was accepted. No major discrepancies were found between the two counts in most of the areas for which the count was repeated. After the quick count, a total of 1,359 segments were chosen from the parts in each shiakha/town and village in the 2005 EDHS sample (i.e., two segments were selected from each of the 682 PSUs with the exception of 5 PSUs for which only one segment was selected). A household listing operation was then implemented in each of the selected segments. To conduct this operation, 13 supervisors and 26 listers were organized into 13 teams. Generally, each listing team consisted of a supervisor and two listers. A one-week training course for the listing staff was held in mid-January 2005. The training involved classroom lectures and two days of field practice in three urban and rural locations not covered in the survey. The listing operation took place during a five-week period, beginning immediately after the training. About 10 percent of the segments were relisted. Two criteria were used to select segments for relisting. First, segments were relisted when the number of households in the listing differed markedly from that expected according to the quick count information. Second, a number of segments were randomly selected to be relisted as an additional quality control test. No major discrepancies were found in comparisons of the listings. The third stage involved selecting the household sample. Using the household listing for each segment, a systematic random sample of households was selected for the 2005 EDHS sample. All ever- 8 | Introduction married women 15-49 who were usual residents or who were present in the sampled households on the night before the interview were eligible for the EDHS. Questionnaire Development The 2005 EDHS involved two questionnaires: a household questionnaire and an individual questionnaire. The questionnaires were based on the model survey instruments developed by MEASURE DHS+ for countries with high contraceptive prevalence. Questions on a number of topics not covered in the DHS model questionnaires were also included in the 2005 EDHS questionnaires. In some cases, those items were drawn from the questionnaires used for earlier rounds of the DHS in Egypt. In other cases, the questions were intended to collect information on new topics. The household questionnaire consisted of three parts: a household schedule, a series of questions related to the socioeconomic status of the household, height and weight measurement, and anemia testing. The household schedule was used to list all usual household members and visitors and to identify those present in the household during the night before the interviewer’s visit. For each of the individuals included in the schedule, information was collected on the relationship to the household head, age, sex, marital status (for those 15 years and older), educational attainment, repetition and dropout (for those 6-24 years), attendance of pre-school programs (for those 3-5 years old), and child labor (for those 6-14 years). The second part of the household questionnaire obtained information on characteristics of the physical and social environment of the household (e.g., type of dwelling, availability of electricity, source of drinking water, household possessions, and the type of salt the household used for cooking). Height and weight measurements were obtained and recorded in the last part of the household questionnaire for ever-married women age 15-49 years, children born since January 2000, and never-married adolescents age 10-19 years. In a subsample of one-third of households, all eligible women, all children born since January 2000, and all adolescents age 10-19 years were eligible for anemia testing. The individual questionnaire was administered to all ever-married women age 15-49 who were usual residents or who were present in the household during the night before the interviewer’s visit. It obtained information on the following topics: • Respondent’s background • Reproduction • Contraceptive knowledge and use • Fertility preferences and attitudes about family planning • Pregnancy and breastfeeding • Immunization and child health • Husband’s background and women’s work • Female circumcision • Health care access and other health concerns • HIV/AIDS and other sexually transmitted infections • Mother and child nutrition. In addition, a domestic violence section was administered to women in the subsample of households selected for the anemia testing. One eligible woman was selected randomly from each of the households in the subsample to be asked the domestic violence section. Introduction | 9 The individual questionnaire included a monthly calendar, which was used to record a history of the respondent’s marriage status, fertility, contraceptive use including the source where the method was obtained, and the reason for discontinuation for each segment of use during each month of an approxi- mately five-year period beginning in January 2000. Pretest A pretest was conducted during the preparation for the 2005 EDHS. After a two-week training course, the household and individual questionnaires were pretested in February 2005 in a small number of households. Four supervisors, four field editors, and 16 interviewers participated in the first pretest. The pretest was conducted in two Upper Egypt governorates (Giza and Fayoum) and two Lower Egypt governorates (Gharbia and Kalyubia). A sample of 304 households were selected: 76 households in each governorate. The data collection took about four days and a total of 268 household and 261 individual interviews were completed during the pretest. The questionnaires for the 2005 EDHS were finalized after the pretest. Both comments from interviewers and tabulations of the pretest results were reviewed during the process of finalizing the questionnaires. English versions of the final Arabic language questionnaires are included in Appendix E. Data Collection Activities Staff recruitment. To recruit interviewers and field editors, a list was obtained from the then Ministry of Social Affairs (now the Ministry of Social Solidarity (MOSS)) of female personnel who were working to fulfill the one-year period of governmental public service that is mandatory for university graduates. All candidates nominated for the field staff positions were interviewed, and only those who were qualified were accepted into the training program. All candidates for the interviewer and field editor positions were recent university graduates. Another basic qualification was a willingness to work in any of the governorates covered in the survey. With a few exceptions, interviewers who had previous experience in surveys were not accepted into the training program. This decision was made to reduce any bias that might result from previous survey experience and to ensure that all trainees had a similar background. However, previous survey experience was a basic qualification for the candidates for the positions of supervisor. All of the staff recruited for the anemia testing were required to have a medical background. Some were assigned by the MOHP, and others were recruited from among newly graduated physicians. Training materials. A variety of materials were developed for use in training personnel involved in the fieldwork. A lengthy interviewer’s manual, including general guidelines for conducting an interview as well as specific instructions for asking each of the questions in the EDHS questionnaires, was prepared and given to all field staff. In addition, a chart for converting months from the Islamic calendar to the Gregorian calendar was designed for the 60 months before the 2005 EDHS and distributed to all field staff along with a calendar of well-known worldwide or local events. Other training materials, including special manuals describing the duties of the team supervisor and the rules for field editing, were prepared. Instructions for anthropometric data collection were included in a manual for the staff trained to collect height and weight data. A special manual covering the procedures to be followed in the anemia testing was also prepared. 10 | Introduction Training for supervisors and interviewers. A special training program for supervisors was conducted during a one-day period prior to the main fieldwork training. This training focused specifically on the supervisor’s duties, but it also covered the 2005 EDHS questionnaires in order to give supervisors a basic understanding of the content of the survey prior to the main training program. Training for interviewers for the 2005 EDHS data collection began in mid-March 2005. Fourteen supervisors, 87 interviewers, and 36 anemia-testing and anthropometric-data-collection staff including 13 physicians and 2 nurses participated in the training program. This five-week training program, which was held in Cairo, included the following: • Lectures related to basic interview techniques and to specific survey topics (e.g., fertility and family planning, maternal and child health, and female circumcision) • Sessions on how to fill out the questionnaire, using visual aids • Role playing and mock interviews • Five days of field practice in areas not covered in the survey • Four quizzes. Trainees who failed to show interest in the survey, who did not attend the training program on a regular basis, or who failed the first two quizzes were terminated immediately. Before the fourth field practice, a list was prepared of the 20 trainees who had performed best during both the classroom and field practices. Following the fourth field practice, 14 of these trainees were chosen to be field editors. A special training session was held for the field editors after their selection. By the end of the training course, 69 of the 87 candidates originally recruited for interviewer training were selected to work as interviewers or field editors in the EDHS fieldwork. Training for anthropometric-data-collection and anemia-testing staff. Thirty-six personnel were selected for training in anthropometric data collection and anemia testing. The training included both classroom lectures and practice measurement and blood testing in a nursery school, in health facilities, and in households. At the end of the program, the 28 most-qualified trainees (14 males and 14 females) were selected for the anthropometric data collection and anemia testing. As discussed earlier, most of the personnel involved in the anemia testing had a medical background. Fieldwork. Fieldwork for the 2005 EDHS began on April 21, 2005 and was completed in late June 2005. The field staff was divided into 14 teams; each team had 1 supervisor, 1 field editor, 3 to 4 interviewers, and 2 staff members assigned to height and weight measurement and anemia testing. All supervisors were males, while the field editors and interviewers were females. One male and one female staff member were involved in the anthropometric measurement and the anemia testing. During the fieldwork, the 14 field teams worked in separate governorates; the number of governorates assigned to an individual team varied from one to three, according to the sample size in the governorates. As a quality control measure, field editors regularly conducted reinterviews using a shortened version of the EDHS questionnaire. The results of the reinterview were compared to the responses in the original questionnaire and any mistakes were discussed with the interviewer. The teams also were closely supervised throughout the fieldwork by a fieldwork coordinator, two assistant fieldwork coordinators, and other senior staff. Introduction | 11 As soon as the main data collection was completed in the first group of governorates, a random sample of up to 10 percent of the households was selected for reinterview as a quality control measure. Shorter versions of the 2005 EDHS questionnaires were prepared and used for the reinterviews. The visits to PSUs to conduct reinterviews also afforded an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit by the 2005 EDHS interviewers. Household or individual questionnaires in which there were significant errors that could not be corrected in the office were also assigned for callbacks. Special teams were organized to handle callbacks and reinterviews. During this phase of the survey, interviewers were not allowed to work in the governorate in which they had worked in the initial fieldwork. Callbacks and reinterviews began in mid- July 2005 and took about two weeks to complete. Data Processing Activities Office editing. Staff from the central office were responsible for collecting questionnaires from the teams as soon as interviewing in a cluster was completed. Office editors reviewed questionnaires for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires, which were reviewed by the senior staff. If serious errors were found in one or more questionnaires from a cluster, the supervisor of the team working in that cluster was notified and advised of the steps to be taken to avoid these problems in the future. Machine entry and editing. Machine entry and editing began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Census and Survey Processing System (CSPro), a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. Fifteen data entry personnel used twelve microcomputers to process the 2005 EDHS survey data. During the machine entry, 100 percent of each segment was reentered for verification. The data processing staff completed the entry and editing of data by the end of July 2005. 1.8 SURVEY COVERAGE Table 1.4 summarizes the outcome of the fieldwork for the 2005 EDHS by place of residence. The table shows that, during the main fieldwork and callback phases of the survey, out of 22,807 households selected for the 2005 EDHS, 22,211 households were found, and 21,972 households were successfully interviewed which represents a response rate of 99 percent. A total of 19,565 women were identified as eligible to be interviewed. Out of these women, 19,474 were successfully interviewed, which represents a response rate of 99.5 percent. The household response rate exceeded 98 percent in all residential categories, and the response rate for eligible women exceeded 99 percent in all areas. In general, response rates were slightly higher in rural areas than urban areas. 12 | Introduction Table 1.4 Sample results Percent distribution of households and eligible women by the result of the interviews, and response rates, according to residence, Egypt 2005 Demographic and Health Survey Lower Egypt Upper Egypt Interview result Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Households Dwellings sampled 11,164 11,643 5,231 6,656 2,071 4,585 9,998 3,247 6,751 922 22,807 Households found 10,746 11,465 5,024 6,500 1,989 4,511 9,806 3,153 6,653 881 22,211 Households interviewed 10,555 11,417 4,923 6,454 1,965 4,489 9,723 3,094 6,629 872 21,972 Response rate 98.2 99.6 98.0 99.3 98.8 99.5 99.2 98.1 99.6 99.0 98.9 Eligible women Eligible women 8,147 11,418 3,568 5,918 1,560 4,358 9,177 2,486 6,691 902 19,565 Eligible women interviewed 8,095 11,379 3,538 5,903 1,553 4,350 9,132 2,471 6,661 901 19,474 Response rate 99.4 99.7 99.2 99.7 99.6 99.8 99.5 99.4 99.6 99.9 99.5 Characteristics of Households | 13 CHARACTERISTICS OF HOUSEHOLDS 2 The objective of this chapter is to provide a demographic and socioeconomic profile of the 2005 EDHS sample and a descriptive assessment of the environment in which women and children live. Information is presented on the age, sex, and education of the household population, as well as on housing facilities and household possessions. The profile of the households provided in this chapter will help in understanding the results of the 2005 EDHS in the following chapters. In addition, it may provide useful input for social and economic development planning. 2.1 CHARACTERISTICS OF THE HOUSEHOLD POPULATION The questionnaire for the 2005 EDHS included two questions distinguishing between the de jure population (persons who usually live in selected household) and the de facto population (persons who spent the night before the interview in the household). The differences between these populations are small, and since past surveys and censuses were based on de facto populations, tabulations for the household data presented in this chapter are based on the de facto definition, unless otherwise stated. Age and Sex Composition Table 2.1 presents the percent distribution of the de facto population by age, according to urban- rural residence and sex. The table describes the demographic context in which the behaviors examined in the report occur. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and urban- rural residence, Egypt 2005 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 10.7 10.4 10.6 13.9 12.8 13.4 12.6 11.8 12.2 5-9 10.4 10.1 10.3 12.9 11.6 12.3 11.9 11.0 11.4 10-14 10.0 9.3 9.6 11.7 10.9 11.3 11.0 10.2 10.6 15-19 11.7 11.3 11.5 12.4 12.4 12.4 12.1 12.0 12.0 20-24 9.6 10.9 10.3 9.3 10.5 9.9 9.4 10.7 10.1 25-29 7.7 8.4 8.1 7.4 8.3 7.9 7.6 8.3 7.9 30-34 5.9 6.5 6.2 5.8 6.2 6.0 5.9 6.3 6.1 35-39 6.0 6.5 6.3 5.4 5.8 5.6 5.7 6.1 5.9 40-44 6.2 6.1 6.2 5.2 4.7 5.0 5.6 5.3 5.5 45-49 5.5 5.5 5.5 4.0 4.5 4.3 4.7 4.9 4.8 50-54 5.0 5.0 5.0 3.3 3.1 3.2 4.0 3.9 4.0 55-59 3.9 3.4 3.6 2.6 2.8 2.7 3.1 3.0 3.1 60-64 3.0 2.4 2.7 2.1 2.3 2.2 2.5 2.3 2.4 65-69 1.9 1.6 1.7 1.5 1.6 1.5 1.6 1.6 1.6 70-74 1.2 1.3 1.3 1.2 1.3 1.2 1.2 1.3 1.3 75-79 0.7 0.6 0.7 0.7 0.5 0.6 0.7 0.6 0.6 80 + 0.5 0.5 0.5 0.5 0.7 0.6 0.5 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 22,185 22,708 44,893 30,453 31,290 61,743 52,638 53,998 106,635 14 | Characteristics of Households The population spending the night before the survey in the households selected for the survey included 106,635 individuals, of which 49 percent were males and 51 percent females. The age structure of the de facto household population reflects the effects of past demographic trends, particularly high fertility. The majority of the household population (56 percent) was less than 25 years old, and around one-third were less 15 years old. The proportion under age 15 was greater in the rural population (37 percent) than in the urban population (31 percent). This difference is an outcome of lower recent fertility in urban areas compared to rural areas. The population pyramid shown in Figure 2.1 was constructed using the sex and age distribution of the 2005 EDHS household population. The pyramid has a wide base. This pattern is typical of countries that have experienced relatively high fertility in the recent past. Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 EDHS 2005 Age Male Percent Female Table 2.2 presents a comparison of the distribution of the household population by broad age groups for the five EDHS surveys carried out between 1988 and 2005. The dependency ratio, defined as the ratio of the nonproductive population (persons under age 15 and age 65 and over) to the population age 15-64, is calculated based on these figures. The ratio declined from a level above 80 at the time of the 1988 survey to 62 at the time of the 2005 EDHS. The decline reflects a substantial lessening in the burden placed on persons in the productive ages to support older and young- er household members. Table 2.2 Trends in population distribution by age, 1988-2005 Percent distribution of the de facto population by age and dependency ratio, Egypt 1988-2005 Age group 1988 EDHS 1992 EDHS 1995 EDHS 2000 EDHS 2005 EDHS Less than 15 41.2 41.7 40.0 37.3 34.2 15-64 55.0 54.6 56.3 59.1 61.7 65+ 3.8 3.7 3.7 3.6 4.1 Total 100.0 100.0 100.0 100.0 100.0 Median age na 18.8 19.3 20.3 21.7 Dependency ratio 81.8 83.2 77.6 69.2 62.1 na = not available Source: El-Zanaty and Way, 2001, Table 2.2 Characteristics of Households | 15 Household Composition Table 2.3 presents the distribution of households in the 2005 EDHS sample by sex of the head of the household and by the number of de jure household members. These characteristics are important because they are often associated with socioeconomic differences between households. For example, female-headed households frequently are poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. Table 2.3 Household composition by residence Percent distribution of households by sex of head of household and by household size, according to residence, Egypt 2005 Lower Egypt Upper Egypt Characteristic Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Household headship Male 86.1 89.1 84.8 88.8 86.1 90.0 87.9 87.6 88.1 92.9 87.7 Female 13.9 10.9 15.2 11.2 13.9 10.0 12.1 12.4 11.9 7.1 12.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of members 1 7.2 3.5 8.4 4.4 7.5 3.1 4.4 5.3 3.9 4.0 5.3 2 12.3 9.1 14.0 9.9 11.1 9.4 9.6 10.9 8.8 8.3 10.6 3 15.4 10.9 15.2 13.4 15.9 12.3 11.4 15.2 9.2 11.0 13.1 4 22.7 15.9 23.8 19.4 22.3 18.1 16.2 21.4 13.2 14.8 19.1 5 21.1 18.2 20.9 22.1 23.5 21.5 16.0 19.5 14.0 19.9 19.6 6 12.1 15.0 10.8 14.1 11.7 15.2 14.7 14.4 14.9 13.2 13.6 7 4.8 10.1 3.8 7.4 5.3 8.2 10.0 5.9 12.4 9.1 7.6 8 2.2 5.8 1.7 3.5 1.3 4.5 6.1 3.7 7.4 6.8 4.1 9+ 2.2 11.5 1.5 5.7 1.2 7.7 11.5 3.8 16.1 13.0 7.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 Mean size 4.2 5.5 4.0 4.8 4.2 5.1 5.4 4.5 6.0 5.8 4.9 Note: Table is based on de jure members, i.e., usual residents The household head is female in 12 percent of households. The proportion of households headed by females does not vary greatly across residential categories, except for the Frontier Governorates, where females head seven percent of households. There are on average 4.9 persons per household. Slightly more than one-quarter of the households have three or fewer members, while around one-fifth of the households have seven or more members. In general, rural households are larger than urban households. For example, two percent of urban households have nine or more members, compared to 12 percent of rural households. Household size varies from an average of 4.0 persons in the Urban Governorates to 6.0 persons in rural Upper Egypt. 2.2 EDUCATION OF THE HOUSEHOLD POPULATION The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Primary education in Egypt starts at age 6 and has until recently 16 | Characteristics of Households consisted of five years of schooling.1 A further three-year period, known as the preparatory stage, is considered basic education and is compulsory. The secondary stage, which includes another three years of schooling, is not compulsory. During the household interviews, questions were included on the highest level of schooling completed for all household members age six and older and on recent school attendance for household members age 6-24 years. In addition, information was obtained on kindergarten attendance for children age 3-5 years. The information collected on the educational attainment of all household members is presented in Tables 2.4.1 and 2.4.2. Information on school attendance among children and young adults is discussed further in Chapter 18. A comparison of Tables 2.4.1 and 2.4.2 highlights the gap in educational attainment between males and females. Overall, 84 percent of males in the EDHS households have ever attended school, compared to 70 percent of females. The median number of years of schooling for men is 6.3, which is almost 2 years higher than the median for women (4.4 years). Table 2.4.1 Educational attainment of male household population by age and residence Percent distribution of the de facto male household population age six and over by highest level of education attended or completed and median number of years of schooling, according to background characteristics, Egypt 2005 Background characteristic None Some primary Com- pleted primary Some secondary Com- pleted secondary More than secondary Don't know/ missing Total Number Median years Age 6-9 15.1 84.3 0.1 0.0 0.0 0.0 0.6 100.0 4,779 0.4 10-14 1.9 36.9 20.9 40.2 0.0 0.0 0.1 100.0 5,772 4.5 15-19 4.4 5.2 3.1 60.3 15.6 11.2 0.1 100.0 6,372 8.6 20-24 6.2 6.7 4.7 12.5 42.0 27.9 0.1 100.0 4,956 10.5 25-29 8.4 7.1 6.9 14.4 41.2 21.8 0.1 100.0 3,977 10.4 30-34 12.0 10.4 4.1 14.8 39.0 19.4 0.2 100.0 3,079 11.3 35-39 17.0 13.4 4.1 9.2 39.6 16.6 0.1 100.0 2,980 11.2 40-44 20.9 13.7 6.4 10.0 29.9 19.1 0.1 100.0 2,969 9.7 45-49 20.0 18.8 7.4 8.7 24.8 20.3 0.1 100.0 2,461 8.1 50-54 32.3 14.7 8.3 9.4 18.3 17.0 0.1 100.0 2,124 5.3 55-59 37.5 14.7 9.2 6.8 15.5 16.2 0.0 100.0 1,638 4.7 60-64 44.5 10.6 10.0 6.7 12.6 15.2 0.4 100.0 1,292 3.8 65+ 61.0 12.5 8.1 3.1 7.5 7.4 0.5 100.0 2,149 0.0 Urban-rural residence Urban 10.8 19.3 7.0 19.6 22.1 21.0 0.2 100.0 19,289 8.3 Rural 19.2 23.5 7.2 20.9 21.0 8.1 0.2 100.0 25,259 5.3 Place of residence Urban Governorates 10.5 17.4 7.7 19.4 21.2 23.5 0.3 100.0 8,391 8.6 Lower Egypt 15.0 22.0 6.9 20.2 22.9 13.0 0.1 100.0 18,451 6.6 Urban 9.3 20.1 6.8 19.3 22.1 22.3 0.1 100.0 4,944 8.6 Rural 17.0 22.7 6.9 20.5 23.2 9.6 0.1 100.0 13,507 5.8 Upper Egypt 18.7 23.5 7.0 20.9 20.0 9.8 0.2 100.0 17,178 5.4 Urban 12.5 21.4 6.1 19.9 23.3 16.7 0.2 100.0 5,630 7.5 Rural 21.7 24.5 7.5 21.4 18.3 6.4 0.2 100.0 11,548 4.7 Frontier Governorates 14.2 18.4 8.7 22.4 24.5 11.1 0.7 100.0 529 6.9 Total 15.6 21.7 7.1 20.3 21.5 13.7 0.2 100.0 44,548 6.3 1 Beginning in 2004, primary education was extended to include six years. Characteristics of Households | 17 An examination of the education distributions for successive cohorts indicates that there have been changes over time in the educational attainment of both men and women. For example, the median number of years of schooling is 10.5 for males age 20-24 years, nearly double the median for males in the 50-54 age group (5.3 years). Women have experienced marked improvements in educational attainment as well. As a result of these gains, the gap in the educational attainment between males and females has almost disappeared among younger cohorts. For example, the differential in the median number of years of schooling is 0.2 years between men and women age 20-24. Urban residents are more likely to have attended school and to have remained in school for a longer period than rural residents. The results in Tables 2.4.1 and 2.4.2 also show that gender differences in educational attainment are less evident in urban than in rural areas. For example, the median number of years of schooling is 5.3 years among rural men, three years greater than the median among rural women (2.3 years). The difference is much smaller in urban areas, where the median number of years of schooling is 8.3 years for men, compared to 7.1 years for women. By place of residence, gender differences in the likelihood of attending school are most evident in rural Upper Egypt where 78 percent men have ever attended school, compared to 55 percent of women. The gender gap is least apparent in urban Lower Egypt where 84 percent of women have had some education, compared to 91 percent of men. Table 2.4.2 Educational attainment of female household population by age and residence Percent distribution of the de facto female household population age six and over by highest level of education attended or completed and median number of years of schooling, according to background characteristics, Egypt 2005 Background characteristic None Some primary Com- pleted primary Some secondary Com- pleted secondary More than secondary Don't know/ missing Total Number Median years Age 6-9 17.0 82.3 0.2 0.0 0.0 0.0 0.5 100.0 4,655 0.3 10-14 6.8 33.9 19.2 39.9 0.0 0.0 0.1 100.0 5,506 4.4 15-19 12.8 4.2 2.2 52.2 17.0 11.5 0.1 100.0 6,458 8.6 20-24 19.3 6.3 3.3 9.7 38.5 22.8 0.0 100.0 5,767 10.3 25-29 22.3 7.2 5.2 10.5 36.3 18.4 0.2 100.0 4,499 10.2 30-34 30.1 8.7 2.2 12.6 33.6 12.5 0.2 100.0 3,405 8.5 35-39 39.1 12.2 3.8 7.2 27.8 9.8 0.1 100.0 3,309 4.7 40-44 43.0 16.0 5.1 5.2 19.6 11.1 0.0 100.0 2,867 2.8 45-49 47.5 19.0 5.7 3.7 13.8 10.1 0.1 100.0 2,665 1.1 50-54 54.6 13.9 7.3 4.9 11.2 7.8 0.3 100.0 2,097 0.0 55-59 64.3 12.7 6.3 3.5 7.1 5.6 0.5 100.0 1,646 0.0 60-64 71.1 11.6 3.7 2.7 5.9 3.5 1.5 100.0 1,243 0.0 65+ 76.9 11.2 4.4 1.1 2.8 1.2 2.4 100.0 2,210 0.0 Urban-rural residence Urban 19.0 18.1 5.8 17.7 22.2 16.9 0.3 100.0 19,850 7.1 Rural 37.6 21.2 5.2 15.9 15.2 4.5 0.4 100.0 26,480 2.3 Place of residence Urban Governorates 18.2 17.4 6.2 17.1 21.8 19.0 0.4 100.0 8,588 7.5 Lower Egypt 27.0 20.0 5.4 17.1 21.0 9.2 0.3 100.0 19,083 4.8 Urban 16.4 17.8 5.6 17.5 24.8 17.7 0.2 100.0 5,149 7.9 Rural 30.9 20.8 5.3 17.0 19.6 6.1 0.3 100.0 13,934 4.0 Upper Egypt 37.7 21.0 5.1 16.0 13.6 6.2 0.3 100.0 18,142 2.3 Urban 22.2 19.5 5.2 18.7 20.6 13.7 0.2 100.0 5,800 5.8 Rural 45.0 21.7 5.1 14.8 10.3 2.7 0.4 100.0 12,341 0.3 Frontier Governorates 31.2 16.8 8.3 17.5 18.1 7.2 1.0 100.0 518 4.3 Total 29.6 19.9 5.5 16.7 18.2 9.8 0.3 100.0 46,331 4.4 18 | Characteristics of Households 2.3 HOUSING CHARACTERISTICS The 2005 EDHS survey collected information on a range of housing characteristics. These data are presented for households and for the total de jure household population. The results for households are further disaggregated by residence. Water Supply Increasing access to improved drinking water is one of the Millennium Development Goals that Egypt along with other nations worldwide has adopted (United Nations General Assembly 2001). The 2005 EDHS collected information that can be used to explore the status of Egyptian households in relation to this goal. Table 2.5 presents a number of characteristics relating to a household’s access to improved drinking water. The first of these characteristics is the source from which the water that household members drink is obtained. Improved sources are defined as those sources which are likely to provide safe drinking water (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2004). Improved sources include water obtained a piped source within the dwelling, a public tap, a tubehole or borehole, or a protected well or spring.2 The results in Table 2.5 show that 98 percent of households in Egypt have access to water from an improved source. In most cases, the source is a piped connection in the dwelling itself or the plot (90 percent). Almost all households get water from a source on premises (94 percent). The majority of households fetching water from a source outside the dwelling or plot are within 30 minutes of this source. Women age 15 and older are generally responsible for fetching water for households in which the water source is not on the premises. Around one-third of households report that they have experienced interruptions in their water supply; 11 percent say the supply is interrupted on a daily or almost daily basis, 15 percent report interruptions at least a few times per week while 8 percent experience less frequent interruptions. Households generally do not treat the water they drink. Among households reporting that the water is treated (6 percent), the most common practices are to filter the water or to let it stand and settle. Looking at the variations in drinking water indicators by residence, households in the Frontier Governorates and rural Upper Egypt are the least likely to obtain water from an improved source (89 percent and 94 percent, respectively). Interruptions in the water supply are more common in Upper Egypt (41 percent) than in other areas within Egypt. 2 A well or spring which is covered or otherwise ‘protected’ from contamination from surface water or animals. Characteristics of Households | 19 Table 2.5 Household drinking water access and treatment by residence Percent distribution of households by source of drinking water, time to collect water (if not within residence or plot), person fetching the water, and interruption of water supply during two week period prior to the survey and percentage of households using various modes for treating drinking water, according to urban-rural residence and place of residence and percent distribution of the de jure population by household drinking water arrangements and percentage of the de jure population living in households using various modes to treat drinking water, Egypt 2005 Lower Egypt Upper Egypt Drinking water Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure population Source of drinking water1 Improved source 99.2 96.9 99.6 99.6 99.3 99.8 95.5 98.9 93.5 89.3 98.0 97.9 Piped into house/plot 98.0 82.2 98.3 91.3 98.7 88.1 83.3 97.5 75.0 74.6 89.7 88.3 Public tap 0.9 6.2 0.8 3.2 0.5 4.4 5.8 1.2 8.4 0.2 3.6 3.8 Tubewell/borehole 0.1 6.7 0.0 3.9 0.1 5.6 5.1 0.1 8.1 3.8 3.5 4.2 Protected well/spring 0.1 1.9 0.0 1.2 0.0 1.7 1.3 0.1 2.0 9.6 1.0 1.5 Unimproved source 0.8 3.0 0.4 0.3 0.6 0.2 4.4 1.1 6.4 10.7 1.9 2.1 Tanker truck/cart 0.7 2.9 0.4 0.3 0.6 0.2 4.3 1.0 6.2 9.8 1.9 2.0 Surface water 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.2 0.0 0.0 0.1 Time to water source On premises 98.8 90.1 98.9 95.2 99.1 93.4 90.6 98.2 86.1 90.9 94.3 93.8 Within 15 minutes 0.5 4.4 0.5 1.9 0.4 2.6 4.4 0.6 6.7 3.2 2.5 2.6 15-29 minutes 0.2 2.2 0.2 1.0 0.1 1.4 2.0 0.2 3.1 2.6 1.2 1.4 30 + minutes 0.3 1.6 0.2 1.2 0.2 1.7 1.1 0.5 1.4 1.7 0.9 1.2 Don’t know/missing 0.3 1.7 0.2 0.7 0.2 0.9 1.9 0.5 2.8 1.5 1.1 1.0 Person obtaining water for household Adult man 15+ 0.3 0.8 0.2 0.6 0.4 0.6 0.6 0.1 0.9 1.9 0.5 0.5 Adult woman 15+ 0.6 7.0 0.5 3.5 0.3 4.8 6.5 1.1 9.7 5.0 4.0 4.3 Male child <15 years 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.2 0.1 0.1 0.1 Female child <15 years 0.0 0.2 0.0 0.1 0.0 0.2 0.3 0.1 0.4 0.1 0.1 0.2 Water on premises/other/missing 99.1 91.9 99.3 95.8 99.3 94.3 92.6 98.7 88.8 92.8 95.3 94.9 Water supply interrupted Not interrupted 70.2 64.8 74.7 70.9 73.3 69.8 59.2 60.5 58.4 67.1 67.4 66.3 Daily/almost daily 9.8 11.2 10.3 8.7 6.3 9.7 12.5 11.5 13.2 17.9 10.5 10.8 Few times per week 13.4 15.1 10.8 12.9 12.7 13.0 17.9 18.3 17.8 9.2 14.3 14.7 Less frequently 6.4 8.7 3.9 7.2 7.3 7.2 10.2 9.5 10.6 5.6 7.6 7.9 Don't know/missing 0.3 0.2 0.3 0.3 0.4 0.3 0.1 0.2 0.1 0.2 0.2 0.2 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 Water treated prior to drinking Not treated 91.6 96.3 89.4 94.7 92.4 95.7 96.1 94.3 97.1 93.8 94.0 94.6 Boiled 0.6 0.2 1.0 0.3 0.5 0.2 0.2 0.2 0.2 0.3 0.4 0.4 Bleach/chlorine added 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Strained 0.4 0.1 0.4 0.3 0.6 0.2 0.2 0.3 0.0 0.2 0.3 0.2 Water filter used 5.5 0.7 7.1 2.2 5.2 0.9 1.5 3.3 0.4 2.4 3.0 2.5 Solar disinfection 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Stand and settle 2.0 2.5 2.4 2.5 1.5 2.9 2.0 1.9 2.1 3.5 2.3 2.3 Number 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 1 Because the quality of bottled water is not known, households using bottled water are classified according to the source of water used for cooking and washing. 20 | Characteristics of Households Sanitation Facilities and Waste Disposal Ensuring adequate sanitation facilities is another Millennium Development Goal. Table 2.6 shows that most Egyptian households have access to a toilet, with 43 percent reporting they have modern flush toilets, and 55 percent traditional flush toilets. Only one percent of households have no toilet facility. Most households (97 percent) report that the toilet is connected to a sewer, bayara (vault), or septic system. Ten percent of households report problems with the drainage system. Five percent report they share the toilet facility with at least one other household. Table 2.6 Sanitation facilities by residence Percent distribution of households by type of toilet facility, drainage system, problems experienced with drainage system, number of households using the toilet facility, type of sanitation facilities, and method of disposal of kitchen waste and trash (according to urban-rural residence and place of residence and percent distribution of de jure population by sanitation facilities, Egypt 2005 Lower Egypt Upper Egypt Sanitation facility Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure popu- lation Toilet facility Modern flush toilet 71.2 17.1 81.2 39.7 73.9 24.9 24.4 53.2 7.5 42.4 43.0 36.2 Traditional (tank flush) 1.5 2.3 0.8 2.6 1.7 3.0 1.8 2.4 1.5 0.9 1.9 1.9 Traditional (bucket flush) 27.0 76.7 17.8 57.2 24.2 71.5 68.5 43.6 83.0 55.5 52.9 59.5 Pit latrine/bucket toilet 0.1 1.8 0.0 0.0 0.0 0.1 2.7 0.5 4.0 1.1 1.0 1.1 Other/missing 0.1 0.2 0.1 0.2 0.1 0.2 0.1 0.0 0.1 0.0 0.1 0.1 No facility 0.1 2.0 0.1 0.3 0.0 0.4 2.6 0.3 3.9 0.1 1.1 1.1 Drainage system Public sewer 88.0 32.4 97.0 63.9 94.0 50.9 31.8 69.5 9.6 43.3 59.0 52.8 Vault (Bayara) 5.9 22.3 1.6 3.7 0.4 5.1 33.6 16.7 43.5 33.1 14.4 17.5 Septic system 5.5 40.0 0.9 30.4 5.6 41.1 28.9 12.4 38.6 22.9 23.5 26.2 Pipe to canal 0.2 1.4 0.3 1.3 0.0 1.9 0.5 0.0 0.8 0.0 0.8 1.0 Pipe to groundwater 0.1 0.1 0.1 0.1 0.0 0.2 0.1 0.3 0.1 0.0 0.1 0.1 Emptied (no connection) 0.2 1.6 0.0 0.3 0.1 0.4 2.2 0.6 3.1 0.4 0.9 1.0 Other 0.0 0.3 0.1 0.1 0.0 0.1 0.3 0.1 0.5 0.1 0.2 0.2 No toilet facility 0.1 2.0 0.1 0.3 0.0 0.4 2.6 0.3 3.9 0.1 1.1 1.1 Problems with drainage system No problems 91.8 88.8 91.2 92.9 97.1 91.2 86.7 88.1 85.9 88.2 90.2 89.7 Pooling around dwelling(s) 6.5 5.1 7.6 4.3 2.4 5.1 6.4 8.5 5.2 7.4 5.8 6.1 Cost of evacuation 1.8 3.8 1.5 2.4 0.4 3.3 4.0 3.4 4.4 4.6 2.8 3.2 Insects 3.4 3.2 4.0 2.0 1.0 2.4 4.2 4.5 4.0 8.9 3.3 3.5 Other 0.0 0.1 0.1 0.0 0.0 0.1 0.1 0.0 0.2 0.0 0.1 0.1 Don’t know/missing 0.2 0.1 0.3 0.1 0.1 0.1 0.2 0.2 0.1 0.4 0.2 0.1 No facility/no connection 0.1 2.0 0.1 0.3 0.0 0.4 2.6 0.3 3.9 0.1 1.1 1.1 Number of households using toilet No facility 0.1 2.0 0.1 0.3 0.0 0.4 2.6 0.3 3.9 0.1 1.1 1.1 One 97.5 90.6 97.0 95.8 99.1 94.4 89.9 96.7 85.8 96.5 93.9 92.4 1-2 1.2 3.9 1.2 2.3 0.6 3.0 3.8 1.7 5.0 1.7 2.6 3.1 3+ households 1.0 3.4 1.4 1.5 0.2 2.1 3.6 1.0 5.0 1.7 2.2 3.2 Not sure/missing 0.2 0.2 0.4 0.1 0.0 0.1 0.3 0.2 0.3 0.0 0.2 0.2 Sanitation facilities Improved1 96.5 86.5 96.1 93.9 98.9 91.7 85.5 95.2 79.8 95.0 91.3 89.5 Not improved 3.5 13.5 3.9 6.1 1.1 8.3 14.5 4.8 20.2 5.0 8.7 10.5 Disposal of kitchen waste/trash Collected from home 53.6 26.4 49.6 42.0 62.2 33.3 31.2 53.6 18.1 20.1 39.5 35.2 Collected from street container 32.8 4.4 44.8 11.2 24.1 5.7 9.5 21.2 2.7 31.6 18.0 15.6 Dumped into street/empty plot 9.9 25.9 4.8 19.7 11.3 23.3 24.3 16.1 29.0 27.6 18.3 20.2 Dumped into canal/drainage 1.3 18.3 0.4 14.5 1.3 20.3 11.1 2.7 16.0 0.8 10.1 11.6 Burned 1.9 18.9 0.1 9.1 0.8 12.7 18.7 5.6 26.5 16.1 10.8 13.2 Fed to animals 0.3 5.9 0.0 3.3 0.3 4.7 4.9 0.6 7.4 3.6 3.2 4.0 Other 0.0 0.1 0.0 0.1 0.0 0.1 0.1 0.0 0.2 0.0 0.1 0.1 Don’t know/missing 0.1 0.0 0.2 0.0 0.1 0.0 0.1 0.2 0.1 0.1 0.1 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 1 The household is considered to have improved sanitation facilities if the household has sole use of a modern or traditional flush toilet that empties into a public sewer, Bayara (vault) or septic system. Characteristics of Households | 21 A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2004). The facilities meeting the latter criteria include toilets that flushed or pour flushed into a sewer, bayara, or septic system. Overall, Table 2.6 shows that 91 percent of Egyptian households have access to an improved toilet facility. The proportion of households using an improved facility is lowest in rural Upper Egypt (80 percent). Table 2.6 also presents information on waste disposal practices. The majority of households (58 percent) report that kitchen waste or trash was collected, either at the dwelling or from a container in the street (i.e., a container shared with others). Slightly more than one-quarter of households say that they dump waste or trash into the street, an empty plot or a canal or drainage ditch, 11 percent burn waste or trash, and 3 percent feed it to animals. Dumping or burning waste or trash is much more common in rural than in urban areas (63 percent and 13 percent, respectively). More than 7 in 10 households in rural Upper Egypt dispose of trash by dumping (45 percent) or burning (27 percent). Cooking Arrangements Indoor pollution from solid fuels (biomass fuels and coal) is a major killer, particularly of children under age five. The 2005 EDHS included questions on the type of fuel, type of stove, and cook- ing location to help assess the proportion of the population relying on solid fuels, another Millennium Development goal indicator (United Nations General Assembly 2001). Table 2.7 shows that virtually all Egyptian households use fossil fuels (LPG, natural gas, or kerosene) for cooking. Among households using other types of fuel, most cook on an open stove without a chimney or hood (94 percent) in a kitchen area within the dwelling unit. In the majority of dwellings (81 percent), the kitchen is separated from other rooms in the dwelling. 22 | Characteristics of Households Table 2.7 Cooking arrangements by residence Percent distribution of households by type of cooking fuel, type of fire/stove, and location of cooking area according to urban-rural residence and place of residence and percent distribution of the de jure population by cooking arrangements, Egypt 2005 Lower Egypt Upper Egypt Cooking arrangements Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure popu- lation Type of cooking fuel Electricity 0.2 0.1 0.0 0.2 0.5 0.1 0.1 0.1 0.2 0.0 0.2 0.2 LPG 76.2 93.5 67.0 93.1 80.9 98.4 86.6 85.3 87.3 95.6 85.2 87.3 Natural gas 22.4 0.1 31.9 5.6 18.2 0.1 4.5 12.0 0.1 1.6 10.8 8.7 Biogas 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 Kerosene 1.0 5.5 0.7 0.9 0.3 1.1 7.8 2.3 11.0 1.8 3.4 3.3 Charcoal/coal 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Wood/straw/shrubs/grass/crops 0.0 0.4 0.0 0.1 0.0 0.1 0.5 0.1 0.8 0.2 0.2 0.3 Dung/other 0.0 0.2 0.0 0.0 0.0 0.0 0.3 0.0 0.5 0.1 0.1 0.2 Missing 0.2 0.1 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.5 0.1 0.0 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 Type of fire/stove1 Open without chimney/hood 92.7 93.7 (94.6) 83.6 * 84.2 94.7 93.3 94.9 * 93.5 93.3 Open with chimney/hood 4.4 5.1 (0.0) 14.4 * 13.7 4.1 4.7 4.1 * 5.0 5.6 Closed with chimney 0.2 0.2 (0.0) 2.0 * 2.1 0.0 0.3 0.0 * 0.2 0.1 Missing 2.7 1.0 (5.4) 0.0 * 0.0 1.1 1.8 1.1 * 1.2 0.9 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 118 704 35 87 7 79 693 72 621 4 817 4,084 Location of cooking area Within dwelling 99.5 98.6 99.6 98.4 99.2 98.0 99.6 99.8 99.4 98.3 99.1 99.2 In separate room 91.0 71.0 93.3 86.9 93.9 83.9 66.0 84.6 55.0 84.2 80.6 78.3 Not separated 8.6 27.6 6.3 11.5 5.3 14.1 33.6 15.1 44.4 14.0 18.5 20.8 In separate building 0.3 1.0 0.2 1.4 0.7 1.7 0.2 0.1 0.3 0.8 0.7 0.7 Outdoors 0.0 0.2 0.0 0.1 0.0 0.2 0.1 0.0 0.1 0.2 0.1 0.1 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 Don’t know/missing 0.2 0.2 0.3 0.1 0.1 0.2 0.1 0.1 0.1 0.5 0.2 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Refers to households reporting use of biomass fuels Other Housing Characteristics Table 2.8 shows the distribution of households according to other dwelling characteristics for which information was obtained in the 2005 EDHS. The results indicate that the majority of urban households (85 percent) live in apartments, whereas the majority of rural households (64 percent) occupy free-standing houses. Eighty-five percent of rural households own their dwelling. Ownership is less common in urban areas, particularly in the Urban Governorates, where slightly less than half of households own their dwelling. Virtually all households in Egypt have electricity, with households in the Frontier Governorates more likely to report that they do not have it than households in other areas. Characteristics of Households | 23 Table 2.8 Dwelling characteristics by residence Percent distribution of households by type and tenure of dwelling, availability of electricity, type of flooring and windows, and number of rooms and mean number of rooms and persons per room according to urban-rural residence and percentage of de jure population by dwelling characteristics, Egypt 2005 Lower Egypt Upper Egypt Dwelling characteristic Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure popu- lation Type of dwelling Apartment 84.5 33.1 93.3 53.6 83.6 40.6 42.0 72.6 24.1 39.7 57.7 49.3 Free standing house 13.2 64.4 3.7 45.2 15.8 57.9 54.6 24.7 72.2 59.2 39.9 48.7 Other 2.3 2.4 3.0 1.2 0.6 1.5 3.3 2.8 3.6 1.1 2.4 2.0 Tenure Owned/Owned jointly 52.0 85.4 46.0 73.5 52.6 82.5 78.1 59.8 88.8 81.0 69.4 74.4 Rented 42.4 5.7 50.2 16.4 38.8 6.7 15.4 34.2 4.4 16.9 23.3 19.2 Other/missing 5.6 8.9 3.8 10.1 8.5 10.8 6.5 6.0 6.8 2.1 7.3 6.4 Electricity Yes 99.8 99.1 99.8 99.7 100.0 99.6 99.1 99.8 98.6 94.6 99.4 99.4 No 0.2 0.9 0.2 0.3 0.0 0.4 0.9 0.2 1.4 5.4 0.6 0.6 Flooring Ceramic/marble tiles 18.3 4.1 22.6 8.7 16.3 5.5 6.5 13.6 2.3 10.7 10.9 9.0 Cement tiles 69.7 40.5 67.0 57.0 73.2 50.0 44.3 71.0 28.7 54.0 54.5 50.4 Cement 6.2 35.3 4.4 27.0 5.7 36.3 24.7 9.0 33.8 28.5 21.3 24.9 Carpet/vinyl/polished wood 3.9 0.8 5.5 2.1 4.2 1.2 0.6 1.3 0.2 1.2 2.3 1.9 Wood/planks 0.1 0.0 0.1 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.1 Earth/sand 1.6 19.3 0.3 5.0 0.5 7.0 23.8 4.9 34.8 5.4 10.8 13.6 Other/missing 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.0 0.1 0.1 0.1 Windows All glass 89.2 56.6 94.9 79.4 90.7 74.5 50.8 78.9 34.3 77.3 72.2 67.3 With and without glass 4.8 15.5 2.5 12.2 6.9 14.5 12.8 6.4 16.6 10.0 10.3 12.9 All without glass 4.6 25.4 1.3 7.5 1.7 10.0 32.6 12.3 44.6 12.3 15.4 17.9 No window openings 1.2 2.4 0.9 0.7 0.4 0.8 3.6 2.3 4.4 0.2 1.8 1.6 Other/missing 0.3 0.1 0.3 0.2 0.3 0.1 0.2 0.2 0.2 0.1 0.2 0.2 Number of rooms1 1-2 11.4 14.3 11.5 9.6 8.9 9.9 17.7 13.8 20.0 6.1 12.9 10.9 3-4 77.9 63.5 80.0 71.6 77.3 69.1 63.5 75.5 56.5 66.0 70.4 66.2 5+ 10.5 22.0 8.3 18.6 13.7 20.8 18.5 10.5 23.2 27.6 16.5 22.6 Don’t know/missing 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.3 0.3 0.2 0.2 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 Mean rooms per household 3.5 3.8 3.4 3.8 3.7 3.9 3.6 3.4 3.7 4.0 3.7 3.9 Mean persons per room 1.3 1.6 1.3 1.3 1.2 1.4 1.7 1.5 1.8 1.5 1.5 1.8 1 Number of rooms does not include kitchens, hallways and bathrooms. With regard to flooring, more than eight in ten households live in dwellings with a tile (ceramic or cement) or cement floor. About 10 percent have a dirt (earth/sand) floor in their dwelling. Rural households are more likely than urban households to live in dwellings with a dirt floor (19 percent and 2 percent, respectively). Dirt floors are around five times more common in rural Upper Egypt than in rural Lower Egypt (35 percent and 7 percent, respectively). Almost all dwellings had some type of window opening. Except in rural Upper Egypt, seven in ten or more households have glass windows throughout their dwelling. In rural Upper Egypt, 45 percent of the households lived in dwellings without any glass windows, and four percent lived in dwellings without a window opening. 24 | Characteristics of Households Table 2.8 also shows that 13 percent of households live in dwellings with one or two rooms, 70 percent have three or four rooms, and 17 percent have five rooms or more. The mean number of rooms per household is 3.7, and there is an average of 1.5 persons per room. Rural households are more crowded than urban households. The mean number of persons per room is 1.3 in urban areas, compared to 1.6 persons in rural areas. 2.4 HOUSEHOLD POSSESSIONS Table 2.9 provides information on household ownership of durable goods and other possessions. More than nine in ten EDHS households own a television (color or black and white), and more than eight in ten households own a radio. Fifteen percent of households have a satellite dish, and 12 percent a video or DVD player. At least half of households have a telephone, with one-quarter having a mobile phone. Eleven percent of households own a computer. A majority of Egyptian households own most basic appliances. More than nine in ten have a stove (gas/electric) and a washing machine (automatic/other). More than eight in ten households own an electric fan and a refrigerator, and more than one-third have a water heater. Fewer households possess the other appliances and electric goods shown in Table 2.9; less than 10 percent have a sewing machine or freezer and less than five percent have an air conditioner or dishwasher. Considering household furnishings, 90 percent or more of households own a bed, sofa and hanging lamp, and 85 percent or more have a chair and table. Six in ten household own a tablia, and around a third have a kolla/zeer. At least one household member owns a watch in 90 percent of the households. Urban households are more likely to have most of these items than rural households. For example, 73 percent of households in urban areas have a telephone (landline or cell) compared to 40 percent of households in rural areas. Rates of ownership of various household possessions also differ by place of residence, with higher rates of ownership for most items reported among households in the Urban Governorates, Lower Egypt, and the Frontier Governorates than in Upper Egypt. For most items, households in rural Upper Egypt have the lowest rates of ownership. Table 2.9 also includes information on household ownership of a means of transportation. Animal carts are owned more often by rural than urban households (8 percent and 1 percent). Relatively few households have a motorcycle, and rates of ownership of bicycles vary from five percent in the Urban Governorates to 20 percent in rural Upper Egypt. Overall, seven percent of households own a car, van, or truck, with the highest rate of ownership in the Urban Governorates (14 percent) and the lowest rate in rural Upper Egypt (3 percent). As expected, households in rural areas are significantly more likely than urban households to own a farm or other land. Twenty-eight percent of rural households own a farm or other land, compared to only 3 percent of urban households. There is also considerable variation in the proportion reporting that they own farm animals, from 54 percent of households in rural Upper Egypt to four percent of households in the Urban Governorates. Table 2.9 also shows that comparatively few households have bank/savings accounts (11 per- cent). Urban households, especially households living in the Urban Governorates, are more than three times as likely as rural households to have an account. Characteristics of Households | 25 Table 2.9 Household possessions by residence Percentage of households possessing various household effects/possessions, means of transportation, property, farm animals, and bank/savings account according to urban-rural residence and place of residence, and percentage of de jure population by household possessions, Egypt 2005 Lower Egypt Upper Egypt Household effect/possession Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total house- holds Total de jure popu- lation Household effects Radio 90.2 79.8 90.6 87.8 92.4 85.9 77.9 87.5 72.3 83.5 84.8 84.5 Television 95.8 90.1 96.8 93.2 96.0 91.9 90.2 94.4 87.8 91.2 92.8 94.0 Black and white TV 10.5 27.5 6.5 19.2 12.3 22.1 27.3 15.4 34.3 9.2 19.3 21.4 Color TV 89.3 67.9 92.8 79.4 89.8 74.9 68.0 83.4 59.1 83.7 78.2 78.2 Video/DVD 20.9 4.1 25.5 8.0 17.3 4.0 8.9 17.0 4.1 15.9 12.2 10.8 Telephone 73.4 39.9 78.9 51.2 70.8 42.7 47.8 67.1 36.5 62.6 56.0 54.6 Landline telephone 70.0 37.7 75.1 48.2 67.4 39.9 45.8 64.3 35.0 56.1 53.2 52.0 Mobile telephone 40.0 11.2 47.3 20.3 36.7 13.3 17.1 31.6 8.5 31.6 25.0 23.1 Satellite dish 24.2 7.0 27.6 12.2 22.3 7.9 11.3 20.5 5.9 22.6 15.3 13.9 Computer 19.0 2.6 24.2 7.1 16.0 3.2 6.3 13.9 1.8 6.9 10.5 9.4 Sewing machine 9.8 6.0 10.9 7.5 9.2 6.8 6.4 8.9 4.9 6.5 7.8 8.1 Electric fan 91.9 83.0 92.1 85.4 91.6 82.7 86.7 92.2 83.4 81.5 87.3 87.6 Air conditioner 6.7 0.7 8.8 1.7 4.0 0.7 2.6 6.1 0.6 1.8 3.6 2.9 Refrigerator 94.4 77.7 95.6 89.2 95.7 86.4 75.9 91.3 66.9 86.4 85.7 85.3 Freezer 10.6 1.9 14.0 4.8 9.7 2.6 2.7 5.7 0.9 9.7 6.0 5.1 Water heater 59.2 15.5 67.5 31.6 58.4 20.0 23.6 46.7 10.0 41.5 36.4 31.6 Dishwasher 2.6 0.2 3.7 0.8 2.2 0.2 0.5 1.4 0.1 0.3 1.3 1.1 Washing machine 96.4 88.1 96.7 95.2 97.9 94.1 85.9 95.0 80.6 88.0 92.1 92.5 Automatic 37.7 5.5 45.2 15.1 34.4 6.8 13.3 29.2 4.0 20.7 20.9 17.7 Other 73.2 85.5 66.9 87.6 79.5 91.1 78.2 77.5 78.7 75.4 79.6 82.6 Gas/electric stove 98.8 93.7 99.1 98.9 99.7 98.6 91.2 97.4 87.6 97.4 96.1 96.1 Bed 99.3 96.9 99.4 99.2 99.7 99.0 96.0 99.0 94.2 98.0 98.1 98.2 Sofa 97.2 93.8 97.7 95.8 97.6 95.0 94.0 96.7 92.4 83.2 95.4 95.5 Hanging lamp 85.2 94.3 83.5 90.9 83.8 94.0 92.6 89.4 94.6 87.0 89.9 91.3 Table 94.3 82.9 96.1 86.4 93.4 83.4 86.3 92.9 82.5 79.4 88.4 87.9 Tablia 47.6 75.2 40.3 64.1 48.1 70.9 72.6 59.3 80.4 47.8 61.9 67.3 Chair 92.0 78.4 93.5 86.0 93.5 82.7 79.0 89.0 73.2 73.6 84.9 83.5 Kolla/zeer 11.4 48.9 7.0 32.1 13.1 40.2 43.7 16.6 59.5 30.6 30.9 36.1 Watch 96.0 84.7 96.5 93.4 97.8 91.5 82.5 93.4 76.1 92.0 90.1 90.2 Means of transportation Animal-drawn cart 0.8 7.9 0.5 5.9 0.9 8.0 5.4 1.2 7.8 6.7 4.5 6.9 Bicycle 9.4 19.2 5.1 16.8 11.8 19.0 17.7 14.2 19.7 6.0 14.5 17.1 Motorcycle/scooter 1.4 1.7 1.9 1.6 0.6 2.1 1.3 1.4 1.3 0.7 1.6 1.8 Car/van/truck 10.9 3.0 14.1 5.1 9.6 3.2 4.2 6.8 2.6 11.6 6.7 6.4 Farm animals 7.8 46.9 3.5 31.4 9.1 41.0 38.9 13.1 54.1 28.3 28.2 35.8 Agricultural land 3.3 27.6 2.0 20.6 4.0 27.7 19.0 4.7 27.4 15.7 16.0 20.9 Bank/savings account 16.6 5.4 20.3 8.4 14.7 5.7 7.7 12.4 5.0 12.1 10.8 9.6 None of the above 0.1 0.1 0.1 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.0 Number of households 10,533 11,439 4,704 9,031 2,724 6,307 8,029 2,968 5,061 208 21,972 107,300 2.5 HOUSEHOLD WEALTH Information on household assets was used to create an index representing the wealth of the households interviewed in the EDHS. The wealth index is a proxy for long-term standard of living of the household. It is based on data collected in the EDHS household questionnaire the household’s ownership of consumer items such as a fan to a television and car; dwelling characteristics such as flooring material; type of drinking water source; toilet facilities; and other characteristics that are related to wealth status. Each household asset for which information is collected is assigned a weight or factor score generated 26 | Characteristics of Households through principal components analysis. The resulting asset scores are standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. These standardized scores are then used to create the break points that define wealth quintiles. Each household is assigned a standardized score for each asset, where the score differs depending on whether or not the household owned that asset (or, in the case of sleeping arrangements, the number of people per room). These scores are summed by household, and individuals are ranked according to the total score of the household in which they reside. The sample is then divided into population quintiles, i.e., five groups with the same number of individuals in each. At the national level, approximately 20 percent of the household population is in each wealth quintile. A single asset index is developed on the basis of data from the entire country sample and used in all the tabulations presented. Separate asset indices are not prepared for rural and urban population groups on the basis of rural or urban data, respectively. Wealth quintiles are expressed in terms of quintiles of individuals in the population, rather than quintiles of individuals at risk for any one health or population indicator. (Thus, for example, the quintile rates for infant mortality refer to the infant mortality rates per 1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live births or newly born infants, who consti- tute the only members of the population at risk of mortality during infancy.) The wealth index has been compared against both poverty rates and gross domestic product per capita for India, and against expenditure data from household surveys in Nepal, Pakistan and Indonesia (Filmer and Pritchett, 1998) and Guatemala (Rutstein 1999). The evidence from those studies suggests that the assets index is highly comparable to conventionally measured consumption expenditures. Table 2.10 shows the distribution of the de jure household population into five wealth levels (quintiles) based on the wealth index by residence. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. A much larger proportion of the Egyptian population in urban areas than in rural areas falls in the highest wealth index group (42 percent and 5 percent, respectively). In turn, more of the rural than urban population is found in the lowest wealth index group (31 percent and 5 percent, respectively). Considering place of residence, slightly over half of the population in the Urban Governorates is in the highest wealth quintile compared to 12 percent of the population in Upper Egypt and 15 percent in Lower Egypt. The population in rural Upper Egypt is especially concentrated at the lower end of the wealth index with 73 percent of the population in the two lowest wealth quintiles. Table 2.10 Wealth quintiles by residence Percent distribution of the de jure household population by wealth quintiles, according to urban-rural residence and place of residence, Egypt 2005 Lower Egypt Upper Egypt Wealth quintiles Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Lowest 4.5 30.9 2.8 15.0 1.6 19.7 32.2 8.6 42.7 30.0 20.0 Second 7.5 28.8 5.0 22.0 6.0 27.5 24.6 12.2 30.1 16.6 20.0 Middle 15.2 23.3 11.0 25.0 16.0 28.2 18.9 20.6 18.2 16.2 20.0 Fourth 30.8 12.5 30.1 23.1 36.4 18.5 12.7 27.4 6.1 16.4 20.0 Highest 41.9 4.5 51.1 14.9 40.0 6.1 11.6 31.2 2.9 20.7 20.0 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 44,360 62,940 18,890 43,644 11,317 32,327 43,554 13,420 30,134 1,212 107,300 Background Characteristics of Respondents | 27 BACKGROUND CHARACTERISTICS OF RESPONDENTS 3 This chapter provides a profile of the ever-married women who were interviewed in the 2005 Egypt DHS. First, information is presented on a number of basic characteristics of the EDHS respondents including age, resi- dence, education, and work status. Then the chapter explores in more depth the women’s educational and employment status, their par- ticipation in household decision-making, and control over earnings. 3.1 BACKGROUND CHARACTERISTICS Table 3.1 presents the distribution of eligible women by age, marital status, urban- rural residence, place of residence, educa- tional level, and wealth quintile. As noted in Chapter 1, ever-married women age 15-49 who were usual residents or present in the household on the night before the inter- viewer’s visit were eligible to be interviewed in the 2005 EDHS. Among the ever-married women in the sample, 93 percent are currently married, four percent widowed, and three percent divorced or separated. Looking at the age distribution in Table 3.1, around two-fifths of 2005 EDHS respondents are under age 30, and more than one-quarter are age 40 and over. There are fewer women in the 15-19 and 20-24 age groups than in the 25-29 cohort. This somewhat older age pattern is the result of the inclusion of only ever-married women in the sample and the increasing tendency to delay marriage until older ages in Egypt. The changes in marriage patterns are described in more detail in Chapter 8. The majority of the women (59 per- cent) are living in rural areas. Considering place of residence, 17 percent of the women are from the Urban Governorates, 43 percent from Lower Egypt, 39 percent from Upper Egypt, and one percent from the Frontier Governorates. Table 3.1 Background characteristics of respondents Percent distribution of ever-married women 15-49 by background characteristics, Egypt 2005 Number of women Background characteristic Weighted percent Weighted Unweighted Marital status Married 93.4 18,187 18,134 Widowed 3.9 765 792 Divorced 2.0 394 413 Separated 0.7 128 135 Age 15-19 4.1 803 858 20-24 15.2 2,968 3,008 25-29 19.4 3,785 3,780 30-34 16.5 3,209 3,189 35-39 16.4 3,191 3,186 40-44 14.7 2,859 2,827 45-49 13.7 2,659 2,626 Urban-rural residence Urban 41.3 8,033 8,095 Rural 58.7 11,441 11,379 Place of residence Urban Governorates 16.9 3,293 3,538 Lower Egypt 43.2 8,410 5,903 Urban 11.3 2,199 1,553 Rural 31.9 6,211 4,350 Upper Egypt 38.8 7,552 9,132 Urban 12.4 2,411 2,471 Rural 26.4 5,141 6,661 Frontier Governorates 1.1 218 901 Education No education 34.6 6,740 6,934 Some primary 11.3 2,197 2,214 Primary complete/some secondary 14.0 2,719 2,756 Secondary complete/higher 40.1 7,818 7,570 Wealth quintile Lowest 18.3 3,565 4,227 Second 19.4 3,778 3,882 Middle 20.2 3,931 3,669 Fourth 21.2 4,137 3,791 Highest 20.9 4,063 3,905 Total 100.0 19,474 19,474 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 28 | Background Characteristics of Respondents The educational level of the 2005 EDHS respondents varies considerably. Around one-third of the women never attended school, while 40 percent have completed at least the secondary level. Looking at the wealth quintiles, 18 percent of women fall in the lowest quintile, and around two- thirds of women are distributed almost equally across the middle, fourth and highest wealth quintiles. 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS An overview of the relationship between women’s educational level and other background characteristics is provided in Table 3.2. As expected, the level of education decreases with increasing age among respondents age 25 and over. However, women age 25-29 have a higher level of education than the younger women in the sample. This pattern is somewhat unexpected because, as described in Chapter 2, participation in schooling has been steadily rising among Egyptian women. The explanation lies in the fact that the EDHS sample included only ever-married women. Women who marry early typically leave school at a younger age than women who marry later. Thus, EDHS respondents in the 15-19 and 20-24 age groups include a disproportionate number of less-educated women in comparison with older cohorts. Table 3.2 Educational attainment by background characteristics Percent distribution of ever-married women by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Egypt 2005 Highest level of schooling Background characteristic No education Some primary Com- pleted primary1 Some secondary Completed secondary2 More than secondary Total Number of women Median years of schooling Age 15-19 31.9 7.1 5.0 21.9 32.6 1.6 100.0 803 6.5 20-24 26.9 7.7 4.5 12.8 40.0 8.1 100.0 2,968 7.9 25-29 24.2 7.5 5.4 11.5 37.7 13.8 100.0 3,785 10.1 30-34 30.2 9.2 2.1 12.5 34.4 11.6 100.0 3,209 8.4 35-39 40.0 12.1 3.6 7.0 28.4 9.0 100.0 3,191 4.5 40-44 43.1 15.8 5.3 5.3 19.4 11.0 100.0 2,859 2.7 45-49 48.6 18.5 5.5 3.8 13.6 10.1 100.0 2,659 0.7 Urban-rural residence Urban 19.7 9.9 4.5 10.9 36.0 19.0 100.0 8,033 10.5 Rural 45.1 12.3 4.3 8.6 25.4 4.3 100.0 11,441 2.3 Place of residence Urban Governorates 18.0 8.5 5.1 12.4 33.6 22.4 100.0 3,293 10.7 Lower Egypt 30.2 12.0 4.6 8.6 35.4 9.1 100.0 8,410 7.1 Urban 15.4 10.9 4.5 8.7 41.5 18.9 100.0 2,199 10.8 Rural 35.4 12.4 4.7 8.6 33.2 5.7 100.0 6,211 5.0 Upper Egypt 46.7 11.8 3.8 9.3 21.9 6.5 100.0 7,552 1.7 Urban 25.5 10.9 3.7 10.7 34.5 14.7 100.0 2,411 9.3 Rural 56.6 12.2 3.8 8.7 16.0 2.7 100.0 5,141 0.0 Frontier Governorates 37.8 6.8 7.0 11.0 29.2 8.2 100.0 218 5.5 Wealth quintile Lowest 70.7 12.7 3.2 5.9 7.2 0.3 100.0 3,565 0.0 Second 50.6 15.5 4.8 9.3 18.6 1.1 100.0 3,778 0.0 Middle 35.1 12.8 5.3 12.1 31.5 3.2 100.0 3,931 4.9 Fourth 17.5 11.2 5.6 12.1 44.0 9.6 100.0 4,137 10.2 Highest 5.0 4.7 3.0 8.0 43.9 35.4 100.0 4,063 11.8 Total 34.6 11.3 4.4 9.6 29.8 10.4 100.0 19,474 5.6 1 Completed 5 grades at the primary level 2 Completed 3 grades at the secondary level Background Characteristics of Respondents | 29 Urban women are more highly educated than those from rural areas. Among urban women, 55 percent have completed at least a secondary education, compared to 30 percent of rural women. Educational levels are lowest in rural Upper Egypt, where 57 percent of the women have never gone to school. The highest educational levels are found in Urban Lower Egypt and the Urban Governorates, where only 15 percent and 18 percent, respectively, of women have never attended school. Educational attainment rises with the wealth quintile. Eight in ten women in the highest wealth quintile have completed secondary school or higher, while around seven in ten women in the lowest quintile have never attended school. 3.3 LITERACY ASSESSMENT The 2005 EDHS assessed literacy levels among women who had never been to school or who had attended only the primary level by asking them to read a couple of simple sentences from a card. To avoid possible bias in households where more than one eligible woman was interviewed, the EDHS teams used two cards, each with a different set of sentences. The sentences on the cards were selected from primary school Arabic textbooks. In addition to assessing literacy, information was collected from women with a primary education or less on whether they had ever attended any literacy program, i.e., any program (outside of primary school) that involved learning to read or write. Table 3.3 shows that the majority of respondents asked to read simple sentences during the EDHS interview could not read at all or could read only part of the sentences. This is not surprising in view of the relatively large proportion of EDHS respondents who never attended school (35 percent) or have less than a primary education (11 percent). The proportion that is illiterate is somewhat higher among respondents age 15-19 than among those in the 20-24 and 25-29 age groups. Again this pattern is related to the fact that the EDHS sample included only ever-married women. Women in their teens who are married are more likely to have never attended school or to have left school early than other women. The strong association between residence and literacy observed in Table 3.3 is clearly a reflection of residential differences in educational levels. Rural women are more than twice as likely as urban women to be unable to read at all. Illiteracy levels are markedly higher among women from Upper Egypt, especially those living in rural areas, than among other women. Table 3.3 also shows that the level of illiteracy decreases with increasing wealth. Seven percent of women in the highest wealth quintile are illiterate compared to around 77 percent of women in the lowest quintile. Literacy programs are one means of increasing the proportion of women who are able to read or write. Table 3.3 shows that 13 percent of women with a primary education or less have ever attended a literacy program. Younger women and women living in urban areas are somewhat more likely than other women to have taken part in a literacy program. Even among these groups, however, only a relatively small proportion participated in a literacy program. 30 | Background Characteristics of Respondents Table 3.3 Literacy by background characteristics Percent distribution of ever-married women by level of schooling and literacy and percentage literate and percentage attending literacy programs, according to background characteristics, Egypt 2005 No schooling/attended primary Background characteristic Attended preparatory school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Total Number of women Percent- age literate1 Percent- age who attended literacy program2 Age 15-19 56.1 3.2 4.4 36.3 0.0 0.0 100.0 803 63.7 20.0 20-24 60.9 2.4 6.1 30.3 0.1 0.2 100.0 2,968 69.3 22.1 25-29 62.9 2.5 5.4 28.9 0.0 0.3 100.0 3,785 70.8 16.9 30-34 58.5 2.2 4.6 34.5 0.0 0.2 100.0 3,209 65.3 12.6 35-39 44.4 2.6 6.5 46.3 0.1 0.1 100.0 3,191 53.5 11.9 40-44 35.7 4.1 7.7 52.2 0.2 0.1 100.0 2,859 47.5 10.2 45-49 27.4 5.9 8.1 58.1 0.2 0.3 100.0 2,659 41.4 7.1 Urban-rural residence Urban 65.9 3.2 6.6 24.0 0.1 0.2 100.0 8,033 75.8 17.5 Rural 38.3 3.2 5.9 52.2 0.1 0.2 100.0 11,441 47.4 11.2 Place of residence Urban Governorates 68.4 3.1 6.7 21.5 0.1 0.2 100.0 3,293 78.2 21.3 Lower Egypt 53.2 2.9 5.7 38.0 0.1 0.2 100.0 8,410 61.7 10.2 Urban 69.2 3.9 5.7 21.1 0.0 0.1 100.0 2,199 78.8 13.0 Rural 47.5 2.5 5.7 44.0 0.1 0.2 100.0 6,211 55.7 9.6 Upper Egypt 37.8 3.5 6.5 51.8 0.2 0.2 100.0 7,552 47.8 13.6 Urban 59.9 2.7 7.2 29.9 0.1 0.1 100.0 2,411 69.8 17.0 Rural 27.4 3.9 6.2 62.1 0.2 0.2 100.0 5,141 37.5 12.7 Frontier Governorates 48.4 3.2 8.8 39.3 0.2 0.0 100.0 218 60.5 6.9 Wealth quintile Lowest 13.4 2.3 6.3 77.4 0.2 0.4 100.0 3,565 22.0 11.4 Second 29.1 3.9 7.0 59.8 0.2 0.0 100.0 3,778 40.0 12.1 Middle 46.8 3.5 7.6 41.8 0.2 0.1 100.0 3,931 57.9 14.6 Fourth 65.8 3.8 7.2 23.0 0.0 0.2 100.0 4,137 76.8 14.5 Highest 87.3 2.4 2.9 7.2 0.0 0.2 100.0 4,063 92.6 15.8 Total 49.7 3.2 6.2 40.6 0.1 0.2 100.0 19,474 59.1 13.0 1 Refers to women who attended preparatory school or higher and women who can read a whole sentence or part of a sentence. The base population for the rate excludes blind/visually impaired women and other women whose literacy was not assessed. 2 The base population for the percentage excludes women attending secondary school or higher. 3.4 EXPOSURE TO MASS MEDIA The 2005 EDHS collected information on the exposure of women to both broadcast and print media. These data are important because they provide some indication of the extent to which Egyptian women are regularly exposed to the mass media, which are extensively used in Egypt to convey family planning and health messages to the population. The level of regular exposure of EDHS respondents to broadcast and print is shown in Figure 3.1. More than 90 percent of respondents watch television at least once a week, about three-quarters listen to radio at least once a week, and slightly less than one in five women read a newspaper or magazine at least once a week. Only 16 percent of women report regular exposure to all three media, and three percent have no exposure to print or broadcast media. Background Characteristics of Respondents | 31 According to the results presented in Table 3.4, women living in urban areas are somewhat more likely to be exposed to the mass media channels, particularly newspapers or magazines, than rural women. Overall, one-quarter of urban women are exposed to all three media at least once a week, compared to less than 10 percent of rural women. Considering place of residence, the majority of women in every residential category watches television and listens to the radio at least once a week. The percentage that reads a newspaper or magazine at least once a week varies considerably, from 6 percent in rural Upper Egypt to 34 percent in the Urban Governorates. Lack of exposure to any of the three media varies from around two percent of women in the Urban Governorates and urban Lower Egypt to nine percent of women in the Frontier Governorates. The percentages reporting exposure to each of the three mass media rise with the woman’s education level, with the increase being especially marked for print media. There is a strong association between wealth and exposure to mass media. Considering exposure to all three media, more than two- fifths of women in the highest wealth quintile report they watch television, listen to the radio and read a newspaper or magazine at least once per week while only one percent of women in the lowest quintile report regular exposure to all three media. 94 72 18 16 3 Television Radio Print All three media No media Figure 3.1 Exposure to Media EDHS 2005 Percentage of ever-married women 15-49 exposed to media at least once per week 32 | Background Characteristics of Respondents Table 3.4 Exposure to mass media by background characteristics Percentage of ever-married women 15-49 who are exposed to specific media weekly by selected background characteristics, Egypt 2005 Background characteristic Watches television at least once a week Listens to the radio at least once a week Reads a magazine/ newspaper at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 93.9 67.0 8.7 7.7 3.8 803 20-24 94.4 70.2 14.7 12.4 3.0 2,968 25-29 95.7 71.5 19.0 16.3 2.5 3,785 30-34 94.7 72.4 19.7 16.3 2.6 3,209 35-39 94.4 72.2 19.4 16.6 3.4 3,191 40-44 93.4 72.6 21.2 17.7 3.7 2,859 45-49 93.6 72.7 17.9 15.4 3.9 2,659 Urban-rural residence Urban 96.4 75.2 30.1 25.1 1.6 8,033 Rural 93.0 69.2 10.0 8.8 4.2 11,441 Place of residence Urban Governorates 96.5 73.3 34.0 27.1 1.5 3,293 Lower Egypt 94.8 79.5 18.4 16.5 2.7 8,410 Urban 96.7 81.5 32.4 28.8 1.6 2,199 Rural 94.2 78.8 13.5 12.2 3.0 6,211 Upper Egypt 93.3 62.8 11.2 9.3 4.3 7,552 Urban 96.5 72.6 22.8 19.1 1.4 2,411 Rural 91.8 58.1 5.8 4.6 5.6 5,141 Frontier Governorates 87.9 57.2 20.3 18.3 9.0 218 Education No education 91.1 61.4 0.4 0.3 6.2 6,740 Some primary 93.2 69.1 3.9 3.1 3.4 2,197 Primary complete/some secondary 95.8 73.9 14.0 11.3 1.8 2,719 Secondary complete/ higher 97.2 80.6 39.3 33.6 0.9 7,818 Wealth quintile Lowest 85.5 52.3 1.9 1.4 10.3 3,565 Second 94.4 67.2 5.0 4.1 3.0 3,778 Middle 95.9 76.0 10.5 9.3 1.7 3,931 Fourth 97.2 79.3 21.5 18.9 1.0 4,137 Highest 98.0 81.0 49.2 41.2 0.6 4,063 Total 94.4 71.7 18.3 15.5 3.2 19,474 3.5 EMPLOYMENT STATUS In the 2005 EDHS, respondents were asked a number of questions in order to identify women who were working at the time of the survey and those who had been employed in the 12 months prior to the survey if they were not working at the time of the survey. Women who were working at the time they were interviewed were asked additional questions about the kind of work they were doing and whether they were paid in cash. Current Employment Table 3.5 shows the percent distribution of 2005 EDHS respondents according to current and recent employment. Overall, 22 percent of women are currently engaged in some economic activity. Most of the women who are not working do not report recent work experience; only one percent of the respondents who were not working at the time of EDHS interview had had a job during the 12-month period before the survey. Background Characteristics of Respondents | 33 Table 3.5 shows that women in the 40-44 age group are more likely to be currently employed than older or younger women. The comparatively small proportion working among women under age 30 and especially women under age 25 may be related to the greater childcare responsibilities. With regard to the other employment differentials presented in Table 3.5, women living in urban Lower Egypt, women who completed secondary school or higher, and women in the highest wealth quintile were much more likely to be employed at the time of the survey than other women. Table 3.5 Employment status by background characteristics Percent distribution of ever-married women by employment status, according to background characteristics, Egypt 2005 Employed in the 12 months prior to the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months prior to the survey Total Number of women Age 15-19 6.9 1.3 91.6 100.0 803 20-24 9.0 1.0 89.9 100.0 2,968 25-29 16.2 0.5 83.2 100.0 3,785 30-34 23.3 0.7 76.0 100.0 3,209 35-39 26.7 0.8 72.6 100.0 3,191 40-44 31.6 0.4 68.0 100.0 2,859 45-49 28.3 0.5 71.2 100.0 2,659 Marital status Married 20.9 0.7 78.4 100.0 18,187 Divorced/separated/widowed 31.0 0.6 68.5 100.0 1,287 Number of living children 0 15.9 1.8 82.2 100.0 1,936 1-2 19.3 0.5 80.1 100.0 7,208 3-4 26.0 0.6 73.5 100.0 7,053 5+ 20.1 0.6 79.3 100.0 3,277 Urban-rural residence Urban 23.8 0.6 75.6 100.0 8,033 Rural 20.0 0.7 79.3 100.0 11,441 Place of residence Urban Governorates 23.7 0.7 75.5 100.0 3,293 Lower Egypt 25.3 0.8 73.9 100.0 8,410 Urban 28.6 0.7 70.7 100.0 2,199 Rural 24.1 0.9 75.0 100.0 6,211 Upper Egypt 16.5 0.5 83.0 100.0 7,552 Urban 19.4 0.3 80.4 100.0 2,411 Rural 15.1 0.6 84.2 100.0 5,141 Frontier Governorates 18.9 0.0 81.1 100.0 218 Education No education 18.0 0.7 81.3 100.0 6,740 Some primary 14.1 0.7 85.1 100.0 2,197 Primary complete/some secondary 8.9 0.5 90.6 100.0 2,719 Secondary complete/higher 31.0 0.7 68.3 100.0 7,818 Wealth quintile Lowest 22.2 1.2 76.6 100.0 3,565 Second 16.6 0.8 82.6 100.0 3,778 Middle 16.3 0.5 83.2 100.0 3,931 Fourth 20.0 0.6 79.4 100.0 4,137 Highest 32.1 0.4 67.5 100.0 4,063 Total 21.5 0.7 77.8 100.0 19,474 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 34 | Background Characteristics of Respondents Occupation In the EDHS 2005, women who indicated that were working or had worked within the year before the survey were asked about the kind of work that they did. Their response was recorded exactly as they gave it and was the basis for the coding of occupation that occurred after the survey in the central office. As Figure 3.2 shows, the majority of women who are currently working are employed in nonagricultural occupations. About half of working women are in professional, technical, and managerial positions or in clerical occupations. An additional 17 percent are in sales and services, and five percent work in jobs categorized as skilled manual labor. Slightly more than one-fourth of working women are involved in some type of agricultural activity. Figure 3.2 Occupation among Working Women EDHS 2005 Agricultural 26% Professional/ technical/ managerial 36% Unskilled manual 3% Skilled manual 5% Sales and services 17% Clerical 13% Table 3.6 looks at the differences in the occupational profile of working women according to selected background characteristics. As expected, the proportions involved in professional, technical and managerial occupations and in clerical positions are much greater among urban women than rural women. These proportions also rise rapidly with both education and wealth. Overall, more than eight in ten working women who have attained a secondary or higher education or fall in the highest wealth quintile are employed in professional, technical, managerial or clerical occupations. Background Characteristics of Respondents | 35 Table 3.6 Occupation by background characteristics Percent distribution of ever-married women employed in the 12 months preceding the survey by occupation, according to background characteristics, Egypt 2005 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Un- skilled manual Agricul- ture Missing Total Number of women Age 15-19 11.5 2.9 11.9 2.5 9.2 62.1 0.0 100.0 66 20-24 24.1 7.0 15.7 8.1 4.3 40.8 0.0 100.0 298 25-29 40.8 6.9 18.5 5.2 3.6 25.0 0.0 100.0 635 30-34 43.2 9.2 13.9 5.6 2.1 25.8 0.2 100.0 769 35-39 34.3 11.8 17.7 5.4 2.7 27.9 0.2 100.0 875 40-44 32.3 20.3 19.1 3.7 4.0 20.2 0.4 100.0 916 45-49 37.7 15.9 18.0 4.4 3.4 20.3 0.2 100.0 764 Marital status Married 37.1 12.9 15.7 4.8 3.2 26.1 0.2 100.0 3,917 Divorced/separated/widowed 25.2 10.0 32.5 7.6 4.7 20.0 0.0 100.0 406 Number of living children 0 39.9 14.5 14.3 7.3 0.6 23.3 0.0 100.0 344 1-2 47.0 11.9 17.9 4.8 2.9 15.3 0.3 100.0 1,432 3-4 35.3 15.2 16.4 4.9 2.6 25.5 0.1 100.0 1,869 5+ 12.5 6.3 19.8 4.8 7.8 48.5 0.3 100.0 677 Urban-rural residence Urban 52.7 17.7 19.3 5.1 3.7 1.3 0.3 100.0 1,954 Rural 22.2 8.5 15.6 5.0 3.0 45.5 0.2 100.0 2,369 Place of residence Urban Governorates 51.1 15.5 20.7 6.7 4.9 0.5 0.6 100.0 804 Lower Egypt 33.9 12.4 16.0 4.8 2.7 30.0 0.1 100.0 2,195 Urban 57.7 17.5 16.6 4.7 2.5 0.9 0.0 100.0 643 Rural 24.0 10.3 15.8 4.9 2.8 42.1 0.1 100.0 1,551 Upper Egypt 29.6 11.0 17.2 4.3 3.6 34.2 0.2 100.0 1,283 Urban 48.2 21.1 20.6 2.9 3.7 3.3 0.1 100.0 474 Rural 18.7 5.1 15.2 5.1 3.6 52.3 0.2 100.0 809 Frontier Governorates 52.2 19.9 16.2 4.3 0.5 6.9 0.0 100.0 41 Education No education 1.5 0.0 21.3 6.5 8.5 62.1 0.0 100.0 1,263 Some primary 4.0 0.0 29.2 10.9 6.9 48.6 0.5 100.0 325 Prim. complete/some secondary 5.3 2.4 36.0 20.6 3.8 31.9 0.0 100.0 255 Secondary complete/higher 60.9 21.8 11.7 1.9 0.2 3.2 0.3 100.0 2,480 Wealth quintile Lowest 2.8 1.2 15.0 4.7 6.7 69.6 0.0 100.0 707 Second 11.2 4.4 22.4 6.5 5.3 50.1 0.0 100.0 655 Middle 26.3 13.2 23.6 6.5 5.3 24.5 0.5 100.0 705 Fourth 48.4 20.2 18.2 7.3 1.9 3.9 0.2 100.0 898 Highest 66.1 18.9 12.3 2.2 0.2 0.0 0.3 100.0 1,358 Total 36.0 12.7 17.3 5.0 3.3 25.5 0.2 100.0 4,323 Type of Employment Table 3.7 shows that, among women who work, 78 percent earn cash for the work they do. Among working women, the majority (66 percent) work for someone other than a relative, around one in five women work for a family member while 14 percent are self-employed. The majority of women who work are working on a full-year basis (87 percent), 10 percent work seasonally, and three percent work occasionally. 36 | Background Characteristics of Respondents Women working agricultural occu- pations are much less likely than other work- ing women to be paid for the work they do (67 percent and 3 percent, respectively). This can be explained by the fact that most women who work in an agricultural occupa- tion are assisting their husbands or another family member; around two in three women who are employed in agricultural occupa- tions are working for a family member compared to four percent of working women who are involved in nonagricultural occupa- tions. Finally, the results in Table 3.7 show that the majority of working women report that they work year-round. However, as expected, seasonal work is more common among women working in agricultural occu- pations than among women employed in nonagricultural occupations (32 percent and 3 percent, respectively). 3.6 DISPOSAL OF EARNINGS The EDHS included a number of questions that were intended to assess the magnitude of women’s earnings relative to those of their husbands, women’s control over the use of their earnings, and women’s participation in decisions on how their husband’s earnings are used. This information has implications for the empowerment of women. Employment and earnings are more likely to empower women if their earnings are perceived as significant relative to those of their husband and if women themselves control their own earnings. Women also are clearly empowered if they have a voice in how their husbands’ earnings are spent. Tables 3.8 and 3.9 present information on the measures related to women’s earnings for currently married women who worked and received cash earnings during the 12-month period prior to the survey. With regard to the magnitude of woman’s earnings, Table 3.8 shows that the majority of women earn less than their husband regardless of the subgroup to which they belong. Table 3.7 Type of employment Percent distribution of ever-married women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Egypt 2005 Employment characteristics Agricultural Non- agricultural Total Type of earnings Cash only 16.0 94.5 74.4 Cash and in-kind 10.5 1.8 4.0 In-kind only 6.8 0.3 2.0 Not paid 66.7 3.4 19.5 Type of employer Employed by family member 68.1 4.0 20.4 Employed by nonfamily member 22.2 80.7 65.8 Self-employed 9.8 15.2 13.8 Continuity of employment All year 64.8 94.5 86.9 Seasonal 31.5 2.7 10.1 Occasional 3.6 2.7 2.9 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number of women 1,104 3,210 4,323 Background Characteristics of Respondents | 37 Table 3.8 Relative magnitude of woman’s earnings by background characteristics Percent distribution of currently married women employed in the 12 months preceding the survey and receiving cash earnings by women’s earnings relative to husband’s earnings, according to background characteristics, Egypt 2005 Background characteristic Woman earns less Woman earns same Woman earns more/ husband no earnings Don’t know/ missing Total Number of women Age 15-19 52.9 9.3 0.0 37.8 100.0 26 20-24 58.4 15.4 8.6 17.5 100.0 176 25-29 71.5 15.8 4.9 7.7 100.0 451 30-34 64.1 20.8 8.5 6.6 100.0 574 35-39 62.2 22.3 10.3 5.1 100.0 601 40-44 58.5 23.9 10.6 6.9 100.0 666 45-49 59.5 21.8 10.9 7.8 100.0 522 Number of living children 0 64.0 16.8 5.3 13.9 100.0 249 1-2 63.7 21.4 7.9 7.0 100.0 1,084 3-4 62.1 22.6 9.8 5.5 100.0 1,344 5+ 58.0 14.9 13.4 13.6 100.0 339 Urban-rural residence Urban 62.2 22.1 8.8 6.8 100.0 1,676 Rural 62.6 19.2 9.5 8.7 100.0 1,339 Place of residence Urban Governorates 58.1 24.6 10.8 6.5 100.0 685 Lower Egypt 66.1 22.1 7.1 4.7 100.0 1,492 Urban 67.6 22.4 6.9 3.1 100.0 553 Rural 65.2 22.0 7.2 5.7 100.0 939 Upper Egypt 59.4 14.5 11.8 14.3 100.0 804 Urban 62.1 16.5 8.7 12.8 100.0 409 Rural 56.6 12.5 15.1 15.9 100.0 395 Frontier Governorates 56.5 34.3 3.4 5.8 100.0 35 Education No education 54.3 18.7 14.9 12.1 100.0 525 Some primary 53.1 15.7 11.3 20.0 100.0 155 Prim. complete/some secondary 56.3 20.6 15.3 7.7 100.0 142 Secondary complete/higher 65.4 21.7 7.2 5.8 100.0 2,193 Wealth quintile Lowest 51.4 15.7 16.1 16.7 100.0 278 Second 58.1 20.7 9.0 12.2 100.0 290 Middle 61.1 17.6 12.3 9.0 100.0 449 Fourth 64.9 22.1 8.4 4.5 100.0 761 Highest 65.4 22.6 6.6 5.4 100.0 1,238 Total 62.4 20.8 9.1 7.7 100.0 3,016 38 | Background Characteristics of Respondents With regard to who decides how a woman’s earnings are used, Table 3.9 shows that most currently married women who have cash earnings either make decisions about how their earnings are used themselves (25 percent) or jointly with the husband (65 percent). Only a small minority of women report that these decisions are made mainly by the husband or someone else. Women are most likely to say that the husband or someone else mainly makes decisions about how the woman’s earnings are used if they have less than a primary education or fall within the lowest wealth quintile; however, even among women in these groups, more than eight in ten women are involved in decisions on how their earnings are spent. Table 3.9 Control over woman’s earnings by background characteristics Percent distribution of currently married women employed in the 12 months preceding the survey and receiving cash earnings by person mainly deciding how the woman’s earnings are used, according to background characteristics, Egypt 2005 Background characteristic Woman Jointly with husband Husband Other/ missing Total Number of women Age 15-19 49.4 34.7 3.4 12.5 100.0 26 20-24 24.8 53.6 16.7 4.9 100.0 176 25-29 27.2 64.1 5.0 3.6 100.0 451 30-34 23.1 67.9 4.9 4.2 100.0 574 35-39 22.4 67.5 6.1 3.9 100.0 601 40-44 24.3 66.7 4.7 4.3 100.0 666 45-49 28.1 63.6 3.5 4.9 100.0 522 Number of living children 0 24.5 61.7 10.3 3.5 100.0 249 1-2 26.5 63.4 5.4 4.7 100.0 1,084 3-4 24.3 67.9 4.2 3.6 100.0 1,344 5+ 23.7 62.1 7.6 6.6 100.0 339 Urban-rural residence Urban 26.7 64.0 4.4 4.8 100.0 1,676 Rural 22.9 66.5 7.0 3.7 100.0 1,339 Place of residence Urban Governorates 32.4 57.5 6.0 4.1 100.0 685 Lower Egypt 20.4 71.4 6.2 2.0 100.0 1,492 Urban 21.3 72.4 4.4 1.9 100.0 553 Rural 19.9 70.9 7.2 2.0 100.0 939 Upper Egypt 27.2 60.0 4.0 8.8 100.0 804 Urban 24.6 63.4 1.8 10.2 100.0 409 Rural 29.9 56.5 6.2 7.4 100.0 395 Frontier Governorates 28.8 62.6 2.8 5.8 100.0 35 Education No education 25.2 57.0 10.7 7.1 100.0 525 Some primary 23.7 61.9 10.3 4.1 100.0 155 Primary complete/some secondary 28.1 63.5 5.8 2.6 100.0 142 Secondary complete/higher 24.9 67.4 3.9 3.8 100.0 2,193 Wealth quintile Lowest 26.2 55.9 10.0 7.9 100.0 328 Second 21.3 63.8 6.4 8.5 100.0 312 Middle 25.6 61.5 7.2 5.7 100.0 442 Fourth 22.1 72.0 2.6 3.4 100.0 729 Highest 27.2 65.2 2.9 4.7 100.0 1,205 Total 25.0 65.1 5.5 4.3 100.0 3,016 Background Characteristics of Respondents | 39 Table 3.10 focuses on decisions about how the husband’s earnings will be spent. The results indicate that, as was true with regard to the woman’s earnings, the majority of women (66 percent) say that these decisions are made jointly by the couple. Around a quarter of the women say the husband decides by himself how to spend his earnings. Women living in rural areas, particularly in Upper Egypt and women from the Frontier Governorates were the most likely to report that the husband made these decisions alone. Even among these groups, however, joint decision-making is the norm. Table 3.10 Control over husband’s earnings by background characteristics Percent distribution of currently married women by person mainly deciding how the husband’s earnings are used, according to background characteristics, Egypt 2005 Background characteristic Woman Jointly Husband Husband no earnings Other/ missing Total Number of women Age 15-19 1.7 58.7 29.7 2.3 7.5 100.0 792 20-24 2.8 62.1 28.8 1.5 4.7 100.0 2,898 25-29 3.0 66.2 26.8 0.9 3.1 100.0 3,653 30-34 3.5 68.4 25.2 0.4 2.4 100.0 3,077 35-39 4.0 66.8 26.6 0.7 1.9 100.0 3,010 40-44 5.1 68.8 24.0 0.7 1.5 100.0 2,525 45-49 5.2 65.3 27.0 1.5 1.1 100.0 2,233 Number of living children 0 3.0 64.8 25.9 1.8 4.6 100.0 1,782 1-2 3.3 68.1 24.5 1.1 3.1 100.0 6,712 3-4 3.9 67.8 25.5 0.7 2.1 100.0 6,677 5+ 4.8 57.8 34.1 1.0 2.3 100.0 3,016 Urban-rural residence Urban 4.3 73.9 20.0 0.6 1.2 100.0 7,490 Rural 3.3 60.4 31.1 1.3 3.8 100.0 10,697 Place of residence Urban Governorates 5.1 76.4 17.0 0.4 1.1 100.0 3,078 Lower Egypt 2.1 71.6 23.0 0.8 2.4 100.0 7,884 Urban 1.7 77.4 19.5 0.4 1.0 100.0 2,057 Rural 2.2 69.6 24.2 1.0 2.9 100.0 5,826 Upper Egypt 5.1 55.3 34.3 1.4 3.9 100.0 7,019 Urban 5.7 67.9 23.9 0.9 1.6 100.0 2,230 Rural 4.8 49.4 39.2 1.7 4.9 100.0 4,789 Frontier Governorates 1.0 54.3 41.6 1.0 2.1 100.0 206 Education No education 4.1 55.9 34.9 1.2 3.8 100.0 6,116 Some primary 4.5 60.8 30.3 1.7 2.7 100.0 2,019 Primary complete/some secondary 4.1 65.0 27.3 0.8 2.7 100.0 2,564 Secondary complete/higher 3.1 75.8 18.5 0.7 2.0 100.0 7,488 Work status Works for cash 3.7 78.3 15.1 0.2 2.7 100.0 2,920 Not working for cash 3.7 63.6 28.8 1.2 2.8 100.0 15,267 Wealth quintile Lowest 4.0 54.1 35.2 1.7 5.0 100.0 3,266 Second 3.1 57.8 33.3 1.4 4.3 100.0 3,509 Middle 3.7 62.6 29.5 1.1 3.1 100.0 3,675 Fourth 3.2 73.3 21.7 0.6 1.2 100.0 3,897 Highest 4.7 79.2 15.2 0.3 0.6 100.0 3,840 Total 3.7 65.9 26.6 1.0 2.8 100.0 18,187 40 | Background Characteristics of Respondents Table 3.11 looks at how a woman’s control over decisions about how her and her husband’s earnings are spent relates to the magnitude of the woman’s earnings relative to that of her husband. As expected, women earning more than the husband have the highest level of autonomy in making decisions about spending decisions. Women who earn less than the husband have a slightly greater degree of personal autonomy in making decisions about how their own earnings will be spent than women earning about the same amount as the husband. Table 3.11 Relative magnitude of earnings and control over woman’s and husband’s earnings Percent distribution of currently married women by person who decides how a woman’s cash earnings are used and the percent distribution by who decides how a woman’s husband/partner’s earnings are used, according to the relation between woman’s and husband’s earnings in last 12 months, Egypt 2005 Control over earnings Woman earns less Woman earns same Woman earns more/ husband no earnings Woman does not know what husband earns Woman no cash earnings/ not working Currently married women1 Control over woman’s earnings Woman 25.7 18.2 42.2 17.4 na 25.0 Jointly with husband 68.4 77.6 53.6 17.9 na 65.1 Husband 5.4 4.1 3.4 0.8 na 4.6 Other 0.4 0.1 0.8 63.9 na 5.3 Total percent 100.0 100.0 100.0 100.0 na 100.0 Number of women 1,881 628 276 231 na 3,016 Control over husband’s earnings Woman 2.8 4.0 11.5 7.3 3.8 3.8 Jointly with husband 78.7 89.1 70.6 73.2 64.3 66.9 Husband 18.1 6.2 17.1 18.2 29.2 26.9 Other/missing 0.4 0.6 0.9 1.3 2.8 2.4 Husband doesn’t bring in any money na na na na na na Total percent 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,881 628 204 229 14,995 17,937 na = Not applicable 1 Excludes cases where the woman or her husband had no earnings and includes cases where the woman does not know whether she earns more or less than the husband. 3.7 HOUSEHOLD DECISION-MAKING To assess women’s roles in household decision-making, EDHS respondents were asked questions about who in the household (respondent, husband, both, other) has the final say in making decisions relating to four areas: the woman’s own health care, major household purchases, daily household purchases, and visits to friends or relatives. Table 3.12 shows that women indicate that they themselves have the final say only with respect to daily household purchases. Other types of decisions are typically made jointly with the husband. Husbands are seen as having the final say most often with regard to major household purchases. Table 3.12 Women's participation in decision-making Percent distribution of currently married women by person who has the final say in making specific decisions, according to type of decision, Egypt 2005 Decision Woman Jointly with husband Husband Someone else Other/ missing Total Own health care 26.3 52.7 19.5 1.2 0.2 100.0 Large household purchases 7.3 47.1 39.9 5.5 0.2 100.0 Daily household purchases 60.3 19.7 11.8 7.8 0.3 100.0 Visits to family or relatives 13.8 58.7 25.5 1.6 0.4 100.0 Background Characteristics of Respondents | 41 Table 3.13 presents differentials in the proportions of women who report that they alone or jointly have the final say with respect to various decisions. The table shows that seven percent of women have no involvement in making any of the decisions. The results in Table 3.13 indicate that women’s involvement in household decision-making generally increases with the age of the woman and with parity up to four children. Rural women, especially those living in Upper Egypt, and women from the Frontier Governorates are generally less likely than other women to report that they make decisions alone or jointly. Education and wealth are directly related to involvement in making the various household decisions. Women working for cash are also more likely than other women to report having a say in the various decisions. Table 3.13 Women's participation in decision-making by background characteristics Percentage of currently married women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Egypt 2005 Alone or jointly have final say in: Background characteristic Own health care Making large purchases Making daily purchases Visits to family or relatives None of the specified decisions Number of women Age 15-19 67.2 38.4 56.0 61.6 14.5 792 20-24 75.0 49.9 72.2 69.4 9.6 2,898 25-29 79.8 53.3 78.1 71.4 7.4 3,653 30-34 80.9 56.6 83.4 74.3 5.6 3,077 35-39 81.1 57.8 84.9 74.7 6.3 3,010 40-44 81.3 58.0 84.6 75.2 6.3 2,525 45-49 79.2 55.7 85.3 73.7 6.0 2,233 Number of living children 0 75.1 51.7 67.4 69.9 10.6 1,782 1-2 79.7 55.4 79.1 72.1 6.9 6,712 3-4 80.7 56.7 83.9 74.7 5.8 6,677 5+ 76.0 48.4 81.1 69.9 9.3 3,016 Urban-rural residence Urban 84.3 61.4 86.9 76.0 4.0 7,490 Rural 75.3 49.5 75.2 70.1 9.5 10,697 Place of residence Urban Governorates 86.5 61.4 89.1 74.7 2.6 3,078 Lower Egypt 80.4 59.6 81.5 76.6 5.0 7,884 Urban 83.5 66.2 87.2 80.5 3.2 2,057 Rural 79.3 57.3 79.4 75.3 5.7 5,826 Upper Egypt 74.4 45.9 75.0 67.5 11.4 7,019 Urban 82.4 58.0 84.9 74.8 6.2 2,230 Rural 70.6 40.3 70.4 64.1 13.9 4,789 Frontier Governorates 72.6 35.7 59.4 51.9 20.0 206 Education No education 73.3 44.2 74.8 65.3 11.4 6,116 Some primary 74.7 51.4 80.4 70.3 8.1 2,019 Primary complete/some secondary 78.2 52.3 80.2 71.9 6.5 2,564 Secondary complete/higher 85.1 64.2 84.1 79.2 3.9 7,488 Work status Working for cash 87.2 69.3 89.1 82.5 2.8 2,920 Not working for cash 77.5 51.5 78.3 70.6 8.1 15,267 Wealth quintile Lowest 72.6 42.4 73.2 65.5 11.2 3,266 Second 72.2 46.4 72.6 67.7 11.8 3,509 Middle 77.2 52.9 78.1 72.5 8.0 3,675 Fourth 83.5 60.3 86.1 74.8 4.3 3,897 Highest 87.9 67.2 88.3 80.6 2.0 3,840 Total 79.0 54.4 80.0 72.5 7.3 18,187 Fertility | 43 FERTILITY 4 This chapter looks at a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women initiate childbearing. Information on current and cumulative fertility is essential in monitoring the progress and evaluating the impact of the population program in Egypt. The data on birth intervals are important since short intervals are strongly associated with childhood mortality. The age at which childbearing begins can also have a major impact on the health and well-being of both the child and the mother. Data on childbearing patterns were collected in the 2005 EDHS in several ways. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who may have died. Next, a complete history of all of the woman’s births was obtained, including the name, sex, month and year of birth, age, and survival status for each of the births. For living children, a question was asked about whether the child was living in the household or away. For dead children, the age at death was recorded. Finally, information was collected on whether currently married women were pregnant at the time of the survey. 4.1 CURRENT FERTILITY LEVELS AND DIFFERENTIALS The level of current fertility is one of the most important topics in this report because of its direct relevance to population policies and programs. Measures of current fertility presented in this chapter include age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate. These rates are generally presented for the three-year period preceding the survey, a period covering portions of the calendar years 2002 through 2005. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of age-specific fertility rates are calculated by identifying live births that occurred in the period 1-36 months prior to the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman-years lived in each of the specified five-year age groups in the period 1-36 months prior to the survey. Although information on fertility was obtained only for ever- married women, the age-specific rates are presented for all women regardless of marital status. Data from the household questionnaire on the age structure of the population of never-married women were used to calculate the all-women rates. This procedure assumes that women who have never been married have had no children. The total fertility rate (TFR) is a useful measure for examining the overall level of fertility. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. The TFR is calculated by summing the age-specific fertility rates. It is presented for women age 15-44 and women 15-49 to facilitate comparisons with other surveys in which the age range of interviewed women may differ from that in the 2005 EDHS. The general fertility rate (GFR) represents the annual number of births in a population per 1,000 women age 15-44. The crude birth rate (CBR) is the annual number of births in a population per 1,000 44 | Fertility persons. Both measures are based on the birth history data for the three-year period before the survey and the age-sex distribution of the household population. Current estimates of fertility levels are presented in Table 4.1 by residence. The total fertility rate indicates that, if fertility rates were to remain constant at the level prevailing during the three-year period before the 2005 EDHS (approximately April 2002 to March 2005), an Egyptian woman would bear 3.1 children during her lifetime. In rural areas, the TFR is 3.4 births per woman, around 25 percent higher than the rate in urban areas (2.7 births). Table 4.1 Current fertility by residence Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence and place of residence, Egypt 2005 Lower Egypt Upper Egypt Age Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total 15-19 27 62 19 41 18 47 67 40 78 26 48 20-24 143 199 118 177 154 185 202 171 217 164 175 25-29 178 206 172 190 174 195 210 188 221 179 194 30-34 120 128 112 112 123 109 145 126 155 156 125 35-39 63 63 60 48 48 47 80 76 83 114 63 40-44 18 21 17 17 16 17 24 21 26 29 19 45-49 1 3 1 1 1 1 4 3 5 0 2 TFR 2.7 3.4 2.5 2.9 2.7 3.0 3.7 3.1 3.9 3.3 3.1 GFR 91 121 81 103 86 107 127 103 138 111 108 CBR 23.6 29.6 21.3 26.1 23.4 26.9 30.7 26.6 32.7 28.1 27.1 Note: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate for ages 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Considering the variation by place of residence, the TFR for rural Lower Egypt (3.0 births per woman) is almost similar to the rate for urban Upper Egypt (3.1 births per woman) and around one birth lower than the TFR for rural Upper Egypt (3.9 births). The TFR for the Frontier Governorates is 3.3 births, a rate that is higher than any other area except rural Upper Egypt (Figure 4.1). The lowest TFR is 2.5 births per woman in the Urban Governorates, almost 1.5 children lower than the rate in rural Upper Egypt. Egyptian women are having children early in the childbearing period. According to the cumulative age-specific fertility rates shown in Table 4.1, the average Egyptian woman will give birth to 1.1 children by age 25 and 2.1 children by age 30. The age pattern of fertility is similar in urban and rural areas. Fertility peaks in the age group 25-29 among rural women (206 births per thousand) and urban women (178 births per thousand). Looking at the variation in age-specific fertility by place of residence, rates are generally higher in rural Upper Egypt than in the other areas except in the 35-44 age groups where the highest rates are observed in the Frontier Governorates. Fertility | 45 Estimates of the crude birth rate and the general fertility rate also are presented in Table 4.1. For the period 2002-2005, the crude birth rate was 27 births per thousand population, and the general fertility rate was 108 births per thousand women. There are substantial differences by residence in both the CBR and the GFR. The lowest rates are found in the Urban Governorates, where the CBR was 21 births per thousand population and the GFR was 81 births per thousand women. In contrast, in rural Upper Egypt where the rates are highest, the CBR was 33 births per thousand population, and the GFR was 138 births per thousand women. 4.2 FERTILITY TRENDS Using the 2005 EDHS data, the trend in fertility in Egypt can be assessed in several ways. Comparison of Current and Cumulative Fertility Levels One approach to assessing the long term trend in fertility is to compare the total fertility rate at the time of the survey with the mean number of children ever born (CEB) among women 40-49. The latter indicator takes into account the fertility behavior of older women who are nearing the end of their reproductive period and thus serves as a measure of cumulative fertility. If fertility is stable over time in a population, the TFR and the mean CEB for women 40-49 will be similar. If fertility levels have been falling, the TFR will be lower than the mean CEB among women age 40-49. The comparison of the current TFR to the mean CEB among older women presented in Table 4.2 indicates that fertility has fallen sharply in Egypt over the past several decades. Women age 40-49 had an average of 4.5 births during their lifetime, about one and a half births more than women bearing children at the current fertility rates will have. The decline in fertility implied by a comparison of the TFR with completed fertility has been greater in rural than in urban areas. The largest implied decline in fertility by place of residence is observed in rural Upper Egypt, where the TFR was 2.2 births lower than the mean number of children ever born to women 40-49. Figure 4.1 Total Fertility Rates by Place of Residence 3.1 2.5 2.9 2.7 3.0 3.7 3.1 3.9 3.3 Total Egypt Urban Governorates Total Urban Rural Total Urban Rural Frontier Governorates Lower Egypt Upper Egypt EDHS 2005 46 | Fertility Table 4.2 highlights marked differences in fertility levels and trends by education. The TFR decreases rapidly with increasing educational level, from 3.8 births among women with no education to 3.0 births among women who had completed the secondary level or higher. The differentials in completed fertility across educational groups are even more striking. The mean number of children ever born is 5.2 among women age 40-49 with no education, compared to 3.0 among women who have completed secondary school. With regard to the trend in fertility, the decline in fertility implied by a comparison of the TFR with the mean CEB is substantial for women with less than a secondary education. However, the TFR for women with a secondary or higher education is the same as the mean number of children ever born among women age 40-49 who have completed at least the secondary level. This pattern suggests that fertility among highly educated women has remained relatively stable for several decades. Fertility levels and trends vary substan- tially by wealth quintile. The TFR deceases from a level of 3.6 births among women in the lowest wealth quintile to 2.6 births among women in the highest wealth quintile. The differentials in com- pleted fertility across different wealth quintiles also are striking. The mean number of children ever born among women 40-49 is 5.9 in the lowest wealth quintile compared to 3.2 among women in the highest wealth quintile. Comparisons of the mean CEB among older women with the TFR suggest that fertility has declined within each of the wealth quintiles between the 1970s when women currently in the 40-49 age cohort began their childbearing years and the current period. Finally, Table 4.2 includes another indicator of current fertility, the percentage of women who are currently pregnant. Overall, 6 percent of the 2005 EDHS respondents were pregnant at the time of the survey. Looking at residential differentials, women in rural Upper Egypt and the Frontier Governorates have the highest percentage currently pregnant (7 percent), while the percentage is lowest in the Urban Governorates and urban Lower Egypt (5 percent). Surprisingly, the percentage of women who were pregnant is higher for women with a secondary or higher education than for other women. This is due at least in part to the fact that, on average, highly educated women were married at older age than women in the other education categories and, thus, are more likely to currently be in the family-building stage than other women. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Egypt 2005 Background characteristic Total fertility rate Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Urban-rural residence Urban 2.7 5.2 3.7 Rural 3.4 6.9 5.2 Place of residence Urban Governorates 2.5 4.8 3.3 Lower Egypt 2.9 6.0 4.3 Urban 2.7 5.1 3.6 Rural 3.0 6.4 4.6 Upper Egypt 3.7 6.9 5.4 Urban 3.1 5.7 4.2 Rural 3.9 7.4 6.1 Frontier Governorates 3.3 7.3 4.5 Education No education 3.8 5.7 5.2 Some primary 3.4 4.5 5.0 Primary complete/some secondary 2.9 4.8 4.2 Secondary complete/higher 3.0 7.4 3.0 Wealth quintile Lowest 3.6 6.2 5.9 Second 3.3 6.4 5.5 Middle 3.3 6.3 4.6 Fourth 3.0 6.9 3.9 Highest 2.6 4.9 3.2 Total 3.1 6.1 4.5 1 Women age 15-49 years Fertility | 47 Retrospective Data Table 4.3 uses information from the retro- spective birth histories obtained from EDHS respond- ents to examine trends in age-specific fertility rates for successive five-year periods before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because women 50 years and over were not interviewed in the 2005 EDHS, the rates for older age groups become pro- gressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years and more prior to the survey, because women in that age group would have been 50 years or older at the time of the survey. The results in Table 4.3 confirm that fertility has fallen substantially among all age groups, with the most rapid relative decline occurring in the 15-19 age group. Overall, the cumulative fertility rate for women age 15-29 decreased by around one birth, from 3.2 births per woman during the period 15-19 years before the survey to 2.1 births per woman in the five-year period preceding the survey. Comparison with Previous Surveys Table 4.4 shows the TFR estimates from a series of surveys conducted in Egypt during the period 1979 through 2005. The surveys vary in the timeframes for which the TFR estimates are available. For example, the rates from the EFS, ECPS and the EMCHS are based on births in a one-year period before the survey, while the rates for the DHS surveys are based on a three-year period before the interview date. In general, three-year rates are subject to less sampling variability than one-year rates. The size of the sample covered in a specific survey is another factor related to sampling variability. In general, rates from surveys with comparatively large samples are subject to less sampling variability than rates from surveys with smaller samples. Thus, the rates for the 1997, 1998, and 2003 Interim DHS surveys have somewhat greater margins of error than the full scale DHS surveys (i.e., the surveys conducted in 1988, 1992, 1995, 2000, and 2005). Sampling errors for the TFRs derived from the 2005 EDHS are presented in Appendix C. As Table 4.4 shows, fertility levels have declined almost continuously in Egypt over the past two decades, from 5.3 births per woman at the time of the 1980 EFS to 3.1 births per woman at the time of the 2005 EDHS. The decline in fertility was especially rapid during the period between the mid-1980s and the mid-1990s. During the ten-year period between the 1995 and 2005 EDHS surveys, the downward trend in the TFR continued although at a slower pace and with some fluctuation. The results in Table 4.4 indicate that all age groups have shared in the decline in fertility rates. However, the decline has been more rapid among older women than among younger women. Age- specific fertility rates among women age 30 and over fell by around 50 percent or more between the 1980 EFS and the 2005 EDHS. In contrast, fertility rates among women under age 30 declined by around one- third during this period. As a result of the differences in the pace of fertility change across various age groups, childbearing has become somewhat more concentrated among women under age 30. Currently, a woman will have an average of 2.1 births by her 30th birthday, roughly two-thirds of her lifetime births. This pattern is typical of countries like Egypt in which fertility levels are declining. Table 4.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Egypt 2005 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 48 60 73 103 20-24 182 204 220 251 25-29 195 217 224 279 30-34 129 147 158 [235] 35-39 65 79 [101] - 40-44 20 [35] - - 45-49 [3] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 48 | Fertility The trend in fertility by residence is presented in Table 4.5 for the period between the 1988 EDHS and the 2005 EDHS.1 Urban fertility declined between the 1988 and 1992 surveys, from 3.5 to 2.9 births. The decline leveled off early in the 1990s, with the urban TFR fluctuating around three births throughout the rest of the 1990s, before falling to a level of 2.7 births in 2005. In rural areas, fertility levels declined continuously, from 5.4 births per woman at the time of the 1988 EDHS to 3.4 births per woman at the time of the 2005 EDHS. Table 4.5 Trends in fertility by residence Total fertility rates by urban-rural residence and place of residence, Egypt 1986-2005 1988 EDHS 1991 EMCHS 1992 EDHS 1995 EDHS 1997 Interim EDHS 1998 Interim EDHS 2000 EDHS 2003 Interim EDHS 2005 EDHS Residence 1986- 19882 1990- 19911 1990- 19922 1993- 19952 1995- 19972 1996- 19982 1997- 20002 2000- 20032 2002- 20052 Urban-rural residence Urban 3.5 3.3 2.9 3.0 2.7 2.8 3.1 2.6 2.7 Rural 5.4 5.6 4.9 4.2 3.7 3.9 3.9 3.6 3.4 Place of residence Urban Governorates 3.0 2.9 2.7 2.8 2.5 2.7 2.9 2.3 2.5 Lower Egypt 4.5 na 3.7 3.2 3.0 3.1 3.2 3.1 2.9 Urban 3.8 3.5 2.8 2.7 2.6 2.4 3.1 2.8 2.7 Rural 4.7 4.9 4.1 3.5 3.2 3.2 3.3 3.2 3.0 Upper Egypt 5.4 na 5.2 4.7 4.2 4.3 4.2 3.8 3.7 Urban 4.2 3.9 3.6 3.8 3.3 3.3 3.4 2.9 3.1 Rural 6.2 6.7 6.0 5.2 4.6 4.5 4.7 4.2 3.9 Frontier Governorates na na na 4.0 na na 3.8 na 3.3 TFR 15-49 4.4 4.1 3.9 3.6 3.3 3.4 3.5 3.2 3.1 Note: Rates for the age group 45-49 may be slightly biased due to truncation. 1 Rates are for the 12-month period preceding the survey. 2 Rates are for the 36-month period preceding the survey. na = Not available Source: El-Zanaty and Way, 2004, Table 2.3 1 Residential differentials in the TFR are not available for the 1980 EFS and the 1984 ECPS surveys. Table 4.4 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, Egypt 1979-2005 EFS ECPS 1988 EDHS 1991 EMCHS 1992 EDHS 1995 EDHS 1997 Interim EDHS 1998 Interim EDHS 2000 EDHS 2003 Interim EDHS 2005 EDHS Age 1979- 19801 1983- 19841 1986- 19882 1990- 19911 1990- 19922 1993- 19952 1995- 19972 1996- 19982 1997- 20002 2000- 20032 2002- 20052 15-19 78 73 72 73 63 61 52 64 51 47 48 20-24 256 205 220 207 208 200 186 192 196 185 175 25-29 280 265 243 235 222 210 189 194 208 190 194 30-34 239 223 182 158 155 140 135 135 147 128 125 35-39 139 151 118 97 89 81 65 73 75 62 63 40-44 53 42 41 41 43 27 18 22 24 19 19 45-49 12 13 6 14 6 7 5 1 4 6 2 TFR 5.3 4.9 4.4 4.1 3.9 3.6 3.3 3.4 3.5 3.2 3.1 1 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: El-Zanaty and Way, 2004, Table 2.2 Fertility | 49 Considering the place of residence, declines in fertility were observed in all areas between the 1988 and 2005 surveys. Women in rural Upper Egypt experienced the greatest absolute change in fertility levels, with the TFR dropping from 6.2 births at the time of the 1988 survey to 3.9 births per woman at the 2005 EDHS. The TFR in rural Lower Egypt, which was 4.7 births at the time of the 1988 survey (the level reached in 2000 in rural Upper Egypt), dropped to 3.0 births at the time of the 2005 EDHS. 4.3 CHILDREN EVER BORN AND LIVING Table 4.6 presents the distributions of all women and currently married women by the total number of children ever born. These distributions reflect the accumulation of births among EDHS respondents over the past 30 years and, therefore, their relevance to the current situation is limited. However, the information is useful in looking at how average family size varies across age groups and for looking at the level of primary infertility. Table 4.6 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Egypt 2005 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children All WOMEN 15-19 94.1 5.2 0.6 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 6,446 0.07 0.07 20-24 59.8 20.1 14.9 4.2 0.7 0.2 0.0 0.0 0.0 0.0 0.0 100.0 5,807 0.66 0.64 25-29 25.9 15.7 28.4 19.2 7.2 2.8 0.6 0.2 0.0 0.0 0.0 100.0 4,655 1.78 1.69 30-34 10.1 7.8 23.1 28.3 14.8 8.6 4.5 1.8 0.9 0.2 0.0 100.0 3,413 2.89 2.73 35-39 7.1 4.2 14.3 24.3 20.6 12.7 7.8 4.7 2.3 1.4 0.6 100.0 3,310 3.68 3.40 40-44 6.1 2.7 11.6 20.6 20.8 14.9 8.5 5.9 4.3 2.4 2.2 100.0 2,933 4.17 3.74 45-49 5.6 2.9 8.5 16.2 16.2 14.2 12.0 9.1 6.4 3.8 5.1 100.0 2,705 4.81 4.17 Total 39.8 9.5 13.9 13.5 8.9 5.7 3.5 2.2 1.4 0.8 0.8 100.0 29,270 2.05 1.87 CURRENTLY MARRIED WOMEN 15-19 52.9 41.3 5.2 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 792 0.53 0.52 20-24 21.2 38.9 29.7 8.5 1.4 0.3 0.1 0.0 0.0 0.0 0.0 100.0 2,898 1.31 1.26 25-29 8.3 18.5 35.4 24.2 9.0 3.5 0.8 0.3 0.0 0.0 0.0 100.0 3,653 2.22 2.11 30-34 3.8 7.3 25.0 30.5 16.1 9.4 4.9 1.9 0.9 0.2 0.0 100.0 3,077 3.12 2.95 35-39 3.3 3.7 14.3 25.4 22.1 13.4 8.4 5.1 2.4 1.4 0.6 100.0 3,010 3.88 3.59 40-44 3.1 2.1 11.4 21.2 21.6 15.7 8.9 6.0 4.7 2.7 2.4 100.0 2,525 4.37 3.92 45-49 3.6 2.5 7.7 16.0 17.2 14.2 12.1 10.1 6.5 4.1 5.9 100.0 2,233 5.03 4.36 Total 9.4 14.2 21.2 20.5 13.5 8.5 5.1 3.3 2.0 1.1 1.2 100.0 18,187 3.07 2.82 Since only ever-married women were interviewed in the 2005 EDHS, information on the reproductive histories of never-married women is not available. However, virtually all births in Egypt occur within marriage; thus, in calculating these fertility measures for all women, never-married women were assumed to have had no births. The marked differences between the results for currently married women and for all women under age 30 are due to the comparatively large numbers of never-married women in those age groups who, as noted, are assumed to have had no births. Table 4.6 shows that the average Egyptian woman has given birth to 2.1 children. Out of that number, 1.9 c

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