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 children are still alive, indicating that about 10 percent of the children ever born to EDHS respondents have died. 50 | Fertility Reflecting the natural family-building process, the number of children that women have born increases directly with age from an average of less than one child among women age 15-19 to an average of 4.8 births among women 45-49. As expected, the likelihood that at least one of a woman’s children will have died also increases with the woman’s age. Out of the average of 4.8 children born to women 45- 49, an average of 0.6 children or 13 percent are no longer alive. 4.4 BIRTH INTERVALS Intervals between Births A birth interval is the period between two successive live births. Research has shown that children born soon after a previous birth (i.e., within 24 months) are at greater risk of illness and death than those born after a longer interval. In addition, short birth intervals may have consequences for other children in the family. The occurrence of closely spaced births gives the mother insufficient time to restore her health, which may limit her ability to take care of her children. The duration of breastfeeding for the older child may also be shortened if the mother becomes pregnant. Table 4.7 shows the percent distribution of second order and higher (non-first) births in the five years preceding the survey by length of the previous birth interval. Birth intervals are relatively long, with eight in ten non-first births occurring at least two years after the previous birth. Around half of births took place at least three years after a prior birth. The median interval is 35.4 months, which is slightly longer than the median interval at the 2000 EDHS (34.3 months). Although the majority of non-first births are appropriately spaced, 21 percent were born too soon after a prior birth, i.e., within 24 months of a previous birth. Younger women have shorter birth intervals than older women. The median interval varies from 24.5 months among the small number of births to women age 15-19 to 64.6 months among births to women age 40-49. Birth intervals do not vary as much with the child sex of the prior birth. However, birth intervals are markedly different depending on the survival status of the prior birth; the average interval is 10 months longer in cases where the prior birth is alive than when that child has died (35.8 months and 25.9 months, respectively). As Table 4.7 shows, the median birth interval in urban areas is 38 months, compared to 34 months in rural areas. Birth intervals are longer in Urban Governorates and urban Lower Egypt (39.9 months and 39.1 months, respectively) than in urban Upper Egypt (36.5 months). In rural areas, the median birth interval is much longer in Lower Egypt (37.0 months) than in Upper Egypt (31.4 months). No clear association is observed between the woman’s educational level and the average birth interval. However, intervals are substantially longer for births to women who are working for cash than for births to other women (39.7 months and 34.8 months, respectively). The average birth interval among women in the highest quintile wealth is around 6 months longer than that observed among women in the lowest quintile. Fertility | 51 Table 4.7 Birth intervals by background characteristics Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Egypt 2005 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48+ Total Number of non-first births Median number of months since preceding birth Sex of preceding birth Male 8.3 11.9 29.0 19.8 31.0 100.0 4,681 36.2 Female 8.9 13.2 31.3 20.2 26.3 100.0 4,722 34.5 Survival of preceding birth Living 7.6 12.4 30.4 20.2 29.3 100.0 8,946 35.8 Dead 27.8 16.4 25.1 15.3 15.5 100.0 458 25.9 Birth order 2-3 9.6 13.8 32.9 21.2 22.5 100.0 6,055 33.6 4-5 6.8 10.6 24.5 16.4 41.7 100.0 2,233 41.2 6+ 7.0 10.0 26.6 20.5 35.8 100.0 1,116 39.1 Age 15-19 15.8 29.8 47.4 6.9 0.0 100.0 48 24.5 20-29 11.8 17.0 37.3 21.0 12.9 100.0 4,637 30.5 30-39 5.8 8.6 24.5 20.2 40.8 100.0 3,981 42.2 40-49 3.1 5.2 14.6 13.1 64.0 100.0 737 64.6 Urban-rural residence Urban 7.7 9.8 27.9 19.7 34.9 100.0 3,258 38.0 Rural 9.1 14.0 31.4 20.2 25.3 100.0 6,145 34.0 Place of residence Urban Governorates 7.6 9.7 24.8 21.3 36.6 100.0 1,209 39.9 Lower Egypt 7.6 10.1 28.6 20.9 32.8 100.0 3,554 37.3 Urban 7.5 8.1 29.6 16.9 37.8 100.0 827 39.1 Rural 7.6 10.6 28.3 22.1 31.3 100.0 2,727 37.0 Upper Egypt 9.7 15.3 32.9 18.9 23.2 100.0 4,516 32.6 Urban 7.7 11.0 29.9 19.9 31.5 100.0 1,146 36.5 Rural 10.4 16.7 33.8 18.6 20.4 100.0 3,370 31.4 Frontier Governorates 7.3 13.5 29.9 20.1 29.3 100.0 125 35.7 Education No education 8.8 14.2 30.4 19.1 27.6 100.0 3,359 34.2 Some primary 7.3 11.1 28.2 20.1 33.3 100.0 949 36.9 Primary complete/some secondary 9.7 13.6 28.8 18.4 29.6 100.0 1,397 35.3 Secondary complete/higher 8.4 11.1 31.0 21.4 28.0 100.0 3,698 35.8 Work status Working for cash 6.3 8.7 27.7 20.0 37.2 100.0 1,180 39.7 Not working for cash 8.9 13.1 30.5 20.0 27.4 100.0 8,224 34.8 Wealth quintile Lowest 9.9 14.2 33.9 19.4 22.5 100.0 2,135 32.5 Second 9.3 16.0 29.3 19.6 25.7 100.0 2,045 34.0 Middle 8.1 12.0 29.6 21.8 28.5 100.0 1,990 36.1 Fourth 8.3 10.4 28.9 19.1 33.3 100.0 1,821 37.0 Highest 6.7 8.7 28.3 20.1 36.3 100.0 1,413 38.7 Total 8.6 12.6 30.2 20.0 28.6 100.0 9,403 35.4 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 52 | Fertility Attitudes about the Ideal Birth Interval Ever-married women were asked about the ideal length of time that a woman should wait between births. The responses for this question are presented in Table 4.8. Around six in ten women believe a woman should wait three or more years between births, and almost one-quarter think that ideally a woman should wait at least four years before having another child. Although these attitudes are encouraging, it also must be noted that around one-third of the women think that the ideal spacing between births should be less than three years. Women in urban areas, particularly in the Urban Governorates, are much less likely than rural women to think births should be spaced less than three years apart. Table 4.8 Ideal birth interval by residence Percent distribution of ever-married women 15-49 by the ideal length of time that a woman should wait between births and median ideal birth interval, Egypt 2005 Lower Egypt Upper Egypt Ideal interval between births (months) Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total <24 months 1.3 2.4 1.2 1.5 1.0 1.6 2.7 1.7 3.2 4.2 1.9 24-35 months 27.2 38.6 22.0 37.2 33.3 38.6 35.4 28.7 38.6 36.2 33.9 36-47 months 39.6 38.3 38.7 41.2 42.0 40.9 36.2 38.5 35.1 39.0 38.8 48-59 months 21.5 12.0 26.3 12.5 15.1 11.5 15.4 21.0 12.7 14.1 16.0 60+ months 9.6 7.0 11.3 6.7 7.9 6.4 8.2 9.0 7.9 5.8 8.1 Don’t know/missing 0.7 1.7 0.4 0.9 0.8 1.0 2.1 1.2 2.5 0.6 1.3 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 of women 8,033 11,441 3,293 8,410 2,199 6,211 7,552 2,411 5,141 218 19,474 Median number of months1 36.5 36.2 36.7 36.3 36.4 36.2 36.3 36.5 36.2 36.2 36.3 1 Women falling into the “don’t know/missing” categories are excluded from calculation of the median. 4.5 AGE AT FIRST BIRTH The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of mother and child. In many countries, postponement of first births has contributed greatly to overall fertility decline. Table 4.9 presents the distribution of women by age at first birth, according to their current age. For women under age 25, the median age at first birth is not shown because less than 50 percent of women in those ages had given birth at the time of the survey. The results in Table 4.9 suggest that there has been a slightly rise in the age at first birth among Egyptian women. Women in younger cohorts are much less likely than older women to have given birth to their first child while they were in their teens. For example, among women age 45-49, 31 percent were mothers before age 20, while only 24 percent of women age 25-29 had given birth to their first child before age 20. Overall, Table 4.9 shows that the median age at first birth ranges from a low of 22.3 years among women age 45-49 to 22.8 years among women age 25-29. These cohort changes parallel increases in the median age at first marriage that took place during the same period (see Chapter 8). Fertility | 53 Table 4.9 Age at first birth Percentage of all women who gave birth by exact ages, and median age at first birth, by current age, Egypt 2005 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 0.2 na na na na 94.1 6,446 a 20-24 0.7 7.5 20.8 na na 59.8 5,807 a 25-29 1.2 10.7 24.3 43.0 64.9 25.9 4,655 22.8 30-34 2.2 14.7 28.6 46.7 69.2 10.1 3,413 22.4 35-39 2.0 16.3 34.1 50.1 70.4 7.1 3,310 22.0 40-44 1.8 16.0 33.4 50.4 70.8 6.1 2,933 22.0 45-49 2.8 15.7 31.4 48.1 70.0 5.6 2,705 22.3 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Table 4.10 presents trends in the median age at first birth across age cohorts for key sub- groups. The measures are presented for women age 25-49 years to en- sure that half of the women have already had a birth. Overall, the median age at first birth is 22.4 years for women 25-49. However, there are wide differences in the age at which women first gave birth among the various subgroups. Urban women started childbearing nearly three years later than their rural counterparts. On average, women in rural Upper Egypt had their first birth around one and half years earlier than women in rural Lower Egypt and about four years earlier than women in the Urban Governorates. Women who have a secondary or higher education had their first birth an average of more than four years later than women with no education. There is a 4.5 year difference in the median age at first birth between women in the highest wealth quintile and women in the first wealth quintile. Table 4.10 Median age at first birth by background characteristics Median age at first birth among women age 25-49 years, by current age and background characteristics, Egypt 2005 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Urban-rural residence Urban 24.2 23.9 23.4 23.3 23.6 23.7 Rural 21.9 21.3 20.8 20.7 21.1 21.3 Place of residence Urban Governorates a 24.4 23.8 23.8 24.1 24.3 Lower Egypt 22.9 22.3 22.2 21.8 22.2 22.3 Urban 24.0 23.4 23.6 23.4 23.4 23.6 Rural 22.5 22.1 21.5 21.2 21.6 21.9 Upper Egypt 21.8 21.1 20.8 20.8 21.3 21.3 Urban 23.1 23.6 22.8 22.7 23.4 23.2 Rural 21.2 19.8 19.9 19.8 20.3 20.4 Frontier Governorates 23.8 22.3 22.4 23.4 22.5 23.0 Education No education 20.8 19.9 19.9 20.2 20.8 20.3 Some primary 20.9 20.2 19.8 20.4 21.1 20.5 Primary complete/some secondary 21.6 21.0 20.6 21.6 22.0 21.3 Secondary complete/higher 24.2 24.4 24.6 25.1 25.9 24.6 Wealth quintile Lowest 21.0 19.9 19.8 19.7 20.8 20.3 Second 21.7 21.1 20.4 20.3 20.9 21.0 Middle 22.2 22.0 21.2 21.2 21.1 21.7 Fourth 23.2 23.4 23.0 22.4 22.6 22.9 Highest a 24.5 24.7 24.5 24.7 24.8 Total 22.8 22.4 22.0 22.0 22.3 22.4 a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group 54 | Fertility 4.6 TEENAGE PREGNANCY AND MOTHERHOOD Teenage fertility is a major health concern because teenage mothers and their children are at high risk of illness and death. Childbearing during the teenage years also frequently has adverse social consequences, particularly on female edu- cational attainment since women who be- come mothers in their teens are more likely to curtail education. Using information from the 2005 EDHS, Table 4.11 shows the percentage of women age 15-19 who are mothers or who are pregnant with their first child. The overall level of teenage childbearing is nine percent. This percentage is virtually the same as that recorded in the 2000 EDHS. Table 4.11 shows that the propor- tion of women who have begun childbear- ing rises rapidly throughout the teenage years, from less than one percent among 15-year-olds to seven percent among 17-year-olds, 15 percent among 18-year- olds, and 23 percent among 19-year-olds. There are significant residential differences in the level of teenage childbearing. In rural areas, the level of teenage fertility (12 percent) is almost twice the level in urban areas (6 percent). Upper Egypt has the highest level of teenage childbearing, espe- cially in the rural areas (14 percent), while the lowest level is observed in urban Lower Egypt (4 percent). The level of teenage fertility is strongly associated with a woman’s educational level. The proportion of women age 15-19 who are pregnant or who have already given birth is highesst among women with no education (23 percent). Teenagers in the lower wealth quintile are three to four times as likely as women in the highest wealth quintile to have begun bearing children. Table 4.11 Teenage pregnancy and motherhood by background charac- teristics Percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics, Egypt 2005 Percentage who are: Background characteristic Mothers Pregnant with first child Percentage who have begun childbearing Number of women Age 15 0.0 0.4 0.5 1,211 16 0.5 1.8 2.2 1,230 17 3.4 3.1 6.5 1,455 18 9.6 5.4 15.0 1,270 19 15.8 6.9 22.7 1,280 Urban-rural residence Urban 4.3 1.6 6.0 2,644 Rural 6.9 4.8 11.7 3,850 Place of residence Urban Governorates 3.7 1.0 4.8 1,081 Lower Egypt 5.4 4.4 9.8 2,334 Urban 2.8 1.6 4.4 690 Rural 5.5 4.6 10.1 1,959 Upper Egypt 9.3 5.1 14.4 2,249 Urban 6.4 2.4 8.8 835 Rural 8.4 5.1 13.5 1,859 Frontier Governorates 3.8 1.7 5.5 79 Education No education 15.7 7.3 23.0 831 Some primary 11.3 3.9 15.2 265 Primary complete/some secondary 3.1 1.8 4.9 3,386 Secondary complete/higher 5.8 5.0 10.8 1,978 Wealth quintile Lowest 6.9 3.2 10.0 1,373 Second 7.5 4.6 12.1 1,349 Middle 7.2 4.6 11.8 1,308 Fourth 5.3 4.1 9.4 1,226 Highest 2.1 1.0 3.1 1,209 Total 5.9 3.6 9.4 6,446 Knowledge, Attitudes, and Ever Use of Family Planning | 55 KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNING 5 The Egyptian family planning program has a strong education and communication program spearheaded by the State Information Service. The communication efforts are aimed at improving family planning awareness nationwide. The program employs a variety of channels to promote family planning, including extensive use of mass media channels with an emphasis on television. This chapter presents results from the 2005 EDHS that can be used in assessing the coverage of current education and communication campaigns and for planning future interventions. EDHS results relating to knowledge of methods and the channels through which Egyptian women receive information about family planning methods are presented first in the chapter. Then the chapter looks at the information obtained in the survey on attitudes toward adoption of family planning for the first time, and the level of ever use of family planning. 5.1 KNOWLEDGE OF FAMILY PLANNING METHODS Awareness of family planning methods is crucial in decisions on whether to use a contraceptive method and which method to use. One of the main objectives of the 2005 EDHS was to determine the level of knowledge of contraceptive methods. To assess contraceptive knowledge, respondents were first asked an open-ended question about the contraceptive methods about which they had heard. All methods named in response to this question were recorded as recognized. When a respondent failed to mention any of the methods listed in the questionnaire, the interviewer would describe the method and ask whether the respondent had heard about it. Methods recognized by the respondent after the description was read were also recorded as known. Information on knowledge of specific methods was collected in the 2005 EDHS for nine modern methods (pill, IUD, injectable, implant, vaginal methods (diaphragm and contraceptive foam or jelly), condom, female sterilization, male sterilization, and emergency contraception) and three traditional methods (periodic abstinence, withdrawal, and prolonged breast- feeding). In addition, provision was made in the questionnaire to record other methods that respondents mentioned spontaneously. No questions were asked to elicit information on depth of knowledge of these methods (e.g., on the respondent’s under- standing of how to use a specific method). Therefore, in the analysis that follows, knowledge of a family planning method is defined simply as having heard of a method. Level of Knowledge The results in Table 5.1 show that knowledge of family planning methods is universal among currently married women in Egypt. Almost all currently married women know about the pill, IUD, and injectable, and more than 90 percent know about Table 5.1 Family planning knowledge Percentage of currently married women 15-49 who know about specific family planning methods by method and the mean number of family planning methods known, Egypt 2005 Method Knows method Any method 99.9 Any modern method 99.9 Pill 99.6 IUD 99.7 Injectable 99.4 Implant 93.5 Diaphragm/foam/jelly 20.7 Condom 52.6 Female sterilization 66.0 Male sterilization 8.2 Emergency contraception 6.6 Any traditional method 70.5 Periodic abstinence 35.4 Withdrawal 27.9 Prolonged breastfeeding 64.8 Folk method 0.5 Mean number known 6.7 Number of women 18,187 56 | Knowledge, Attitudes, and Ever Use of Family Planning implant. Two in three women know about female sterilization, and half of women know about condom. Other methods are less widely recognized. One-fifth know about vaginal methods, eight percent know about male sterilization, and emergency contraception is recognized by around seven percent. Prolonged breastfeeding is the most commonly recognized traditional method (65 percent). The mean number of methods known by women is 6.7. Figure 5.1 compares the levels of knowledge of specific methods found in the 2005 EDHS with levels observed in the 2000 EDHS survey.1 Almost all women in both surveys knew about the pill, IUD and injectable, and there was a notable increase in recognition of the implant between 2000 and 2005, from 83 percent to 94 percent. For all of the other methods, however, knowledge levels decreased over the period. The declines were greatest in the case of vaginal methods (from 58 percent to 21 percent) and the condom (from 68 percent to 53 percent). 100 100 99 83 58 68 75 16 38 31 68 100 100 99 94 21 53 66 8 35 28 65 Pill IUD Injectable Implant Vaginal methods Condom Female sterili- zation Male sterili- zation Periodic abstinence With- drawal Prolonged breast- feeding 2000 2005 Figure 5.1 Trends in Family Planning Knowledge, Egypt 2000-2005 Percentage of currently married women 5.2 EXPOSURE TO FAMILY PLANNING MESSAGES A strong mass media public information and education program conducted by the State Information Service has been one of the main components of the Egyptian family planning program since the mid-1980s. After focusing initially on general “population awareness” messages, the education and communication effort has increasingly moved to providing more specific advice and information on family planning. The 2005 EDHS obtained information on the types of media through which women received any family planning information. This information may be useful in guiding future information and education efforts in Egypt's family planning program. 1 Information on knowledge of emergency contraception was not collected in the 2000 survey; thus, this method is not included in Figure 5.1. Knowledge, Attitudes, and Ever Use of Family Planning | 57 Table 5.2 presents the percentage of currently-married women who heard messages about family planning on broadcast media (television or radio) and through printed materials, community meetings and religious leaders. The 2005 EDHS collected these data by asking respondents whether they had heard a family planning message through these channels during the 6 months prior to the interview. Table 5.2 Exposure to family planning messages by background characteristics Percentage of currently married women by whether they have heard a family planning message in the 6 months prior to the interview according to background characteristics, Egypt 2005 Background characteristic Radio Television Newspaper/ magazine Poster/ billboard/ sign Community meeting Religious leader No exposure to family planning messages Number of women Age 15-19 58.0 88.6 15.2 26.3 3.3 2.1 9.1 792 20-24 62.8 89.6 19.1 28.7 3.0 2.0 7.7 2,898 25-29 62.9 89.8 24.0 30.5 4.0 3.1 8.0 3,653 30-34 63.7 90.0 23.4 30.8 4.5 3.9 7.6 3,077 35-39 63.6 89.2 20.5 27.3 3.4 3.2 8.7 3,010 40-44 61.5 86.3 20.8 25.8 4.0 3.2 11.3 2,525 45-49 60.9 84.4 18.4 23.2 4.2 3.0 13.5 2,233 Urban-rural residence Urban 60.0 87.6 30.0 36.9 5.3 3.9 9.7 7,490 Rural 64.3 89.1 14.7 21.8 2.8 2.4 8.8 10,697 Place of residence Urban Governorates 49.6 80.9 28.7 40.6 5.1 3.2 15.5 3,078 Lower Egypt 73.0 89.7 25.4 23.6 2.8 2.4 8.3 7,884 Urban 74.1 91.9 38.4 31.8 3.9 2.6 5.9 2,057 Rural 72.6 88.9 20.9 20.7 2.4 2.4 9.1 5,826 Upper Egypt 56.9 90.9 12.8 27.4 4.4 3.6 7.1 7,019 Urban 61.9 93.4 24.3 36.3 7.0 6.2 4.8 2,230 Rural 54.6 89.7 7.4 23.2 3.2 2.5 8.2 4,789 Frontier Governorates 44.3 76.8 17.5 31.9 2.5 0.9 19.6 206 Education No education 56.1 85.1 2.0 12.9 1.3 1.4 12.4 6,116 Some primary 59.5 87.6 5.7 19.0 1.5 2.1 9.9 2,019 Primary complete/ some secondary 60.4 86.1 14.7 25.7 2.2 2.1 11.2 2,564 Secondary complete/higher 69.3 92.4 42.8 43.6 7.0 4.9 5.6 7,488 Work status Working for cash 69.3 89.2 42.9 42.7 11.3 6.6 7.8 2,920 Not working for cash 61.2 88.4 16.8 25.2 2.4 2.3 9.4 15,267 Wealth quintile Lowest 49.2 82.2 2.8 17.1 2.1 1.9 14.6 3,266 Second 62.0 88.6 8.9 17.6 1.8 1.9 9.2 3,509 Middle 68.5 90.7 15.6 23.0 2.7 2.6 7.6 3,675 Fourth 66.9 91.1 28.5 33.0 3.6 3.1 7.0 3,897 Highest 64.0 89.1 45.1 46.6 8.3 5.4 8.3 3,840 Total 62.5 88.5 21.0 28.0 3.8 3.0 9.2 18,187 As expected, Table 5.2 confirms that television is the principal source of family planning information. Around 90 percent of women have seen a recent family planning message on television, compared to 63 percent who have listened to a message on the radio. Other communication channels reach far fewer women than messages broadcast on television or the radio. Twenty-eight percent of EDHS respondents had seen a family planning poster, billboard, or signboard, and 21 percent had read about family planning in a newspaper or magazine. Community meetings and religious leaders were 58 | Knowledge, Attitudes, and Ever Use of Family Planning named by four percent and three percent, respectively of women as a source from which they had received information about family planning. Considering the differentials in Table 5.2, the proportions of currently-married women who have heard a family planning message on either television or radio vary markedly by residence, with women in the Urban Governorates and the Frontier Governorates being least likely to have been reached by these channels. As expected, exposure to family planning information through print media increases with educational level. Differences in the proportions who had heard about family planning at a com- munity meeting or from religious leader are minor. For example, the percentage of respond- ents who had received family planning informa- tion at a community meeting ranged from two percent in rural Lower Egypt to seven percent in urban Upper Egypt. 5.3 ATTITUDE ABOUT TIMING OF ADOPTION OF CONTRACEPTION The EDHS included questions about the appropriateness of a couple’s use of family plan- ning before the first pregnancy and after the first birth. Most ever-married women (93 percent) in Egypt consider it appropriate for a couple to begin using family planning after the first birth. In sharp contrast, only two percent regard use before the first pregnancy as appropriate. Although few women in any subgroup consider it appropriate to adopt family planning before the first birth, the results in Table 5.3 indi- cate there is some variability across subgroups in the attitude toward family planning use after the first birth. The groups with the highest propor- tions considering use after the first birth as appro- priate include women from the Urban Governor- ates (98 percent), women from Lower Egypt (97 percent), and women with a secondary or higher education (97 percent). The groups with the lowest proportions considering use after the first birth as appropriate are women from rural Upper Egypt and women with no education (85 percent, and 88 percent respectively). 5.4 KNOWLEDGE OF FERTILE PERIOD An elementary understanding of repro- ductive physiology, particularly knowledge of when in the ovulatory cycle a woman is most like- ly to become pregnant, may be useful in ensuring success in the use of coitus-related methods such Table 5.3 Timing of use of family planning among newly married couples by background characteristics Percentage of ever-married women by attitude about appropriate- ness of a couple's using family planning before the first pregnancy and after the first birth, according to background characteristics, Egypt 2005 Family planning use appropriate Background characteristic Before first pregnancy After first birth Number of women Age 15-19 2.5 91.9 803 20-24 2.5 94.5 2,968 25-29 3.1 94.9 3,785 30-34 2.4 93.9 3,209 35-39 2.2 93.2 3,191 40-44 2.0 92.9 2,859 45-49 2.0 89.8 2,659 Urban-rural residence Urban 2.6 96.1 8,033 Rural 2.3 91.3 11,441 Place of residence Urban Governorates 3.1 97.6 3,293 Lower Egypt 2.9 96.9 8,410 Urban 2.7 96.9 2,199 Rural 2.9 97.0 6,211 Upper Egypt 1.6 87.4 7,552 Urban 1.7 93.3 2,411 Rural 1.6 84.6 5,141 Frontier Governorates 1.1 90.9 218 Education No education 1.8 88.3 6,740 Some primary 1.7 93.0 2,197 Primary complete/some secondary 2.1 95.1 2,719 Secondary complete/higher 3.2 97.0 7,818 Work status Working for cash 3.5 96.1 3,288 Not working for cash 2.2 92.7 16,186 Wealth quintile Lowest 2.4 87.3 3,565 Second 2.1 89.7 3,778 Middle 2.0 94.4 3,931 Fourth 2.3 96.6 4,137 Highest 3.2 97.4 4,063 Total 2005 EDHS 2.4 93.3 19,474 Total 2003 EDHS 4.9 90.1 8,958 Total 2000 EDHS 4.7 84.7 15, 024 Knowledge, Attitudes, and Ever Use of Family Planning | 59 as the condom, vaginal methods and withdrawal. Such knowledge is especially critical for the practice of periodic abstinence. To investigate women’s knowledge about their fertile period, 2005 EDHS respondents were asked whether there are certain days a woman is more likely to become pregnant if she has sexual intercourse. Those who responded affirmatively to that question were asked whether this time is just before the period begins, during the period, right after the period ends, or halfway between two periods. Table 5.4 shows that understanding of the ovulatory cycle is limited among Egyptian women. Around one-fourth of EDHS respondents knew that a woman has a greater probability of becoming pregnant if she has sexual intercourse halfway between two periods. Around half of respondents either were unable to say when a woman is most at risk of pregnancy or believed that a woman’s risk does not vary. 5.5 EVER USE OF FAMILY PLANNING The 2005 EDHS collected data on the level of ever use of family planning methods. These data were obtained by asking respondents separately about whether they had ever used each of the family planning methods that they knew. The following sections explore the level of ever use of family planning methods among Egyptian women. Levels of Ever Use Table 5.5 shows the percentage of ever-married women and currently married women who have ever used a family planning method according to the woman’s current age. Overall, the results indicate that eight in ten married women have used a family planning method at some time. Across age groups, the highest level of ever use of any family planning method among currently-married women is observed in the 35-39 age group (90 percent), while the lowest level is found among women age 15-19 (34 percent). About eight in ten women who have ever used a method have experience with modern methods. The most commonly used modern method is the IUD, followed by the pill and the injectable. Much smaller proportions of women report that they have used condoms or implant. Slightly more than one in ten women has had experience using any traditional method. The most widely used traditional method is prolonged breastfeeding, followed by periodic abstinence. Table 5.4 Knowledge of fertile period Percent distribution of ever-married women 15-49 by knowledge of the fertile period during the ovulatory cycle, Egypt 2005 Perceived fertile period Just before her period begins 1.8 During her period 0.4 Right after her period has ended 26.1 Halfway between two periods 23.1 Other 0.0 No specific time 20.6 Don't know 27.5 Missing 0.6 Total 100.0 Number of women 19,474 60 | Knowledge, Attitudes, and Ever Use of Family Planning Table 5.5 Ever use of family planning methods by age Percentage of ever-married women and currently married women who have ever used a family planning method, by specific method and age, Egypt 2005 Modern method Traditional method Age Any method Any modern method Pill IUD Inject- ables Im- plants Dia- phragm/ foam/ jelly Con- dom Female sterili- zation Male sterili- zation Emer- gency contra- cep- tion Any tradi- tional method Peri- odic absti- nence With- drawal Pro- longed breast- feeding Other Never used Number of women EVER-MARRIED WOMEN 15-19 33.7 30.9 12.1 20.6 3.6 0.0 0.0 0.0 0.0 0.0 0.0 3.6 0.0 0.0 3.6 0.0 66.3 803 20-24 63.9 60.6 24.6 45.1 11.8 1.2 0.1 1.0 0.0 0.0 0.0 9.9 0.3 0.7 9.2 0.0 36.1 2,968 25-29 81.2 78.8 35.9 61.6 20.1 1.2 0.2 3.1 0.1 0.0 0.1 13.0 1.5 1.2 10.9 0.1 18.8 3,785 30-34 87.9 86.3 39.8 69.5 25.4 2.0 0.4 4.3 0.6 0.1 0.2 14.7 2.4 2.2 11.7 0.0 12.1 3,209 35-39 88.3 87.0 45.6 70.1 28.2 1.8 0.5 4.1 1.7 0.1 0.2 13.5 2.1 1.6 11.0 0.1 11.7 3,191 40-44 86.0 84.8 48.4 68.4 23.8 1.6 1.3 6.3 2.5 0.0 0.2 15.0 3.2 1.8 11.6 0.3 14.0 2,859 45-49 81.4 79.8 47.8 59.1 18.5 0.9 0.9 5.5 3.4 0.0 0.1 13.8 3.1 2.1 10.2 0.4 18.6 2,659 Total 79.6 77.7 38.9 60.7 20.7 1.4 0.5 3.8 1.2 0.0 0.1 12.9 2.0 1.5 10.5 0.1 20.4 19,474 CURRENTLY MARRIED WOMEN 15-19 33.9 31.1 12.2 20.6 3.6 0.0 0.0 0.0 0.0 0.0 0.0 3.7 0.0 0.0 3.7 0.0 66.1 792 20-24 64.6 61.3 25.1 45.5 11.8 1.3 0.1 1.0 0.0 0.0 0.0 10.1 0.3 0.7 9.4 0.0 35.4 2,898 25-29 82.6 80.2 36.8 62.8 20.4 1.2 0.2 3.2 0.1 0.0 0.1 13.3 1.5 1.2 11.1 0.1 17.4 3,653 30-34 89.4 87.7 40.8 70.6 26.2 2.1 0.4 4.2 0.7 0.1 0.2 15.2 2.5 2.2 12.2 0.0 10.6 3,077 35-39 90.2 89.0 46.8 71.6 29.2 1.8 0.5 4.3 1.8 0.1 0.2 13.9 2.2 1.7 11.3 0.1 9.8 3,010 40-44 89.1 88.2 50.3 71.6 25.7 1.9 1.5 6.6 2.6 0.0 0.2 15.8 3.5 1.9 12.2 0.3 10.9 2,525 45-49 84.6 83.1 50.1 62.4 20.5 0.9 1.1 6.0 3.9 0.0 0.1 14.6 3.2 2.4 10.8 0.4 15.4 2,233 Total 81.2 79.2 39.7 62.1 21.5 1.5 0.6 3.9 1.3 0.0 0.1 13.3 2.0 1.6 10.8 0.1 18.8 18,187 Trends in Ever Use Table 5.6 presents trends in the level of ever use of family planning among ever-married women during the period 1980-2005. The level of ever-use of any method among ever-married women doubled between 1980 and 2005 (Figure 5.2). With regard to the trends in use of specific methods, the most significant change has been the continuing rise in IUD use. The level of ever use of the IUD was 62 percent at the time of the 2005 EDHS, almost seven times the level reported in 1980 (9 percent). In the case of the pill, the level of ever use peaked at 46 percent in 1988, before dropping to 40 percent in 2005. Ever use of the injectable was rare before the mid 1990s when use of this method began to steadily increase, reaching a level of 22 percent in 2005. Knowledge, Attitudes, and Ever Use of Family Planning | 61 Table 5.6 Trends in ever use of family planning method Percentage of ever-married women ever using any family planning method, Egypt 1980-2005 Method 1980 EFS 1984 ECPS 1988 EDHS 1991 EMCHS 1992 EDHS 1995 EDHS 2000 EDHS 2005 EDHS Any method 39.8 48.2 57.4 63.2 64.6 68.4 75.1 79.6 Any modern method 38.9 46.7 55.9 59.8 62.9 66.7 73.4 77.7 Pill 35.8 41.0 46.0 44.7 44.0 44.2 39.8 38.9 IUD 8.7 14.8 24.6 32.3 39.7 46.1 55.9 60.7 Injectables 0.5 1.1 2.3 na 2.9 6.2 14.1 20.7 Implants na na na na na na 0. 3 1.4 Vaginal methods 1.2 3.9 5.3 na 3.6 2.2 1.5 0.5 Condom 5.0 3.4 8.6 na 7.5 7.7 3.7 3.8 Female sterilization 0.7 1.4 1.5 na 1.1 1.1 1.4 1.2 Male sterilization 0.1 0.0 0.0 na 0.0 0.0 0.0 0.0 Emergency contraception na na na na na na U 0.1 Any traditional method na 5.3 11.4 na 9.5 10.8 8. 3 12.9 Periodic abstinence 2.7 1.4 3.7 na 3.4 3.3 1. 5 2.0 Withdrawal 2.3 1.0 2.4 na 2.6 2.5 0. 8 1.5 Prolonged breastfeeding NA 3.1 6.5 na 4.9 6.6 6. 3 10.5 Other methods NA 0.5 0.8 na 0.4 0.4 0. 3 0.1 Number of women 8,788 10,013 8,911 9,073 9,864 14,779 15,573 19,474 na = Information on the method was not collected or was not reported. Source: El-Zanaty and Way, 2001, Table 5.12 40 48 57 65 68 75 80 1980 1984 1988 1992 1995 2000 2005 Figure 5.2 Trends in Ever Use of Family Planning, Egypt 1980-2005 EDHS 2005 Percentage of ever-married women ever using any family planning method 62 | Knowledge, Attitudes, and Ever Use of Family Planning Differentials in Ever Use Table 5.7 presents differences in the overall proportions of ever-married women who have ever used family planning and in the number of methods with which ever users have had experience. About half (48 percent) of the ever users have had experience with only one method, while 33 percent have used two methods, and 19 percent have tried three or more methods. Table 5.7 Ever use of family planning methods by background characteristics Percentage of ever-married women who have ever used a family planning method, and, among ever users, percent distribution by number of methods ever used, according to background characteristics, Egypt 2005 Number of methods ever used Background characteristic Percentage ever used any method Number of ever- married women 1 2 3+ Total Mean number of methods ever used Number of women ever used family planning Age 15-19 33.7 803 83.4 14.6 2.0 100.0 1.2 271 20-24 63.9 2,968 63.2 28.0 8.8 100.0 1.5 1,896 25-29 81.2 3,785 52.8 30.5 16.7 100.0 1.7 3,072 30-34 87.9 3,209 46.6 33.7 19.8 100.0 1.8 2,822 35-39 88.3 3,191 40.9 36.0 23.1 100.0 1.9 2,817 40-44 86.0 2,859 38.9 35.7 25.4 100.0 2.0 2,459 45-49 81.4 2,659 42.6 35.8 21.6 100.0 1.9 2,164 Urban-rural residence Urban 83.6 8,033 49.0 32.8 18.2 100.0 1.8 6,717 Rural 76.8 11,441 46.7 33.3 20.1 100.0 1.8 8,784 Place of residence Urban Governorates 85.0 3,293 48.9 32.4 18.7 100.0 1.8 2,800 Lower Egypt 84.2 8,410 48.6 32.9 18.5 100.0 1.8 7,084 Urban 84.8 2,199 50.2 32.8 16.9 100.0 1.7 1,865 Rural 84.0 6,211 48.0 33.0 19.0 100.0 1.8 5,219 Upper Egypt 72.2 7,552 45.9 33.5 20.6 100.0 1.8 5,456 Urban 80.9 2,411 48.1 33.2 18.8 100.0 1.8 1,951 Rural 68.2 5,141 44.7 33.7 21.6 100.0 1.8 3,505 Frontier Governorates 73.3 218 48.4 35.2 16.3 100.0 1.7 160 Education No education 75.9 6,740 44.5 35.3 20.2 100.0 1.8 5,118 Some primary 85.3 2,197 38.2 34.9 26.9 100.0 2.0 1,874 Primary complete/some secondary 81.1 2,719 46.5 33.9 19.7 100.0 1.8 2,207 Secondary complete/higher 80.6 7,818 53.5 30.4 16.1 100.0 1.7 6,302 Work status Working for cash 83.8 3,288 46.6 32.8 20.6 100.0 1.8 2,756 Not working for cash 78.7 16,186 47.9 33.1 19.0 100.0 1.8 12,745 Wealth quintile Lowest 73.1 3,565 43.1 35.1 21.9 100.0 1.8 2,608 Second 76.5 3,778 45.3 34.5 20.2 100.0 1.8 2,892 Middle 80.4 3,931 46.8 33.5 19.7 100.0 1.8 3,161 Fourth 82.7 4,137 49.6 32.5 17.9 100.0 1.7 3,421 Highest 84.1 4,063 52.2 30.4 17.3 100.0 1.7 3,418 Total 79.6 19,474 47.7 33.1 19.3 100.0 1.8 15,500 Knowledge, Attitudes, and Ever Use of Family Planning | 63 Older women are not only more likely to have ever used family planning but also, if they have used it, to have experience with a greater number of methods than younger women. For example, less than 10 percent of women age 15-24 have used three or more methods, compared to more than 20 percent of women age 40-49. Looking at the other subgroups for which information is presented in Table 5.7, women from urban areas, women with at least some primary education, women who are working for cash, and women in higher wealth quintiles are more likely than other women to have ever used a family planning method. Women from rural Upper Egypt have the least experience with family planning (68 percent), followed by women from the Frontier Governorates (73 percent), while women from Urban Governorates have the most experience with family planning (85 percent). There is comparatively little variation by residence among ever users in the number of methods that ever users have tried. 5.6 FIRST USE OF FAMILY PLANNING Women who reported that they had used family planning methods at some time were asked about the number of children they had when they first used family planning. These data are useful in identifying the stage in the family-building process when women begin using family planning as well as their motivation for adopting family planning. Table 5.8 presents the percent distribution of ever-married women by the number of living children at the time of the first use of family planning. Almost none of the women started using family planning immediately after marriage while they were still childless. Overall, half of women began use of family planning after they had had their first child, 14 percent started after they had had two children, and 15 percent had three or more children before using family planning. Looking at the age patterns, there appears to have been a shift in the timing of the adoption of the first contraceptive method, with younger women initiating use of family planning methods at lower parities than older women. For example, 60 percent of women age 25-29 started family planning use after their first child compared to 34 percent of women 45-49. Table 5.8 Number of living children at time of first use of family planning Percent distribution of ever-married women by number of living children at the time of first use of family planning and age, Egypt 2005 Number of living children at time of first use of contraceptive Age Never used 0 1 2 3 4+ Missing Number of women 15-19 66.3 0.1 31.7 1.7 0.2 0.0 0.0 803 20-24 36.1 0.4 54.3 7.6 1.3 0.3 0.0 2,968 25-29 18.8 0.4 60.4 14.2 4.3 1.9 0.0 3,785 30-34 12.1 0.3 58.7 16.4 6.1 6.4 0.0 3,209 35-39 11.7 0.1 48.7 17.2 9.0 13.3 0.0 3,191 40-44 14.0 0.3 42.9 15.4 10.3 17.1 0.1 2,859 45-49 18.6 0.3 34.4 16.4 10.1 20.1 0.1 2,659 Total 20.4 0.3 50.0 14.0 6.4 8.9 0.0 19,474 Current Use of Family Planning | 65 CURRENT USE OF FAMILY PLANNING 6 The data on the current use of family planning is among the most important information collected in the 2005 EDHS since it provides insight into one of the principal determinants of fertility and serves as a key measure for assessing the success of the national family planning program. This chapter focuses on data from the 2005 EDHS on levels, differentials, and trends in current use. Information on the service providers from which users obtain their methods and on the willingness to pay for the widely used methods is also presented. 6.1 CURRENT USE OF FAMILY PLANNING Overall, 59 percent of currently married women in Egypt are using contraception (Table 6.1 and Figure 6.1). The IUD, pill, and injectables are the most widely used methods: 37 percent of currently married women are using the IUD, 10 percent are relying on the pill, and seven percent are employing injectables. Relatively small proportions of women are using other modern methods; e.g., one percent report currently using the condom. Three percent of women report use of traditional methods. Table 6.1 Current use of family planning methods by residence Percent distribution of currently married women 15-49 by family planning method currently used according to urban-rural residence and place of residence, Egypt 2005 Lower Egypt Upper Egypt Method Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Any method 62.6 56.8 63.9 65.9 64.1 66.5 49.9 60.0 45.2 50.7 59.2 Any modern method 59.8 54.2 61.2 64.2 62.3 64.8 46.1 56.1 41.4 47.2 56.5 Pill 11.0 9.1 8.2 10.0 12.3 9.2 10.3 13.5 8.8 14.4 9.9 IUD 40.5 33.6 43.9 44.0 42.3 44.5 25.2 35.0 20.6 21.9 36.5 Injectables 4.5 8.8 4.4 7.1 4.3 8.0 8.2 4.8 9.8 7.1 7.0 Implants 0.7 0.9 0.9 0.7 0.6 0.7 0.9 0.5 1.2 1.4 0.8 Diaphragm/foam/jelly 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Condom 1.7 0.5 2.5 0.8 1.0 0.7 0.5 1.0 0.3 1.5 1.0 Female sterilization 1.3 1.2 1.1 1.7 1.7 1.7 0.8 1.2 0.7 0.9 1.3 Any traditional method 2.8 2.7 2.6 1.7 1.8 1.7 3.8 3.9 3.8 3.5 2.7 Periodic abstinence 1.4 0.3 1.5 0.5 1.0 0.3 0.6 1.5 0.3 0.4 0.7 Withdrawal 0.6 0.1 0.8 0.2 0.5 0.1 0.2 0.4 0.1 0.6 0.3 Prolonged breastfeeding 0.8 2.2 0.4 1.0 0.3 1.2 2.9 1.9 3.4 2.3 1.6 Other 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 Not currently using 37.4 43.2 36.1 34.1 35.9 33.5 50.1 40.0 54.8 49.3 40.8 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 women 7,490 10,697 3,078 7,884 2,057 5,826 7,019 2,230 4,789 206 18,187 66 | Current Use of Family Planning Current users were asked questions about participation in the decision to use family planning. The results indicate that virtually all women felt that they had a main role in the decision to use a family planning method. The majority of users made the decision to use jointly with their husband (81 percent), 14 percent saw the decision as one they made mainly on their own, and five percent indicated that the husband or someone else were mainly responsible for the decision to adopt a method (not shown in table). Virtually all users indicated that their husband was aware that they were using contraception; less than one percent reported that the husband did not know that they were using a method (not shown in table). 6.2 DIFFERENTIALS IN CURRENT USE OF FAMILY PLANNING Differentials by Residence There are marked differences in the level of current use of family planning methods by residence (Table 6.1). Urban women are more likely to be using than rural women (63 percent and 57 percent, respectively). Use rates are higher in the Urban Governorates (64 percent) and Lower Egypt (66 percent) than in Upper Egypt (50 percent) and the Frontier Governorates (51 percent). Within Upper Egypt, the use rate among urban women (60 percent) is markedly higher than the rate among rural women (45 percent). Within Lower Egypt, the urban-rural differential is much narrower and, somewhat surprisingly, favors rural women; 64 percent of married women living in urban areas in Lower Egypt are using a family planning method compared to 67 percent of rural women. The IUD is the most frequently used method in every residential category, followed by the pill and injectables. The extent to which the IUD dominates the method mix, however, varies across residential subgroups. For example, women in the Urban Governorates and in rural Lower Egypt are around five times as likely to be using the IUD as the pill. In all other residential areas except the Frontier Governorates, there are two to four times as many IUD users as pill users. The pill is the second most Figure 6.1 Current Use by Method EDHS 2005 Other modern 2% Pill 10% Traditional method 3% IUD 37% Injectables 7% Not currently using 41% Current Use of Family Planning | 67 widely used method in all areas except rural Upper Egypt, where the proportion of women using injectables is slightly higher than the proportion relying on the pill. Differentials by Selected Background Characteristics Differentials in the levels of current use by background characteristics other than residence are presented in Table 6.2. Current use rises rapidly with age, from a level of 26 percent among currently married women 15-19 to a peak of 73 percent among women 35-39. The IUD is the most popular method among women in all age groups, with the highest levels of IUD use found among women age 30-39 (45 percent). Table 6.2 Current use of family planning methods by selected demographic and social characteristics Percent distribution of currently married women 15-49 by family planning method currently used according to selected demographic and social characteristics, Egypt 2005 Background characteristics Any method Any modern method Pill IUD Inject- ables Im- plant Dia- phragm/ foam/ jelly Con- dom Female sterili- zation Any tradi- tional Peri- odic absti- nence With- drawal Pro- longed breast- feeding Other Not using Total percent Number of women Age 15-19 26.3 24.1 6.3 15.9 1.9 0.0 0.0 0.0 0.0 2.2 0.0 0.0 2.2 0.0 73.7 100.0 792 20-24 44.7 41.3 8.0 27.8 4.5 0.5 0.0 0.4 0.0 3.4 0.2 0.1 3.2 0.0 55.3 100.0 2,898 25-29 57.4 54.4 11.3 34.5 7.4 0.7 0.0 0.4 0.1 3.1 0.2 0.3 2.6 0.0 42.6 100.0 3,653 30-34 69.0 66.4 11.0 44.5 8.5 1.0 0.1 0.8 0.7 2.6 0.7 0.3 1.6 0.0 31.0 100.0 3,077 35-39 73.3 71.2 11.4 45.3 10.3 1.2 0.0 1.2 1.8 2.2 0.7 0.4 1.1 0.0 26.7 100.0 3,010 40-44 70.1 67.6 11.0 43.0 7.5 1.3 0.2 2.0 2.6 2.5 1.7 0.4 0.4 0.1 29.9 100.0 2,525 45-49 47.8 45.3 6.6 27.8 4.7 0.5 0.0 1.9 3.9 2.5 1.6 0.5 0.1 0.3 52.2 100.0 2,233 Number of living children 0 0.5 0.4 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 99.5 100.0 1,782 1 46.0 42.4 9.4 30.1 1.9 0.3 0.0 0.7 0.0 3.6 0.4 0.3 3.0 0.0 54.0 100.0 2,676 2 66.7 64.2 11.3 44.5 5.9 1.0 0.2 1.2 0.3 2.5 0.9 0.3 1.2 0.0 33.3 100.0 4,036 3 74.8 71.4 11.9 48.2 8.2 0.8 0.0 1.1 1.2 3.4 1.2 0.4 1.8 0.1 25.2 100.0 4,041 4+ 67.5 64.7 10.7 36.8 11.7 1.2 0.0 1.2 3.0 2.8 0.6 0.3 1.8 0.1 32.5 100.0 5,652 Education No education 54.8 52.2 8.7 30.2 10.1 1.1 0.0 0.4 1.7 2.5 0.0 0.1 2.4 0.0 45.2 100.0 6,116 Some primary 62.8 60.5 9.3 37.4 9.4 1.1 0.1 1.2 2.0 2.3 0.3 0.3 1.5 0.3 37.2 100.0 2,019 Primary complete/ some secondary 60.2 57.9 10.6 37.8 7.3 0.8 0.0 0.8 0.7 2.2 0.1 0.4 1.7 0.0 39.8 100.0 2,564 Secondary complete/ higher 61.5 58.4 10.8 40.8 3.8 0.6 0.1 1.5 0.9 3.1 1.6 0.4 1.1 0.0 38.5 100.0 7,488 Work status Working for cash 66.2 62.5 9.7 42.2 6.1 0.9 0.1 1.6 1.5 3.9 2.3 0.6 0.8 0.1 34.0 100.0 2,920 Not working for cash 57.4 54.9 9.9 35.3 7.2 0.8 0.0 0.9 1.2 2.5 0.4 0.2 1.8 0.0 42.1 100.0 15,267 Wealth quintile Lowest 53.4 50.0 7.7 27.0 12.9 1.0 0.0 0.2 1.1 3.3 0.0 0.1 3.2 0.1 46.6 100.0 3,266 Second 56.7 54.4 9.0 33.3 9.5 1.1 0.0 0.3 1.3 2.2 0.2 0.1 1.9 0.1 43.3 100.0 3,509 Middle 59.5 57.2 10.1 37.0 7.1 1.1 0.0 0.9 1.1 2.3 0.2 0.2 1.9 0.0 40.5 100.0 3,675 Fourth 62.5 60.0 11.6 40.6 4.8 0.5 0.1 1.0 1.5 2.5 0.8 0.5 1.2 0.0 37.5 100.0 3,897 Highest 62.9 59.6 10.6 42.6 2.0 0.6 0.1 2.5 1.3 3.3 2.3 0.5 0.4 0.1 37.1 100.0 3,840 Total 59.2 56.5 9.9 36.5 7.0 0.8 0.0 1.0 1.3 2.7 0.7 0.3 1.6 0.1 40.8 100.0 18,187 Note: If more than one method is used, only the most effective method is considered in this tabulation. Use rates also are related to family size. Few women use contraception before having the first birth; less than one percent of childless women are currently using a method. After the first child, contraceptive use increases sharply with the number of living children, peaking at 75 percent among women with 3 children. 68 | Current Use of Family Planning Considering education status, the main differential is between women who never attended school and those who had at least some schooling. Among the latter group, there are only minor variations in use rates by the level of schooling. IUD and pill use levels increase directly with a woman’s educational level. In contrast, injectable use declines with the woman’s educational level. Women employed in a job for which they are paid in cash are more likely to use family planning methods than other women (66 percent and 57 percent, respectively). This is largely due to the higher rate of IUD use among women working for cash than among other women. As expected, contraceptive use increases with the wealth quintile, from 53 percent among women in the lowest quintile to 63 percent of women in the highest quintile. There is strong direct relationship between wealth and the level of IUD use. Among women in the highest quintile, the level of IUD use is 43 percent, 16 percentage points higher than that among women in the lowest quintile. Pill use also generally rises with the wealth quintile, peaking at 12 percent among women in the fourth quintile. On the other hand, injectable use decreases with the wealth quintile, from 13 percent among women in the lowest quintile to two percent among women in the highest quintile. Differentials by Governorate Current use levels are presented in Table 6.3 for the Urban Governorates and the governorates in Lower Egypt and Upper Egypt. They are not shown for the five Frontier Governorates because the samples from the individual governorates in this region were not sufficiently large to allow separate estimation of the use rates. Table 6.3 Current use of family planning by governorate Percentage of currently married women 15-49 currently using any method, any modern method, the pill, the IUD or injectables by governorate, Egypt2005 Governorate Any method Any modern method Pill IUD Inject- ables Number of women Urban Governorates 63.9 61.2 8.2 43.9 4.4 3,078 Cairo 63.8 61.0 8.3 44.1 4.6 1,899 Alexandria 64.5 61.8 6.8 45.5 3.8 888 Port Said 61.6 59.1 11.5 35.8 4.4 168 Suez 64.0 62.5 13.2 41.1 4.7 123 Lower Egypt 65.9 64.2 10.0 44.0 7.1 7,884 Damietta 63.9 62.9 11.8 43.1 4.3 238 Dakahlia 64.4 63.4 9.1 42.5 7.5 1,341 Sharkia 61.2 60.1 17.2 32.1 8.3 1,273 Kalyubia 69.4 66.2 9.4 47.1 6.8 1,126 Kafr El-Sheikh 65.8 64.9 8.9 43.0 8.7 652 Gharbia 69.7 68.2 8.6 53.3 4.4 1,254 Menoufia 64.2 61.4 7.1 44.6 6.3 824 Behera 68.7 67.2 6.2 49.9 8.6 957 Ismailia 59.6 56.3 14.1 28.4 7.9 219 Upper Egypt 49.9 46.1 10.3 25.2 8.2 7,019 Giza 62.1 58.5 10.5 41.0 4.4 1,837 Beni Suef 56.0 54.2 8.5 31.0 11.4 533 Fayoum 55.9 53.9 10.1 27.5 14.3 604 Menya 51.4 44.5 10.1 18.8 12.1 1,109 Assuit 37.9 32.7 6.1 18.2 8.1 748 Souhag 32.7 28.9 7.6 12.8 6.7 1,136 Qena 47.2 44.5 16.9 17.3 7.8 805 Aswan 49.0 48.1 18.3 21.0 6.4 246 Total 59.2 56.5 9.9 36.5 7.0 18,187 Note: If more than one method is used, only the most effective method is shown in this tabulation. Current Use of Family Planning | 69 There is considerable variability in the levels of current use in the governorates for which results are presented in Table 6.3. At the time of the 2005 EDHS, use rates were 60 percent or higher in all of the Urban Governorates and in the nine governorates in Lower Egypt. Within the Urban Governorates, Alexandria had the highest use rate (65 percent) and Port Said (62 percent) the lowest rate. Within Lower Egypt, use rates varied from 60 percent in Ismailia to 70 percent in Gharbia. In Upper Egypt, only Giza governorate, of which a large part is included in the Cairo Metropolitan area, had a use rate over 60 percent. Among the other governorates in Upper Egypt, use rates ranged from 33 percent in Souhag to 56 percent in Beni-Suef and Fayoum. Table 6.3 also shows the rates of current use of the pill, the IUD, and injectables for each governorate. The IUD is the most popular method among users in all governorates. The highest level of IUD use is observed in Gharbia (53 percent), followed by Behera (50 percent), and the lowest level is in Souhag (13 percent). Aswan has the highest level of pill use (18 percent), while the lowest levels are found in Assuit and Behera (6 percent each). Use of injectables is highest in Fayoum (14 percent), Menya (12 percent), and Beni Suef (11 percent). 6.3 TRENDS IN CURRENT USE OF FAMILY PLANNING Trends by Method The results from the 2005 EDHS, as well as those from earlier surveys, can be used to examine the changes that have taken place in the level and pattern of contraceptive use in Egypt over the past 25 years. Figure 6.2 highlights the trend in family planning use at the national level between 1980 and 2005. Contraceptive use levels rose rapidly in the 1980s, and by 1992, the overall use rate was 47 percent, almost twice the rate reported in the 1980 Egypt Fertility Survey (24 percent). The use rate continued to rise after 1992—although at a more moderate rate—reaching 56 percent by the time of the 2000 EDHS. After 2000, the use rate increased but at much a slower rate than in the latter half of the 1990s. 24 30 47 48 56 59 1980 1988 1992 1995 2000 2005 Figure 6.2 Trends in Current Use, Egypt 1980-2005 EDHS 2005 Percentage of currently married women currently using a family planning method 70 | Current Use of Family Planning Table 6.4 presents the trends in use by method. IUD use rose from four percent in 1980 to 36 percent in 2000, where it remained essentially unchanged through 2005. Pill use declined steadily during the period 1980-1995 and then stabilized at a rate of around 10 percent beginning in 2000. Injectables first became available in the 1990s, and use of this method increased to 7-8 percent in the first half of the current decade. Table 6.4 Trends in current use of family planning Percent distribution of currently married women 15-49 by the family planning method currently used, Egypt 1980-2005 Method 1980 EFS 1984 ECPS 1988 EDHS 1991 EMCHS 1992 EDHS 1995 EDHS 1997 EIDHS 1998 EIDHS 2000 EDHS 2003 EIDHS 2005 EDHS Any method 24.2 30.3 37.8 47.6 47.1 47.9 54.5 51.8 56.1 60.0 59.2 Any modern method 22.8 28.7 35.4 44.3 44.8 45.5 51.8 49.5 53.9 56.6 56.5 Pill 16.6 16.5 15.3 15.9 12.9 10.4 10.2 8.7 9.5 9.3 9.9 IUD 4.1 8.4 15.7 24.2 27.9 30.0 34.6 34.3 35.5 36.7 36.5 Injectables na 0.3 0.1 na 0.5 2.4 3.9 3.9 6.1 7.9 7.0 Implants na na na na 0.0 0.0 0.1 0.0 0.2 0.9 0.8 Diaphragm/foam/jelly 0.3 0.7 0.4 na 0.4 0.1 0.2 0.1 0.2 0.1 0.0 Condom 1.1 1.3 2.4 na 2.0 1.4 1.5 1.1 1.0 0.9 1.0 Female sterilization 0.7 1.5 1.5 na 1.1 1.1 1.4 1.3 1.4 0.9 1.3 Any traditional method 1.4 1.6 2.4 3.3 2.3 2.4 2.7 2.3 2.2 3.4 2.7 Periodic abstinence 0.5 0.6 0.6 na 0.7 0.8 0.6 0.8 0.6 0.8 0.7 Withdrawal 0.4 0.3 0.5 na 0.7 0.5 0.4 0.3 0.2 0.4 0.3 Prolonged breastfeeding na 0.6 1.1 na 0.9 1.0 1.5 1.1 1.2 2.1 1.6 Other 0.3 0.1 0.2 na 0.1 0.1 0.1 0.1 0.1 0.1 0.1 Not using 75.8 69.7 62.2 62.2 52.9 52.1 45.5 48.2 43.9 40.0 40.8 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 of women 8,012 9,158 8,221 8,406 9,153 13,710 5,157 5,971 14,382 8,445 18,187 na = Information on the method was not collected or was not reported. Source: El-Zanaty and Way, 2004, Table 3.4 Trends over time in the method mix among users, that is, the distribution of users according to the method used are presented in Table 6.5. The dramatic shift from pill to IUD use that occurred during the past two decades is clear in the table. In 1980, almost 70 percent of current users relied on the pill, more than four times the percentage of users who relied on the IUD. By 2005, more than 60 percent of current users relied on the IUD compared to 17 percent who employed the pill. The relatively rapid expansion of the use of injectables is also evident. Twelve percent of current users relied on injectables in 2005, compared to five percent in 1995 and only one percent in 1992. Table 6.5 Trends in family planning method mix Percent distribution of currently married women 15-49 who are currently using any family planning method by the method used, Egypt 1980-2005 Method 1980 EFS 1984 ECPS 1988 EDHS 1992 EDHS 1995 EDHS 2000 EDHS 2005 EDHS Pill 68.6 54.4 40.5 27.4 21.7 16.9 16.7 IUD 15.9 27.7 41.6 59.2 62.6 63.4 61.5 Injectables 0.0 1.0 0.3 1.1 5.0 10.9 11.9 Condom 4.5 4.3 6.3 4.2 2.9 1.7 1.7 Female sterilization 2.9 5.0 4.0 2.3 2.3 2.5 2.2 Other modern methods 1.3 2.3 1.0 0.9 0.5 0.7 1.5 Traditional methods 5.8 5.3 6.3 4.9 5.0 3.9 4.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,939 2,775 3,108 4,311 6,567 8,063 10,779 Source: El- Zanaty and Way, 2001, Table 6.2 Current Use of Family Planning | 71 Trends by Urban-Rural Residence and Place of Residence Table 6.6 presents trends in the rate of current use of family planning methods between 1984 and 2005 by residence. Urban prevalence rose steadily during the 1980s, before appearing to plateau in the early 1990s. After 1995, the survey results document a pattern of slow and somewhat erratic increases in urban use levels, with the rate peaking at 66 percent in 2003 before falling off slightly to 63 percent at the time of the 2005 EDHS. Although all urban areas experienced substantial increases in contraceptive use during the period between 1984 and 2005, the pace of change was more rapid and consistently upward in urban Upper Egypt compared to the pattern in the Urban Governorates and in urban Lower Egypt. Table 6.6 Trends in family planning use by residence Percentage of currently married women 15-49 currently using any family planning method by urban-rural residence and place of residence, Egypt 1984-2005 Residence 1984 ECPS 1988 EDHS 1992 EDHS 1995 EDHS 1997 EIDHS 1998 EIDHS 2000 EDHS 2003 EIDHS 2005 EDHS Urban-rural residence Urban 45.1 51.8 57.0 56.4 63.1 59.3 61.2 65.5 62.6 Rural 19.2 24.5 38.4 40.5 47.1 45.6 52.0 55.9 56.8 Place of residence Urban Governorates 49.6 56.0 59.1 58.1 67.0 62.1 62.7 68.5 63.9 Lower Egypt 34.1 41.2 53.5 55.4 61.6 59.2 62.4 65.2 65.9 Urban 47.6 54.5 60.5 59.1 65.9 62.2 64.9 66.3 64.1 Rural 28.5 35.6 50.5 53.8 59.9 58.1 61.4 64.8 66.5 Upper Egypt 17.3 22.1 31.4 32.1 37.4 36.5 45.1 49.4 49.9 Urban 36.8 41.5 48.1 49.9 52.1 50.8 55.4 59.8 60.0 Rural 7.9 11.5 24.3 24.0 30.3 29.9 40.2 44.7 45.2 Frontier Governorates na na na 44.0 na na 43.0 na 49.3 Total 30.3 37.8 47.1 47.9 54.5 51.8 56.1 60.0 59.2 na = Information on the method was not collected or was not reported Source: El-Zanaty and Way, 2004, Table 3.5 In rural areas, the decade of the eighties was also a period of substantial growth in contraceptive use. The rural use rate recorded a moderate increase during the period from 1984 to 1988 (from 19 percent to 25 percent), followed by a period of very rapid growth between 1988 and 1992 when the use rate increased to 38 percent. At that point, the pace of change in rural areas slowed. During the period between 1992 and 2005, the increase in the rural use level averaged about 1.5 percentage points per year, about half the annual increase observed between 1988 and 1992. Rural areas in both Lower Egypt and Upper Egypt showed similar absolute gains in use between 1984 and 2005. However, the timing of major changes in the levels of contraceptive use differed in the two areas. Much of the increase in rural Lower Egypt took place in the first 20 years of the period while, in rural Lower Egypt, the absolute increase in use was greatest in the last decade. Trends by Governorate Table 6.7 presents the trend in current use rates at the governorate level between 1988 and 2000. Some caution should be used in interpreting the changes in use levels for individual governorates. The comparatively small sample sizes on which the governorate-level estimates are based increases the sampling variability and, thus, reduces the likelihood that small changes are significant. 72 | Current Use of Family Planning All governorates experienced increases in use levels over the roughly 17-year period be- tween the 1988 and 2005 EDHS surveys. In abso- lute terms, the governorates in Upper Egypt, where use levels were lowest in 1988 (i.e., rates of 20 percent or less), had the largest increases during the period. Within Upper Egypt, the great- est absolute increase took place in Beni Suef, where use more than tripled, from 15 percent in 1988 to 56 percent in 2005. Giza governorate, where use levels were moderately high in 1988, had the lowest absolute gain in use during the period between 1988 and 2005 (16 percent). Souhag, where the prevalence level is currently the lowest among all Upper Egypt governorates, also experienced a comparatively modest growth in use levels between 1988 and 2005 (17 per- centage points). Looking at the pattern of change within Lower Egypt governorates, Behera, where the use rate was lowest in 1988, experienced the greatest absolute growth in use levels between the 1988 and 2005 surveys (36 percentage points). Damietta, which had the highest level of use in 1988, registered the lowest absolute change in use levels (10 percentage points). Considering the Urban Governorates, Suez had a somewhat larger overall increase in its use rate (14 percentage points) between 1988 and 2005 than was observed in either Port Said or Alexandria (13 percentage points each). The overall increase in use levels was, however, much greater in all of these governorates than that experienced in Cairo, where the use rate grew by five percentage points over the 17-year period. Trends by Other Background Characteristics Table 6.8 presents trends in contraceptive use during the period between 1988 and 2005 by selected background characteristics of women for all methods and for the pill, IUD, and the injectable. Looking at the entire period, the use rate increased markedly across all age groups. Similarly, the use level increased substantially in each family size category through the period, except among childless women, where a negligible percentage were using at any time during the period. Considering education, the change in use over the period was greatest among women who never attended school; the use rate in 2005 among these women was 55 percent, nearly double the rate in 1988. Smaller increases were observed during the period among educated women. As a result the gap in use according to educational level narrowed substantially during the period. During the period, all groups experienced increases in the use of the IUD and injectable and a drop in the use of the pill. Table 6.7 Trends in current use of family planning methods by governorate Percentage of currently married women 15-49 who are currently using any family planning method by governorate, Egypt 1988-2005 Governorate 1988 EDHS 1992 EDHS 1995 EDHS 2000 EDHS 2005 EDHS Urban Governorates 56.0 59.1 58.1 62.7 63.9 Cairo 58.9 58.1 56.9 62.3 63.8 Alexandria 51.6 62.1 59.8 64.7 64.5 Port Said 48.2 60.5 59.7 57.7 61.6 Suez 50.3 57.3 62.4 58.0 64.0 Lower Egypt 41.2 53.5 55.4 62.4 65.9 Damietta 54.1 53.4 57.4 58.8 63.9 Dakhalia 41.3 52.8 54.9 62.8 64.4 Sharkia 35.2 49.2 53.1 61.4 61.2 Kalyubia 42.3 57.9 55.6 64.0 69.4 Kafr-El-Sheikh 41.7 47.2 54.4 64.2 65.8 Gharbia 50.1 55.9 55.9 65.7 69.7 Menoufia 43.9 55.7 54.3 61.3 64.2 Behera 32.5 54.7 58.7 59.8 68.7 Ismailia 41.0 50.2 58.5 58.9 59.6 Upper Egypt 22.1 31.4 32.1 45.1 49.9 Giza 45.7 49.9 50.9 60.5 62.1 Beni-Suef 15.3 29.2 30.4 53.0 56.0 Fayoum 20.2 33.3 34.0 50.4 55.9 Menya 16.6 21.9 24.3 46.7 51.4 Assuit 12.7 28.2 22.1 32.9 37.9 Souhag 16.2 19.8 21.7 27.5 32.7 Qena 12.2 24.7 26.3 34.6 47.2 Aswan 18.6 31.9 36.0 44.9 49.0 Total 37.8 47.1 47.9 56.1 59.2 Source: El-Zanaty and Way, 2004, Table 6.7 Table 6.8 Trends in current use of family planning by socio-demographic characteristics Percentage of currently married women 15-49 currently using any method, the pill, IUD and injectables by selected socio-demographic characteristics, Egypt 1988-2005 Any method Pill IUD Injectables Background characteristic 1988 1992 1995 2000 2003 2005 1988 1992 1995 2000 2003 2005 1988 1992 1995 2000 2003 2005 1988 1992 1995 2000 2003 2005 Age 15-19 5.5 13.3 16.1 23.4 25.4 26.3 3.5 4.1 3.2 4.3 5.7 6.3 1.7 8.4 11.3 15.0 14.3 15.9 0.0 0.0 1.1 2.4 2.7 1.9 20-24 24.3 29.7 33.2 42.7 48.0 44.7 10.8 6.8 6.6 6.6 8.7 8.0 10.7 21.2 21.7 29.6 29.1 27.8 0.0 0.2 2.1 3.9 5.6 4.5 25-29 37.1 46.0 47.6 57.0 57.2 57.4 14.9 13.3 9.8 9.2 8.8 11.3 17.7 29.3 33.1 38.3 35.8 34.5 0.0 0.2 2.2 5.8 7.3 7.4 30-34 46.8 58.8 58.1 67.2 69.2 69.0 19.2 16.2 13.3 11.3 9.8 11.0 20.2 36.7 37.3 42.9 43.5 44.5 0.2 0.5 3.2 7.8 9.7 8.5 35-39 52.8 59.6 60.7 68.0 73.3 73.3 23.2 18.2 13.8 12.4 10.8 11.4 21.2 34.0 37.2 42.8 45.5 45.3 0.1 0.8 3.2 7.8 10.3 10.3 40-44 47.5 55.5 58.8 63.4 71.9 70.1 15.5 14.0 12.5 11.3 11.6 11.0 18.5 28.9 34.4 37.4 43.6 43.0 0.3 1.1 2.5 7.0 8.8 7.5 45-49 23.4 34.5 33.3 42.0 46.9 47.8 8.6 7.9 7.6 6.4 6.8 6.6 6.6 14.9 16.2 23.3 25.7 27.8 0.0 0.5 1.2 4.7 7.0 4.7 Number of living children 0 0.7 0.5 1.2 0.2 0.2 0.5 0.1 0.3 0.5 0.3 0.0 0.2 0.4 0.2 0.5 0.0 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 1 23.1 31.6 31.6 42.3 45.1 46.0 7.6 6.7 4.7 7.3 9.7 9.4 11.4 22.4 23.3 30.8 29.3 30.1 0.0 0.0 0.9 1.9 2.2 1.9 2 43.4 52.5 53.9 66.0 70.1 66.7 14.7 12.7 8.9 9.2 10.9 11.3 20.5 34.3 38.9 46.9 47.6 44.5 0.0 0.0 1.6 4.9 4.9 5.9 3 47.8 59.3 65.4 69.3 74.3 74.8 19.9 17.1 13.7 11.2 11.2 11.9 19.6 34.8 40.3 47.1 46.0 48.2 0.0 0.5 3.8 5.6 9.6 8.2 4+ 44.4 54.3 53.9 62,2 68.1 67.5 17.1 15.8 13.9 11.7 9.6 10.7 17.1 30.0 30.6 33.8 37.4 36.8 0.2 1.0 3.2 9.9 13.6 11.7 Education No education 27.5 37.5 40.6 51.5 57.4 54.8 13.4 12.0 11.0 8.9 7.8 8.7 10.0 20.7 23.8 29.6 32.0 30.2 0.1 0.5 2.3 8.3 11.9 10.1 Some primary 42.5 53.5 50.5 57.5 59.0 62.8 20.3 17.6 12.2 10.3 8.6 9.3 16.3 29.4 30.2 33.7 35.8 37.4 0.1 0.5 3.1 7.9 8.4 9.4 Prim. complete/ some secondary 52.3 56.1 51.2 57.2 59.2 60.2 15.6 13.7 10.1 11.9 11.8 10.6 23.9 34.0 32.8 36.3 35.5 37.8 0.0 0.6 2.3 4.4 7.5 7.3 Sec. complete/ higher 53.2 58.0 56.5 61.2 63.2 61.5 13.8 9.8 8.3 8.9 10.1 10.8 27.1 40.0 39.0 43.9 42.0 40.8 0.1 0.4 2.0 3.2 4.1 3.8 Total 37.8 47.1 47.9 56.1 60.0 59.2 15.3 12.9 10.4 9.5 9.3 9.9 15.7 27.9 30.0 35.5 36.7 36.5 0.1 0.5 2.4 6.1 7.9 7.0 Source: El- Zanaty and Way, 2004, Table 3.6 C urrent U se of Fam ily Planning | 73 74 | Current Use of Family Planning 6.4 SOURCES FOR MODERN FAMILY PLANNING METHODS Sources by Method In the 2005 EDHS detailed information was collected on sources from which family planning methods were obtained. To obtain these data, current users of modern methods were asked for the name and location of the source where they had gotten their method at the beginning of the current segment of use. A code identifying the type of source was then recorded in the questionnaire and in the calendar in the month at the beginning of the period of use. Users relying on supply methods like the pill and the injectable were also asked about the source where they had most recently obtained the method. Table 6.9 shows the distribution of current users by source. Overall, current family planning users are more likely to obtain their method from a governmental source as from a private sector source (57 percent and 43 percent, respectively). The source for family planning method, however, varies markedly by method. The majority of current users of the IUD (62 percent) have the method inserted at a public sector source. In general, those users relying on a government source for the IUD get the device inserted at a static facility; however, four percent obtain the method from mobile clinics. One-third of IUD users go to private physicians, hospitals, or clinics for the method, while five percent obtain the method at clinics operated by private voluntary organizations, including those of the Egyptian Family Planning Association and the Clinical Services Improvement Project. The public sector is the main source for injectables, with more than eight in ten users obtaining the method from a governmental source. As was the case with the IUD, most injectable users obtain their method at a static facility, especially rural health units (43 percent). Five percent get injectables from a mobile clinic. Regarding the sources for other methods, pill users mainly get their method from a pharmacy (74 percent), as do couples using the condom (75 percent). Sterilizations are more frequently performed at private hospitals or clinics than at governmental facilities. Current Use of Family Planning | 75 Table 6.9 Source for modern family planning methods Percent distribution of current users of modern family planning methods by most recent source, according to specific methods, Egypt 2005 Source Pill IUD Injectable Condom Female sterilization Total1 Public sector 19.4 61.8 86.6 16.7 39.1 56.6 Urban hospital(general/district) 1.7 7.8 6.1 2.3 21.1 7.0 Urban health unit 3.8 16.3 15.4 4.7 0.2 13.4 Health office 0.9 6.7 4.6 4.3 0.0 5.2 Rural hospital(complementary) 1.8 4.0 6.9 0.1 1.0 3.8 Rural health unit 8.1 14.1 42.8 2.7 0.7 16.1 MCH centre 1.5 6.7 4.0 1.6 0.0 5.3 Mobile unit 1.5 3.7 5.4 0.9 0.0 3.4 University/teaching hospital 0.0 1.0 0.2 0.0 7.6 1.0 Health Insurance Organization 0.1 0.5 0.5 0.0 2.9 0.5 Curative Care Organization 0.0 0.1 0.1 0.0 0.0 0.1 Other governmental 0.0 1.0 0.6 0.1 5.6 0.9 Private sector 79.6 38.1 12.2 77.4 59.6 42.9 Nongovernmental/private voluntary organization (NGO/PVO) 0.3 4.5 1.0 0.6 0.1 3.1 Egypt Family Planning Association 0.0 1.3 0.2 0.5 0.0 0.9 Clinical Services Improvement 0.1 2.4 0.6 0.1 0.0 1.6 Other NGO/PVOs 0.1 0.8 0.2 0.0 0.1 0.6 Private medical 79.3 33.7 11.2 76.8 59.5 39.9 Private hospital/clinic 0.8 2.7 0.2 0.3 11.1 2.2 Private doctor 4.0 29.0 4.9 1.3 45.8 21.2 Nurse 0.0 0.0 2.6 0.0 0.0 0.3 Pharmacy 74.1 0.0 3.3 75.2 0.0 14.7 Mosque health unit 0.3 1.7 0.1 0.0 1.9 1.2 Church health unit 0.0 0.3 0.1 0.0 0.7 0.2 Other non-medical 0.8 0.0 1.2 5.1 0.0 0.4 Shop/other vendor 0.1 0.0 0.0 0.0 0.0 0.0 Friends/relative 0.8 0.0 0.9 5.1 0.0 0.3 Other 0.0 0.0 0.4 0.0 0.0 0.0 Don't know 0.2 0.0 0.0 0.8 1.3 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of users 1,798 6,629 1,281 180 239 10,285 1Includes users of the implant and vaginal method users for whom the source distribution is not shown separately Sources by Method and Residence Residential variations in the type of source are presented in Table 6.10 for all modern methods and for the pill and the IUD. In general, rural women are more likely to go to a public sector source to obtain their method than urban women (63 percent and 48 percent, respectively). The proportion of users obtaining their method from a public health facility ranges from 42 percent of users in urban Lower Egypt to 64 percent of users in rural Upper Egypt. In all areas, the pharmacy is the principal source for pill users, with only a minority getting their method from public sector facilities. However, the size of this minority varies by residence; only eight percent of pill users in urban Lower Egypt get their method from a public sector facility, compared to 39 percent in the Frontier Governorates. 76 | Current Use of Family Planning Table 6.10 Sources of family planning methods by residence Percent distribution of current users of modern family planning methods by method and most recent source, according to residence, Egypt 2005 Lower Egypt Upper Egypt Method and source Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total PILL Public sector 11.9 25.8 11.4 18.0 7.7 22.9 22.9 14.1 29.2 38.8 19.4 Private sector 86.4 73.8 85.5 81.3 90.9 76.7 76.4 84.8 70.5 61.2 79.6 NGO/PVOs 0.5 0.0 1.0 0.1 0.2 0.0 0.2 0.5 0.0 0.0 0.3 Private hospital/doctor 6.7 3.2 1.7 3.0 6.2 1.5 8.0 11.6 5.4 2.5 4.8 Mosque/church clinic 0.5 0.2 0.6 0.0 0.0 0.0 0.6 0.8 0.6 0.0 0.3 Pharmacy 78.6 70.3 82.2 78.2 84.5 75.2 67.6 71.9 64.5 58.7 74.1 Other/don’t know/missing 1.7 0.4 3.1 0.7 1.4 0.4 0.7 1.1 0.4 0.0 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of users 827 971 254 790 252 538 725 301 424 30 1,798 IUD Public sector 54.8 67.7 60.5 62.8 48.8 67.5 60.9 51.8 68.1 61.4 61.8 Private sector 45.1 32.3 39.3 37.2 51.2 32.5 39.1 48.2 31.9 38.6 38.1 NGO/PVOs 5.5 3.5 4.0 4.0 6.9 3.1 5.7 6.8 4.8 2.0 4.5 Private hospital/ doctor 36.6 27.7 31.4 32.0 41.8 28.7 31.4 39.5 25.0 35.2 31.8 Mosque/church clinic 3.0 1.0 3.9 1.1 2.5 0.6 2.0 1.9 2.1 1.4 1.9 Pharmacy 0.1 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of users 3,032 3,597 1,352 3,466 871 2,595 1,766 781 985 45 6,629 ALL MODERN METHODS1 Public sector 48.0 63.2 54.2 57.2 41.5 62.6 56.8 44.9 64.3 59.6 56.6 Private sector 51.4 36.4 44.7 42.4 58.1 37.0 42.9 54.7 35.4 40.4 42.9 NGO/PVOs 4.0 2.3 3.1 2.9 4.8 2.2 3.4 4.8 2.5 0.9 3.1 Private hospital/doctor 27.8 20.6 23.9 25.1 32.5 22.6 21.7 29.4 16.8 18.7 23.8 Mosque/church clinic 2.3 0.7 3.1 0.9 2.0 0.5 1.3 1.4 1.2 0.6 1.4 Pharmacy 17.2 12.8 14.7 13.5 18.8 11.7 16.5 19.1 14.8 20.2 14.7 Other/DK/Missing 0.6 0.4 1.0 0.4 0.4 0.4 0.3 0.3 0.4 0.0 0.5 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 users 4,485 5,799 1,890 5,063 1,282 3,781 3,234 1,251 1,983 97 10,285 NGO =Nongovernmental organization PVO =Private voluntary organization 1Includes users of the implant and vaginal methods for whom the source distribution is not shown separately. A majority of IUD users rely on public sector sources for the method, except urban Lower Egypt. Reliance on public sector sources for the IUD is most frequent in rural areas; slightly more than two- thirds of IUD users in rural Upper Egypt and rural Lower Egypt obtained the method from a public health facility. Trends in Sources of Modern Methods Table 6.11 present trends in the source of family planning methods during the period between the 1995 EDHS and the 2005 EDHS for IUD users and for users of all modern methods. Overall, the percentage of modern method users relying on the public sector for services rose from 36 percent in 1995 to 57 percent at the time of the 2005 EDHS. Much of that change is due to increased reliance on the Current Use of Family Planning | 77 public sector for the IUD. Table 6.11 shows that the percentage of users who obtained the IUD at a public sector provider increased from 45 percent in 1995 to 62 percent in 2005. Considering the variation by residence, the trend toward an increased reliance on public sector providers was observed among users in all areas. However, the magnitude of the increase was much greater for rural users than for urban users. Table 6.11 Trends in reliance on public sector source for contraceptive method by residence Percentage of current users of the IUD and of all modern methods obtaining the method at a public sector source by urban-rural residence and place of residence, Egypt 1995-2005 IUD Modern methods Residence 1995 EDHS 2000 EDHS 2005 EDHS 1995 EDHS 2000 EDHS 2005 EDHS Urban-rural residence Urban 42.8 48.7 54.8 34.0 42.0 48.0 Rural 46.7 59.4 67.7 37.7 54.8 63.2 Place of residence Urban Governorates 46.5 48.8 60.5 39.7 43.5 54.2 Lower Egypt 44.4 54.9 62.8 35.2 50.2 57.2 Urban 37.4 47.5 48.8 27.5 40.9 41.5 Rural 47.3 58.0 67.5 38.6 54.1 62.6 Upper Egypt 42.1 57.3 60.9 32.3 50.0 56.8 Urban 39.9 50.1 51.8 29.6 40.8 44.9 Rural 44.5 63.5 68.1 34.8 56.3 64.3 Frontier Governorates 31.3 44.9 61.4 25.2 41.0 59.6 Total 44.5 54.0 61.8 35.7 48.6 56.6 Source: El-Zanaty and Way, 2001, Table 6.10 6.5 PILL BRANDS A number of questions were included in the 2005 EDHS relating to the brand of pills women were using and that they had heard about. Information about the brands pill users had adopted was collected by asking pill users to show the packet of pills. If the packet was available, interviewers recorded the name of the brand. If a user was unable to show the EDHS interviewer the packet, she was asked to name the brand she was using. Table 6.12 shows that about a fifth of pill users were not able to show a packet or identify the brand they were using. Combined pills or pills containing both estrogen and progestin may interfere with the pro- duction of milk among breastfeeding mothers and also may affect breastmilk composition (Blackburn et al. 2000). Breastfeeding mothers are advised to take progestin-only pills in order to avoid these Table 6.12 Brand of pill Percent distribution of current users by the brand of pill used and breastfeeding status, Egypt 2005 Pill brand Currently breast- feeding users Non- breast- feeding users All users Suitable for breastfeeding users 44.7 4.9 15.2 Microlut 29.6 3.9 10.6 Exluton 7.3 0.8 2.5 Levonor 7.8 0.2 2.1 Other brands 35.1 74.5 64.3 Nordette 0.9 2.1 1.8 Microvlar 0.2 1.9 1.5 Marvelon 0.1 2.4 1.8 Microcept 18.4 36.2 31.5 Microgynon 3.2 9.2 7.7 Triocept 8.1 12.9 11.7 Gynera 3.2 6.6 5.7 Cilest 0.9 1.4 1.3 Other 0.2 1.5 1.5 Don't know 20.2 20.6 20.5 Total 100.0 100.0 100.0 Number of pill users 467 1,331 1,798 78 | Current Use of Family Planning adverse effects. In order to look at the extent to which breastfeeding mothers are following this recommendation, Table 6.12 identifies pill brands according to their hormonal composition and classifies pill users according to their breastfeeding status. Among the breast- feeding mothers for whom information on pill brands was obtained, slightly less than half were using progestin-pills. An additional question was included in the 2005 EDHS to ascertain the extent to which women in Egypt are aware of the availability of pill brands that are suitable for use by breastfeeding mothers. Overall, Table 6.13 shows that around three in five ever- married women reported they had heard about a contraceptive pill which was suitable for breastfeeding women. However, most of these women were not able to identify a brand of pills appropriate for use by breastfeeding mothers. 6.6 COST AND WILLINGNESS TO PAY In the 2005 EDHS, users of the pill, the IUD and injectables were asked about the actual amounts they had paid for their method. In addition, questions were included on the willingness of users to pay various amounts for their methods. One of the challenges that the Egyptian family planning program faces is sustaining the delivery of quality services. Questions on the amount users are willing to pay for their contraceptive method represent an effort to gauge the extent to which users might accept increases in contraceptive prices as part of an effort to achieve sustainable family planning services. Some caution should be exercised in interpreting the response to these questions; the questions are hypothetical and, thus, may not provide an accurate measure of the user’s actual ability to pay higher amounts for their method. In order to look at trends, similar information on actual costs and willingness to pay obtained in the 2000 EDHS are presented along with the 2005 results. Pill Users According to the results in Table 6.14, virtually all pill users are paying more than 50 piastres for a cycle of pills, and 49 percent pay more than one pound (100 piastres). The median cost of a cycle is just over 1 pound (101 piastres), which is only marginally higher than the median cost reported at the time of the 2000 EDHS (95 piastres). Table 6.13 Knowledge of pill brand suit- able for breastfeeding women Percent distribution of ever-married women by knowledge of pill brand suitable for breastfeeding women, Egypt 2005 Pill brand Percent Knows about pill suitable for breastfeeding women 58.9 Names correct brand 2.7 Names incorrect brand 0.8 Cannot name brand 55.4 Doesn't know about pill for breastfeeding women 40.6 Missing 0.5 Total 100.0 Number of women 19,474 Table 6.14 Cost of method for pill users Percent distribution of current users of the pill by cost of a cycle of pills (in piastres) and trends in the median and mean amounts paid for the pill, Egypt 2000-2005 Cost of pill cycle Percent Free 1.3 1-50 piastres 0.4 51-75 piastres 35.7 76-100 piastres 11.2 101-200 piastres 6.5 201-300 piastres 13.5 301-999 piastres 9.9 1000-1300 piastres 8.1 More than 1300 piastres 10.6 Don't know/missing 2.7 Total 100.0 Number of pill users 1,798 2005 EDHS Median 101.0 Mean 426.8 2000 EDHS Median 95.2 Mean 204.8 Current Use of Family Planning | 79 Table 6.15 looks at the willingness of pill users who were interviewed in the 2000 and 2005 EDHS surveys to pay various amounts for the method. In both surveys, almost all pill users reported they were willing to at least one pound. Pill users were somewhat more likely to indicate a willingness to pay higher amounts for a pill cycle in the 2005 survey than in the 2000 survey. For example, in the 2005 EDHS, 82 percent of users expressed a willingness to pay 2 pounds for a cycle compared to 69 percent in the 2000 survey. Injectable Users Table 6.16 presents information on the cost of injectables at the time of the 2005 EDHS. Eight percent of injectable users paid nothing for their method, and 63 percent paid less than two pounds. The median cost was 1.7 pounds, which is lower than the median amount paid for injectables at the time of 2000 EDHS (2.3 pounds). The drop in the median cost between 2000 and 2005 reflects the effect of a reduction in the price charged for the injectable at public health facilities between the two surveys. Table 6.17 looks at the proportions of users reporting that they were willing to pay various amounts for the injectable in the 2000 and 2005 surveys. In general, users interviewed in the 2000 survey were more willing to pay higher amounts for the injectable than users in the 2005 survey. For example, 80 percent of injectable users in the 2000 EDHS were willing to pay at least 5 pounds for the survey compared to 68 percent of injectable users in the 2005 EDHS. Table 6.15 Amount users are willing to pay for the pill Percentage of current users of pill willing to pay various amounts to obtain the method, Egypt 2000 and 2005 Amount pill users are willing to pay 2000 EDHS 2005 EDHS 50 piasters 99.8 99.4 75 piasters 98.7 98.1 1 pound 92.7 94.6 2 pounds 69.4 81.6 5 pounds 35.8 56.0 More than 5 pounds 24.5 41.8 Number of pill users 1,362 1,798 Table 6.16 Cost of method for injectable users Percent distribution of current users of injectables by the cost of the method (in pounds) and trends in the median and mean amounts paid for the injectable, Egypt 2000-2005 Cost of injectable Total Free 7.7 < 1 pounds 0.2 1-1.9 pounds 63.2 2-2.9 pounds 11.6 3-4.9 pounds 4.9 5-6.9 pounds 3.9 7-8.9 pounds 3.0 9-9.9 pounds 0.4 10+ pounds 4.2 Don't know/missing 0.8 Total 100.0 Number of injectable users 1,281 Median 1.7 2005 EDHS Median 1.7 Mean 3.7 2000 EDHS Median 2.3 Mean 3.7 Table 6.17 Amount users are willing to pay for injectables Percentage of current users of injectables willing to pay various amounts to obtain the method, Egypt 2000 and 2005 Amount injectable users are willing to pay 2000 EDHS 2005 EDHS 2 pounds 97.5 96.0 5 pounds 79.8 68.1 10 pounds 46.6 32.8 15 pounds 22.9 15.5 20 pounds 14.2 9.2 More than 20 pounds 10.1 5.3 Number of injectable users 876 1,281 80 | Current Use of Family Planning IUD Users Table 6.18 presents the actual amount that IUD users paid for services. The table shows that, while relatively few IUD users (6 percent) get the method for free, more than one-quarter of users pay less than 3 pounds for IUD. At the other extreme, 27 percent of IUD users pay 20 pounds or more to obtain the method. The amount that a user pays to obtain an IUD varies with the type of provider. The lowest median cost is observed among those users who obtained the method from a public sector source (2.9 pounds). The median cost at a NGO/PVO clinic is 15.2 pounds, almost five times the cost that an average user pays at a public sector facility, but roughly half the amount users who have the IUD inserted by a private doctor or at a private hospital or clinic pay (30.4 pounds). Table 6.18 Cost of method for IUD users Percent distribution of current users of IUD by cost of the method (in pounds), according to the type of provider, Egypt 2005, and trends in median and mean amounts paid for the IUD, Egypt 2000-2005 Cost of IUD Public health facility Private doctor/ clinic NGO/ PVO clinic Mosque/ church clinic Total Free 8.7 2.7 1.2 4.2 6.4 < 3 pounds 44.2 0.6 5.6 7.4 27.9 3-4.9 pounds 23.3 0.5 4.7 5.5 14.9 5-9.9 pounds 15.1 3.2 15.1 9.4 11.2 10-14.9 pounds 3.8 6.0 19.1 13.9 5.4 15-19.9 pounds 1.5 7.7 15.1 13.1 4.3 20-29.9 pounds 1.0 24.1 18.2 26.7 9.6 30-49.9 pounds 0.4 25.4 9.8 12.3 9.0 50 pounds or more 0.4 25.3 7.1 4.2 8.7 Don't know/missing 1.6 4.4 4.1 3.4 2.7 Total 100.0 100.0 100.0 100.0 100.0 Number of IUD users 4,098 2,105 296 130 6,629 2005 EDHS Median 2.9 30.4 15.2 15.8 4.7 Mean 4.0 39.7 19.0 17.9 14.1 2000 EDHS Median 3.1 25.7 11.8 15.6 5.8 Mean 4.4 34.1 11.5 18.2 15.7 NGO =Nongovernmental organization PVO =Private voluntary organization A comparison of the median cost for an IUD at the time of the 2005 EDHS with the cost paid by IUD users at the time of the 2000 EDHS indicates that the amount the average user paid for having an IUD inserted at a governmental facility declined slightly between the surveys. At all other types of sources, however, the median amount a user paid for the IUD rose between the two surveys. The increasing gap between the costs of the IUD in public and private sector facilities may be one factor explaining the rise in the proportion of users obtaining the IUD at governmental facilities between the 2000 and 2005 surveys. Current Use of Family Planning | 81 The results in Table 6.19 indicate that IUD users would be willing to pay considerably more for the method than they currently pay. Almost all IUD users (97 percent) would be willing to pay 5 pounds, and 82 percent say they are willing to pay 10 pounds. Somewhat more than half of users would be willing to pay 25 pounds, and 31 percent express a willingness to pay at least 50 pounds. Relatively few women would be willing to pay more than 100 pounds, with only four percent of IUD users saying they would pay more than 200 pounds for an IUD. Comparing the 2000 and 2005 results, there appear to have been only very modest declines in the proportions willing to pay various amounts for the IUD. 6.7 INFORMED CHOICE Informed choice is a necessary part of family planning programs. Users should be informed of the choices they have with respect to other methods. Family planning providers should also inform all method users of the potential side effects and what they should do if they encounter any of the effects. This information both assists the user in coping with side effects and decreases unnecessary discontinua- tion of temporary methods. The 2005 EDHS included a number of questions designed to assess whether women who were currently using family planning at the time of the survey had received sufficient information to make informed choices. Current users were asked whether they had been told about other methods, told about side effects, or given advice about what to do about side effects by the provider from whom they obtained their method. If they were not told about other methods or about side effects during that consultation, they were asked if they had ever received information from a provider about these topics. Caution must be exercised in interpreting the responses to these questions since they are subjective. In addition, they also suffer from an unknown degree of recall error, i.e., many users had gone to the provider months or even years before the EDHS interview and may not have remembered accurately everything that took place during the encounter. Nevertheless, the results of these questions provide at least some insight into the nature of the counseling that family planning users are receiving from their providers. Table 6.20 presents information on the informed choice for current users adopted the method in January 2000 or later. In general, the information exchange between many current users and their provider is fairly limited. Somewhat more than one in two users report that the provider discussed methods other than the one the user received. A similar but slightly smaller proportion was told about side effects. Two in five users were told what to do if they experienced side effects. In those cases where the users received information needed to make an informed choice, they generally reported that they received the information from the provider whom they consulted at the beginning of the current segment of use. Table 6.20 also shows that the proportion of users receiving the information needed to make an informed choice does not vary markedly with the type of clinical providers. The largest differentials are observed in the percentages receiving information about method side effects. However, users obtaining the method from a pharmacy are much less likely than other users to have received information, especially about side effects, necessary to make an informed choice. Table 6.19 Amount users are willing to pay for IUD insertion Percentage of current users of the IUD willing to pay various amounts for the method, Egypt 2005 Amount IUD users are willing to pay 2000 EDHS 2005 EDHS 5 pounds 97.8 96.6 10 pounds 88.5 82.2 25 pounds 64.8 57.0 50 pounds 33.1 31.2 100 pounds 12.8 12.3 150 pounds 7.2 6.7 200 pounds 4.8 4.7 More than 200 pounds 4.1 3.6 Number of IUD users 5,112 6,629 82 | Current Use of Family Planning Table 6.20 Informed choice Percentage of current users who began the current segment of use since January 2000 who reported they were advised about various aspects of the method they obtained according to type of source and method Egypt 2005 Information provided Public sector NGO/ PVO clinic Private clinical1 Pharmacy Total PILL Told about other methods 60.1 * 62.9 39.5 54.8 At start of current segment of use 54.2 * 54.6 23.7 45.0 Ever but not during current segment 5.9 * 8.2 15.7 9.9 Told about side effects 44.1 * 55.6 28.1 43.5 At start of current segment of use 41.9 * 52.1 21.9 39.6 Ever but not during current segment 2.2 * 3.6 6.2 3.9 Told what to do about side effects 33.8 * 43.2 16.1 31.8 Number of users 450 11 549 447 1,461 INJECTABLES Told about other methods 62.5 * 59.9 * 62.1 At start of current segment of use 56.3 * 55.5 * 55.8 Ever but not during current segment 6.2 * 4.3 * 6.3 Told about side effects 55.6 * 55.1 * 55.8 At start of current segment of use 50.8 * 52.6 * 50.9 Ever but not during current segment 4.8 * 2.5 * 4.9 Told what to do about side effects 37.7 * 43.3 * 38.6 Number of users 909 13 118 26 1,068 IUD Told about other methods 54.9 59.6 57.8 na 56.1 At start of current segment of use 48.2 54.4 49.2 na 48.8 Ever but not during current segment 6.8 5.2 8.6 na 7.3 Told about side effects 51.6 53.9 57.2 na 53.5 At start of current segment of use 45.8 47.5 52.1 na 47.9 Ever but not during current segment 5.8 6.4 5.1 na 5.6 Told what to do about side effects 40.3 38.5 47.4 na 42.5 Number of users 2,887 215 1,454 na 4,556 ALL MODERN METHODS2 Told about other methods 57.0 61.2 59.5 40.3 56.6 At start of current segment of use 50.4 55.7 51.1 24.8 48.9 Ever but not during current segment 6.6 5.6 8.4 15.4 7.7 Told about side effects 51.6 55.3 56.8 28.3 51.5 At start of current segment of use 46.3 49.4 52.3 21.9 46.4 Ever but not during current segment 5.3 5.9 4.4 6.4 5.1 Told what to do about side effects 38.9 39.2 45.6 16.6 39.3 Number of users 4,437 240 2,230 539 7,454 Note: Table excludes users who obtained method from friends/relatives. An asterisk indicates figure is based on fewer than 25 cases and has been suppressed. na = Not applicable NGO=Nongovernmental organization PVO=Private voluntary organization 1 Includes private hospital/clinic, private doctor/nurse, mosque/church clinic 2 Includes current users of modern methods who began current segment of use since January 2000 Nonuse of Family Planning and Intention to Use | 83 NONUSE OF FAMILY PLANNING AND INTENTION TO USE 7 One of the primary objectives of the 2005 EDHS is to provide information on reasons for nonuse and on the intention to use family planning in the future. Such information is considered to be of particular interest to policymakers and program managers as they seek to address the contraceptive needs of nonusers who are concerned about spacing or limiting their fertility. Thus, this chapter focuses on women who are not using family planning. It presents information on the following topics: levels of family planning discontinuation, reasons for discontinuation, reasons for nonuse, intention to use in the future, timing of future use, and the methods preferred among women who are not currently using a family planning method. 7.1 CONTRACEPTIVE DISCONTINUATION RATES A key concern for family planning programs is the rate at which users discontinue use of contraception and the reasons for such discontinuation. Reasons for discontinuation may vary among couples but usually include factors such as contraceptive failure, dissatisfaction with the method, and health concerns as well as the lack of availability or the cost of contraceptive methods. If the rates of discontinuation are high, greater attention should be focused on counseling and follow-up, to help users to deal with the various obstacles to continued use. The data used to analyze discontinuation were collected in the 2005 EDHS by asking respondents for information on all episodes of contraceptive use between January 2000 and the date of the interview. For each interval of use, the woman was asked the contraceptive method used and the date of use (year and month) and, if applicable, the date she stopped using and the reason for discontinuation. If a woman reported that she was using a method in January 2000, she was also asked for the date when that segment of use began. Life-table techniques were used to calculate discontinuation rates from the 2005 EDHS calendar data. Specifically, the rates are based on episodes of use that began during the period 3 to 59 months prior to the 2005 EDHS. The rates are one-year discontinuation rates; i.e., they represent the proportion of users discontinuing within the first 12 months after beginning to use the method. The rates are calculated separately for the following five methods: pills, injectables, IUDs, condoms, and prolonged breastfeeding. To ensure a sufficient number of segments of use to allow calculation of the rates, the reasons for discontinuation were grouped into seven specific categories: method failure, desire for pregnancy, other fertility-related reasons, side effects/health concerns, wanted a more effecdtive method, other method- related reasons, and other reasons. In calculating the rates, the month of interview and the two preceding months were dropped to avoid any bias that might be introduced by unrecognized pregnancy. The rates are cumulative, i.e., they are obtained by dividing the number of discontinuations at each duration of use (in single months) by the number of months of exposure at that duration. The single-month rates were then cumulated to produce a one-year rate. In deriving these rates, the reasons for discontinuation are treated as competing risks; thus, the rates are additive across the reasons for discontinuation. Overall, Table 7.1 shows that around one-third of users in Egypt stop using a method within 12 months of starting use. The desire for a more effective method motivated 12 percent of the users to stop using. Three percent of users stop using due to method failure (i.e., they became pregnant while 84 | Nonuse of Family Planning and Intention to Use using the method), four percent stop using because they want to become pregnant, four percent stop using as a result of other fertility-related reasons including marital dissolution, infrequent sex, and the onset of menopause, six percent stop because of health concerns or side effects, and two percent stop using for other reasons. Regarding individual methods, the highest rate is observed for the pill (50 percent), followed by the injectable (46 percent) and prolonged breastfeeding (44 percent). The IUD has the lowest discontinuation rate; 15 percent of IUD users stopping use during the first 12 months of use. The reasons for discontinuation vary by method. Women using prolonged breastfeeding are the most likely to discontinue because of the desire for a more effective method. This is a frequent motivation for discontinuation among users of the pill, injectable, and condom, who are between three and four times as likely as IUD users to stop using because of a desire for a more effective method. The proportion of users who stop use because of method failure is very low for the IUD and injectables (about 1 percent) and highest for the pill and condom (7 percent). Pill users are more likely than users of other methods to discontinue use because they want to become pregnant or for other fertility-related reasons. The rate of discontinuation due to side effects or health concerns is greatest among injectable users. The impact of discontinuation clearly depends on whether or not the user is left exposed to the risk of unintended pregnancy. Table 7.1 also examines the extent to which users who discontinue adopt another method within two months of the time they discontinue. Overall, 12 percent of users who discontinue use switch to another method within two months after discontinuing use. Thus, around four in ten users who discontinue use within 12 months of adopting a method are protected from an unintended pregnancy within a short period after they stop use. Table 7.1 Contraceptive discontinuation rates Percentage of contraceptive users who discontinued a method within 12 months after beginning its use, by reason for discontinuation and percentage who switched to another method, Egypt 2005 Reason for discontinuation Method Method failure Desire to become pregnant Other fertility related reasons2 Side effects/ health reasons Wanted more effective method Other method related reasons3 Other reasons Any reason Switched to another method4 Pill 6.7 7.1 9.6 8.3 16.6 0.2 1.6 50.0 16.8 IUD 1.3 3.3 1.0 3.8 5.4 0.3 0.3 15.3 5.4 Injectables 1.1 4.6 6.5 13.5 17.3 0.4 2.0 45.5 17.3 Male condom 7.2 4.4 3.6 0.5 20.2 0.4 1.4 37.7 20.4 Prolonged breastfeeding 5.2 1.2 0.0 0.3 26.3 9.8 1.1 44.0 26.5 All methods1 3.2 4.3 4.1 6.1 12.1 1.0 1.0 31.8 12.2 Note: Figures are based on lifetable calculations using information on episodes of use that began 3-59 months prior to the survey. 1Includes methods for which rates are not shown separately in table 2Includes infrequent sex/husband away, difficult to get pregnant/menopausal, and marital dissolution/separation 3Includes lack of access/too far, costs too much, and inconvenient to use 4Used a different method in the month following discontinuation or said they wanted a more effective method and started another method within two months of discontinuation 7.2 REASONS FOR DISCONTINUATION OF CONTRACEPTIVE USE Table 7.2 looks in greater detail at the reasons the 2005 EDHS respondents gave for discontinuing use. The table shows the percent distribution of all discontinuations in the five-year period prior to the survey by the main reason for discontinuing according to the specific method. Nonuse of Family Planning and Intention to Use | 85 Table 7.2 Reasons for discontinuation Percent distribution of discontinuations of methods in the five years preceding the survey by main reason for discontinuation, according to method, Egypt 2005 Reason Pill IUD Injectables Condom Prolonged breast- feeding All methods1 Became pregnant while using 14.7 4.5 2.8 23.3 14.6 8.7 Wanted to become pregnant 24.4 43.8 13.0 23.4 6.0 29.1 Husband disapproved 0.5 0.3 0.6 6.4 0.0 0.4 Side effects 30.1 36.7 58.5 4.7 0.4 34.7 Health concerns 2.8 2.2 3.4 0.0 0.4 2.3 Access/availability 0.5 0.1 0.8 0.4 0.0 0.3 Wanted a more effective method 7.2 0.4 1.0 23.2 15.6 4.3 Inconvenient to use 1.1 0.8 0.9 3.4 58.4 5.8 Infrequent sex/husband away 12.4 2.9 9.1 6.2 0.2 6.6 Cost too much 0.3 0.0 0.1 0.0 0.0 0.1 Fatalistic 0.2 0.0 0.2 0.0 0.4 0.1 Difficult to get pregnant/menopausal 1.5 1.2 2.2 1.1 0.0 1.4 Marital dissolution/separation 1.4 3.5 1.4 3.3 0.0 2.2 Doctor's opinion 0.2 1.0 0.4 1.0 0.0 0.6 IUD expelled 0.0 0.8 0.0 0.0 0.0 0.4 Other 1.6 0.5 4.0 0.3 0.3 1.4 Don't know 0.0 0.0 0.0 0.0 0.0 0.0 Missing 1.2 1.1 1.8 3.4 3.8 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 3,606 5,438 2,071 166 1,060 12,616 1 Includes methods for which the distributions are not shown separately in the table. Side effects (35 percent) were the most common reason for discontinuation of all modern methods. Health concerns were cited as the reason for another two percent of discontinuations. The desire to become pregnant was also a frequently mentioned reason for discontinuing use. Overall, nearly three in ten discontinuations during the five-year period before the 2005 EDHS occurred because the user wanted to have a child. This reason was the most frequently mentioned factor in discontinuations among IUD users. For other women, an unintended pregnancy was the reason for discontinuation; nine percent of discontinuations were the result of method failure; i.e., the woman became pregnant while using a method. Women using periodic abstinence were most likely to report method failure as the reason they stopped using the method. Side effects were the most common reason for discontinuations of the pill and injectable and they were the second most common cause of discontinuation among IUD users. Dissatisfaction with the method was a major factor in discontinuations for some methods. In the case of prolonged breastfeeding, for example, 58 percent of discontinuations were because the woman found the method inconvenient to use. Concern about method effectiveness was a factor in more than two in ten discontinuations of periodic abstinence and the condom. Table 7.2 also shows that program-related factors such as cost or access were almost never cited as reasons for discontinuation. Except for the condom, the husband’s disapproval was also rarely cited as a main factor affecting the decision to discontinue use. Six percent of discontinuations of the condom were due to the husband’s unwillingness to use the method. Factors that reduced or eliminated the risk of 86 | Nonuse of Family Planning and Intention to Use pregnancy (e.g., infrequent sex/husband away, difficulty in getting pregnant/menopause, and marital dissolution) accounted for 10 percent of discontinuations. 7.3 INTENTION TO USE CONTRACEPTION IN THE FUTURE To obtain information about potential demand for family planning services, all currently married women who were not using contraception at the time of the survey were asked about their intention to adopt family planning methods in the future. Table 7.3 shows the percent distribution of nonusers by their intention to use in the future, according to number of living children. Table 7.3 Future use of family planning Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Egypt 2005 Number of living children1 Intention 0 1 2 3 4+ Total Intends to use 69.0 80.0 74.6 62.2 42.2 64.2 Unsure 6.1 4.6 3.9 3.8 3.4 4.2 Does not intend to use 24.9 14.7 20.4 32.7 53.4 30.8 Missing 0.0 0.6 1.1 1.3 1.0 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,135 1,602 1,458 1,231 1,992 7,418 1Includes current pregnancy Among all currently married nonusers, 64 percent intend to use family planning at some time in the future, 31 percent do not plan to use in the future, and the remaining nonusers are unsure about their intentions. The intention to use varies with the number of living children the nonuser has. Overall, the proportion saying they plan to use in the future decreases from a high of 80 percent among women with one child to 42 percent of women with four or more children. Among childless women, more than half (69 percent) say they intend to use in the future. This represents a substantial increase over the proportion of childless women at the time of the 2000 EDHS who said they intended to adopt contraception in the future (57 percent). 7. 4 REASONS FOR NONUSE Table 7.4 presents the distribution of currently married non-users who do not intend to use in the future by the main reason for not using. The reasons for nonuse given by women who do not intend to use family planning are of interest to the family planning program since they help to identify areas for potential interventions to support the adoption of contraception by nonusers. More than 70 percent of nonusers have various fertility-related reasons for not planning to adopt contraception. These reasons include a perceived lack of need for contraception because the woman is subfecund or infecund (40 percent), is menopausal or has had a hysterectomy (18 percent), or is not sexually active or has sex infrequently (8 percent). In addition, seven percent of the nonusers want more children. Method-related reasons are cited by 18 percent of nonusers; nine percent mention fear of side effects and eight percent other health concerns. Opposition to use—either the woman’s own attitude or that of her husband or others—is a factor for 8 percent of the nonusers. Nonuse of Family Planning and Intention to Use | 87 Table 7.4 classifies women into two age groups (under age 30 and age 30 and over) in order to consider how the reasons for nonuse are related to a woman’s age. Nonusers under age 30 are more likely to mention the desire to have more children than those age 30 or over (26 percent and 4 percent, respectively), while, as might be expected, lack of need for contraception because of menopause or hys- terectomy is a reason given almost exclusively by older nonusers. Opposition to use, especially on the part of the husband, is cited more often by younger than older nonusers (23 percent and 5 percent, respectively). Fear of side effects is reported around twice as often among younger women as among older women (15 percent and 8 percent, respectively). Table 7.4 Reason for not intending to use contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by main reason for not intending to use, according to age, Egypt 2005 Reason 15-29 30-49 Total Fertility-related reasons 53.2 75.5 72.8 Not having sex 0.0 3.4 3.0 Infrequent sex/no sex 2.8 5.0 4.8 Menopausal/had hysterectomy 1.8 19.9 17.7 Subfecund/infecund 22.4 42.7 40.3 Wants as many children as possible 26.2 4.4 7.1 Opposition to use 23.4 5.4 7.6 Respondent opposed 6.9 2.3 2.8 Husband/partner opposed 12.9 2.0 3.3 Others opposed 1.5 0.0 0.2 Religious prohibition 2.2 1.0 1.2 Lack of knowledge 0.0 0.1 0.1 Knows no source 0.0 0.1 0.1 Method-related reasons 22.0 17.6 18.1 Health concerns 5.9 8.7 8.4 Fear of side effects 14.7 7.6 8.5 Lack of access/too far 0.3 0.0 0.1 Costs too much 0.8 0.1 0.1 Inconvenient to use 0.0 0.2 0.1 Interfere with body's normal processes 0.3 1.0 0.9 Other 0.0 0.4 0.4 Don’t know 0.8 0.6 0.7 Missing 0.5 0.4 0.4 Total 100.0 100.0 100.0 Number of women 277 2,006 2,283 7.5 PREFERRED METHOD Nonusers who planned to use family planning in the future were asked about the method they would prefer to use. Table 7.5 shows 40 percent of all nonusers who plan to use prefer the IUD. The remaining nonusers are divided between those who prefer the pill (15 percent) and those who prefer injectables (9 percent). Around one-third of the nonusers intending to use a method in the future indicate that either they are unsure which method they prefer (17 percent) or they will rely on the doctor’s advice (17 percent). 88 | Nonuse of Family Planning and Intention to Use Table 7.5 Preferred family planning method Percent distribution of currently married women who are not using a family planning method but who intend to use in the future by preferred method, Egypt 2005 Method Total Pill 14.7 IUD 39.5 Injectables 8.6 Diaphragm/foam/jelly 0.1 Condom 0.1 Female sterilization 0.8 Male sterilization 0.0 Implants (Norplant) 1.8 Periodic abstinence 0.2 Withdrawal 0.0 Prolonged breastfeeding 0.0 Other 0.0 As doctor recommends 16.8 Unsure 17.3 Total 100.0 Number of women 4,758 7.6 CONTACT OF NONUSERS WITH OUTREACH WORKERS/HEALTH CARE PROVIDERS The 2005 EDHS collected information on whether nonusers had any recent contact with community workers or health care providers. Such contacts provide an opportunity to counsel the nonuser about the need for family planning. To obtain this information, nonusers were asked whether they had been visited at home at anytime during the 6 months preceding the survey by an outreach worker (e.g., a raiyda refia) or anyone else who had talked with them about family planning. They were also asked about any visits they had made to governmental health facilities or private doctors or clinics during the six months preceding the survey and, if they had visited any of these providers, whether anyone had spoken to them about family planning during their visit(s). Table 7.6 presents the data on both the proportion of currently married nonusers who had any contact with an outreach worker or health facility and the proportion who discussed family planning with an outreach worker or other health care provider during the 6 months prior to the EDHS interview. Relatively few women had been reached through community outreach efforts, with only four percent of nonusers reporting that they had been visited at home by a fieldworker. The proportion reporting outreach visits was similar to the level at the time of the 2000 EDHS (4 percent) and lower than at the time of the 1995 EDHS when 11 percent of nonusers had reported a home visit during the six-month period before the survey. The decrease in outreach contacts was particularly striking in rural Upper Egypt: in 1995, 17 percent of nonusers in rural Upper Egypt reported being visited at home by a fieldworker while six percent of nonusers reported being contacted at home in the 2005 EDHS, a level slightly above that reported in 2000 (5 percent). Nonuse of Family Planning and Intention to Use | 89 Table 7.6 also looks at the extent to which nonusers had an opportunity to discuss family planning during visits they made to health facilities. Around three in ten nonusers made at least one visit to a government health facility during the six-month period before the survey, and a similar proportion had gone to a private doctor or private health facility at least once. Looking at whether family planning was discussed during those contacts, women who visited private sector health facilities were somewhat less likely than those visiting public facilities to report that family planning was discussed during a visit (5 percent and 8 percent, respectively). Table 7.6 Discussion of family planning in contacts with fieldworkers or health providers by background characteristics Percentage of nonusers of family planning who were visited at home by a family planning worker, who visited a health facility, and who discussed family planning at a health facility, during the 6 months preceding the survey, according to selected background characteristics, Egypt 2005 Background characteristic Visted at home by FP worker Visted public health facility (PHF) Visited PHF, discussed FP Visited private health facility (PrHF) Visited PrHF, discussed FP Had some contact with FP worker or health facility Discussed FP with FP worker or staff at health facility Number of women Age 15-19 4.4 38.6 9.4 41.8 5.7 58.6 12.3 584 20-24 5.2 40.3 11.9 41.7 7.4 60.1 15.6 1,601 25-29 5.7 39.6 11.1 36.1 7.6 55.5 15.0 1,556 30-34 4.9 35.9 11.1 32.9 5.6 51.8 14.0 954 35-39 3.4 26.1 5.3 26.1 4.4 39.2 8.3 802 40-44 2.3 19.5 4.5 20.8 2.0 31.6 5.6 756 45-49 1.9 17.4 1.7 18.3 1.2 27.9 2.6 1,165 Urban-rural residence Urban 1.5 30.6 6.6 37.0 5.9 47.5 9.9 2,800 Rural 5.8 33.2 9.4 28.8 4.9 47.9 11.9 4,617 Place of residence Urban Governorates 0.2 29.3 5.1 37.2 4.9 45.7 8.0 1,112 Lower Egypt 4.9 32.2 6.0 36.5 5.1 49.9 9.2 2,688 Urban 2.0 31.7 6.9 39.3 6.8 49.7 10.9 738 Rural 5.9 32.4 5.7 35.4 4.5 50.0 8.6 1,949 Upper Egypt 4.6 33.0 11.1 26.9 5.4 46.6 13.7 3,516 Urban 1.7 30.7 7.9 35.3 6.4 47.5 11.5 892 Rural 5.6 33.7 12.2 24.0 5.1 46.3 14.4 2,624 Frontier Governorates 15.3 37.4 10.6 27.1 5.0 49.5 12.2 101 Education No education 4.1 29.0 9.4 20.3 3.4 39.5 10.7 2,766 Some primary 3.9 32.8 6.0 30.3 3.1 47.7 7.6 751 Primary complete/some secondary 4.6 32.4 7.4 31.1 6.0 47.8 11.3 1,021 Secondary complete/higher 4.2 35.1 8.3 43.7 7.3 55.6 12.5 2,880 Work status Working for cash 4.4 29.3 7.0 34.0 4.0 46.6 9.2 993 Not working for cash 4.2 32.7 8.6 31.6 5.4 47.9 11.5 6,425 Wealth quintile Lowest 5.6 33.4 10.5 22.1 3.4 45.0 12.1 1,524 Second 4.6 32.2 9.0 24.7 4.3 43.8 10.6 1,520 Middle 5.7 33.7 10.1 31.0 5.8 48.7 13.3 1,489 Fourth 3.3 35.3 7.3 41.4 7.5 54.1 11.9 1,462 Highest 1.4 26.2 4.6 41.4 5.3 47.3 7.8 1,423 Total 4.2 32.2 8.4 31.9 5.2 47.7 11.2 7,418 90 | Nonuse of Family Planning and Intention to Use Taking into account both contacts with fieldworkers and contacts with health facilities, one in ten nonusers reported a contact in which family planning was discussed during the six months prior to the survey. This proportion was slightly higher than the level reported in the 2000 EDHS (7 percent). Although the results in Table 7.6 suggest that there are many “missed” opportunities for inform- ing and motivating nonusers about family planning, some caution must be exercised in drawing such conclusions. Not all visits to health providers present appropriate opportunities for offering family plan- ning information or services, and not all nonusers are interested in or in need of family planning when they visit a facility. Nevertheless, the results in Table 7.6 suggest that there is potential for taking more advantage of visits to facilities to offer family planning information and counseling to nonusers. Proximate Determinants of Fertility | 91 PROXIMATE DETERMINANTS OF FERTILITY 8 This chapter considers a number of factors other than contraception that influence fertility. Marriage is among the most important of these proximate determinants since it is a primary indicator of women’s exposure to the risk of pregnancy. Early age at first marriage in a population is usually associated with a longer period of exposure to the risk of pregnancy and thus higher fertility levels. The early initiation of childbearing associated with early marriage may also adversely affect women’s and children’s health. Besides marriage, this chapter explores several other factors that influence fertility, including postpartum amenorrhea, postpartum abstinence, and menopause. Postpartum amenorrhea and postpartum abstinence determine the length of time a woman is insusceptible to pregnancy after childbirth, affecting birth intervals and thus fertility levels. Menopause is important since it marks the end of a woman’s period of exposure to the risk of pregnancy. In the 2005 EDHS, questions about the proximate determinants of fertility were included in the individual questionnaire, which was administered only to ever-married women. However, a number of the tables, which examine the proximate determinants in this chapter, are based on all women, i.e., on ever- married women and never-married women. In constructing these tables, the denominators have been expanded to represent all women by multiplying the number of ever-married women by an inflation factor equal to the ratio of all women to ever-married women reported in the household questionnaire. The inflation factors are calculated by single years of age, either for the population as a whole or, in cases where the results are presented by background characteristics, separately for each category of the characteristic in question. 8.1 MARITAL STATUS Table 8.1 shows the distribution of all women age 15-49 by current marital status. Overall, 62 percent of women are currently married, three percent are widowed, two percent are divorced or separated (not living together), and 34 percent have never married. The proportion never married decreases rapidly with age, from 88 percent among women age 15-19 to 49 percent among women age 20-24. The virtual universality of marriage among women is further evidenced from the fact that among women age 30 and over, 94 percent or more are or have been married. Table 8.1 Current marital status Percent distribution of women by current marital status, according to age, Egypt 2005 Age Never married Married Divorced Separated Widowed Total Number of women 15-19 87.5 12.3 0.1 0.1 0.0 100.0 6,446 20-24 48.9 49.9 0.7 0.4 0.1 100.0 5,807 25-29 18.7 78.5 1.7 0.5 0.6 100.0 4,655 30-34 6.0 90.2 1.9 0.5 1.5 100.0 3,413 35-39 3.6 90.9 2.0 0.5 3.0 100.0 3,310 40-44 2.5 86.1 2.6 0.9 7.9 100.0 2,933 45-49 1.7 82.5 2.2 0.6 12.9 100.0 2,705 Total 33.5 62.1 1.3 0.4 2.6 100.0 29,270 92 | Proximate Determinants of Fertility Most disruption of marital unions appears to be due to the death of the husband. As expected, the proportion widowed increases steadily with age, from less than one percent among women under age 30 to 13 percent among women age 45-49. The proportion divorced and separated does not exceed four percent of women in any age group. 8.2 CONSANGUINITY Marriages between relatives (consanguineous marriages) are common in Egypt. According to the 2005 EDHS data presented in Table 8.2, around one-third of ever-married women report that their current or, in the case of widowed or divorced women, their most recent husband was a relative. Slightly more than half of consanguineous marriages involve first cousins. In such marriages, the husband is somewhat more likely to be a relative from the father’s side than the mother’s side. Table 8.2 Consanguinity by background characteristics Percent distribution of ever-married women by relationship to their (last) husband, according to background characteristics, Egypt 2005 First cousin Second cousin Background characteristic Father's side Mother's side Father's side Mother's side Other blood relative Relative by marriage/ not related Missing Total Number of women Current age 15-19 12.6 11.0 5.4 2.1 9.2 59.5 0.1 100.0 803 20-24 11.7 7.4 4.6 2.3 8.3 65.5 0.2 100.0 2,968 25-29 10.6 5.4 4.8 3.1 7.2 68.7 0.1 100.0 3,785 30-34 10.2 6.0 4.4 3.1 7.2 69.0 0.1 100.0 3,209 35-39 10.8 6.1 4.5 2.8 7.8 67.9 0.0 100.0 3,191 40-44 11.1 6.8 3.9 3.3 7.5 67.3 0.1 100.0 2,859 45-49 11.1 6.6 3.7 2.8 5.7 70.0 0.1 100.0 2,659 Urban-rural residence Urban 7.9 5.1 3.2 2.8 5.0 75.9 0.1 100.0 8,033 Rural 13.1 7.5 5.3 3.0 9.0 62.0 0.1 100.0 11,441 Place of residence Urban Governorates 7.0 5.2 2.8 3.2 4.3 77.3 0.2 100.0 3,293 Lower Egypt 8.5 5.7 3.1 2.4 6.8 73.4 0.1 100.0 8,410 Urban 6.3 4.4 2.1 1.7 4.9 80.4 0.2 100.0 2,199 Rural 9.2 6.2 3.4 2.7 7.5 70.9 0.1 100.0 6,211 Upper Egypt 15.4 8.0 6.5 3.3 9.3 57.5 0.0 100.0 7,552 Urban 10.3 5.4 4.6 3.3 5.8 70.5 0.1 100.0 2,411 Rural 17.7 9.1 7.4 3.3 11.0 51.4 0.0 100.0 5,141 Frontier Governorates 15.6 5.1 8.1 2.7 9.9 58.6 0.1 100.0 218 Education No education 14.8 7.9 6.0 3.5 8.1 59.4 0.1 100.0 6,740 Some primary 12.0 6.4 4.9 3.3 8.5 65.0 0.0 100.0 2,197 Primary complete/some secondary 10.5 6.8 4.5 3.3 8.4 66.4 0.2 100.0 2,719 Secondary complete/higher 7.5 5.2 2.8 2.1 6.1 76.1 0.1 100.0 7,818 Work status Working for cash 7.2 4.2 2.5 2.2 6.0 77.6 0.3 100.0 3,288 Not working for cash 11.7 7.0 4.8 3.0 7.7 65.7 0.1 100.0 16,186 Wealth quintile Lowest 15.8 7.4 6.7 3.1 10.2 56.7 0.1 100.0 3,565 Second 13.7 7.7 5.5 3.5 9.1 60.5 0.0 100.0 3,778 Middle 11.8 7.9 4.8 2.6 7.6 65.2 0.1 100.0 3,931 Fourth 8.1 5.8 3.3 3.0 5.7 73.8 0.1 100.0 4,137 Highest 6.3 3.9 2.1 2.3 4.8 80.4 0.2 100.0 4,063 Total 11.0 6.5 4.4 2.9 7.4 67.7 0.1 100.0 19,474 Proximate Determinants of Fertility | 93 As expected, consanguineous marriages are more common in rural than in urban areas; more than one-third of the marriages in rural areas involve relatives. Even in urban areas, however, around one- quarter of women marry a blood relative. Considering place of residence, the highest rate of consanguineous marriages is found in rural Upper Egypt, where around half of marriages are between relatives. The rate of consanguineous marriage is lowest in urban Lower Egypt (20 percent) and the Urban Governorates (23 percent). A woman’s chance of marrying a relative decreases from 41 percent among women with no education to 24 percent among women with a secondary education or higher. The likelihood of consanguineous marriage is higher among women who are not working for cash than among women who are working for cash. It decreases by wealth quintile, from a level of 43 percent among women in the lowest wealth quintile to 20 percent of women in the highest quintile. 8.3 AGE AT FIRST MARRIAGE The duration of exposure to the risk of pregnancy in a society is closely associated with the age at which women first marry. Thus, trends in age at first marriage can help explain changes in fertility levels in Egypt. Table 8.3 shows both the percentage of women who have ever married by selected exact ages and the median age at first marriage, according to current age. The results document a substantial increase in the age at first marriage among younger cohorts. Accompanying the overall trend to later marriage is an especially marked decline in the proportion of women marrying at very young ages. The percentage of women married by exact age 15 has dropped from 13 percent among women age 45-49 to three percent among women age 20-24. The percentage of women married by exact age 18 has fallen from 36 percent among women 45-49 to 17 percent among women 20-24. Table 8.3 Age at first marriage Percentage of women who were first married by specific exact age 15, 18, 20, 22 and 25, and median age at first marriage, according to current age, Egypt 2005 Percentage first married by exact age: Current age 15 18 20 22 25 Percentage never married Number Median age at first marriage 15-19 1.0 na na na na 87.5 6,446 a 20-24 2.5 16.6 34.1 na na 48.9 5,807 a 25-29 5.3 21.8 38.7 56.2 75.0 18.7 4,655 21.3 30-34 8.0 27.0 43.4 59.8 78.5 6.0 3,413 20.7 35-39 9.5 34.3 50.6 64.6 80.6 3.6 3,310 19.9 40-44 11.0 34.7 51.9 66.8 81.9 2.5 2,933 19.8 45-49 12.8 35.8 51.5 67.0 83.2 1.7 2,705 19.8 Women age 25-49 8.8 29.7 46.3 62.1 79.3 7.7 17,017 20.4 na = Not applicable a Omitted because less than 50 percent of women married for the first time by the beginning of the age group Differentials in the median age at first marriage by selected background characteristics are presented in Table 8.4. The table shows early marriage is much more common in rural than in urban areas. The median age at first marriage among urban women age 25-49 is 22 years, around three years higher than the median age at first marriage among rural women (19.2 years). 94 | Proximate Determinants of Fertility There are marked differentials in the age of first marriage among women 25-49 by place of residence. On average, Table 8.4 shows that women marry about two years earlier on average in rural Upper Egypt (18 years) than in rural Lower Egypt (20 years). The median age at first marriage is also around one year earlier in urban Upper Egypt (21.1 years) than in urban Lower Egypt (22 years). In turn, the median age at first marriage in the Urban Governorates (22.7 years) is higher than in either urban Lower Egypt or urban Upper Egypt. An examination of the trend across age cohorts suggests that there have been substantial increases over time in the median age at marriage within all areas, with the changes in rural Upper Egypt being especially marked. Table 8.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49, by current age and background characteristics, Egypt 2005 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Urban-rural residence Urban 22.7 22.3 21.7 21.4 21.7 22.0 Rural 20.3 19.7 18.6 18.3 18.3 19.2 Place of residence Urban Governorates 23.4 22.9 22.2 22.0 22.5 22.7 Lower Egypt 21.3 20.8 20.4 19.7 20.0 20.6 Urban 22.6 21.8 22.2 21.6 21.6 22.0 Rural 20.9 20.6 19.6 19.0 19.3 20.0 Upper Egypt 20.2 19.2 18.3 18.0 18.2 19.0 Urban 21.8 21.8 20.4 20.0 20.8 21.1 Rural 19.5 17.8 17.4 17.1 17.2 18.0 Frontier Governorates 22.2 20.9 20.6 20.9 19.0 21.0 Education No education 18.8 17.8 17.6 17.8 18.0 17.9 Some primary 19.1 18.2 17.7 18.0 18.6 18.3 Primary complete/some 20.0 19.6 18.9 19.7 20.2 19.7 Secondary complete/higher 22.7 22.9 23.0 23.4 24.2 23.0 Wealth quintile Lowest 19.0 18.0 17.3 16.9 17.4 17.8 Second 20.2 19.4 18.1 17.7 18.3 18.9 Middle 20.7 20.4 19.3 19.2 18.7 19.9 Fourth 21.7 21.7 21.3 20.4 20.4 21.3 Highest 23.9 23.0 23.0 22.8 22.9 23.1 Total 21.3 20.7 19.9 19.8 19.8 20.4 Note: Medians are not shown for women 15-19 and 20-24 because less than 50 percent have married by age 15 and age 20, respectively for most subgroups shown in the table. Table 8.4 also shows large differences in age at first marriage by educational level. The median age at first marriage among women with a secondary education is 23 years, more than three years higher than the median age among women who have completed the primary but not the secondary level (19.7 years) and about five years higher than among women who never attended school (17.9 years). The magnitude of the educational differential in the age at marriage does not vary greatly across age cohorts, which suggests that much of the upward trend in the age at marriage over the past several decades in Egypt has been due to increases in educational attainment among women. The median age at first marriage also rises with the wealth quintile. The median age at first marriage among women in the lowest wealth quintile is 17.8 years compared to 23.1 years among women in the highest quintile. Proximate Determinants of Fertility | 95 8.4 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY Among women who are not using contraception, exposure to the risk of pregnancy in the period after a birth is influenced primarily by two factors: breastfeeding and sexual abstinence. Breastfeeding prolongs postpartum protection from conception through its effect on the length of the period of amenorrhea (the period prior to the return of menses) after a birth. More frequent breastfeeding for longer durations as well as delays in the age at which supplementary foods are introduced are associated with longer periods of postpartum amenorrhea. Delaying the resumption of sexual relations after a birth also prolongs the period of postpartum protection. For the purposes of the following discussion, women are considered insusceptible to pregnancy if they are not at risk of conception, either because they are amenorrheic or abstaining after a birth. The percentage of births occurring during the three years preceding the survey for which mothers are postpartum amenorrheic, postpartum abstaining, and postpartum insusceptible is shown in Table 8.5, according to the number of months since the birth. These distributions are based on current status information, i.e., on the proportion of births occurring x months before the survey for which mothers were still amenorrheic, abstaining, or insusceptible at the time of the survey. Thus, the results presented in the table are based on cross-sectional data, representing the experience of mothers of all births at a single point in time rather than showing the experience of a cohort of mothers over time. The data are grouped in two-month intervals to minimize the fluctuations in the estimates. The median and mean estimates shown at the bottom of Table 8.5 are calculated from the current status distributions presented in the table. The prevalence/incidence mean, which is also shown in Table 8.5, is obtained by dividing the number of mothers who are amenorrheic, abstaining, or insusceptible by the average number of births per month over the 36-month period. Table 8.5 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Egypt 2005 Percentage of births for which the mother is: Months since birth Amenorrheic Abstaining Insusceptible Number of births < 2 95.5 81.0 95.8 352 2-3 55.2 18.0 60.9 419 4-5 39.6 6.1 41.4 486 6-7 32.7 3.9 34.4 483 8-9 25.8 4.5 29.3 481 10-11 26.1 1.7 27.6 413 12-13 15.6 0.8 16.2 461 14-15 17.0 2.2 18.6 413 16-17 10.6 2.0 11.7 503 18-19 7.9 2.0 9.5 422 20-21 3.2 1.2 4.2 507 22-23 2.6 1.2 3.7 408 24-25 3.1 0.8 3.8 369 26-27 2.5 2.1 4.5 478 28-29 2.5 1.1 3.6 477 30-31 2.2 0.2 2.4 454 32-33 2.4 0.0 2.4 490 34-35 2.3 0.7 2.7 441 Total 18.3 6.2 19.7 8,057 Median 3.6 1.8 3.9 - Mean 7.2 2.9 7.7 - Prevalence/incidence mean 6.5 2.2 7.0 - 96 | Proximate Determinants of Fertility Overall, the period of amenorrhea after birth is not long for the average Egyptian woman. As Figure 8.1 shows, the percentage of babies whose mothers are amenorrheic declines from over 90 percent in the two months immediately after a birth to 55 percent during the period two to three months after birth. By the period 4 to 5 months after a birth, mothers of 40 percent of births are still amenorrheic, and by 12 to 13 months after a birth, mothers have not resumed menstruation in the case of only 16 percent of births. The median duration of postpartum amenorrhea is 3.6 months, and the mean duration is 7.2 months. The relatively short average duration of postpartum amenorrhea is related to breastfeeding patterns, especially the early introduction of supplemental foods (see Chapter 13). As in other Islamic countries, many couples in Egypt observe the traditional practice of abstain- ing from sexual relations for a period of 40 days after a birth. Reflecting this tradition, the percentage of births for which the mother is still abstaining decreases rapidly, from 81 percent in the 2-month period immediately after a birth to 18 percent at 2 to 3 months after a birth. The combined effects of postpartum amenorrhea and postpartum abstinence are reflected in the period of postpartum insusceptibility after a birth. Overall, about 60 percent of Egyptian women are susceptible to the risk of pregnancy by 4 months after a birth. The median duration of the period of postpartum insusceptibility is 3.9 months. The median durations of postpartum amenorrhea, postpartum abstinence, and postpartum insus- ceptibility according to selected background characteristics are presented in Table 8.6. In general, the periods of insusceptibility to the risk of conception are longer for older women, rural women, women in Upper Egypt, women with no education and women in the lowest wealth quintile than for women in other groups. The median duration of postpartum insusceptibility is longest for women with no education (5.7 months). Differentials in the durations of insusceptibility are owed primarily to differences in the length of the periods of postpartum amenorrhea, since the average duration of postpartum abstinence does not vary greatly among the population subgroups. Figure 8.1 Percentage of Births Whose Mothers are Amenorrheic, Abstaining, or Insusceptible EDHS 2005 ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 0 20 40 60 80 100 Percent Amenorrheic Abstaining Insusceptible( ) Proximate Determinants of Fertility | 97 Table 8.6 Median duration of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Egypt 2005 Percentage of births for which the mother is: Background characteristic Amenorrheic Abstaining Insusceptible Number of births Age 15-29 3.6 1.9 3.9 5,426 30-49 3.8 1.8 4.3 2,631 Urban-rural residence Urban 3.4 1.9 3.8 2,927 Rural 3.8 1.8 4.1 5,130 Place of residence Urban Governorates 3.4 1.8 3.5 1,132 Lower Egypt 2.9 1.9 3.1 3,184 Urban 2.5 2.0 2.7 743 Rural 3.0 1.8 3.2 2,441 Upper Egypt 4.6 1.8 5.3 3,642 Urban 4.4 2.0 5.1 990 Rural 4.8 1.7 5.5 2,652 Frontier Governorates (3.7 ) (2.1) (3.8) 99 Education No education 5.2 1.7 5.7 2,446 Some primary 4.6 1.7 5.3 681 Primary complete/some secondary 3.3 1.8 3.4 1,193 Secondary complete/higher 3.1 1.9 3.4 3,737 Wealth quintile Lowest 5.0 1.5 5.3 1,650 Second 3.3 1.9 3.6 1,673 Middle 3.4 1.8 3.8 1,769 Fourth 3.1 2.0 3.4 1,633 Highest 3.8 2.0 4.0 1,331 Total 3.6 1.8 3.9 8,057 Note: Medians are based on current status and figures in parentheses are based on 25-49 unweighted cases. 8. 5 TERMINATION OF EXPOSURE TO PREGNANCY Another factor influencing the risk of pregnancy among women is menopause among older women. Table 8.7 presents data on the proportion menopausal among women age 30 and over who are currently married, non-pregnant and non-amenorrheic. For the purposes of the table, an EDHS respondent is considered menopausal if she met one of the two following conditions: 1) she declared herself menopausal at the time of the interview, or 2) she had not had a period for six months or more before the survey and was neither pregnant nor amenorrheic. Based on this definition, Table 8.7 shows that few respond- ents under age 40 are considered menopausal. However, the propor- tion menopausal rises rapidly with age, from eight percent of women age 40-41 to 44 percent of women in the oldest age group (48-49 years). Table 8.7 Menopause Percentage of women age 30-49 who are menopausal, by age, Egypt 2005 Age Percentage menopausal1 Number of women 30-34 2.6 3,209 35-39 4.8 3,191 40-41 7.6 1,313 42-43 10.5 1,111 44-45 18.1 1,208 46-47 25.2 874 48-49 44.2 1,012 Total 11.2 11,917 1 Includes women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey and women who declare themselves to be menopausal Fertility Preferences | 99 FERTILITY PREFERENCES 9 Insight into the fertility desires in a population is important, both for estimating the potential unmet need for family planning and for predicting future fertility. This chapter presents data from the 2005 EDHS on the fertility intentions of Egyptian women, the need for family planning services, and desired family size. It also considers the potential effect on fertility if unwanted pregnancies were prevented. 9.1 DESIRE FOR MORE CHILDREN To obtain information on fertility preferences, non-sterilized currently married women were asked the question: “Would you like to have (a/another) child or would you prefer not to have any (more) children?” For pregnant women, the question was prefaced by the wording, “After the child you are expecting. . . .” Women who wanted more children were then asked how long they would like to wait before the birth of their next child. Sterilized women were considered to want no more children for the purposes of the fertility preference tabulations presented in this chapter. Table 9.1 and Figure 9.1 show the reproductive intentions of currently married women in Egypt. The majority of married women do not want any more children (63 percent) or are sterilized (1 percent). Almost all of the remaining women (30 percent) want another child. Among those wanting another child, the majority—17 percent of all currently married women—either want to wait two years or more to have the next birth or are unsure of when they want another child. Less than half of the women who want another child—13 percent of all currently married women—want a child soon (within two years). Table 9.1 Fertility preferences by number of living children Percent distribution of currently married women by desire for children, according to number of living children, Egypt 2005 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total Wants soon2 91.6 26.6 9.2 3.1 1.7 0.9 0.8 13.1 Wants later3 0.2 62.1 21.8 5.0 1.6 0.9 0.3 16.2 Wants, unsure timing 0.4 1.8 1.1 0.4 0.3 0.3 0.1 0.7 Undecided 0.6 2.0 5.6 2.5 1.3 0.9 0.6 2.5 Wants no more 0.9 5.6 60.5 85.7 89.4 88.3 89.7 63.3 Sterilized 0.0 0.0 0.3 1.2 2.5 3.1 3.2 1.3 Declared infecund 6.2 1.8 1.4 2.1 3.2 5.4 5.3 2.9 Missing 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,143 2,834 4,148 4,254 2,726 1,508 1,574 18,187 Note: Women who have been sterilized are considered to want no more children. 1 Includes current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 100 | Fertility Preferences The desire for a child is strongly related to the number of living children the woman has. There is very little interest in spacing the first birth. More than nine in ten women who had not yet begun childbearing at the time of the survey want a birth soon. More than eight in ten women who have one child also express a desire to have another; however, the majority (62 percent) of women who have one child want to wait two years or more to have the next birth. Among women with more than one child, the desire to cease childbearing rises rapidly with the number of children, from 61 percent among women with two children to 90 percent among women with six or more children. Table 9.2 shows the distribution of currently married women by the desire for children, according to age. As expected, older women are much more likely to want no more children than younger women. The proportion of women who want no more children or who are sterilized is only five percent in the youngest age group, increases to 26 percent among those age 20-24, and peaks at 89 percent among women age 40-44. Table 9.2 Fertility preferences by age Percent distribution of currently married women by desire for children, according to age, Egypt 2005 Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Wants soon1 33.6 23.6 17.6 10.9 8.1 5.4 3.5 13.1 Wants later2 57.9 45.6 23.1 8.0 1.9 0.3 0.1 16.2 Wants, unsure timing 1.4 1.2 0.9 1.0 0.6 0.2 0.0 0.7 Undecided 1.9 3.9 4.4 3.1 1.7 0.9 0.1 2.5 Wants no more 5.1 25.6 53.4 75.9 84.3 86.1 77.4 63.3 Sterilized 0.0 0.0 0.1 0.7 1.8 2.6 3.9 1.3 Declared infecund 0.0 0.1 0.4 0.4 1.5 4.5 14.9 2.9 Missing 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 792 2,898 3,653 3,077 3,010 2,525 2,233 18,187 Note: Women who have been sterilized are considered to want no more children. 1 Wants next birth within 2 years 2 Wants to delay next birth for 2 or more years Figure 9.1 Desire for More Children among Currently Married Women EDHS 2005 Want another soon 13% Want no more/ sterilized 65% Want another later 16% Declared infecund 3% Want another, unsure timing 1% Undecided 2% Fertility Preferences | 101 The desire to space children is concentrated among younger women. Fifty-eight percent of women age 15-19 and 46 percent of the women age 20-24 want to delay having a child for at least two years, compared to eight percent of those age 30-34. Table 9.3 shows the variation in the percentage of currently married women who wanted no more children or who are sterilized with the number of living children (including any current pregnancy) for various subgroups. The results indicate that urban women express a desire to limit family size at lower parities than rural women. For example, 68 percent of urban women with two children want to stop childbearing, compared to 54 percent of rural women with two children. The urban-rural differential in the desire for children narrows among women with four or more children. Table 9.3 Desire to limit childbearing by background characteristics Percentage of currently married women who want no more children, by number of living children and background characteristics, Egypt 2005 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Urban-rural residence Urban 1.5 8.0 68.0 88.8 92.8 92.1 93.9 65.8 Rural 0.5 3.9 53.9 85.3 91.4 91.2 92.6 63.6 Place of residence Urban Governorates 0.8 11.1 73.8 90.5 94.4 91.8 92.4 67.4 Lower Egypt 0.7 5.3 63.5 93.0 94.6 92.1 95.0 66.9 Urban 0.0 6.9 66.1 91.8 92.0 91.9 92.4 65.5 Rural 0.9 4.7 62.4 93.5 95.4 92.1 95.5 67.4 Upper Egypt 1.3 3.5 48.6 75.6 88.3 91.0 92.2 60.8 Urban 4.1 4.8 60.2 83.5 92.1 93.2 95.0 64.1 Rural 0.2 2.8 41.3 70.3 86.5 90.4 91.6 59.2 Frontier Governorates 0.0 4.8 52.8 79.4 83.9 83.4 90.0 59.2 Education No education 1.9 6.4 56.5 82.8 89.6 89.8 92.9 71.0 Some primary 0.0 7.2 62.8 90.1 95.0 94.1 93.4 76.6 Primary complete/some secondary 0.0 7.0 57.7 85.2 95.0 91.4 92.8 61.7 Secondary complete/higher 0.8 4.9 63.0 89.0 92.8 94.4 90.9 57.0 Work status Working for cash 1.4 8.9 67.1 91.1 94.0 95.0 94.2 71.6 Not working for cash 0.8 5.2 59.4 85.8 91.6 90.9 92.8 63.2 Wealth quintile Lowest 0.9 4.9 53.1 80.5 88.5 93.2 92.4 66.8 Second 1.1 6.1 51.1 84.2 91.6 87.7 92.9 64.4 Middle 1.0 3.8 55.9 87.5 92.3 92.4 94.5 63.0 Fourth 0.9 4.8 64.6 89.1 93.8 95.0 94.6 63.9 Highest 0.6 8.5 70.6 89.7 93.9 88.4 86.4 64.9 Total 0.9 5.7 60.8 86.9 92.0 91.4 92.9 64.5 Note: Women who have been sterilized are considered to want no more children. 1 Includes current pregnancy 102 | Fertility Preferences Looking at the differentials by place of residence, married women living in the Frontier Governorates and rural Upper Egypt are generally the least likely to want to limit childbearing. For example, 60 percent or more of married women with two children in the Urban Governorates, in urban areas in Upper and Lower Egypt, and in rural Lower Egypt want no more children (or are sterilized). In contrast, 41 percent of married women with two children in rural Upper Egypt and 53 percent in the Frontier Governorates want to limit childbearing. Table 9.3 also shows that overall the proportion wanting no more children generally declines as the woman’s educational level increases. To some extent, this pattern reflects the interrelationships between a woman’s age, education level and her fertility preferences; educational levels are higher among younger women than older women and younger women are more likely to want another child than older women. Interestingly, the relationship between the woman’s educational status and the desire for children is not uniformly positive within parity groups. Women who are working for cash are consistently slightly more likely to want to limit childbearing than other women, regardless of the number of children the woman has. On the other hand, the desire to limit childbearing is not consistently related to wealth. 9.2 NEED FOR FAMILY PLANNING One of the major concerns of family planning programs is to define the size of the potential demand for contraception and to identify women who are the most in need of contraceptive services. Table 9.4 presents estimates of unmet need and of met need for family planning services, and of the total demand for family planning in Egypt as a whole and for various subgroups. Women with an unmet need for family planning (shown in columns 1-3 of Table 9.4) include the following: (1) Currently married women who are in need of family planning for spacing purposes. This group includes (a) pregnant women whose pregnancy is mistimed (i.e., wanted later); (b) amenorrheic women whose last birth was mistimed; and (c) nonusers who are neither pregnant nor amenorrheic and who either want to delay the next birth at least two or more years, are unsure whether they want another child, or want another child but are unsure when to have the birth. (1) Currently married women who are in need of family planning for limiting purposes. This group includes: (a) pregnant women whose pregnancy is unwanted; (b) amenorrheic women whose last child was unwanted; and (c) nonusers who are neither pregnant nor amenorrheic and who want no more children. Menopausal and infecund women are excluded from the unmet need category as are pregnant or amenorrheic women who became pregnant while using a contraceptive method. These women are considered to be in need of better contraception. Women with a met need for family planning (shown in columns 4-6 of Table 9.4) include women who are currently using contraception. The total demand for family planning (shown in columns 10-12 of Table 9.4) represents the sum of unmet need and met need. The total demand also includes pregnant and amenorrheic women who became pregnant while using a family planning method. The percentage of the total demand that is satisfied is shown in the column 13 in Table 9.4. Fertility Preferences | 103 Table 9.4 Need for family planning by background characteristics Percentage of currently married women with unmet need and met need for family planning, and the total demand for family planning, by background characteristics, Egypt 2005 Unmet need1 Met need (currently using)2 Contraceptive failure3 Total demand 4 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percent- age of demand satisfied Number of women Age 15-19 8.2 0.8 9.0 24.2 2.1 26.3 1.1 0.0 1.1 33.5 2.9 36.5 75.3 792 20-24 8.0 2.6 10.6 30.5 14.3 44.7 1.0 0.1 1.0 39.5 17.0 56.4 81.1 2,898 25-29 6.5 5.1 11.6 20.6 36.8 57.4 1.0 0.7 1.6 28.1 42.5 70.6 83.6 3,653 30-34 2.7 8.5 11.3 9.4 59.6 69.0 0.6 0.8 1.3 12.7 68.9 81.6 86.2 3,077 35-39 0.8 10.0 10.8 3.5 69.8 73.3 0.2 0.5 0.6 4.5 80.2 84.7 87.3 3,010 40-44 0.3 9.1 9.4 1.0 69.1 70.1 0.1 0.4 0.5 1.4 78.5 79.9 88.3 2,525 45-49 0.0 7.1 7.1 0.1 47.8 47.8 0.0 0.1 0.1 0.1 54.9 55.0 87.1 2,233 Urban-rural residence Urban 2.9 5.6 8.5 13.1 49.6 62.6 0.6 0.3 0.9 16.5 55.5 72.0 88.3 7,490 Rural 4.1 7.4 11.5 11.9 44.9 56.8 0.5 0.5 1.0 16.5 52.9 69.3 83.4 10,697 Place of residence Urban Governorates 2.5 6.1 8.5 12.9 51.0 63.9 0.8 0.4 1.2 16.2 57.4 73.6 88.4 3,078 Lower Egypt 2.6 4.6 7.1 13.2 52.7 65.9 0.4 0.5 0.9 16.2 57.7 74.0 90.4 7,884 Urban 2.8 4.4 7.3 13.0 51.1 64.1 0.2 0.5 0.6 16.0 56.0 72.0 89.9 2,057 Rural 2.5 4.6 7.1 13.3 53.3 66.5 0.5 0.5 1.0 16.3 58.3 74.6 90.5 5,826 Upper Egypt 5.2 9.3 14.6 11.2 38.7 49.9 0.5 0.3 0.8 16.9 48.4 65.3 77.7 7,019 Urban 3.5 6.0 9.5 13.3 46.7 60.0 0.6 0.2 0.8 17.5 52.8 70.3 86.5 2,230 Rural 6.0 10.9 17.0 10.2 35.0 45.2 0.4 0.4 0.9 16.7 46.3 63.0 73.1 4,789 Frontier Governorates 2.2 6.8 9.1 12.3 38.4 50.7 0.9 0.5 1.4 15.4 45.7 61.1 85.2 206 Education No education 3.3 9.6 12.9 7.2 47.6 54.8 0.3 0.5 0.8 10.8 57.7 68.5 81.1 6,116 Some primary 1.6 8.3 9.9 7.5 55.3 62.8 0.7 0.6 1.2 9.8 64.2 73.9 86.6 2,019 Primary complete/some secondary 4.1 6.0 10.1 14.1 46.1 60.2 0.4 0.2 0.6 18.5 52.3 70.8 85.8 2,564 Secondary complete/ higher 4.1 4.1 8.2 17.3 44.2 61.5 0.8 0.4 1.2 22.3 48.7 70.9 88.4 7,488 Work status Working for cash 1.9 5.7 7.7 9.5 56.5 66.0 0.4 0.3 0.7 11.8 62.6 74.3 89.7 2,920 Not working for cash 3.9 6.9 10.8 12.9 45.0 57.9 0.6 0.4 1.0 17.4 52.3 69.7 84.6 15,267 Wealth quintile Lowest 5.1 9.0 14.2 9.1 44.3 53.4 0.5 0.4 0.8 14.7 53.7 68.3 79.3 3,266 Second 3.7 7.8 11.5 11.4 45.3 56.7 0.4 0.7 1.1 15.5 53.7 69.3 83.4 3,509 Middle 4.0 6.6 10.6 13.9 45.6 59.5 0.5 0.2 0.7 18.4 52.4 70.8 85.0 3,675 Fourth 3.2 5.1 8.4 13.8 48.7 62.5 0.6 0.4 1.0 17.6 54.3 71.9 88.4 3,897 Highest 2.1 5.3 7.5 13.2 49.7 62.9 0.7 0.4 1.0 16.0 55.4 71.4 89.6 3,840 Total 3.6 6.7 10.3 12.4 46.8 59.2 0.5 0.4 1.0 16.5 53.9 70.4 85.4 18,187 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning and say they want to wait 2 or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrheic women who became pregnant while using a method (these women are in need of a better method of contraception). Also excluded are menopausal or infecund women. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Contraceptive failure includes pregnant or amenorrheic women who became pregnant while using a contraceptive method. These women are considered in need for better contraception. 4 Total demand includes pregnant or amenorrheic women who became pregnant while using a method (contraceptive failure) in addition to the unmet and met need for family planning. 104 | Fertility Preferences According to Table 9.4, the total unmet need in Egypt is 10 percent; about a third of this need represents a desire to space the next birth, and the remainder represents an interest in limiting births. The total met need for family planning (i.e., the proportion of women currently using contraception) is 59 percent. Most users are limiters, with only about one in eight users reporting a desire to delay the next birth for two or more years. Overall, the total demand for family planning comprises 70 percent of married women in Egypt. Eighty-five percent of that demand is satisfied. Looking at variations in the proportion of the total demand for family planning that is satisfied, the most striking finding in Table 9.4 is the fact that 80 percent or more of the demand for services is satisfied in almost all subgroups. The level of satisfied demand is highest among women living in rural Lower Egypt (91 percent) and lowest among women living in rural Upper Egypt (73 percent). Table 9.5 considers the reasons women who want to delay or avoid another method give in response to the question of why they are not using contraception. Almost two-thirds of these women gave fertility-related reasons in response to this question; 35 percent mentioned that they were not exposed to pregnancy because they were menopausal or had had a hysterectomy, had difficulty becoming pregnant. or were still amenorrheic following their last birth. Around one in four said they were not having sexual intercourse or had sex infrequently. Health con- cerns, side effects, and lack of knowledge were each cited by between 10 and 15 percent of the women. 9.3 IDEAL NUMBER OF CHILDREN The discussion of fertility preferences earlier in this chapter focused on the respond- ent’s wishes for the future. A woman’s prefer- ences obviously are influenced by the number of children she already has. The 2005 EDHS at- tempted to obtain a measure of fertility prefer- ences that is less dependent on the woman’s cur- rent family size by asking about the respondent’s ideal number of children. The question about ideal family size required a woman to perform the difficult task of considering the number of children she would choose to have in her whole life regardless of the number (if any) that she had already borne. Eight percent of women gave a nonnumeric response to the question about ideal family size, reflecting the difficulty that these respondents had with the abstract nature of the question. Table 9.6 shows the distribution of ever-married women by their ideal number of children, according to number of living children. In considering the results in Table 9.6, it is important to remember that for several reasons, the ideal number of children tends to be fairly closely associated with the actual number of children a woman has. First, women who want a large family tend to have more children than other women. Second, women may rationalize their ideal family size so that as the actual number of Table 9.5 Reason for not intending to use contraception Percentage of currently married women who are not using a contraceptive method and who want to delay or avoid having a birth by the reasons they are not using a method, according to the fertility intention, Egypt 2005 Reason Wants later Does not want Total Fertility-related 66.6 65.7 65.9 Not having sex 1.9 4.4 3.9 Infrequent sex/no sex 23.3 21.5 21.9 Menopausal/had hysterectomy 0.1 17.1 13.9 Subfecund/infecund 3.8 11.7 10.2 Postpartum/amenorrheic 26.2 7.5 11.0 Breastfeeding 11.3 3.5 5.0 Opposition to use 11.8 6.8 7.8 Respondent opposed 1.7 2.0 2.0 Husband/partner opposed 8.1 3.7 4.5 Others opposed 1.8 0.4 0.7 Religious prohibition 0.2 0.7 0.6 Lack of knowledge 6.4 11.7 10.7 Knows no source 6.4 11.7 10.7 Method-related 20.2 28.9 27.1 Health concerns 6.4 11.7 10.7 Fear of side effects 12.9 14.6 14.2 Lack of access/too far 0.4 0.2 0.2 Costs too much 0.2 0.2 0.2 Inconvenient to use 0.3 0.6 0.5 Interfere with body's normal processes 0.0 1.6 1.3 Other 7.9 7.7 7.7 Fatalistic 0.8 3.5 3.0 Waiting for period to return 6.4 3.6 4.1 Other 0.7 0.6 0.6 Number of women 556 2,408 2,964 Fertility Preferences | 105 children increases, their preferred family size also increases. Furthermore, women with a larger family— being on average older than women with small families—may prefer a larger ideal family size because of attitudes that they acquired 20 to 30 years ago. Overall, Table 9.6 shows that ever-married women who expressed a numeric preference wanted an average of 2.9 children. Forty percent of ever-married women who expressed a numeric preference want a two-child family, while 27 percent consider a three-child family ideal. Relatively few want five or more children. As expected, higher parity women show a preference for more children; the mean ideal number of children ranges from 2.5 children among women with one child to 4.0 children among women with six or more children. Table 9.6 Ideal number of children Percent distribution of ever-married women by ideal number of children, and mean ideal number of children for ever- married women and for currently married women, according to number of living children, Egypt 2005 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total 0 1.1 0.2 0.4 0.2 0.3 0.5 0.7 0.4 1 9.5 3.3 2.2 1.9 1.2 0.7 0.3 2.3 2 52.4 58.2 56.2 32.6 28.7 21.8 16.7 40.4 3 16.7 25.2 24.8 42.9 21.3 24.6 17.0 27.3 4 8.7 6.9 9.0 12.4 32.0 24.3 30.0 16.0 5 2.3 0.9 1.3 1.8 2.7 10.2 8.0 2.9 6+ 2.4 1.1 1.2 1.6 3.1 3.9 11.9 2.8 Non-numeric responses 6.9 4.1 4.9 6.7 10.8 14.0 15.3 7.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,297 3,073 4,406 4,488 2,867 1,639 1,704 19,474 Mean ideal number children Ever-married women 2.5 2.5 2.5 2.9 3.2 3.5 4.0 2.9 Number of women 1,208 2,946 4,191 4,187 2,557 1,409 1,442 17,940 Currently married women 2.5 2.5 2.5 2.9 3.2 3.4 3.9 2.9 Number 1,072 2,738 3,949 3,978 2,432 1,292 1,337 16,798 Note: The mean excludes women giving non-numeric answers. 1 Includes current pregnancy The results in Table 9.6 also clearly show that many women in Egypt have had more children than they would now prefer. For example, more than half of the women with four children say that they would prefer to have three or fewer children. More than 70 percent of the women with five children consider a smaller family ideal. Table 9.7 presents the mean ideal number of children for ever-married women among various subgroups. On average, women who live in the Urban Governorates, in Lower Egypt (either in urban or rural areas) and in urban Upper Egypt, women have completed at least a primary education, and women in the middle through highest wealth quintiles want fewer than three children. The mean ideal family size is highest (3.3 children) in the Frontier Governorates and in rural Upper Egypt. 106 | Fertility Preferences Table 9.7 Mean ideal number of children by background characteristics Mean ideal number of children for ever-married women, by age and background characteristics, Egypt 2005 Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Urban-rural residence Urban 2.6 2.4 2.6 2.7 2.7 2.9 3.0 2.7 Rural 2.6 2.6 2.8 2.9 3.1 3.4 3.6 3.0 Place of residence Urban Governorates 2.6 2.4 2.5 2.6 2.6 2.7 2.8 2.6 Lower Egypt 2.4 2.4 2.5 2.7 2.8 3.1 3.2 2.7 Urban 2.3 2.4 2.5 2.7 2.8 3.0 3.0 2.7 Rural 2.4 2.4 2.5 2.7 2.8 3.1 3.3 2.7 Upper Egypt 2.8 2.8 2.9 3.1 3.3 3.6 3.9 3.2 Urban 2.7 2.5 2.7 2.9 2.9 3.1 3.4 2.9 Rural 2.8 2.9 3.0 3.2 3.5 3.8 4.1 3.3 Frontier Governorates 2.8 3.3 3.3 3.3 3.4 3.4 3.6 3.3 Education No education 2.6 2.8 2.9 3.1 3.2 3.4 3.6 3.2 Some primary 2.8 2.5 2.7 2.9 3.0 3.1 3.5 3.0 Primary complete/some secondary 2.8 2.6 2.7 2.8 2.9 3.1 3.3 2.8 Secondary complete/higher 2.4 2.5 2.6 2.7 2.7 2.8 2.8 2.6 Work status Working for cash 2.3 2.4 2.6 2.7 2.7 3.0 2.9 2.8 Not working for cash 2.6 2.6 2.7 2.8 3.0 3.2 3.5 2.9 Wealth quintile Lowest 2.6 2.8 2.9 3.1 3.3 3.7 3.9 3.2 Second 2.8 2.6 2.8 3.0 3.2 3.3 3.6 3.0 Middle 2.5 2.6 2.7 2.8 3.0 3.2 3.5 2.9 Fourth 2.5 2.5 2.7 2.8 2.8 3.0 3.2 2.8 Highest 2.9 2.4 2.5 2.7 2.7 2.9 2.9 2.7 Total 2.6 2.6 2.7 2.8 3.0 3.1 3.3 2.9 The results in Table 9.8 indicate that 64 percent of currently married women believe that they and their husband agree about the number of children they want. Among the remaining women, the majority believe that their husband would like to have more children than they themselves want. Women whose ideal family size is between two and four children are more likely to say that their husband shares the same family size goal than women who want less than two children or more than five children. Table 9.8 Husband’s fertility preference by wife’s ideal number of children Percent distribution of currently married women by husband’s fertility preference, according to the woman’s ideal number of children, Egypt 2005 Woman’s ideal umber of children1 Husband’s fertility preference 0 1 2 3 4 5 6+ Non- numeric responses Total Wants same 10.7 48.1 69.5 70.6 62.9 50.1 40.1 37.0 64.3 Wants more 38.7 39.2 22.9 18.2 23.1 25.8 34.6 16.5 22.0 Wants fewer 6.7 1.0 2.5 4.4 5.9 7.9 13.8 3.0 4.1 Sterilized 0.8 1.4 0.9 1.3 1.3 1.6 2.1 2.5 1.3 Don’t know 43.1 10.4 4.1 5.6 6.8 14.6 9.4 40.9 8.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 51 401 7,360 5,055 2,910 531 489 1,390 18,187 1 Includes current pregnancy Fertility Preferences | 107 9.4 UNPLANNED AND UNWANTED FERTILITY Several indicators of the level of unwanted fertility can be derived from the 2005 EDHS data. First, responses to a question about the planning status of prior births, i.e., whether a birth was planned (wanted then), unplanned (wanted later), or not wanted at all, provide some indication of the extent of unwanted childbearing. In interpreting these data, however, it is important to remember that women may rationalize mistimed or unwanted pregnancies, declaring them as wanted after the children are born. Table 9.9 shows the percent distribution of births in the five years preceding the 2005 EDHS by planning status of the birth. Overall, 19 percent of births in the five-year period were not wanted at the time of conception, with seven percent wanted but at a later time and 12 percent not wanted at all. The proportion of births that were not wanted at the time of conception increases directly with birth order. Somewhat more than two-fifths of all fourth and higher order births were unplanned, compared to only about 15 percent of second order births. The planning status of births is also affected by the age of the mother. In general, the older the mother, the larger the percentage of children that are unwanted at conception; for example, more than half of the births to women age 40-44 are unwanted. Table 9.9 Fertility planning status Percent distribution of births in the five years preceding the survey (including current pregnancies), by fertility planning status, according to birth order and mother's age at birth, Egypt 2005 Planning status of birth Birth order and mother's age at birth Wanted then Wanted later Wanted no more Missing Total Number of births Birth order 1 97.6 1.5 0.1 0.9 100.0 4,731 2 83.7 14.2 1.1 0.9 100.0 4,057 3 78.2 8.9 11.8 1.1 100.0 2,915 4+ 55.1 5.8 38.3 0.7 100.0 3,693 Age at birth <20 93.2 4.8 0.5 1.4 100.0 1,750 20-24 87.7 8.8 2.7 0.8 100.0 5,447 25-29 80.8 8.7 9.4 1.0 100.0 4,331 30-34 68.5 5.7 25.3 0.5 100.0 2,420 35-39 55.7 2.8 40.9 0.6 100.0 1,125 40-44 43.3 2.5 52.6 1.6 100.0 303 45-49 * * * * 100.0 19 Total 80.1 7.3 11.7 0.9 100.0 15,394 Note: An asterisk indicates a figure is based on fewer than 25 cases and has been suppressed. A second approach to measuring unwanted fertility is to calculate what the fertility rate would be if all unwanted births were avoided. This wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as those that exceed the number considered ideal by the respondent. Women who did not report a numeric ideal family size are assumed to have wanted all their births. To the extent that women are unwilling to report an ideal family size that is lower than their actual family size, the wanted fertility rate may be overestimated. 108 | Fertility Preferences Table 9.10 presents total wanted fertility rates and total fertility rates for the three-year period before the survey for various subgroups. Overall, the wanted fertility rate is 2.3 births per woman. Thus, if unwanted births could be eliminated, the total fertility rate in Egypt would decline by around 25 percent. The gap between the wanted and actual fertility rates is greatest among rural women (especially those living in Upper Egypt), women in the Frontier Governorates, women who never attended school or have less than a primary education, and women in the lowest wealth quintile. Table 9.10 Wanted fertility rates by background characteristics Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Egypt 2005 Background characteristic Total wanted fertility rates Total fertility rate Urban-rural residence Urban 2.1 2.7 Rural 2.5 3.4 Place of residence Urban Governorates 1.9 2.5 Lower Egypt 2.3 2.9 Urban 2.1 2.7 Rural 2.3 3.0 Upper Egypt 2.5 3.7 Urban 2.4 3.1 Rural 2.6 3.9 Frontier Governorates 2.3 3.3 Education No education 2.6 3.8 Some primary 2.4 3.4 Primary complete/some secondary 2.0 2.9 Secondary complete/higher 2.4 3.0 Wealth quintile Lowest 2.4 3.6 Second 2.3 3.3 Middle 2.4 3.3 Fourth 2.3 3.0 Highest 2.1 2.6 Total 2.3 3.1 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fer- tility rates are the same as those presented in Table 4.2. Infant and Child Mortality | 109 INFANT AND CHILD MORTALITY 10 This chapter deals with information on the levels and trends in mortality among children under five years of age in Egypt. The chapter also looks at the variation in mortality levels according to demographic and socioeconomic characteristics that have been shown to influence infant and childhood mortality (e.g., residence, young maternal age at birth, and short birth intervals). The mortality levels from the 2005 EDHS are central to the assessment of the current demographic situation in Egypt. Mortality levels are also one of the main indicators of the standard of living or development of a population. Thus, identifying segments of the child population that are at greater risk of dying contributes to efforts to improve child survival and lower the exposure of young children to risk. 10.1 ASSESSMENT OF DATA QUALITY The 2005 EDHS mortality estimates are calculated from information that was collected in the birth history section of the woman’s questionnaire. The birth history section includes a set of initial questions about the number of sons and daughters living with the mother, the number who live elsewhere, and the number who have died. These questions are followed by a retrospective birth history in which a listing of all of the respondent’s births is obtained, starting with the first birth. For each birth, information is collected on the sex, month and year of birth, survivorship status, and current age, or age at death, of each of the respondent’s live births. This information is used to directly estimate the mortality rates. In this chapter, the following rates are used to assess and measure infant and child mortality: Neonatal mortality: the probability of dying within the first month of life; Postneonatal mortality: the difference between infant and neonatal mortality; Infant mortality: the probability of dying during the first year of life; Child mortality: the probability of dying between the first and fifth birthday; Under-five mortality: the probability of dying before the fifth birthday. The reliability of mortality estimates derived from birth history data is affected by a number of factors. These factors include the completeness with which deaths of children are reported, and the extent to which birth dates and ages at death are accurately reported. Omissions of either births or deaths are a more serious problem since they affect the level of the mortality estimates. Errors in reporting of birth dates may cause a distortion of trends over time, while errors in reporting of age at death can distort the age pattern of mortality. Omissions can be detected by examining the proportion of neonatal deaths that occur during the first week of life and the proportion of infant deaths that take place during the first month of life. If there is substantial underreporting of deaths, the result would be an abnormally low ratio of deaths under seven days to all neonatal deaths. Since underreporting of deaths is likely to be more common for births that occurred a long time before the survey, it is important to explore whether these ratios change markedly over time. Inspection of the ratio of deaths in the first six days of life to all neonatal deaths (shown in Appendix Table D.5) shows that the proportion of neonatal deaths that took place in the first week of life ranges from 68 percent for deaths during the period 0-4 years before the survey to 54 percent for deaths during the period 10-14 years before the survey. There is less variation over time in the proportion of 110 | Infant and Child Mortality neonatal to all infant deaths (shown in Appendix Table D.6), which ranges from 63 percent in the period 0-4 years before the survey to 49 percent during the period 15-19 years before the survey. These ratios are within acceptable limits for the levels of mortality observed during these time periods. Errors in the reporting of birth dates also affect the accuracy of period mortality estimates. An examination of the distribution of dead children according to their birth date indicates that there is an excess of deaths in calendar year 1999 (shown in Appendix Table D.4). The transference occurred in the case of both living and dead children. A similar pattern is evident in the data from Demographic and Health Surveys in other countries as well as Egypt; it is thought to result, at least partially, from interviewer transference of births out of the period for which health data were collected (January 2000 through the date of the survey) in order to reduce the workload. The effect of the transference is a slight underestimate of mortality in the period 0-4 years prior to the survey and an overestimate of mortality in the period 5-9 years prior to the survey. Results from a simulation study conducted with a number of DHS countries suggests the error introduced in the mortality estimates is typically less than five percent (Macro International Inc., 1993). Another problem common to the collection of birth history data is heaping of age at death, especially at age 12 months. Errors in the reporting of the age at death will bias estimates of the age pattern of mortality if the errors result in transference of deaths between the age segments for which the rates are calculated. For example, an overestimate of child mortality relative to infant mortality may result if children who died during the first year of life are reported to have died at age one year (12 months) or older. In an effort to avoid this problem, EDHS interviewers were instructed to record the age at death in months for deaths under age two years. In addition, they were asked to probe whenever the mother reported an age at death of “1 year” or “12 months.” Despite these procedures, the data on age at death from the 2005 EDHS exhibits considerable heaping at age 12 months (shown in Appendix Table D.6). However, the heaping is much less evident for deaths occurring in the period 0-4 years before the survey than for deaths taking place further in the past. Moreover, the effect of heaping on the 2005 EDHS mortality estimates is not large. 10.2 LEVELS AND TRENDS IN EARLY CHILDHOOD MORTALITY Neonatal, postneonatal, infant, child, and under-five mortality rates are shown in Table 10.1 for a fifteen-year period preceding the 2005 EDHS. These results describe the current level of mortality in Egypt and allow an assessment of recent trends in mortality among young children. Levels Under-five mortality for the period 0-4 years before the survey was 41 deaths per 1,000 births. At this level, about one in twenty-four Egyptian children will die before the fifth birthday. 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 before a child’s first birthday, with nearly half occurring during the first month of life. Trends Based on Retrospective Data The mortality estimates shown in Table 10.1 may be used to examine the trends in early childhood mortality in Egypt over the past 15 years. The results suggest that early childhood mortality levels have declined steadily over the period. Infant mortality decreased by around 45 percent, from a level of 60 deaths per 1,000 births during the period 10-14 years before the survey (circa 1991-1995) to a level of 33 deaths per 1,000 in the five-year period preceding the EDHS (circa 2001-2005). Under-five Infant and Child Mortality | 111 mortality declined from 81 deaths per 1,000 births during the period 10-14 years before the survey to 41 deaths in the five-year period before the survey. Table 10.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Egypt 2005 Years preceding the survey Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) 0-4 19.7 13.5 33.2 8.1 41.0 5-9 26.0 21.8 47.8 12.2 59.4 10-14 32.2 28.1 60.3 22.1 81.0 1 Computed as the difference between the infant and neonatal mortality rates Trends Based on Data from Multiple Surveys Another approach to looking at trends in mortality levels involves the comparison of estimates from surveys conducted at different points in time. Table 10.2 and Figure 10.1 present the trend in early childhood mortality rates for successive five-year periods before the four rounds of the Egypt DHS surveys and the 1980 Egypt Fertility Survey. Together the estimates span the forty-year period between the 1980 EFS and the 2005 EDHS. Table 10.2 Trends in early childhood mortality Trends in neonatal, infant, and under-five mortality from various selected surveys, Egypt 1965-2005 Preference period Approximate midpoint Survey Neonatal mortality Infant mortality Under-five mortality 2001-2005 2003 2005 EDHS 20 33 41 1996-2000 1998 2005 EDHS 26 48 59 1996-2000 1998 EDHS-00 24 44 54 1991-1995 1993 2005 EDHS 32 60 81 1991-1995 1993 EDHS-00 34 66 84 1991-1995 1993 EDHS-95 30 63 81 1988-1992 1990 EDHS-92 33 62 85 1986-1990 1988 EDHS-00 37 74 103 1986-1990 1988 EDHS-95 44 82 110 1984-1988 1986 EDHS-88 39 73 102 1983-1987 1985 EDHS-92 51 97 130 1981-1985 1983 EDHS-95 45 97 139 1979-1983 1981 EDHS-88 58 120 167 1978-1982 1980 EDHS-92 48 108 157 1975-1979 1977 EFS-80 59 132 191 1974-1978 1976 EDHS-88 53 124 203 1970-1974 1972 EFS-80 67 146 238 1965-1969 1967 EFS-80 63 141 243 Source: EFS-80: Abdel-Azeem et al., 1993, Table 10.4 EDHS-88: Sayed et al., 1989, Table 8.3 and 8.4 EDHS-92: El-Zanaty et al., 1993, Table 10.1 EDHS-95: El-Zanaty et al., 1995, Table 9.1 EDHS-00: El-Zanaty and Way., 2001, Table 10.1 112 | Infant and Child Mortality In examining the estimates, it is important to remember that the reporting of mortality events is generally better for the five-year period immediately before a survey since mothers are more likely to forget or fail to mention deaths further back in time. Thus, the estimate for the five-year period immediately prior to each of the surveys shown in Table 10.2 is likely to be the most accurate. Sampling error also must be taken into account in interpreting the trends in the table. Sampling errors are typically fairly large for mortality rates. For these reasons, the differences between mortality estimates for roughly the same time periods from the various surveys in Table 10.2 should be interpreted with caution, par- ticularly where they are small. The estimates presented in Table 10.2 confirm that early childhood mortality has fallen significantly in Egypt during the past three decades. An Egyptian child was almost six times as likely to die before the fifth birthday in the mid-1960s as in the late 1990s (Figure 10.1). The trends in Table 10.2 also document the changing age pattern of deaths among young children. As the overall rates decreased, mortality is increasingly concentrated in the earliest months of life. In the mid-1960s, around 40 percent of deaths occurred after the child’s first birthday; by the time of the 2005 EDHS, only 20 percent of all deaths under age five took place after the first 12 months of life. 10.3 DIFFERENTIALS IN MORTALITY Selected demographic and socio-economic differentials in early childhood mortality are presented in Tables 10.3 and 10.4, respectively. For most variables, the mortality estimates are calculated for a ten- year period before the survey so that the rates are based on a sufficient number of cases in each category to ensure statistical significance. However, because the information on birth-size was collected only for births occurring between January 2000 and the date of the survey interview, the mortality rates for this variable relate to only the five-year period before the EDHS. Figure 10.1 Trends in Under-five Mortality, Egypt 1967-2003 EDHS 2005 ( ( ( # # # $ $ $ ' ' ' ) ) ) , , , 67 72 7677 8081 83 8586 88 90 93 98 2003 Mid-point of calendar reference period 0 50 100 150 200 250 300 Deaths per 1,000 births 1980 EFS 1988 EDHS 1992 EDHS 1995 EDHS 2000 EDHS 2005 EDHS, ) ' $ # ( Infant and Child Mortality | 113 Socioeconomic Differentials Table 10.3 shows that urban-rural differences in early childhood mortality favor urban children, i.e., urban children have a lower probability of dying at any stage of early childhood than rural children. For example, under-five mortality in urban areas is 39 per 1,000 births, 30 percent lower than under-five mortality in rural areas (56 per 1,000). Considering place of residence, the lowest mortality rates are found in the Urban Governorates and urban Lower Egypt, while the highest rates are found in rural Upper Egypt (see Figure 10.2). Under-five mortality in rural Upper Egypt is 72 deaths per 1,000 births, around 80 percent higher than under-five mortality in rural Lower Egypt (40 deaths per 1,000 births). Although mortality in rural Upper Egypt is higher at all ages than mortality in rural Lower Egypt, the large differential in postneonatal mortality is particularly noteworthy. The postneonatal mortality rate in rural Upper Egypt is 31 deaths per 1,000 births, almost three times the rate in rural Lower Egypt (11 deaths per 1,000 births). The child mortality rate in rural Upper Egypt (16 per 1,000) is more than twice as high as the rate in rural Lower Egypt (6 per 1,000). Table 10.3 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by socioeconomic characteristics, Egypt 2005 Socioeconomic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Urban-rural residence Urban 21.4 10.3 31.7 7.6 39.1 Rural 23.5 21.7 45.2 11.4 56.1 Place of residence Urban Governorates 16.5 9.6 26.0 8.2 34.0 Lower Egypt 22.6 10.1 32.7 5.8 38.4 Urban 24.1 5.8 30.0 4.6 34.5 Rural 22.1 11.4 33.6 6.2 39.6 Upper Egypt 24.8 26.7 51.6 14.4 65.2 Urban 24.7 14.6 39.3 9.5 48.4 Rural 24.9 31.3 56.2 16.3 71.5 Frontier Governorates 24.5 8.7 33.3 9.1 42.1 Education No education 24.2 27.9 52.1 16.5 67.7 Some primary 30.8 24.8 55.6 12.7 67.5 Primary complete/some secondary 23.0 14.2 37.1 5.9 42.8 Secondary complete/higher 19.5 7.3 26.8 4.0 30.7 Wealth quintile Lowest 27.8 31.4 59.2 16.4 74.6 Second 23.4 19.7 43.0 12.6 55.1 Middle 22.5 16.3 38.8 8.3 46.8 Fourth 20.9 11.7 32.7 8.7 41.1 Highest 18.0 5.0 23.0 2.1 25.1 1 Computed as the difference between the infant and neonatal mortality rates Mortality levels among urban children are also higher in Upper Egypt than in either Lower Egypt or the Urban Governorates, primarily because of higher infant mortality. The urban infant mortality rate is 39 deaths per 1,000 births in Upper Egypt compared to 30 deaths per 1,000 in Lower Egypt and 26 deaths per 1,000 in the Urban Governorates. Mortality levels among children age 1-4 years range from a low of 5 per 1,000 in urban Lower Egypt to 10 per 1,000 in urban Upper Egypt. 114 | Infant and Child Mortality Overall, mortality is generally inversely related to mother's education, with children born to women who never attended school being more than twice as likely to die by the fifth birthday as children born to mothers with a secondary or higher education. Births to mothers in the highest wealth quintile are nearly three times as likely to survive to their fifth birthday as children born to mothers in the lowest quintile. Demographic Differentials Table 10.4 shows the relationship between early childhood mortality and selected demographic variables including the sex of the child, mother's age at birth, birth order, length of the previous birth intervals, and mother's perception concerning the size of the child at birth. As expected, neonatal mortality is higher among boys than girls (27 deaths per 1,000 and 19 deaths per 1,000, respectively). Sex differentials in postneonatal and child mortality rates are quite small. The effect of young maternal age at birth on mortality is evident in Table 10.4. Children born to mothers who were under age 20 at the time of the birth are significantly more likely to die at all ages than children born to older mothers. Mortality levels are lowest for births to mothers age 20-29. Considering birth order, seventh order and higher births have the highest mortality. For example, the infant mortality rate for births of order seven or higher is 74 compared to 52 deaths per 1000 or lower among other births. The length of the previous birth interval is also associated with mortality levels. Overall, the under-five mortality rate among children born less than two years after a previous birth is 92 deaths per 1,000 births, almost three times the level among children born four or more years after a previous birth. Coupled with the finding in Chapter 4 that about one quarter of all non-first births occur within 24 months of the previous birth, these results indicate the importance of continuing efforts to promote the use of family planning for birth spacing. Figure 10.2 Under-Five Mortality by Place of Residence 34 38 35 40 65 48 72 42 Urban Governorates Total Urban Rural Total Urban Rural Frontier Governorates Lower Egypt Upper Egypt EDHS 2005 Infant and Child Mortality | 115 Table 10.4 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by demographic characteristics, Egypt 2005 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Child's sex Male 26.5 16.8 43.3 9.6 52.5 Female 18.9 18.2 37.1 10.4 47.1 Mother's age at birth <20 27.7 22.9 50.5 12.4 62.4 20-29 20.4 16.2 36.6 8.6 44.9 30-39 26.2 18.0 44.2 12.4 56.1 40-49 23.7 19.8 43.5 5.0 48.2 Birth order 1 22.0 12.5 34.5 6.2 40.5 2-3 19.5 14.2 33.7 8.7 42.1 4-6 26.6 25.1 51.7 14.4 65.3 7+ 37.0 36.7 73.7 18.9 91.3 Previous birth interval <2 years 35.1 40.8 75.9 16.9 91.6 2 years 18.2 15.8 34.0 10.9 44.5 3 years 21.0 11.8 32.8 8.5 41.0 4+ years 16.6 9.3 25.9 8.9 34.6 Birth size2 Small/very small 54.6 26.4 81.0 - - Average or larger 13.4 10.7 24.2 - - 1 Computed as the difference between the infant and neonatal mortality rates 2 Rates for the five-year period before the survey Research has shown that a child's size at birth is an important predictor of the risk of dying during early infancy. For all births in the five-year period before the 2005 EDHS, mothers were asked if the child was small or very small, average or large. Table 10.4 shows that the children who were considered by their mothers to be small or very small at birth were at greater risk of dying than children who were described as average or larger. For example, infant mortality for children who were considered by their mothers to be small or very small is 81 deaths per 1,000 compared to 24 deaths per 1,000 for children regarded as average or larger. 10.4 PERINATAL MORTALITY Perinatal deaths include deaths to live births within the first seven days of life (early neonatal deaths) and pregnancy losses occurring after seven months of gestation (stillbirths). In the 2005 EDHS, information on stillbirths was obtained for the five years preceding the survey and recorded in the calendar. The distinction between a stillbirth and an early neonatal death is often a fine one, depending on observing and then recalling sometimes-faint signs of life following delivery. The causes of stillbirths and early neonatal deaths are closely linked, thus, it is important to consider both in order to understand the true level of mortality around delivery. Table 10.5 presents the number of still births and early neonatal deaths and the perinatal mortality rate for the five-year period prior to the 2005 EDHS by selected background characteristics. Overall, the perinatal mortality rate is 23 per 1,000 pregnancies. 116 | Infant and Child Mortality Table 10.5 Perinatal mortality by background characteristics Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Egypt 2005 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother's age at birth <20 15 19 22.0 1,536 20-29 64 110 20.1 8,689 30-39 42 51 29.0 3,206 40-49 8 6 46.9 298 Previous pregnancy interval in months First pregnancy 34 44 20.5 3,829 <15 17 30 39.6 1,191 15-26 29 27 21.1 2,621 27-38 17 39 22.2 2,539 39+ 32 45 21.9 3,549 Urban-rural residence Urban 32 78 22.0 4,980 Rural 97 108 23.5 8,749 Place of residence Urban Governorates 10 27 19.6 1,889 Lower Egypt 44 72 21.3 5,443 Urban 5 23 22.0 1,303 Rural 38 49 21.1 4,140 Upper Egypt 75 83 25.3 6,228 Urban 16 25 24.3 1,685 Rural 59 58 25.7 4,543 Frontier Governorates 1 4 25.3 169 Mother’s education No education 50 56 24.6 4,331 Some primary 11 31 34.5 1,230 Primary complete/some secondary 15 28 21.0 2,055 Secondary complete/higher 52 71 20.1 6,113 Wealth quintile Lowest 31 47 27.6 2,849 Second 25 30 19.2 2,854 Middle 38 38 25.2 2,977 Fourth 28 50 27.7 2,813 Highest 7 22 12.9 2,236 Total 129 186 22.9 13,729 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months' duration. Infant and Child Mortality | 117 10.5 HIGH-RISK FERTILITY BEHAVIOR Research has indicated there is a strong relationship between maternal fertility patterns and children's survival risks. Typically, the risk of early childhood death increases among children born to mothers who are too young or too old, children born after a too short birth interval, and children that are high birth order. For the purpose of this analysis, a mother is classified as “too young” if she is less than 18 years of age, and “too old” if she is over 34 years at the time of the birth. A “short birth interval” is defined by the birth occurring less than 24 months after a previous birth; and a child is of “high birth order,” if the mother had previously given birth to three or more children (i.e., the child is of birth order four or higher). Table 10.6 shows the percent distributions of births in the five-year period of currently married women according to these elevated risk factors. The table also examines the relative risk of dying for children by comparing the proportion dead in each specified high-risk category with the proportion dead among children not in any high-risk category. First births, although often at increased risk, are included in the not in any high-risk category in this analysis because they are not considered an avoidable risk. Forty percent of births in the five-year period before the survey were in at least one of the specified high-risk categories, and 11 percent were associated with two or more high-risk factors. A short birth interval and high birth order were the most common high-risk factors. As the second column of Table 10.6 shows, the risk of dying for a child who falls into any of the high-risk categories is 1.7 times that for a child not in any high-risk category. Considering the risk categories separately, children are at highest risk of dying if the mother is 35 years and older at the time of the birth or if the child is born within than two years of a previous birth. Generally, risk ratios were higher for children in multiple high-risk categories than for children in any single high-risk category. The final column in Table 10.6 examines the potential for high-risk births among currently married women. A woman's current age, time elapsed since the last birth, and parity are used to determine the risk categories in which any birth she conceived at the time of the survey would fall. For example, if a respondent who is age 40, has had four births and had her last birth 12 months ago were to become pregnant, she would fall in the multiple high-risk category of being too old, too high parity (four or more births), and giving birth too soon (less than 24 months) after a previous birth. Overall, the majority of currently married women (73 percent) have the potential of giving birth to a child at elevated risk of mortality. About one in three women has the potential for having a birth in a single high-risk category (mainly high birth order), while about 40 percent have the potential for having a birth in a multiple high-risk category (mainly older maternal age and high birth order). 118 | Infant and Child Mortality Table 10.6 High-risk fertility behavior Among children born in the five years preceding the survey, percent distribution by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Egypt 2005 Births in the 5 years preceding the survey Risk category Percentage of births Risk ratio Percentage of currently married women1 Not in any high risk category 32.7 1.00 19.92 Unavoidable risk category First order births between ages 18 and 34 years 27.4 1.02 7.5 Single high-risk category Mother's age <18 2.9 1.17 0.4 Mother's age >34 2.1 1.59 7.8 Birth interval <24 months 10.0 1.58 10.0 Birth order >3 13.6 1.28 12.8 Subtotal 28.6 1.39 31.0 Multiple high-risk category Age <18 and birth interval <24 monthsa 0.2 5.30 0.1 Age >34 and birth interval <24 months 0.2 0.00 0.2 Age >34 and birth order >3 6.7 2.00 33.9 Age >34 and birth interval <24 months and birth order >3 0.6 2.22 1.8 Birth interval <24 months and birth order >3 3.6 3.40 5.6 Subtotal 11.4 2.50 41.6 In any avoidable high-risk category 40.0 1.71 72.6 Total 100.0 na 100.0 Number of births 13,600 na 18,187 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women Maternal Health Care | 119 MATERNAL HEALTH CARE 11 Using data from the 2005 EDHS, this chapter looks at the extent to which women are obtaining medical care during pregnancy and at the time of delivery. The chapter also looks at the care that women and newborns received in the postpartum period. Finally, the chapter employs results from the 2005 EDHS and earlier surveys to look at trends across time in key maternal care indicators. 11.1 PREGNANCY CARE The 2005 EDHS collected a range of information on the type of care that Egyptian women received during pregnancy, including information on antenatal care and tetanus toxoid vacci- nations. The survey also obtained information on whether women had sought medical care during pregnancy for reasons not directly related to the pregnancy. Finally, women were also asked a number of questions about the nature of the care they received. Antenatal Care Coverage Early and regular checkups by trained medical providers are very important in assessing the physical status of women during pregnancy. Table 11.1 presents data from the 2005 EDHS on the coverage of antenatal care services for births taking place during the five-year period before the survey. A birth is con- sidered to have received regular care if the mother said that she had made at least four antenatal care visits, i.e., visits to a trained medical provider for care for the pregnancy. The results in Table 11.1 indicate that Egyptian women received antenatal care from a medical provider for 70 percent of the births during the five-year period before the survey. Most women saw a doctor for care, with less than one percent report- ing that they had received care only from a trained nurse or midwife. Antenatal care was obtained more than twice as often from a private sector provider as from a public sector provider (48 percent and 21 percent, respectively). Women received regular antenatal care (i.e., they made four or more visits to a provider) for around 60 percent of births during the five years before the survey. Considering only those births for which care was received, the median number of antenatal visits was 6.8. Table 11.1 Antenatal care Percent distribution of births during the five- year period before the survey by type of provider for antenatal care, the type of facility where antenatal (ANC) care was sought, and the number of antenatal care visits, and percent distribution of last births in the five- year period prior to the survey by the stage of pregnancy at the time of the first and last visits, Egypt 2005 Antenatal care indicator Total ANC provider Doctor 69.5 Trained nurse/midwife 0.1 Birth attendant 0.0 Missing 0.2 No care 30.2 Source for ANC Public sector 21.4 Urban hospital 1.7 Urban health unit 5.1 Health office 1.1 Rural hospital 1.6 Rural health unit 8.2 MCH center 2.3 Other government 1.4 Private sector 48.3 Nongovernmental 1.3 Private medical 47.0 Other nonmedical 0.1 Don’t know/missing 0.1 No care 30.2 Number of ANC visits None 30.2 1 0.9 2 3.9 3 5.2 4+ 58.5 Don't know/missing 1.3 Total 100.0 Number of births 13,600 Median number of ANC visits 6.8 Number of months pregnant at first ANC visit No antenatal care 28.5 <4 54.9 4-5 12.3 6-7 3.1 8+ 0.8 Don't know/missing 0.5 Months pregnant at last ANC visit No antenatal care 28.5 < 6 months 1.6 6-7 months 4.5 8+ months 65.2 DK/missing 0.3 Total 100.0 Number of last births 9,845 120 | Maternal Health Care Table 11.1 shows that most Egyptian mothers who received antenatal care began seeing a provider within the first six months of pregnancy. Mothers saw a provider for care for the first time before the sixth month of pregnancy for 94 percent of last births for which antenatal care was reported (i.e., for 67 percent of all births). To detect problems that might affect the delivery, women should also see a provider late in the pregnancy. Table 11.1 shows that, if a woman received antenatal care, she generally saw a provider within the last two months of pregnancy; the mother saw a provider in the eighth month of pregnancy or later for 91 percent of last births in which the mother had any antenatal care (i.e., for 65 percent of all births). Tetanus Toxoid Vaccinations Tetanus toxoid injections are given to women during pregnancy to prevent deaths from neonatal tetanus. Neonatal tetanus can result when sterile procedures are not followed in cut- ting the umbilical cord after delivery. In the 2005 EDHS, infor- mation was collected on the number of doses of tetanus toxoid vaccine the mother received and on the source from which the tetanus toxoid vaccination was received for all births during the five-year period prior to the survey. In addition, questions were included to ascertain whether mothers who received tetanus injections prior to the last birth were advised to seek antenatal care and to determine if the last birth was fully protected from neonatal tetanus. Table 11.2 shows that women received one dose of tetanus toxoid vaccine in the case of 37 percent of the births during the five-year period before the 2005 EDHS, and two or more doses in the case of 41 percent of the births. Mothers reported obtaining the injection from a public sector provider for nine in ten births in which a tetanus toxoid vaccination was received. The MOHP has a program to promote antenatal care during the visits that women make to medical providers for tetanus toxoid vaccinations. To assess the impact of these efforts, the 2005 EDHS collected information from women who received a tetanus toxoid vaccination before their last birth on whether anyone had encouraged them to seek antenatal care at the time that they received the tetanus injection(s). Table 11.2 shows that 22 percent of the women who received a tetanus toxoid injection but reported they did not have any antenatal care were advised to obtain antenatal care at the time they received the tetanus injection. Table 11.3 considers whether the last birth was fully protected against neonatal tetanus. An infant is considered to be fully protected if any of the following criteria are met: (1) the mother had two tetanus toxoid injections during the pregnancy; (2) the mother had a tetanus toxoid injection during the pregnancy plus an additional injection in the 10 years prior to the pregnancy; or (3) the mother did not have a tetanus toxoid injection during pregnancy but had at least five injections prior to the pregnancy. According to the EDHS results, slightly more than 70 percent of last-born children during the five-year period before the survey were fully protected against neonatal tetanus. Table 11.2 Tetanus toxoid coverage during pregnancy Percent distribution of births during the five-year period before the survey by the number of tetanus toxoid (TT) injections and source for injections and percent distribution of last births in the five-year period by whether mothers receiving a TT injection but no ANC were advised during a TT visit to go for antenatal care, Egypt 2005 Tetanus toxoid indicator Total Number of doses None 20.5 One dose 37.1 Two doses or more 41.4 Don't know/missing 0.9 Source for TT injection Public sector 71.6 Urban hospital 3.2 Urban health unit 15.5 Health office 5.3 Rural hospital 6.4 Rural health unit 35.5 MCH center 5.0 Other government 0.7 Private sector 6.7 Nongovernmental 1.4 Private medical 4.6 Other nonmedical 0.7 Don’t know/missing 1.2 No injection 20.5 Total 100.0 Number of births 13,600 Advised to get antenatal care Had ANC and TT 71.4 Had TT but no ANC 20.3 Advised to seek ANC 4.5 Not advised about ANC 14.5 Don’t know/missing 1.3 No ANC or TT 8.1 Missing 0.2 Total 100.0 Number of last births 9,845 Maternal Health Care | 121 Table 11.3 Last birth protected against neonatal tetanus Percent distribution of last births during the five-year period before the survey by protection against neonatal tetanus, Egypt 2005 Total Protected 71.5 Two doses during pregnancy 37.5 One dose during pregnancy and one dose in 10-year period before pregnancy 32.6 None but 5 or more lifetime doses 1.4 Unprotected 26.8 One dose during pregnancy but no other dose in 10-year period before pregnancy 6.6 None and less than five lifetime doses 20.2 Don't know/missing 1.7 Total 100.0 Number of last births 9,845 Any Medical Care during Pregnancy The 2005 EDHS collected information about other medical consultations women may have had in addition to visits they made to a provider for pregnancy-related care. Women reported seeing a medical provider for care unrelated to their pregnancy in the case of nine percent of last births that occurred during the five-year period prior to the EDHS. The information on antenatal visits, tetanus toxoid immunizations, and medical consultations unrelated to the woman’s pregnancy is combined in Table 11.4 in order to assess the extent of the contacts women have with medical pro- viders during pregnancy. The table shows that all but seven percent of women saw a medical provider for some type of care when they were pregnant with their last born child. Women saw a provider for both an antenatal checkup and a tetanus toxoid injection in the case of 57 percent of last births. Fourteen percent of the women had antenatal care but did not receive a tetanus toxoid injection, and 20 percent of mothers received a tetanus toxoid injection(s) without going for an antenatal checkup. Differentials in Pregnancy Care Indicators Table 11.5 presents the differentials in pregnancy care indicators by selected background characteristics. Three of the indicators are presented for all births during the five-year period prior to the survey: the percentage for receiving any antenatal care, the percentage receiving regular antenatal care, and the percentage whose mother was given at least one tetanus toxoid injection. The table also presents differentials for three indicators for which information was collected only for the last birth: the percentage whose mother reported a medical consultation unrelated to the pregnancy, the percentage whose mother Table 11.4 Medical care other than visit for antenatal care or tetanus toxoid injection during pregnancy Percent distribution of last births during the five-year period before the survey by mother's report of seeing doctor or other health worker at any time during the pregnancy for care other than an antenatal care (ANC) checkup or tetanus toxoid (TT) injection, according to mother's ANC and TT status, Egypt 2005 Other medical care ANC only ANC and TT injection TT injection only Neither ANC nor TT injection Total Had other care 0.9 4.2 2.8 1.3 9.1 No other care 13.5 52.8 17.5 7.1 90.9 Total 14.4 57.0 20.3 8.3 100.0 122 | Maternal Health Care consulted a medical provider for any reason (i.e., for ANC, for a TT injection, and/or for care unrelated to the pregnancy), and the percentage considered to be fully protected against neonatal tetanus. In general, mothers age 35 and over are less likely to report receiving care than younger mothers. Although not uniform, the child’s birth order is negatively related to most of the pregnancy care indicators. Birth order differentials are especially large in the case of regular antenatal care, with mothers of first-order births being more than twice as likely as mothers of sixth-order or higher births to have regular care. Table 11.5 Care during pregnancy by background characteristics Percentage of all births in the five-year period before the survey whose mother received any antenatal care, regular antenatal care from a trained medical provider, and one or more tetanus toxoid injections, and percentage of last births during the five-year period before the survey whose mothers received other medical care unrelated to the pregnancy, whose mothers received any medical care during pregnancy and who were protected against neonatal tetanus, by selected background characteristics, Egypt 2005 Background characteristic Any ANC ANC Regular One or more TT injection(s) Number of births during five- year period before survey Medical care unrelated to the pregnancy Any medical care Protected against neonatal tetanus Number of last births Age at birth <20 68.3 54.3 88.0 1,521 10.3 95.6 81.9 875 20-34 70.9 59.7 79.0 10,776 8.9 93.9 72.8 7,814 35-49 60.7 52.1 63.1 1,303 9.5 84.8 54.9 1,156 Birth order 1 81.2 71.7 87.2 4,112 9.4 98.2 78.2 2,346 2-3 71.4 58.5 78.4 6,138 8.3 94.9 72.3 4,796 4-5 56.9 46.1 69.9 2,233 10.0 88.6 64.8 1,785 6+ 42.5 32.9 64.2 1,116 11.1 77.7 62.8 917 Urban-rural residence Urban 82.4 74.7 70.3 4,948 7.9 93.9 61.8 3,753 Rural 62.3 49.1 83.2 8,651 9.9 92.3 77.4 6,092 Place of residence Urban Governorates 84.4 78.9 65.2 1,879 7.1 92.7 57.8 1,460 Lower Egypt 78.0 66.5 81.9 5,399 8.1 95.1 73.9 4,066 Urban 88.4 80.6 73.4 1,297 9.5 96.5 63.9 987 Rural 74.7 62.0 84.5 4,101 7.6 94.7 77.1 3,079 Upper Egypt 57.8 45.0 79.9 6,153 11.0 91.2 74.0 4,200 Urban 76.0 65.7 73.4 1,669 7.9 93.8 64.4 1,235 Rural 51.0 37.2 82.3 4,484 12.3 90.2 78.0 2,965 Frontier Governorates 68.2 58.8 69.6 169 2.9 83.1 69.0 119 Education No education 48.2 35.6 78.9 4,280 10.4 86.8 72.2 2,983 Some primary 64.2 51.2 76.9 1,218 9.9 90.8 72.2 878 Primary completed/some secondary 70.3 57.1 80.0 2,040 7.5 94.4 73.6 1,491 Secondary complete/ higher 85.6 76.3 78.0 6,061 8.7 97.0 70.2 4,494 Work status Working for cash 80.3 70.0 74.4 1,614 8.9 94.6 64.3 1,261 Not working for cash 68.2 56.8 79.1 11,986 9.2 92.7 72.5 8,584 Wealth quintile Lowest 46.7 30.7 78.6 2,818 11.0 87.1 73.0 1,929 Second 59.0 45.3 83.3 2,829 9.9 91.6 77.4 1,981 Middle 71.0 59.1 83.6 2,939 8.2 93.7 77.4 2,114 Fourth 84.2 76.1 79.2 2,785 8.3 95.9 72.2 2,078 Highest 92.1 86.9 64.7 2,229 8.3 96.6 55.1 1,742 Total 69.6 58.4 78.5 13,600 9.1 92.9 71.5 9,845 Maternal Health Care | 123 Urban mothers see medical providers for antenatal care during pregnancy more often than rural mothers. For example, mothers received regular antenatal care for 75 percent of urban births compared to 49 percent of rural births. On the other hand, rural mothers are more likely than urban mothers to receive tetanus toxoid injections during pregnancy and also are slightly more likely to see a medical provider for care unrelated to the pregnancy. Births in rural Upper Egypt rank lowest on all of the pregnancy care indicators, except the measures of tetanus toxoid coverage. There is a generally positive association between the women’s education and wealth status and the various pregnancy care indicators. The relationships are particularly marked in the case of regular antenatal care. Women who have a secondary or higher education are more than twice as likely as women who have never attended school to have received regular antenatal care and mothers in the highest wealth quintile are almost three times as likely as mothers in the lowest wealth quintile to have received regular care. 11.2 CONTENT OF PREGNANCY CARE In the 2005 EDHS, women who reported that they received antenatal care, tetanus toxoid injections, or other medical care unrelated to the pregnancy were asked whether they were weighed, their blood pressure measured, and urine and blood samples taken during any of the visits they made to a medical provider during their pregnancy. These women were also asked whether they had been told about the signs of pregnancy complications, and, if they were told, whether they received any information about where to go if they experienced any complications. Finally, women were also asked whether they were given or had bought iron tablets or syrup. Iron supplementation during pregnancy is recommended to prevent iron deficiency anemia, which is a common problem among pregnant women. Some caution must be exercised in considering the information in Table 11.6 since it depends on the mother’s understanding of the questions, e.g., her understanding of what blood pressure measurement involves. It also depends on the mother’s recall of events during visits to the provider that may have taken place a number of years before the 2005 EDHS interview. Nonetheless, the results are useful in providing insight into the content of the care Egyptian women receive during pregnancy. Table 11.6 shows that, for more than eight in ten last births for which mothers saw a medical provider during pregnancy, the women reported that they had been weighed or their blood pressure had been monitored during the visit to the provider. Mothers reported that urine and blood samples were taken in the case of more than seven in ten births and 57 percent received or bought iron tablets or syrup. Mothers were advised about the complications that they might experience in 32 percent of the births and were told to seek assistance if they actually had problems in 28 percent of the births. The quality of the medical care that a woman received was better for mothers who saw a medical provider for antenatal care than for other mothers. Mothers who saw a provider for regular antenatal were the most likely to report that routine screening procedures were performed; for example, more than nine in ten mothers who had regular antenatal care were weighed and had their blood pressure monitored and around eight in ten had urine or blood samples taken. The proportions who reported receiving or being given iron supplement and who were advised about pregnancy complications were also higher for mothers who saw a provider for regular antenatal care than for other mothers. 124 | Maternal Health Care Table 11.6 Content of pregnancy care by background characteristics Percentage of last births in the five-year period before the survey whose mothers received any medical care during the pregnancy, by content of the care and selected background characteristics, Egypt 2005 Background characteristic Weighed Blood pressure measured Urine sample Blood sample taken Received/ bought iron tablets/ syrup Told about signs of compli- cations Told where to go for any compli- cations Number of last births Medical care during pregnancy Had ANC 92.5 92.6 81.2 80.7 64.1 36.3 31.4 7,027 Four or more visits 93.4 93.9 83.9 82.9 66.6 38.2 33.1 5,969 1-3 visits 87.6 85.2 65.8 68.3 49.8 25.9 21.4 1,058 No ANC 72.5 62.5 45.2 48.6 31.6 18.7 15.1 2,123 Had TT injection 74.3 63.1 46.3 50.0 31.4 18.6 15.4 1,999 No TT/DK/missing 43.7 53.5 28.1 25.9 34.4 19.7 10.1 124 Type of ANC provider Public sector 96.2 94.7 85.8 85.5 63.1 34.7 28.7 2,159 Private sector 90.9 91.7 79.6 79.0 64.6 37.2 32.5 5,024 Both 92.7 94.3 89.9 91.5 67.4 43.1 32.7 149 No ANC/missing 72.6 62.4 45.0 48.5 31.5 18.7 15.1 2,117 Age at birth <20 91.2 85.5 74.3 76.7 54.4 31.2 25.2 837 20-34 88.0 85.9 73.4 74.0 57.5 32.7 28.0 7,334 35-49 84.1 83.0 68.0 65.0 51.3 29.6 26.2 980 Birth order 1 93.3 91.5 83.5 84.7 65.0 37.1 31.6 2,304 2-3 88.4 86.5 72.8 73.2 57.4 32.5 27.7 4,552 4-5 84.0 79.6 64.6 64.6 50.2 30.0 26.3 1,581 6+ 75.5 73.8 57.4 55.8 37.8 20.2 16.5 713 Urban-rural residence Urban 91.1 91.0 81.4 78.3 66.0 38.5 32.7 3,525 Rural 85.9 82.2 67.5 70.1 50.6 28.3 24.4 5,625 Place of residence Urban Governorates 93.9 93.3 84.7 80.8 74.1 39.6 32.9 1,354 Lower Egypt 91.0 89.4 76.3 78.7 59.7 31.0 27.5 3,867 Urban 93.8 93.7 83.8 81.8 65.5 34.8 30.6 952 Rural 90.1 88.0 73.8 77.6 57.8 29.8 26.4 2,915 Upper Egypt 82.5 78.9 65.0 65.1 47.0 30.7 25.8 3,831 Urban 85.3 86.2 75.2 72.5 56.7 40.1 33.8 1,158 Rural 81.3 75.7 60.5 61.8 42.7 26.7 22.3 2,673 Frontier Governorates 93.5 91.6 84.6 76.9 60.2 37.7 31.0 99 Education No education 82.4 77.0 61.6 63.5 43.2 24.0 19.5 2,590 Some primary 81.8 80.1 62.3 65.3 45.7 29.7 24.8 797 Primary complete/some secondary 86.2 82.2 69.9 70.3 54.1 30.0 25.0 1,407 Secondary complete/higher 92.8 92.8 82.5 81.4 67.2 38.3 33.8 4,357 Work status Working for cash 90.3 90.1 79.5 77.6 64.6 37.9 34.5 1,192 Not working for cash 87.5 84.9 71.9 72.6 55.3 31.4 26.6 7,958 Wealth quintile Lowest 80.2 74.6 60.1 64.3 38.9 19.8 16.3 1,680 Second 85.1 80.0 63.6 66.4 47.1 27.3 23.0 1,815 Middle 88.3 86.6 73.4 72.9 57.0 32.4 27.6 1,980 Fourth 90.4 90.5 78.0 76.5 64.8 34.8 29.2 1,993 Highest 95.1 95.5 88.9 86.2 73.9 46.8 41.9 1,683 Total 87.9 85.6 72.9 73.3 56.5 32.2 27.6 9,150 Maternal Health Care | 125 The content of the care women received varies according to the other demographic and socioeconomic characteristics shown in Table 11.6. For example, there is a negative association between the proportions reporting routine antenatal care procedures and the child’s birth order. In general, the procedures were more likely to have been performed for urban than for rural births, with particularly low levels found for births in rural Upper Egypt. The likelihood that the routine antenatal care procedures shown in Table 11.6 were carried out increases with both education and wealth. The procedures are also more common among births to women who worked for cash than for births to other women. 11.3 DELIVERY CARE Hygienic conditions and proper medical assistance at the time of delivery can reduce the risk of complications and infection for both the mother and the child. For all births in the five-year period before the survey, the 2005 EDHS collected information on where the delivery occurred and on whether the mother was assisted by trained medical personnel. Place of Delivery Around two in three births in the five-year period before the survey occurred in a health facility (Table 11.7). The majority of women delivering in a facility (50 percent) spent less than 24 hours in the facility after giving birth, and 40 percent reported they spent less than 6 hours at the facility after the birth (Figure 11.1). Table 11.7 shows that, as expected, births to women who had antenatal care were much more likely to take place in a health facility than other births. Among births in which the mother had received antenatal care, deliveries were much more likely to occur at home if the mother had three or fewer antenatal visits prior to the birth (44 percent) than if the mother reported going for antenatal care checkups four or more times (22 percent). Table 11.7 also shows that the likelihood of the delivery outside a facility is greatest for births of order six or higher, rural births, especially births in rural Upper Egypt, births to women with no education, and births to women in the lowest wealth quintile. Around six in ten births in those groups took place at home. Regarding the type of health facility, the majority of facility deliveries (40 percent of all births) occurred in private health facilities. Births to mothers living in Lower Egypt, mothers with a secondary or higher education, and mothers in the highest wealth quintile were most likely to be delivered in a private facility. 126 | Maternal Health Care Table 11.7 Place of delivery by background characteristics Percent distribution of births in the five-year period before the survey by place where the mother gave birth, according to selected background characteristics, Egypt 2005 Health facility Background characteristic Any Public Private At own/ other home Other/ missing Total Number of births Antenatal care during pregnancy Had ANC 74.7 26.5 48.3 25.2 0.0 100.0 9,493 Four or more visits 78.4 26.9 51.5 21.5 0.0 100.0 7,967 1-3 visits 55.5 24.2 31.3 44.4 0.1 100.0 1,527 No ANC/DK/missing 41.3 22.1 19.2 58.4 0.3 100.0 4,106 Age at birth <20 59.3 23.8 35.5 40.3 0.4 100.0 1,521 20-34 65.5 24.8 40.7 34.4 0.1 100.0 10,776 35-49 63.8 29.4 34.4 36.1 0.1 100.0 1,303 Birth order 1 75.9 29.4 46.5 23.9 0.2 100.0 4,112 2-3 65.1 23.7 41.4 34.8 0.1 100.0 6,138 4-5 53.8 23.4 30.5 46.1 0.1 100.0 2,233 6+ 42.2 21.2 21.0 57.8 0.0 100.0 1,116 Urban-rural residence Urban 82.9 33.5 49.4 17.0 0.1 100.0 4,948 Rural 54.2 20.4 33.8 45.7 0.1 100.0 8,651 Place of residence Urban Governorates 87.6 43.3 44.3 12.3 0.1 100.0 1,879 Lower Egypt 73.2 22.6 50.6 26.8 0.0 100.0 5,399 Urban 87.7 25.4 62.2 12.3 0.0 100.0 1,297 Rural 68.6 21.8 46.9 31.3 0.1 100.0 4,101 Upper Egypt 50.2 21.5 28.8 49.6 0.2 100.0 6,153 Urban 74.7 28.3 46.5 25.2 0.1 100.0 1,669 Rural 41.1 19.0 22.2 58.6 0.2 100.0 4,484 Frontier Governorates 61.1 36.7 24.3 38.8 0.2 100.0 169 Education No education 45.0 22.7 22.3 54.8 0.2 100.0 4,280 Some primary 58.5 26.8 31.7 41.3 0.2 100.0 1,218 Primary complete/some secondary 64.0 30.7 33.3 35.8 0.2 100.0 2,040 Secondary complete/higher 80.0 24.7 55.3 20.0 0.0 100.0 6,061 Work status Working for cash 75.8 29.0 46.8 24.2 0.0 100.0 1,614 Not working for cash 63.2 24.6 38.5 36.7 0.1 100.0 11,986 Wealth quintile Lowest 40.9 21.6 19.3 58.8 0.3 100.0 2,818 Second 51.5 22.0 29.5 48.4 0.1 100.0 2,829 Middle 66.2 27.4 38.8 33.7 0.1 100.0 2,939 Fourth 78.4 28.2 50.2 21.6 0.0 100.0 2,785 Highest 92.0 26.8 65.3 7.8 0.1 100.0 2,229 Total 64.6 25.1 39.5 35.2 0.1 100.0 13,600 Maternal Health Care | 127 Women who did not deliver the last birth in a health facility were asked about the reason(s) for not going to a facility for the delivery. Table 11.8 shows that the majority (63 percent) reported that they had not considered it “necessary” to deliver in a facility, suggesting that they see facility deliveries as taking place only when there are problems. An additional 22 percent gave as a reason that facility deliveries were not the custom, 15 percent cited the cost of a facility delivery, and nine percent mentioned poor quality of services at facilities. Assistance at Delivery Table 11.9 presents information on the person assisting with the delivery for all births during the five years before the survey. If the mother was assisted at delivery by more than one individual, only the most qualified is shown in the table. Doctors (69 percent) or trained nurses or midwives (6 percent) assisted at delivery for three in four births in the five-year period before the survey. Most of the remaining births were assisted by dayas (traditional birth attendants). Just under 30 percent of births occurring outside of a health facility were assisted by trained medical personnel. Table 11.8 Reason for not delivering last birth in health facility Percentage of last births in the five-year period before the survey whose mothers did not deliver in a health facility according to the reason for not giving birth in a facility, Egypt 2005 Reason Number of births Costs too much 14.9 Facility not open 2.4 Too far/no transport 2.2 Poor quality service 8.7 No female provider 1.1 Husband/family did not allow 2.2 Not necessary 62.5 Not customary 21.5 Other 6.2 Total 3,309 Figure 11.1 Time Spent in Facility after Delivery EDHS 2005 1-2 days 23% 12-23 hours 2% 6-11 hours 8% 3-5 days 10% 6 or more days 3% Don’t know/ missing 14% 0-5 hours 40% 128 | Maternal Health Care Table 11.9 Assistance during delivery by background characteristics Percent distribution of live births in the five years preceding the survey by type of assistance during delivery, according to selected background characteristics, Egypt 2005 Assisted by medical provider Background characteristic Any Doctor Trained nurse/ midwife Daya Relative/ other No one Total Number of births Antenatal care during pregnancy Had ANC 83.4 78.4 5.0 14.8 1.3 0.5 100.0 9,493 Four or more visits 86.1 81.7 4.4 12.2 1.2 0.5 100.0 7,967 1-3 visits 69.4 61.4 8.0 28.2 1.7 0.6 100.0 1,527 No ANC/don’t know/missing 52.7 45.7 7.0 41.5 3.6 2.2 100.0 4,106 Place of delivery Health facility 99.3 99.1 0.2 0.0 0.6 0.1 100.0 8,792 Not in health facility 28.2 12.8 15.5 64.7 4.4 2.7 100.0 4,808 Age at birth <20 68.9 64.0 4.9 28.4 1.9 0.8 100.0 1,521 20-34 74.9 69.4 5.5 22.1 2.0 1.0 100.0 10,776 35-49 74.5 67.3 7.2 22.3 2.0 1.1 100.0 1,303 Birth order 1 83.6 79.1 4.5 14.3 1.6 0.6 100.0 4,112 2-3 74.7 68.9 5.8 22.8 1.7 0.8 100.0 6,138 4-5 65.8 59.1 6.6 30.1 2.3 1.8 100.0 2,233 6+ 53.2 46.9 6.3 40.3 4.2 2.3 100.0 1,116 Urban-rural residence Urban 88.7 84.5 4.2 9.5 1.4 0.4 100.0 4,948 Rural 65.8 59.4 6.4 30.5 2.3 1.4 100.0 8,651 Place of residence Urban Governorates 90.7 87.9 2.9 7.2 2.1 0.0 100.0 1,879 Lower Egypt 81.6 76.4 5.2 17.2 0.8 0.4 100.0 5,399 Urban 92.9 89.0 3.9 6.7 0.2 0.3 100.0 1,297 Rural 78.0 72.4 5.6 20.6 0.9 0.5 100.0 4,101 Upper Egypt 62.6 55.9 6.7 32.7 2.8 1.8 100.0 6,153 Urban 83.8 78.0 5.7 14.0 1.5 0.8 100.0 1,669 Rural 54.8 47.7 7.1 39.7 3.3 2.2 100.0 4,484 Frontier Governorates 71.8 63.6 8.2 17.2 9.5 1.5 100.0 169 Education No education 54.3 49.1 5.2 40.4 3.6 1.8 100.0 4,280 Some primary 67.9 61.7 6.2 27.9 2.3 1.9 100.0 1,218 Primary completed/some secondary 75.3 69.8 5.5 22.7 1.1 1.0 100.0 2,040 Secondary complete/higher 89.1 83.3 5.8 9.6 1.1 0.3 100.0 6,061 Work status Working for cash 85.0 79.8 5.2 13.2 1.1 0.7 100.0 1,614 Not working for cash 72.7 67.0 5.6 24.2 2.1 1.0 100.0 11,986 Wealth quintile Lowest 50.5 44.6 5.8 43.7 3.6 2.2 100.0 2,818 Second 63.5 57.4 6.1 32.3 2.4 1.7 100.0 2,829 Middle 78.2 71.1 7.1 19.9 1.4 0.5 100.0 2,939 Fourth 87.4 81.6 5.8 11.3 0.9 0.4 100.0 2,785 Highest 95.7 93.2 2.6 2.8 1.3 0.1 100.0 2,229 Total 74.2 68.6 5.6 22.9 2.0 1.0 100.0 13,600 Maternal Health Care | 129 Antenatal care, particularly regular antenatal care, is strongly associated with the likelihood that births will be medically assisted. Considering other characteristics, medically-assisted deliveries were most common for urban births, particularly those in the Urban Governorates and in urban Lower Egypt, births to highly educated mothers, and births to mothers in the highest wealth quintile. Dayas were most likely to assist at delivery when the mother lived in rural Upper Egypt, the birth was of order six or higher, and the mother never attended school. Caesarean Deliveries The 2005 EDHS obtained information on the frequency of caesarean sections. Table 11.10 shows that one-fifth of deliveries in the five-year period before the 2005 EDHS survey were by caesarean section. Women delivering in a private health facility were slightly more likely than women delivering in a government facility to have a caesarean delivery. The likelihood of a caesarean delivery increased with the age of the mother and decreased with the child’s birth order. Caesarean deliveries were twice as common in urban areas as in rural areas. Around one-third of births in urban Lower Egypt and the Urban Governorates were caesarean deliveries. The likelihood of a caesarean delivery increased with both the mother’s educational status and with the wealth quintile and was greater among women working for cash than among other women. Birth Weight The majority of babies were not weighed at birth (45 percent) or the mother was unable to report a birth weight (18 percent) (not shown in table). Among those births for which the mother was able to report the baby’s weight, Table 11.11 shows that 12 percent were clas- sified as low birth weight; i.e., they weighed less than 2.5 kilograms at birth. Births to women in the highest wealth quintile were least likely to weigh less than 2.5 kilograms (10 percent). Low-weight births were most common among children whose birth order was seven or higher (16 percent) Table 11.11 also includes information on the mother’s assess- ment of the baby’s size at birth. It is important to remember that this assessment may vary among respondents since it is based on the mother’s own perception of what is a small, average, or large baby and not on a uniform definition. Only four percent of mothers considered their babies as very small while an additional 10 percent reported that their babies were smaller than average. Again there are only relatively minor variations by background characteristics in the proportion of births regarded as small or smaller than average. Table 11.10 Caesarean deliveries by background characteristics Percentage of births in the five-year period before the survey by whether the birth was a caesarean delivery or not, according to selected background characteristics, Egypt 2005 Background characteristic Place of delivery Public health facility 28.3 Private health facility 32.4 At home/don’t know/missing na Age at birth <20 13.4 20-34 20.4 35-49 23.2 Birth order 1 24.9 2-3 20.2 4-5 14.6 6+ 10.2 Urban-rural residence Urban 29.2 Rural 14.6 Place of residence Urban Governorates 33.8 Lower Egypt 24.5 Urban 34.9 Rural 21.2 Upper Egypt 11.8 Urban 20.4 Rural 8.6 Frontier Governorates 14.3 Education No education 9.8 Some primary 17.3 Primary complete/some secondary 19.0 Secondary complete/higher 27.9 Work status Working for cash 29.5 Not working for cash 18.6 Wealth quintile Lowest 8.7 Second 12.7 Middle 19.1 Fourth 25.9 Highest 36.9 Total 19.9 130 | Maternal Health Care Table 11.11 Child’s size at birth by background characteristics Among births in the five years preceding the survey with a reported birth weight, the percent distribution by the birth weight and, among births in the five-years preceding the survey, the percent distribution by the mother’s estimate of the baby’s size at birth, according to background characteristics, Egypt 2005 Birth weight among births with reported weight Child’s size among all live births Background characteristic Less than 2.5 kg 2.5 kg or more Total percent Number of births Very small Smaller than average Average or larger Don’t know/ missing Total percent Number of births Age at birth <20 13.3 86.7 100.0 495 4.1 9.4 86.1 0.5 100.0 1,521 20-34 11.5 88.5 100.0 4,127 3.8 9.6 86.1 0.6 100.0 10,776 35-49 13.3 86.7 100.0 464 3.6 9.2 86.4 0.8 100.0 1,303 Birth order 1 11.8 88.2 100.0 1,802 4.1 9.8 85.5 0.6 100.0 4,112 2-3 10.8 89.2 100.0 2,379 3.6 9.2 86.8 0.5 100.0 6,138 4-6 14.2 85.8 100.0 691 3.8 10.0 85.5 0.8 100.0 2,233 7+ 15.9 84.1 100.0 215 4.1 9.3 85.9 0.8 100.0 1,116 Urban-rural residence Urban 12.0 88.0 100.0 2,569 3.7 11.1 84.8 0.5 100.0 4,948 Rural 11.7 88.3 100.0 2,517 3.9 8.6 86.9 0.6 100.0 8,651 Place of residence Urban Governorates 11.3 88.7 100.0 1,219 2.6 10.9 85.9 0.6 100.0 1,879 Lower Egypt 11.3 88.7 100.0 2,384 4.5 8.0 87.1 0.4 100.0 5,399 Urban 11.0 89.0 100.0 681 5.5 8.8 85.4 0.3 100.0 1,297 Rural 11.4 88.6 100.0 1,702 4.2 7.8 87.6 0.4 100.0 4,101 Upper Egypt 13.1 86.9 100.0 1,419 3.7 10.4 85.2 0.7 100.0 6,153 Urban 14.1 85.9 100.0 620 3.4 13.3 82.9 0.4 100.0 1,669 Rural 12.3 87.7 100.0 799 3.8 9.3 86.1 0.8 100.0 4,484 Frontier Governorates 13.0 87.0 100.0 64 1.5 9.4 88.2 0.9 100.0 169 Education No education 13.9 86.1 100.0 882 3.7 9.7 85.6 0.9 100.0 4,280 Some primary 13.7 86.3 100.0 396 4.6 10.5 84.4 0.5 100.0 1,218 Primary completed/some secondary 12.1 87.9 100.0 768 4.7 10.5 84.3 0.5 100.0 2,040 Secondary complete/higher 10.9 89.1 100.0 3,041 3.4 8.8 87.4 0.4 100.0 6,061 Work status Working for cash 11.9 88.1 100.0 794 3.3 9.1 87.2 0.3 100.0 1,614 Not working for cash 11.8 88.2 100.0 4,292 3.9 9.6 85.9 0.6 100.0 11,986 Wealth quintile Lowest 13.9 86.1 100.0 528 4.5 9.4 85.3 0.9 100.0 2,818 Second 14.1 85.9 100.0 752 4.0 9.4 86.1 0.6 100.0 2,829 Middle 13.4 86.6 100.0 1,044 4.1 9.8 85.5 0.7 100.0 2,939 Fourth 10.9 89.1 100.0 1,349 3.5 9.9 86.2 0.4 100.0 2,785 Highest 9.6 90.4 100.0 1,414 2.9 9.0 87.8 0.3 100.0 2,229 Total 11.8 88.2 100.0 5,086 3.8 9.5 86.1 0.6 100.0 13,600 11.4 TRENDS IN ANTENATAL AND DELIVERY CARE INDICATORS Table 11.12 presents the trends in antenatal and delivery care indicators by residence for the period between the 1988 and 2005 EDHS surveys. The table documents upward trends in all of the indicators, with the trend in tetanus toxoid coverage being particularly notable. Overall, there was a more than sixfold increase in the percentage of births for which the mother received at least one tetanus toxoid injection, from 11 percent at the time of the 1988 EDHS to the current level of 79 percent. Maternal Health Care | 131 During the period between the 1988 and 2005 surveys, there were also substantial gains in antenatal care coverage and in the proportion of medically assisted deliveries. Regarding the latter indicator, Table 11.12 shows that only about a third of births were medically assisted at the time of the 1988 survey. By the time of the 2005 survey, this proportion had climbed to slightly more than 70 percent. All residential categories shared in the improvements in maternal health indicators. Rural areas, however, continued to lag behind urban areas in both antenatal care coverage and in medically assisted deliveries. Within rural Egypt, the gains in both antenatal care coverage and the proportion of medically assisted deliveries have been somewhat greater in Lower Egypt than in Upper Egypt. As a result, the gap in both antenatal care and medically assisted deliveries between rural Lower Egypt and rural Upper Egypt increased during the time between the 1988 and 2000 surveys. Table 11.12 Trends in maternal health indicators by residence Percentage of births in the five years preceding the survey whose mothers had at least one tetanus toxoid injection, antenatal care from a doctor or trained nurse-midwife, four or more antenatal care visits, were assisted at delivery by a medical provider, and were delivered by caesarean section by urban-rural residence and place of residence, Egypt, 1988-2005 Lower Egypt Upper Egypt Maternal health indicator Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Any antenatal care 1988 na na na na na na na na na na na 1992 na na na na na na na na na na na 1995 58.3 27.2 59.2 41.9 65.2 34.5 28.6 51.2 20.8 41.4 39.1 2000 70.4 41.9 74.1 53.5 71.2 47.2 44.3 65.1 36.9 44.6 52.9 2005 82.2 62.1 84.0 78.0 88.4 74.7 57.5 75.8 50.6 68.1 69.6 Regular antenatal care1 1988 na na na na na na na na na na na 1992 na na na na na na na na na na na 1995 50.0 14.9 55.1 27.9 52 20.2 17.9 40.6 10.1 na 28.3 2000 53.9 25.9 56.0 38.9 56.2 32.8 27.2 49.8 19.2 28.5 36.7 2005 74.8 49.2 78.9 66.7 80.8 62.2 45.0 65.8 37.3 59.1 58.5 Tetanus toxoid injections 1988 12.6 10.6 8.8 13.1 14.8 12.5 11.1 17.3 8.6 na 11.4 1992 56.9 57.5 52 64 67.8 62.7 53.3 55.3 52.8 na 57.8 1995 66.7 71.2 64.2 75.6 70.2 77.4 66.3 67.6 65.9 59.8 69.5 2000 70.1 73.9 62.4 79.1 75.3 80.4 70.0 75.4 68.1 64.2 72.4 2005 70.3 83.2 65.2 81.9 73.4 84.5 79.9 73.4 82.3 69.6 78.5 Medically-assisted deliveries 1988 57.0 19.1 64.9 31.1 54.4 23.3 23.9 46.9 14.4 na 34.6 1992 62.5 27.5 68.3 39.7 62.9 32.5 29.7 51.8 23.0 na 40.7 1995 67.9 32.8 69.2 51.4 75.1 43.9 32.2 59.6 22.9 59.3 46.3 2000 81.4 48.0 83.7 65.1 84.7 58.1 47.8 74.7 38.2 60.4 60.9 2005 88.7 65.8 90.7 81.6 92.9 78.0 62.6 83.8 54.8 71.8 74.2 Caesarean deliveries 1988 na na na na na na na na na na na 1992 na na na na na na na na na na na 1995 10.7 4.2 12.3 7.3 11.3 6.1 3.8 7.9 2.4 3.4 6.6 2000 16.7 6.3 19.3 11.2 17.7 8.9 6.1 12.6 3.8 5.3 10.3 2005 29.2 14.6 33.8 24.5 34.9 21.2 11.8 20.4 8.6 14.3 19.9 na = Not available 1 A woman is considered to have had regular antenatal care if she had 4 or more visits during the pregnancy. Source: El-Zanaty and Way, 2004, Table 5.14 132 | Maternal Health Care As the proportion of medically-assisted deliveries increased, Table 11.12 also shows that there has been a substantial rise in the proportions of births reported by the mother to have been delivered by caesarean section.1 Caesarean deliveries were almost three times as common in 2005 as in 1995. Although increases in the proportions of caesarean deliveries were observed in all residential categories between 1995 and 2005, caesarean deliveries continued to be much more common in urban than in rural areas. 11.5 POSTNATAL CARE Care after delivery is very important for both the mother and her child. Proper care after delivery is especially important for births occurring in the home. The Ministry of Health and Population recommends several visits for postnatal care. The first visit should occur within two day of delivery, and the last at 40 days. In addition there should be at least two other visits, one at seven days after delivery and another at 15 days. Postnatal Checkup for the Mother Both women delivering in health facilities and those delivering outside of facilities were asked questions about the receipt of postnatal care. The results may be subject to some degree of error, especially for women delivering in facilities. Women giving birth in a health facility were asked if a provider checked on their health after they delivered before they were discharged and, if not, whether they had seen someone for a postnatal checkup after they were discharged from the facility. It is possible that women delivering in a facility may not have remembered or recognized that a postnatal checkup was conducted during their stay in the facility. However, it is felt that most women could accurately report on whether they were seen by a provider for a checkup before discharge and that this approach to collecting the information is preferable to an assumption that all women delivering in a health facility had a postnatal checkup.2 Table 11.13 presents the percent distribution of all births during the five-year period before the survey by whether or not the mother received postnatal care and, if so, the type of provider. The table also shows the source of postnatal care and timing of the first postnatal checkup. Overall, women report they had a postnatal checkup in the case of 58 percent of all births during the five-year period before the survey. Postpartum care is largely confined to births assisted by a medical provider; postnatal checkups were reported by mothers of 74 percent of the births assisted at delivery by a health provider (largely a doctor) during the five-year period prior to the survey. Mothers rarely reported receiving postnatal care when the birth was assisted by a daya or other person (11 percent). Table 11.13 also shows that most mothers who had a postnatal checkup saw a medical provider for the care. Among last births during the five-year period prior to the survey, postnatal checkups took place more often in private facilities than in facilities operated by the government. With regard to the timing of postnatal checkups, mothers saw a provider for the checkup within two days of the delivery for almost all last births for which any postnatal care was reported. 1 The same question was used in all of the EDHS surveys to collect information on the prevalence of caesarean deliveries. However, it is possible that as the proportion of all births occurring in health facilities increased over the period covered by the surveys, a somewhat greater number of women may have misunderstood the reference to caesarean birth. 2 The latter assumption was made in the 2000 EDHS and 2003 EIDHS surveys and, thus, the results of the current survey are not comparable to the findings published in the reports for those surveys. Maternal Health Care | 133 Table 11.13 Postnatal care for mother Percent distribution of births during the five-year period before the survey by type of provider and percent distribution of last births during the five- year period before the survey by source of the first postnatal checkup for mother and timing of first postnatal care checkup, according to the type of assistance at delivery, Egypt 2005 Medically- assisted births Births assisted by daya/other Total Provider of postnatal care Doctor 72.5 7.6 55.8 Trained nurse/ midwife 0.7 0.2 0.6 Traditional birth attendant 0.5 3.3 1.2 No postnatal care 26.2 88.9 42.4 Total 100.0 100.0 100.0 Number of births 10,084 3,515 13,600 Place of first checkup Health facility 73.2 7.0 57.3 Public sector 28.0 3.1 22.0 Private sector 45.2 4.0 35.3 At own/other home 0.9 0.9 0.9 Don’t know/missing 0.1 0.0 0.1 No postnatal care 25.8 92.1 41.7 Total 100.0 100.0 100.0 Number of last births 7,489 2,356 9,845 Timing of first checkup Within 2 days of delivery 71.9 5.6 56.1 Less than 4 hours 53.2 2.6 41.2 4-23 hours 11.5 2.1 9.1 24-48 hours 7.2 1.2 5.8 3-7 days after delivery 1.6 1.8 1.7 8-27 days after delivery 0.1 0.1 0.1 28 or more days after delivery 0.1 0.0 0.1 Don't know/ missing 0.5 0.1 0.4 No postnatal care 25.8 92.1 41.7 Total 100.0 100.0 100.0 Number of last births 7,489 2,356 9,845 Table 11.14 presents differentials in postnatal care indicators for the last birth during the five-year period before the survey. The table shows that the likelihood of receiving postnatal care was higher for urban than rural women. Women living in rural Upper Egypt were least likely to report receiving postnatal care. The percentages of women who had postnatal care increased with both the mother’s education level and with the wealth quintile. 134 | Maternal Health Care Table 11.14 Postnatal care for mother by background characteristics Percentage of last births during the five-year period before the survey whose mother had any postnatal checkup and whose mother had a postnatal checkup within two days of the delivery, according to the type of assistance at delivery, Egypt 2005 Medically assisted births Births assisted by dayas/others All births Background characteristic Had any postnatal care Had postnatal checkup within 2 days after delivery Number of last births assisted by health providers Had any postnatal care Had postnatal checkup within 2 days after delivery Number of last births assisted by dayas/ others Had any postnatal care Had postnatal checkup within 2 days after delivery Number of last births Age at birth <20 70.0 68.1 631 11.8 8.4 245 53.7 51.4 875 20-34 74.9 72.5 5,986 7.5 5.8 1,828 59.1 56.9 7,814 35-49 72.6 70.5 872 7.0 4.0 283 56.5 54.2 1,156 Birth order 1 78.2 75.0 2,027 9.6 8.1 319 68.9 65.9 2,346 2-3 74.9 73.1 3,732 8.5 6.5 1,065 60.2 58.3 4,796 4-6 70.9 68.4 1,225 7.4 4.9 560 51.0 48.4 1,785 7+ 60.6 58.6 505 5.7 3.7 413 35.9 33.9 917 Urban-rural residence Urban 82.5 80.4 3,371 9.5 6.4 382 75.1 72.9 3,753 Rural 67.4 64.9 4,118 7.6 5.8 1,974 48.0 45.7 6,092 Place of residence Urban Governorates 89.6 88.7 1,346 18.6 16.2 114 84.0 83.1 1,460 Lower Egypt 77.6 75.0 3,322 9.2 7.3 743 65.1 62.7 4,066 Urban 84.1 80.9 911 3.0 0.0 75 77.9 74.7 987 Rural 75.2 72.8 2,411 9.9 8.1 668 61.0 58.8 3,079 Upper Egypt 62.5 59.7 2,734 6.5 4.3 1,466 43.0 40.4 4,200 Urban 72.4 69.7 1,057 7.0 3.1 179 63.0 60.0 1,235 Rural 56.3 53.5 1,677 6.4 4.5 1,287 34.6 32.2 2,965 Frontier Governorates 72.2 71.6 86 5.5 5.5 33 53.9 53.4 119 Education No education 62.4 60.0 1,708 4.7 3.5 1,275 37.7 35.9 2,983 Some primary 70.1 67.9 612 11.8 9.6 266 52.4 50.3 878 Primary complete/some secondary 72.0 70.0 1,136 9.4 6.2 355 57.1 54.8 1,491 Secondary complete/ higher 80.4 78.0 4,033 13.4 9.9 461 73.5 71.0 4,494 Work status Working for cash 80.0 77.7 1,081 9.4 5.0 179 70.0 67.4 1,261 Not working for cash 73.2 70.9 6,408 7.8 5.9 2,177 56.6 54.4 8,584 Wealth quintile Lowest 61.5 58.9 1,009 5.2 3.9 921 34.7 32.7 1,929 Second 60.4 57.6 1,301 7.2 5.6 680 42.1 39.7 1,981 Middle 71.1 69.0 1,679 9.1 6.2 434 58.4 56.1 2,114 Fourth 81.3 78.6 1,822 12.3 9.5 256 72.8 70.1 2,078 Highest 87.9 86.3 1,678 27.4 19.4 65 85.6 83.8 1,742 Total 74.2 71.9 7,489 7.9 5.9 2,356 58.3 56.1 9,845 Maternal Health Care | 135 Postnatal Checkup for the Baby Women were asked whether or not the child had had a postnatal checkup for each birth they had during the five-year period before the survey. In addition, information was collected for the last birth the woman had during the period on the source where the postnatal checkup occurred and the timing of the first checkup following delivery. A question was also included for all last-born children about whether or not a blood sample had been taken from the child’s heel. The MOHP has established a program to promote the collection of blood samples in the two- week period following a child’s birth to screen for genetic problems. Table 11.15 presents the percent distri- bution of all births during the five-year period before the survey by whether or not the child received postnatal care and, if so, the type of provider. For the last birth during this period, the table also shows the source of postnatal care and timing of the first postnatal checkup. Overall, women report their infants had a postnatal checkup in the case of 36 percent of all births during the five-year period before the survey. Postnatal checkups were reported by mothers of 40 percent of the births assisted at delivery by a health provider (largely a doctor) during the five-year period prior to the survey compared to 22 percent of births assisted by a daya or other person. Table 11.15 shows that almost all infants who had a postnatal checkup were seen by a doctor. Infants were more than twice as likely to have been taken to a private provider for the postnatal checkup as to a public health facility (25 percent and 11 percent, respectively). Since many of the children who die in infancy die in the early neonatal period, it is important for the postnatal checkup to take place soon after delivery in order to screen for conditions that may threaten an infant’s survival. The results in Table 11.15 indicate that most infants are seen for the first checkup within a week following delivery but that only about one-quarter of the infants receiving a postnatal checkup (9 percent of all last births) were seen for the first checkup within two days of their birth. Table 11.5 also shows that a blood sample was taken from the child’s heel within two weeks of birth in the case of 60 percent of last-born children. Table 11.15 Postnatal care for child Percent distribution of births during the five-year period before the survey by provider for first postnatal checkup for child and percent distribution of last births during the five-year period before the survey by the source for first postnatal care checkup for the child, timing of the first checkup, and mother's report as to whether sample of blood was taken from baby's heel during the first 2 weeks following delivery, according to the type of assistance at delivery, Egypt 2005 Postnatal care for child Medically assisted births Births assisted by daya/other All births Provider of postnatal care Doctor 40.2 21.1 35.3 Trained nurse/ midwife 0.1 0.7 0.3 Traditional birth attendant 0.0 0.2 0.1 No postnatal care 59.7 77.9 64.4 Total 100.0 100.0 100.0 Number of births 10,084 3,515 13,600 Source for first checkup Health facility 40.4 22.7 36.2 Public sector 11.6 9.0 11.0 Private sector 28.8 13.7 25.2 At own/other home 0.7 0.6 0.6 Don’t know/missing 0.1 0.0 0.1 No postnatal care 58.9 76.7 63.1 Timing of first checkup Within 2 days of delivery 10.5 2.8 8.7 Less than 4 hours 4.6 0.4 3.6 4-23 hours 1.1 0.5 1.0 24-48 hours 4.7 1.9 4.1 3-7 days after delivery 16.6 10.0 15.0 8-27 days after delivery 4.9 3.9 4.7 4+ weeks after delivery 8.2 6.0 7.7 Don't know/ missing 0.9 0.5 0.8 No postnatal care 58.9 76.7 63.1 Blood sample from heel Sample taken 62.5 52.3 60.1 Sample not taken 33.4 43.4 35.8 Don't know/missing 4.1 4.3 4.1 Total 100.0 100.0 100.0 Number of last births 7,489 2,356 9,845 136 | Maternal Health Care Postnatal checkups were more prevalent among urban infants than rural infants (Table 11.16). The likelihood that an infant would have a checkup was lowest in the Frontier Governorates (14 percent), and it increased with both the mother’s education and the wealth quintile. However, even among infants born to mothers with a secondary or higher education and among infants in the highest wealth quintile, less than half were seen for a checkup. Table 11.16 Postnatal care for child by background characteristics Percentage of last births in the five-year period before the survey for which the child received any postnatal checkup, percentage receiving a postnatal checkup within two days of the delivery, and percentate of babies from whom a blood sample was taken from the heel by type of delivery assistance, according to selected background characteristics, Egypt 2005 Medically assisted births Births assisted by daya/other All births Background characteristic Had any post- natal care Had postnatal checkup within 2 days after delivery Had heel sample taken within 2 weeks of delivery Number of births assisted by health providers Had any post- natal care Had postnatal checkup within 2 days after delivery Had heel sample taken within 2 weeks of delivery Number of last births assisted by dayas/ others Had any post- natal care Had postnatal checkup within 2 days after delivery Had heel sample taken within 2 weeks of delivery Number of last births Age at birth <20 41.8 7.1 70.1 631 25.0 2.3 61.2 245 37.1 5.8 67.6 875 20-34 42.0 10.9 63.0 5,986 23.8 3.0 53.3 1,828 37.7 9.1 60.7 7,814 35-49 35.1 10.2 53.5 872 18.9 2.3 38.5 283 31.1 8.3 49.8 1,156 Birth order 1 47.5 11.1 73.7 2,027 32.3 4.2 67.2 319 45.4 10.1 72.8 2,346 2-3 41.1 10.9 61.5 3,732 23.6 2.6 55.8 1,065 37.2 9.1 60.2 4,796 4-5 36.3 10.0 54.0 1,225 23.4 3.7 44.5 560 32.3 8.1 51.0 1,785 6+ 27.6 6.5 46.4 505 15.7 1.1 42.4 413 22.2 4.1 44.6 917 Urban-rural residence Urban 44.7 12.7 64.4 3,371 27.2 3.1 54.2 382 42.9 11.7 63.4 3,753 Rural 38.2 8.7 61.0 4,118 22.6 2.8 51.9 1,974 33.1 6.8 58.0 6,092 Place of residence Urban Governorates 43.3 12.5 75.0 1,346 25.2 2.6 54.6 114 41.9 11.8 73.4 1,460 Lower Egypt 44.7 10.0 64.8 3,322 30.5 4.0 50.6 743 42.1 8.9 62.2 4,066 Urban 48.6 11.3 66.1 911 41.2 1.8 67.8 75 48.0 10.5 66.2 987 Rural 43.2 9.6 64.4 2,411 29.3 4.2 48.6 668 40.2 8.4 61.0 3,079 Upper Egypt 36.5 10.1 53.5 2,734 20.0 2.3 53.0 1,466 30.7 7.4 53.4 4,200 Urban 44.7 14.3 49.6 1,057 24.3 4.2 48.4 179 41.8 12.8 49.4 1,235 Rural 31.3 7.5 56.0 1,677 19.4 2.1 53.7 1,287 26.1 5.1 55.0 2,965 Frontier Governorates 16.9 8.7 63.6 86 (5.5) (0.0) (49.5) 33 13.8 6.3 59.8 119 Education No education 29.9 6.6 56.7 1,708 18.7 1.8 48.9 1,275 25.1 4.5 53.4 2,983 Some primary 39.9 10.6 60.5 612 24.5 2.1 49.6 266 35.2 8.0 57.2 878 Primary complete/some secondary 39.2 8.5 63.5 1,136 26.6 4.1 52.1 355 36.2 7.4 60.8 1,491 Secondary complete/ higher 46.6 12.7 65.0 4,033 32.9 5.2 63.3 461 45.2 12.0 64.8 4,494 Work status Working for cash 45.6 14.2 60.0 1,081 24.2 7.1 53.1 179 42.5 13.1 59.1 1,261 Not working for cash 40.4 9.9 62.9 6,408 23.3 2.5 52.2 2,177 36.0 8.0 60.2 8,584 Wealth quintile Lowest 32.4 6.7 56.9 1,009 22.1 2.2 52.9 921 27.5 4.5 55.0 1,929 Second 35.7 8.2 59.7 1,301 19.7 2.5 46.8 680 30.2 6.2 55.2 1,981 Middle 37.9 9.3 63.9 1,679 24.9 4.0 55.1 434 35.3 8.2 62.1 2,114 Fourth 45.1 10.7 63.5 1,822 31.2 3.5 60.5 256 43.4 9.8 63.1 2,078 Highest 49.5 15.7 65.6 1,678 36.9 5.0 50.4 65 49.0 15.3 65.1 1,742 Total 41.1 10.5 62.5 7,489 23.3 2.8 52.3 2,356 36.9 8.7 60.1 9,845 Note: Figures in parentheses are based on 25-49 unweighted cases. Maternal Health Care | 137 Table 11.16 also shows that blood samples were taken from 63 percent of children whose mothers were assisted at delivery by medical personnel compared to 52 percent of children whose mothers were assisted by dayas or others. Children born to mothers age 35-49 were least likely (50 percent) while first births and children from the Urban Governorates (73 percent) were most likely to have had a blood sample collected. 11.6 FAMILY PLANNING AND BREASTFEEDING ADVICE The 2005 EDHS collected information from women who delivered their last birth within the five-year period before the EDHS on whether or not they had received any advice about family planning and breastfeeding during the time they were pregnant, at the time they delivered or during the two months following delivery. Table 11.17 shows that around a quarter of these mothers said that they were given advice. With regard to the source of the advice, health providers were the most frequently mentioned source for both family planning and breastfeeding advice. The results also suggest that women were more likely to seek advice from relatives about breastfeeding than about family planning. 11.7 EXPOSURE TO SAFE PREGNANCY MESSAGES Media messages designed to make women more aware of the danger signs during pregnancy are part of an information, education and communication campaign to promote safe pregnancy. The 2005 EDHS included questions to assess the coverage of these messages and to identify the media through which women had heard or seen the messages most recently. Table 11.18 shows that 29 percent of ever-married women had heard about the danger signs to watch for during pregnancy. Women age 45-49, women with no education and those living in households ranked in the lowest quintile on the wealth index were least likely to have heard a message (19 percent, 23 percent, and 22 percent, respectively). Women age 15-19 and women with a secondary or higher education were the most likely to have heard or seen a message (41 percent and 40 percent, respectively). With regard to the most recent information source, 57 percent last received the information through television while 31 percent cited medical providers as the most recent source of information. Five percent or less of women mentioned other mass media sources (radio or print media). Six percent or less mentioned receiving information from relatives (including the husband), friends or neighbors, or other sources. Television was cited most frequently by women living in urban Upper Egypt (72 percent). The largest proportions mentioning medical providers were found among women under age 25, especially women 15-19, and women from Lower Egypt. Table 11.17 Exposure to family planning and breastfeeding information Percentage of last births in the five- year period before the survey whose mothers received informa- tion about family planning and breastfeeding from various sources, Egypt 2005 Source of information Family planning Health provider 17.8 Social worker 1.0 Daya 0.2 Neighbors/friends 0.8 Household member 1.9 Other relative 4.4 Other 0.1 Any source 24.9 Breastfeeding Health provider 15.3 Social worker 0.7 Daya 0.5 Neighbors/friends 1.1 Household member 3.9 Other relative 11.2 Other 0.1 Any source 27.8 Number of births 9,845 138 | Maternal Health Care Table 11.18 Coverage of safe pregnancy messages by background characteristics Percentage of ever-married women 15-49 reporting they had received information about danger signs women must be aware of to have a safe pregnancy during the six months prior to the survey and, among women receiving information, the percent distribution by the last source from which they received information, according to background characteristics, Egypt 2005 Source of information Background characteristic Percentage receiving information about danger signs Number of women TV Radio Print media1 Service provider Husband/ other relatives Friends/ neighbors/ other Total percent Number of women knowing danger signs Antenatal care Had birth 30.2 9,845 57.1 0.5 1.1 32.8 5.1 3.5 100.0 2,977 Antenatal care 31.0 6,975 54.9 0.3 1.3 36.0 4.8 2.7 100.0 2,164 No antenatal care 28.3 2,870 62.8 0.9 0.6 24.0 5.9 5.6 100.0 813 No birth 26.9 9,629 57.8 0.7 1.4 29.1 6.5 4.4 100.0 2,591 Age 15-19 41.1 803 40.3 0.5 0.3 47.5 7.1 4.2 100.0 330 20-24 38.1 2,968 45.9 0.9 0.5 42.2 7.5 2.8 100.0 1,132 25-29 33.4 3,785 57.2 0.6 1.8 32.9 4.5 3.1 100.0 1,263 30-34 28.1 3,209 60.4 0.2 1.0 30.5 4.1 3.9 100.0 903 35-39 24.0 3,191 65.2 0.8 1.0 23.7 4.6 4.7 100.0 767 40-44 23.8 2,859 66.5 0.3 2.4 19.8 5.5 5.5 100.0 681 45-49 18.5 2,659 65.9 0.4 1.1 17.9 9.8 4.9 100.0 493 Urban-rural residence Urban 32.0 8,033 60.6 0.4 2.0 29.6 4.8 2.5 100.0 2,568 Rural 26.2 11,441 54.7 0.7 0.6 32.3 6.6 5.1 100.0 3,000 Place of residence Urban Governorates 34.9 3,293 60.4 0.5 2.2 29.8 4.9 2.2 100.0 1,150 Lower Egypt 20.4 8,410 44.9 0.7 1.2 43.2 5.8 4.1 100.0 1,713 Urban 23.3 2,199 44.0 0.9 2.7 45.6 4.1 2.8 100.0 513 Rural 19.3 6,211 45.3 0.6 0.7 42.1 6.5 4.7 100.0 1,201 Upper Egypt 34.8 7,552 64.6 0.5 0.8 23.5 6.2 4.4 100.0 2,632 Urban 35.5 2,411 71.7 0.0 1.1 19.3 5.2 2.7 100.0 856 Rural 34.5 5,141 61.2 0.8 0.6 25.6 6.7 5.2 100.0 1,776 Frontier Governorates 33.5 218 46.1 0.8 0.8 38.8 7.3 6.4 100.0 73 Education No education 22.5 6,740 59.6 0.5 0.0 25.1 8.0 6.9 100.0 1,514 Some primary 24.9 3,053 60.5 0.8 0.1 25.3 6.5 3.7 100.0 759 Primary complete/some secondary 32.6 7,666 55.0 0.7 1.3 32.8 5.1 2.8 100.0 2,499 Secondary complete/higher 39.5 2,016 58.0 0.0 4.3 35.0 3.3 1.8 100.0 797 Work status Working for cash 30.5 3,288 55.9 0.6 3.9 33.0 3.0 3.6 100.0 1,002 Not working for cash 28.2 16,186 57.8 0.6 0.6 30.6 6.4 4.0 100.0 4,567 Wealth quintile Lowest 22.4 2,964 52.4 0.8 0.2 28.3 8.7 9.7 100.0 664 Second 27.2 3,581 60.2 0.7 0.6 26.8 7.2 4.5 100.0 973 Middle 26.2 4,217 56.7 0.9 0.4 32.5 5.4 4.1 100.0 1,104 Fourth 30.7 4,425 54.1 0.2 1.0 35.5 6.1 3.1 100.0 1,359 Highest 34.2 4,287 61.4 0.5 2.9 30.0 3.6 1.6 100.0 1,468 Total 28.6 19,474 57.4 0.6 1.2 31.1 5.8 3.9 100.0 5,568 1 Includes newspaper, magazine, pamphlet, brochure, or poster Child Health | 139 CHILD HEALTH 12 Many of the deaths in early childhood can be prevented by immunizing children against preventable diseases and by ensuring that children receive prompt and appropriate treatment when they become ill. This chapter presents information from the 2005 EDHS on the level of immunization among young children. The chapter also considers information from the EDHS on the prevalence and treatment of a number of common childhood illnesses including diarrhea, acute respiratory infections and fever. 12.1 IMMUNIZATION OF CHILDREN World Health Organization guidelines for childhood immunizations call for all children to receive a BCG vaccination against tuberculosis; three doses of the DPT vaccine to prevent diphtheria, pertussis, and tetanus; three doses of polio vaccine; and a measles vaccination during the first year of life. In addition to these standard immunizations, Egypt’s childhood immunization program recommends that children receive three doses of the hepatitis vaccine. Collection of Data In Egypt, routine immunizations are recorded on a child’s birth record (certificate) or on a special health card. In collecting data on immunization coverage in the 2005 EDHS, mothers were asked to show the interviewer the birth record and/or health card for each child born since January 2000. When the mother was able to show the birth record and/or health card, the dates of vaccinations were copied from the document(s) to the questionnaire. If neither a birth record nor a health card was available (or a vaccination was not recorded), mothers were asked a series of questions to determine whether the child had ever received specific vaccines and, if so, the number of doses. In addition to the program of routine immunizations, Egypt has recently conducted a number of special national immunization days (NID) in the effort to eradicate polio. Children’s vaccination records are generally not updated to reflect the immunizations received in these campaigns. Therefore the EDHS asked several questions on whether the child had participated in any of the NID campaigns and, if so, during how many of the campaigns the child had received a polio immunization. Routine Immunization Against Common Childhood Illnesses Table 12.1 shows information on vaccination coverage according to the source of the informa- tion, i.e., the child’s birth record and/or health card or the mother’s report. The table is restricted to children 12-23 months of age in order to focus on recent coverage levels. The first three columns of the table provide information on the proportions of children who were immunized at any age up to the time of the survey. The fourth column presents the proportion of children who were vaccinated by age 12 months, the age at which children should have received all of the recommended vaccinations. For children with vaccination records, the percentage of children immunized by age 12 months was calculated based on the child’s birth date and the dates on which specific vaccines were given as reported on the vaccination record. For children whose information was based on mother’s recall, the proportion of vaccinations given during the first year of life was assumed to be the same as that for children with a written vaccination record. 140 | Child Health Table 12.1 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother's report), and percentage vaccinated by 12 months of age, Egypt 2005 Vaccinated at any time before survey Vaccination Vaccination card Mother's report Either source Vaccinated by 12 months of age3 Valid dates BCG 71.7 26.3 98.0 98.0 89.4 DPT 1 72.7 26.4 99.1 99.0 90.7 DPT 2 71.7 25.9 97.5 97.2 84.8 DPT 3+ 70.2 23.4 93.5 93.2 77.2 Polio 01 22.1 21.2 43.3 43.3 28.2 Polio 1 73.1 26.5 99.6 99.5 97.7 Polio 2 72.5 26.3 98.8 98.6 94.8 Polio 3+ 71.4 25.7 97.0 96.7 87.1 Hepatitis 1 67.0 24.2 91.2 91.1 72.2 Hepatitis 2 64.1 22.3 86.4 86.4 63.4 Hepatitis 3 60.0 19.8 79.8 79.6 53.4 Measles 70.5 26.1 96.6 94.5 85.5 MMR 11.2 11.4 22.6 1.5 12.0 Fully immunized2 66.2 22.6 88.7 86.2 63.5 Fully immunized plus 3 doses of the hepatitis vaccine 57.0 18.9 75.9 74.2 44.1 No vaccinations 0.1 0.2 0.2 0.3 0.6 Number of children 1,965 715 2,680 2,680 1,965 1 Polio 0 is the polio vaccination given at birth. 2 A child is considered to be fully immunized if the child has received BCG, a measles or MMR vaccination, three DPT vaccinations, and three polio vaccinations 3 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccinations. Table 12.1 shows that birth records and/or health cards were available in the case of 1,965 out of 2,680 of the children age 12-23 months (73 percent). For the remaining children, the information on vaccinations was based on the mother’s report. The results in Table 12.1 indicate that the childhood immunization program in Egypt has wide coverage. Among children 12-23 months, less than one percent has never been immunized against any of the vaccine preventable diseases. Coverage levels for BCG are virtually universal, and 97 percent of children 12-23 months have received a measles vaccination. The proportions receiving three doses of the DPT and polio vaccines are 94 percent and 97 percent, respectively. Overall, 89 percent of children are considered immunized against all of these preventable diseases, i.e., they have received a BCG and measles vaccination and three doses of the DPT and polio vaccines. Hepatitis vaccinations were introduced into Egypt’s childhood immunization program in the mid- 1990s. Table 12.1 shows that coverage levels are high for the hepatitis vaccine, with 80 percent of children reported as having received the third dose of this vaccine. Overall, 76 percent of children 12-23 months are fully immunized against hepatitis as well as the other six preventable illnesses. Finally, the percentages in the third column of Table 12.1 can be compared to those in the fourth column to assess the proportion of vaccinated children who, as recommended, had received the vaccinations before the child’s first birthday. Overall, 86 percent of the children 12-23 months had received all of the required vaccinations (excluding hepatitis) by their first birthday. This proportion Child Health | 141 represents 97 percent of all children who were fully immunized against the six primary preventable childhood illnesses at the time of the survey. Trends and Differentials in Vaccination Coverage As Table 12.2 shows, the levels of vaccination coverage increased substantially during the period between the 1992 and 2005 EDHS surveys. Overall, the proportion fully immunized at the time of the 2005 survey (89 percent), i.e., the proportion receiving BCG and measles vaccinations and three doses of DPT and polio, was one-third higher than the level recorded at the time of the 1992 EDHS (67 percent). Table 12.2 also presents differentials in vaccination coverage among children 12-23 months according to selected background characteristics. There is little variation in coverage levels, with 85 percent or more of the children in all subgroups fully vaccinated. Participation in National Immunization Days During the two-year period before the survey, a series of national immunization day campaigns were held in an effort to ensure that all young children in Egypt are fully immunized against polio. The 2005 EDHS collected information on children’s participation in the NID campaigns. Table 12.3 shows that the NID campaigns have achieved wide coverage; almost all children under age five have received an immunization during one of the NIDs. If both NIDs participation and vaccinations received during routine care are taken into account, it is estimated that 99 percent of all children age 12-23 months can be considered fully immunized against polio, i.e., they have received at least three doses of polio vaccine. Table 12.2 Differentials and trends in vaccination coverage by background characteristics Among children 12-23 months, percentage who had a vaccination record seen and percentage who received each vaccine (according to the vaccination cards or the mother's report), by selected background characteristics, Egypt 2005, and trends in percentage receiving various vaccines, Egypt 1992-2005 Background characteristic Record seen BCG DPT 1 DPT 2 DPT 3+ Polio 0 Polio 1 Polio 2 Polio 3+ Hepa- titis 1 Hepa- titis 2 Hepa- titis 3 Measles MMR Fully immu- nized Fully immu- nized plus 3 doses hepatitis None Number of children Sex Male 73.6 97.8 99.1 97.4 93.6 26.6 99.7 98.8 96.7 91.1 85.6 79.2 96.8 23.0 88.9 75.3 0.2 1,375 Female 73.0 98.3 99.2 97.6 93.5 28.9 99.4 98.9 96.4 91.2 87.3 80.5 96.3 22.2 88.5 76.6 0.3 1,305 Birth order 1 71.2 97.9 98.9 96.8 91.9 27.7 99.7 99.2 96.8 92.3 88.0 80.3 97.4 25.4 87.0 75.7 0.0 829 2-3 72.1 98.6 99.3 98.2 94.8 28.1 99.4 98.7 96.8 90.9 86.5 81.0 97.1 21.5 91.2 78.4 0.3 1,247 4-5 77.2 97.3 99.0 96.9 92.7 27.4 99.6 99.1 95.8 89.7 85.0 77.8 94.1 22.4 85.5 72.5 0.4 415 6+ 81.6 96.5 99.6 97.7 94.2 25.8 99.6 97.8 96.4 91.4 82.2 74.7 94.7 17.6 86.9 68.2 0.4 190 Urban-rural Urban 71.4 98.8 99.1 97.1 93.5 23.3 99.2 98.7 96.7 93.4 89.4 83.6 96.8 24.5 89.1 80.1 0.2 972 Rural 74.4 97.6 99.2 97.8 93.5 30.2 99.8 98.9 96.5 89.9 84.8 77.7 96.5 21.5 88.5 73.6 0.2 1,708 Place of residence Urban Governorates 72.0 99.0 99.0 97.6 94.6 17.0 98.9 98.7 96.1 95.0 91.4 85.6 97.0 24.0 90.3 83.3 0.4 402 Lower Egypt 71.3 98.4 99.3 98.1 94.4 36.8 99.7 99.4 98.1 92.9 88.8 83.0 97.6 25.5 90.9 79.6 0.2 1,071 Urban 60.9 100.0 99.2 96.1 92.3 40.1 99.3 98.6 95.7 93.6 88.4 84.3 97.1 33.3 89.5 80.3 0.0 235 Rural 74.3 98.0 99.3 98.6 95.0 35.8 99.8 99.6 98.7 92.8 88.9 82.6 97.7 23.3 91.2 79.4 0.2 836 Upper Egypt 75.4 97.3 99.1 97.1 92.5 23.5 99.6 98.4 95.4 88.1 82.4 74.7 95.7 19.7 86.3 69.8 0.2 1,169 Urban 78.3 97.7 99.1 97.2 93.1 19.4 99.4 98.7 98.2 90.7 87.2 79.9 96.6 19.2 87.5 75.5 0.0 312 Rural 74.4 97.1 99.1 97.0 92.2 25.0 99.7 98.3 94.4 87.1 80.7 72.8 95.3 19.9 85.9 67.8 0.3 857 Frontier Governorates 77.7 98.9 98.2 95.3 90.9 13.2 100.0 99.2 95.5 96.6 92.4 88.4 92.7 14.4 85.6 81.6 0.0 37 Education No education 75.8 97.9 99.4 97.1 92.3 27.4 99.9 99.0 95.6 87.5 81.9 75.8 96.0 20.0 86.2 70.9 0.1 801 Some primary 72.3 96.5 98.4 95.7 94.0 23.2 99.4 97.5 96.1 87.9 83.3 77.3 94.3 19.6 88.5 73.8 0.2 212 Primary completed/some secondary 75.8 97.4 98.9 97.4 92.2 27.2 99.0 98.0 97.0 90.9 87.8 79.4 95.8 21.8 88.7 76.3 0.8 420 Secondary completed/higher 71.0 98.5 99.2 98.2 94.7 28.8 99.5 99.3 97.2 94.2 89.4 83.0 97.6 25.0 90.4 79.5 0.1 1,247 Work status Working for cash 65.9 96.0 99.4 97.2 93.4 29.7 98.8 98.5 97.0 95.3 91.6 81.6 97.5 26.4 86.8 66.1 0.6 276 Not working for cash 74.2 98.2 99.1 97.6 93.5 27.5 99.6 98.9 96.5 90.7 85.9 79.6 96.5 22.1 88.9 73.6 0.2 2,404 Wealth quintile Lowest 74.6 97.4 99.0 96.8 91.6 29.2 99.8 98.9 94.4 88.2 81.4 72.5 95.1 20.9 85.0 68.6 0.2 529 Second 74.2 97.3 98.8 96.8 93.1 25.0 99.3 98.5 96.0 89.8 85.1 78.3 95.4 17.1 87.5 73.2 0.7 557 Middle 75.1 98.1 99.6 98.3 94.1 32.7 99.9 99.0 97.2 90.4 85.2 79.5 97.8 24.8 90.1 75.8 0.1 610 Fourth 71.3 98.7 98.9 97.8 93.6 26.3 99.2 98.6 96.7 92.2 88.0 82.9 97.4 22.9 90.0 80.0 0.2 551 Highest 70.6 98.8 99.4 98.0 95.5 24.0 99.4 99.4 99.0 96.3 94.2 87.3 97.2 28.3 91.3 83.6 0.0 433 Total EDHS 2005 73.3 98.0 99.1 97.5 93.5 27.7 99.6 98.8 96.6 91.2 86.4 79.8 96.6 22.6 88.7 75.9 0.2 2,680 Total EDHS 2000 72.5 99.3 99.2 97.1 94.0 na 99.6 97.7 94.9 98.7 96.3 93.0 96.9 na 92.2 91.1 0.2 2,170 Total EDHS 1995 50.1 94.7 96.2 92.8 83.0 na 97.0 93.9 84.2 75.4 71.0 56.9 89.2 na 79.1 na 2.5 2,085 Total EDHS 1992 55.2 89.5 92.8 87.8 76.4 na 94.5 90.1 78.9 81.5 na na na na 67.4 na 3.8 1,594 Note: A child is considered to be fully immunized if the child has received BCG, a measles or MMR vaccination, three DPT vaccinations, and three polio vaccinations. na = not available Polio 0 is the polio vaccination given at birth; MMR - Measles, mumps, and rubella 142 | C hild H ealth Child Health | 143 Table 12.3 Number of times vaccinated in national immunization day campaigns by residence Percent distribution of children under five years by the number of times the child received a polio immunization during a national immunization day (NID) campaign within a two-year period before the survey, Egypt 2005 Lower Egypt Upper Egypt Number of times vaccinated in NID campaigns Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total None 6.3 2.4 5.7 1.1 0.8 1.2 5.7 11.6 3.5 2.3 3.8 1-4 20.2 24.2 18.2 26.5 25.1 27.0 20.9 19.1 21.6 16.6 22.7 5-9 37.6 40.2 35.4 40.9 41.9 40.6 39.0 36.6 39.8 39.1 39.2 10 or more 34.7 32.1 39.7 30.6 30.8 30.5 33.0 31.6 33.5 40.4 33.1 Don’t know/missing 1.2 1.2 0.9 0.9 1.5 0.7 1.5 1.2 1.6 1.6 1.2 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of children 4,778 8,342 1,826 5,235 1,248 3,987 5,897 1,604 4,292 162 13,120 12.2 ACUTE RESPIRATORY INFECTION Acute respiratory infection (ARI), particularly pneumonia, is a common cause of death among infants and young children. Early diagnosis and treatment with antibiotics can prevent a large proportion of the deaths due to pneumonia. Prevalence of ARI The prevalence of ARI was estimated by asking mothers of all children under five years of age three questions. The first question was used to identify children who had been ill with a cough in the two weeks before the survey. One-fifth of all children under age five had had a cough during the two-week period before the survey (Table 12.4). For the children who had had a cough, a second question was asked to determine if the child had breathed faster than usual during the illness with short rapid breaths or had had difficulty breathing. If the mother indicated that the child had experienced fast or difficult breathing, they were asked whether it was the result of a problem in the chest or to a blocked or runny nose. Mothers reported that 11 percent of the children with a cough experienced fast or difficult breathing. Table 12.4 shows that mothers attributed the breathing problems in most of these children—9 percent of all children under age five—to a problem in the chest. In considering the ARI findings, several points should be noted. First, the prevalence of ARI varies seasonally, and the EDHS results represent the situation at the time of the interview (circa April- June 2005) and not the situation at other times of the year in Egypt. The data also are subject to reporting error although the short reference period (two weeks) reduces the likelihood of such error. The symptoms for which information is collected in the EDHS—cough with fast or difficult breathing involving a chest problem—are signs of pneumonia but are less appropriate for assessing the presence of other ARI-related conditions (coughs and colds, wheezing, ear infection, and streptococcal sore throat). Thus, the EDHS results do not provide information on the prevalence and treatment of the full range of ARI problems children experience. Finally, the 2005 EDHS findings are not strictly comparable to earlier DHS surveys since those surveys did not directly ascertain whether the mother considered the child’s cough and rapid or difficult breathing to be chest-related. Table 12.4 Prevalence of ARI symptoms Percent distribution of children under five years with cough by presence of ARI symptoms during the two weeks before the survey, Egypt 2005 Type of illness Total Cough with short, rapid, or difficult breathing 11.1 Chest-related only 3.9 Blocked/runny nose only 2.0 Both 5.1 Don’t know/missing 0.1 Cough, no ARI symptoms 8.2 No cough 80.7 Total 100.0 Number of children 13,120 Note: Symptoms of ARI (cough accompanied by short, rapid breath- ing that was chest-related) is conside- red proxy for pneumonia. 144 | Child Health Consultation, Treatment and Feeding Practices Women whose children had chest-related ARI symptoms were asked whether they had sought advice or treatment for the illness. Table 12.5 indicates that, according to the mother’s report, advice or treatment was sought from a health provider for 73 percent of the children who were ill. Most of the families sought advice from only one provider when a child was ill with ARI symptoms. Private health care providers were the first source consulted in two-thirds of the cases. For the majority of children ill with ARI symptoms, the first consultation took place the day they became ill. Table 12.6 considers the actions taken to treat the illness. Eighty-five percent of children with chest-related ARI symptoms were given some type of medicine. Antipyretics and cough medicine were the most frequently given medicines. Just over half of the ill children received an antibiotic, with most receiving the drug orally. Questions were also asked about feeding practices during the illness. It is recommended that children receive increased liquids when they are ill and that food not be reduced. The results in Table 12.6 indicate the actions taken when the child had ARI symptoms were often counter to this advice. Children ill with chest-related ARI symptoms were most often given either less fluids than normal (45 percent) or nothing to drink (6 percent). There also was a clear tendency for children to receive less food than normal; just under one-fifth of the children were given the same or more food than normal. Table 12.5 Consultation for children ill with ARI symptoms Among children under age 5 ill with chest- related ARI symptoms, percent distribution by number of sources consulted during illness and, among ill children for whom a source was consulted, the percent distribution by the first source consulted during the illness and the timing of the first consultation, Egypt 2005 Consultation Number of sources consulted None 26.5 1 source 71.3 2 or more sources 2.0 Don’t know/missing 0.2 Total percent 100.0 Number of ill children 1,186 Source consulted first Public sector 32.2 Urban Hospital 9.3 Urban health unit 2.4 Health office 1.2 Rural hospital 1.4 Rural health unit 8.5 MCH center 1.2 Other government 8.2 Private sector 66.9 Nongovernmental 5.1 Private medical 61.8 Private hospital/clinic 4.2 Private doctor 50.0 Pharmacy 7.6 Other nonmedical 0.1 Don’t know/missing 0.8 Timing of first consultation First day child ill 68.3 2-3 days after child ill 26.3 4-5 days after child ill 2.5 6 or more days after child ill 2.3 Don’t know/missing 0.7 Total percent 100.0 Number of children having consultation(s) 869 Note: Symptoms of ARI (cough accompanied by short, rapid breathing that was chest- related) is considered proxy for pneumonia. Child Health | 145 Table 12.6 Treatment and feeding practices for children ill with ARI symptoms Among children under age 5 ill with ARI symptoms, percentage giving various drugs to treat the illness and percent distribution by feeding practices during illness, Egypt 2005 Treatment practices Drugs given to treat illness Given any drug(s) 85.2 Any antibiotic 52.0 Pill/syrup 43.4 Had antibiotic at home 3.1 Got antibiotic elsewhere 40.2 Injection 14.2 Antipyretic 55.6 Cough medicine 56.4 Other/unknown drug/missing 3.5 No drug given/missing 14.8 Number of ill children 1,186 Amount of liquids offered Same as usual 33.0 More 15.9 Somewhat less 30.9 Much less 14.0 Nothing to drink 5.8 Don't know 0.0 Missing 0.3 Amount of food offered Same as usual 18.1 More 0.3 Somewhat less 30.2 Much less 24.9 Stopped food 13.9 Never gave food 12.4 Missing 0.2 Total 100.0 Number of ill children 1,186 Note: Percentages given various drugs will not add to the total percentage given any drug(s) because more than response regarding the drugs given was possible. Differentials in ARI Prevalence and Responses to the Illness Table 12.7 presents differences in the prevalence of chest-related ARI symptoms and in consultation and treatment practices by background characteristics. The proportion of children ill with chest-related ARI symptoms does not vary greatly with the background characteristics shown in the table. It peaks at 13 percent among children age 6-11 months and children living in urban areas in Upper Egypt. Children in the Frontier Governorates and children age 48-59 months were the least likely to have symptoms (5 percent and 6 percent, respectively). Table 12.7 shows that the majority of families take some action when a child is ill with chest- related ARI symptoms; mothers report that there was no consultation or treatment given in the case of only 10 percent of children ill with chest-related ARI symptoms. Families are least likely to have taken any action if a child is under 12 months of age, of birth order 4 or higher, female, or living in a rural area. 146 | Child Health Table 12.7 Prevalence and treatment of ARI symptoms by background characteristics Percentage of children under five ill with ARI symptoms in the two weeks before the survey and, among ill children, percentage receiving medical care, given antibiotic, and receiving no treatment/consultation by selected background characteristics, Egypt 2005 Among children with ARI symptoms, percentage: Medical provider consulted Background characteristic Percentage ill with ARI symptoms Number of children under age 5 Any Public Private Given antibiotic No consul- tation/ treatment Offered increased fluids Offered increased/ same amount of food Number of ill children Child's age Under 6 months 7.2 1,242 68.8 17.1 50.7 26.7 18.6 3.4 4.9 90 6-11 months 13.4 1,349 74.5 13.7 59.0 49.6 15.3 9.2 8.6 180 12-23 months 11.6 2,680 73.5 26.8 46.2 56.4 9.4 19.4 18.5 312 24-35 months 9.9 2,671 69.9 20.3 49.5 52.3 10.4 15.0 24.1 263 36-47 months 7.1 2,682 79.8 35.4 44.0 60.0 6.1 23.4 18.7 189 48-59 months 6.1 2,497 71.4 23.3 47.2 50.2 6.6 16.4 27.3 152 Sex Male 9.6 6,688 76.4 25.4 50.8 53.8 8.0 16.9 17.9 642 Female 8.5 6,432 69.5 21.5 46.9 49.9 13.0 14.7 18.9 544 Birth order 1 9.2 3,994 74.7 24.1 50.2 49.9 9.8 15.9 14.4 367 2-3 9.2 5,943 73.4 20.8 51.8 55.8 7.9 16.5 21.1 546 4-5 8.6 2,123 70.9 27.6 43.3 47.5 15.3 11.5 17.1 183 6+ 8.4 1,059 71.1 30.2 39.1 46.7 16.8 21.5 20.7 89 Urban-rural residence Urban 10.7 4,778 79.8 21.9 57.1 58.9 7.0 14.5 17.2 511 Rural 8.1 8,342 68.2 24.9 42.8 46.8 12.9 17.0 19.2 674 Place of residence Urban Governorates 10.3 1,826 77.4 20.5 56.0 56.0 7.5 13.9 16.6 189 Lower Egypt 6.8 5,235 72.7 20.9 51.3 59.1 11.2 13.5 21.6 357 Urban 8.6 1,248 74.3 19.7 54.7 64.8 12.0 16.4 24.6 107 Rural 6.3 3,987 72.0 21.5 49.9 56.7 10.9 12.3 20.3 250 Upper Egypt 10.7 5,897 72.6 25.8 46.0 46.9 10.5 18.1 17.0 632 Urban 13.1 1,604 85.1 23.9 60.1 58.8 3.7 14.5 13.6 211 Rural 9.8 4,292 66.3 26.8 38.9 40.9 13.9 19.9 18.6 421 Frontier Governorates 4.9 162 (56.6 ) (34.6 ) (21.9) (44.9) (23.1) (0.0) (29.8) 8 Education No education 8.4 4,087 75.7 28.6 46.0 50.1 12.6 12.5 20.9 344 Some primary 12.4 1,149 67.4 29.9 37.4 46.9 13.5 8.2 17.9 143 Primary complete/some secondary 10.2 1,973 74.0 20.0 53.1 41.5 5.4 19.0 15.0 201 Secondary complete/higher 8.4 5,911 72.9 19.7 52.7 59.0 9.8 19.3 18.1 498 Work status Working for cash 7.1 1,561 72.5 21.3 51.3 59.0 8.6 20.3 19.5 110 Not working for cash 9.3 11,559 73.3 23.8 48.8 51.3 10.5 15.5 18.3 1,076 Wealth quintile Lowest 9.5 2,684 66.2 25.7 39.9 42.5 17.1 16.5 18.6 254 Second 8.6 2,731 70.6 30.8 39.4 45.6 9.8 16.3 18.1 234 Middle 9.2 2,848 73.2 21.9 50.8 58.0 11.6 12.2 18.7 262 Fourth 9.6 2,671 78.4 23.5 53.5 56.6 5.2 14.5 19.0 257 Highest 8.2 2,187 79.4 13.7 65.6 58.6 7.0 22.2 17.1 179 Total 9.0 13,120 73.2 23.6 49.0 52.0 10.3 15.9 18.4 1,186 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Percentages consulting public and private sources may not add to percentage consulting any provider because respondents were able to name more than one provider. With regard to feeding practices, younger children, especially those under 6 months of age, were less likely to have been offered increased liquids or given increased or the same amount of food than older children. Child Health | 147 12.3 DIARRHEA Dehydration caused by severe diarrhea is a major cause of death among young children. A simple and effective response to dehydration is a prompt increase in the child’s fluid intake through some form of oral rehydration therapy (ORT). ORT may include the use of a solution prepared from commercially produced packets of oral rehydration salts (ORS) or a homemade mixture usually prepared from sugar, salt, and water. Increasing the amount of any other liquids given to a child during a diarrheal episode is another means of preventing dehydration. In the 2005 EDHS, mothers were asked whether any of their children under five years of age had had diarrhea during the two-weeks preceding the survey. If the child had had diarrhea, the mother was asked about what actions were taken to treat the diarrhea and about feeding practices during the diarrheal episode. Prevalence of Diarrhea Table 12.8 shows the percentages of children under five years of age who had any diarrhea and who had diarrhea with blood in the feces, at some time during the two-week period before the survey. Blood in the stools is a symptom of dysentery. In considering the information in Table 12.8, it is impor- tant to note that the prevalence figures may involve some reporting error since they are based on the mothers’ subjective assessment of the child’s illness. Since there are seasonal variations in the pattern of diarrheal illnesses, it also should be remembered that the percentages in Table 12.8 represent the preva- lence of diarrhea at the time of the 2000 EDHS (circa April-June 2005) and not the situation at other times of the year in Egypt. Among children under age five, 18 percent were reported to have been ill with diarrhea during the two-week period before the EDHS interview, and one percent had diarrhea with bloody stools. Diarrheal episodes were most common among the small number of children living in households in which the drinking water source were classified as “not improved.” Children under age 3 were much more likely to have suffered from diarrhea than older children. Diarrheal prevalence decreased markedly with both mother’s education and the wealth quintile and was somewhat higher in Upper Egypt than in other areas. Table 12.8 Prevalence of diarrhea by background character- istics Percentage of children under five years with diarrhea in the two weeks preceding the survey, by background characteristics, Egypt 2005 Background characteristic All diarrhea Diarrhea with blood Number of children Age in months <6 22.0 0.6 1,242 6-11 33.6 1.5 1,349 12-23 28.8 1.7 2,680 24-35 17.9 1.9 2,671 36-47 9.1 0.8 2,682 48-59 7.7 0.4 2,497 Sex Male 18.5 1.3 6,688 Female 18.3 1.1 6,432 Source of drinking water Improved1 18.2 1.2 12,010 Not improved 24.7 0.8 310 Not de jure resident/missing 18.5 1.6 800 Toilet facility Improved2 18.2 1.2 10,802 Not improved 19.3 1.1 1,520 Not de jure resident/missing 18.6 1.6 797 Urban-rural residence Urban 17.1 1.3 4,778 Rural 19.1 1.1 8,342 Place of residence Urban Governorates 15.3 0.8 1,826 Lower Egypt 16.6 0.8 5,235 Urban 15.2 1.1 1,248 Rural 17.0 0.7 3,987 Upper Egypt 21.0 1.7 5,897 Urban 20.8 2.1 1,604 Rural 21.1 1.5 4,292 Frontier Governorates 14.8 0.4 162 Education No education 19.5 1.4 4,087 Some primary 20.9 1.0 1,149 Primary complete/some secondary 19.6 1.4 1,973 Secondary complete/higher 16.7 1.0 5,911 Work status Working for cash 13.5 0.9 1,561 Not working for cash 19.0 1.2 11,559 Wealth quintile Lowest 22.9 2.1 2,684 Second 19.4 1.1 2,731 Middle 17.3 0.8 2,848 Fourth 17.5 1.4 2,671 Highest 14.0 0.5 2,187 Total 18.4 1.2 13,120 1 Improved sources are defined as those sources which are likely to provide safe drinking water and include water obtained from a piped source within the dwelling, a public tap, a borehole, or a protected well or spring. 2 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. 148 | Child Health Consultation, Treatment and Feeding Practices Information was obtained in the 2005 EDHS on the actions that were taken when a child was ill with diarrhea during the two-week period prior to the survey. Table 12.9 considers the extent to which medical advice was sought during the diarrheal episode. Mothers report advice or treatment was sought at a health facility in just over half of all recent diarrheal episodes. Among those seeking medical advice, almost all consulted only one provider. Private health care providers were consulted nearly twice as often as providers at public sector facilities. Around two-thirds of the consultations were reported to have occurred on the first day the child was ill, and parents waited 4 or more days to seek advice in a small minority of cases (3 percent). Table 12.10 presents information on the drugs or other treatments employed when a child was ill with diarrhea. Slightly more than one-fifth of children were not given anything to treat the diarrhea. Virtually all mothers (95 percent) are aware of the availability of packets of oral rehydration salts that can be used to prevent dehydration (not shown in table). However, only a third of the mothers report that the child was given a solution prepared using a packet of oral rehydration salts. In three percent of the cases, the child was given a solution of sugar and salt (i.e., a recommended home fluid (RHF)). Antibiotics and other antidiarrheal medications are generally not recommended to treat diarrhea in young children. However, Table 12.10 shows that antibiotics were given to 26 percent of the children with diarrhea, 14 percent received antimotility drugs, and around 45 percent were given other drugs, e.g., antipyretics to treat the fever accompanying the diarrhea. The results in Table 12.10 suggest that feeding practices during diarrheal episodes are not optimal. To prevent dehydration, the amount of liquids given to the child should be increased during the diarrheal episode. As Table 12.10 shows, fluids were increased for only 20 percent of the children ill with diarrhea. In 15 percent of the cases, the mother said that the child was either given nothing to drink (6 percent) or much less fluid than normal (8 percent), while about a quarter of the children received somewhat less than the normal amount of liquids. Table 12.9 Consultation about diarrheal episode Among children with diarrhea, percent distribution by number of sources consulted during illness and, among ill children for whom a source was consulted, the first source consulted during the illness and the timing of the first consultation, Egypt 2005 Consultation All diarrhea Diarrhea with blood Number of sources consulted None 45.2 33.9 One 53.5 65.0 2 or more 1.2 1.1 Don’t know/missing 0.0 0.0 Total percent 100.0 100.0 Number of ill children 2,411 157 Source consulted first Public sector 34.2 39.8 Urban Hospital 6.4 11.2 Urban health unit 4.5 1.6 Health office 0.7 0.0 Rural hospital 1.9 0.6 Rural health unit 13.9 16.4 MCH center 0.8 0.2 Other government 6.1 9.8 Private sector 65.4 59.8 Nongovernmental 3.0 3.5 Private medical 62.3 56.3 Private hospital/clinic 3.5 3.9 Private doctor 46.5 40.5 Pharmacy 12.3 11.8 Other nonmedical 0.0 0.4 Don’t know/missing 0.4 0.0 Timing of first consultation First day child ill 68.3 65.8 2-3 days after child ill 28.5 28.5 4-5 days after child ill 2.2 4.5 6 or more days after child ill 0.7 0.8 Don’t know/missing 0.4 0.4 Total percent 100.0 100.0 Number of children having consultation(s) 1,320 104 Child Health | 149 It also is important that children who have diarrhea receive adequate nutrients, and thus it is recommended that the solids given to a child be increased or at least stay the same during diarrheal episodes. The child was given more than normal to eat in only two percent of the cases while 27 percent of children were fed normally during the diarrheal episode. In about one-quarter of the diarrheal episodes, the mother either completely stopped feeding the child (12 percent) or gave the child much less than normal to eat (16 percent). Differentials in Consultation, Treatment, and Feeding Practices The majority of children in all of the subgroups received some care or treatment for the diarrhea (Table 12.11). With some exceptions, care and treatment practices do not vary markedly across subgroups. Medical advice was most frequently sought for children in the highest wealth quintile and least often in the case of children living in the Frontier Governorates. With regard to ORT use, children under 6 months of age were considerably less likely than other children to have been given some form of ORT or increased fluids. Children in the highest wealth quintile and children living in urban areas, particularly the Urban Governorates and urban Upper Egypt, were more likely than other children to have been given antibiotics. Medical consultations and ORT use were more frequent among the small number of children who had experienced bloody stools compared to other children ill with diarrhea; however, medical advice was not sought in the case of one-third of children with this symptom of dysentery, and more than 40 percent were not treated with some form of ORT or given increased fluids. 12.4 DISPOSAL OF CHILDREN’S STOOLS If feces are left uncontained, disease may be spread by direct contact or through animal contact. Children’s feces are often a cause of fecal contamination in the household environment since they are frequently not disposed of properly. Thus, the proper disposal of children’s feces is important in preventing the spread of disease. To obtain information on this issue, mothers who had at least one child born since January 2000 were asked about what was done to dispose of the stools the last time their youngest child had passed stools. Almost all mothers reported that the child either used a toilet or latrine when defecating (42 percent) or the child’s stools were thrown into the toilet or latrine (51 percent) (not shown in table). Mothers reporting other means of stool disposal generally said the stools were thrown outside. Table 12.10 Treatment and feeding practices during diarrhea Percent distribution of children under five years who had diarrhea in the two weeks preceding the survey by ORS packet and drugs or other remedies used to treat diarrhea and by amount of liquids and food offered compared to normal practice, Egypt 2005 All diarrhea Diarrhea with blood Drugs/other treatment Any drug/other treatment 77.9 82.8 ORT 35.7 45.1 ORS packet 33.5 44.6 RHS 2.7 1.6 Antibiotic pill/syrup/injection 25.7 30.0 Antimotility 14.4 13.0 IV 0.1 0.5 Zinc 0.8 1.3 Other/unknown pill/syrup/injection 44.5 45.7 Home remedy 1.3 0.6 No medication 22.1 17.2 Amount of liquids offered Same as usual 40.1 25.3 More 19.9 26.3 Somewhat less 25.1 23.2 Much less 8.4 19.7 None 6.2 5.5 Don't know/missing 0.4 0.0 Amount of food offered Same as usual 26.8 21.3 More 1.5 1.1 Somewhat less 27.3 22.5 Much less 15.8 26.5 None 11.9 20.6 Never gave food 16.6 8.0 Don't know/missing 0.1 0.0 Total 100.0 100.0 Number of children 2,411 157 Note: Percentages given various drugs will not add to the total percentage given drug(s) because more than response regarding the drugs given was possible Table 12.11 Prevalence and treatment of diarrhea by background characteristics Among children ill with diarrhea, percentage receiving medical care, oral rehydration therapy (ORT), other treatment and no treatment, according to background characteristics, Egypt 2005 Medical care from: Oral rehydration therapy (ORT) Background characteristic Any health provider Public provider Private provider ORS packet RHS at home Either ORS or RHS Increased fluids Given ORT/ Increased fluids Increased/ same amount of food Antibiotic injection/ pill/syrup Other injection/ pill/syrup/ zinc/IV Home remedy/ other No care/ treatment Number of ill children Type of diarrhea Non-bloody 54.0 18.2 35.5 32.7 2.8 35.0 19.4 46.9 25.4 45.0 2.1 19.2 28.7 2,254 Bloody 66.1 26.3 39.8 44.6 1.6 45.1 26.3 57.4 30.0 46.9 1.7 12.7 22.4 157 Age in months <6 56.0 16.7 39.3 19.8 1.9 21.4 10.3 27.2 21.3 47.2 4.8 26.6 4.1 273 6-11 62.9 18.1 44.5 35.3 2.0 36.6 18.0 46.3 27.8 43.5 0.8 18.7 19.6 454 12-23 52.8 18.8 33.7 38.6 2.9 41.0 21.7 53.3 27.5 47.7 2.2 16.0 30.2 771 24-35 49.7 16.1 33.4 32.8 2.7 35.1 25.0 52.8 26.1 40.5 0.8 19.5 36.9 477 36-47 49.3 20.1 29.2 36.3 3.1 39.0 17.9 48.3 21.0 47.6 2.3 17.5 41.0 245 48-59 61.1 27.3 33.4 26.7 4.1 29.8 20.4 42.5 24.3 43.7 3.5 18.4 38.4 192 Sex Male 55.7 18.7 36.8 33.6 3.1 36.0 19.7 48.1 25.8 44.7 2.3 18.3 27.2 1,234 Female 53.8 18.8 34.8 33.5 2.3 35.3 20.0 47.0 25.5 45.4 1.8 19.2 29.5 1,177 Urban-rural residence Urban 59.4 16.2 42.9 28.3 2.5 30.3 19.6 41.9 30.3 51.4 2.2 14.5 23.4 818 Rural 52.4 20.0 32.2 36.2 2.8 38.4 20.0 50.4 23.3 41.9 2.0 20.9 30.8 1,593 Place of residence Urban Governorates 58.0 20.0 38.0 21.6 2.2 23.7 14.3 34.8 27.6 54.2 1.3 18.7 23.9 280 Lower Egypt 56.2 17.5 38.4 33.9 5.0 37.7 18.5 49.0 24.4 43.2 2.0 16.6 29.6 869 Urban 67.7 16.1 50.8 39.3 5.2 42.6 24.8 52.8 25.6 51.5 3.5 6.9 20.6 190 Rural 53.0 17.9 34.9 32.3 4.9 36.3 16.8 47.9 24.0 40.9 1.5 19.4 32.1 678 Upper Egypt 53.2 19.1 33.9 36.2 1.2 37.2 21.9 49.4 26.2 44.7 2.2 19.9 28.1 1,239 Urban 56.3 12.5 43.8 28.0 1.1 29.0 20.8 41.4 35.5 49.6 2.0 14.5 23.7 333 Rural 52.1 21.5 30.3 39.2 1.2 40.2 22.3 52.3 22.8 42.9 2.3 21.9 29.7 906 Frontier Governorates 42.2 29.2 13.0 21.7 3.7 24.1 31.3 50.5 21.2 29.1 7.1 36.2 44.5 24 Education No education 51.5 21.2 30.1 37.7 2.3 39.7 19.0 50.6 23.4 39.1 1.7 24.1 31.7 796 Some primary 54.6 21.8 32.8 29.5 3.5 32.4 17.6 42.8 32.9 36.5 0.5 21.5 27.6 241 Primary complete/some secondary 57.0 18.9 37.3 29.6 1.9 31.4 19.1 42.0 27.9 47.5 3.2 16.0 30.9 387 Secondary complete/higher 56.5 15.9 40.6 32.7 3.1 34.9 21.4 48.4 24.9 51.0 2.3 14.9 24.7 987 Work status Working for cash 50.3 16.7 33.6 33.9 4.0 36.4 26.8 53.3 21.6 47.2 2.1 17.9 27.9 210 Not working for cash 55.2 18.9 36.0 33.5 2.6 35.6 19.2 47.0 26.0 44.9 2.1 18.8 28.3 2,201 Wealth quintile Lowest 55.0 21.3 33.3 40.5 1.8 42.0 23.6 54.2 25.2 42.6 1.6 21.7 30.0 616 Second 48.3 18.2 29.9 34.4 2.0 36.0 16.0 46.7 19.9 40.7 2.2 25.3 31.3 529 Middle 53.2 19.4 33.5 33.7 3.7 37.4 17.2 48.2 25.2 41.8 2.3 15.3 29.6 493 Fourth 56.4 19.6 36.8 28.9 2.9 30.6 19.7 41.3 27.2 50.2 1.8 16.3 24.2 466 Highest 65.2 12.0 53.3 24.5 3.6 27.5 23.6 44.1 34.9 55.2 2.6 10.7 24.0 306 Total 54.8 18.7 35.8 33.5 2.7 35.7 19.9 47.5 25.7 45.1 2.1 18.7 28.3 2,411 150 | C hild H ealth Feeding Practices and Micronutrient Supplementation | 151 FEEDING PRACTICES AND MICRONUTRIENT SUPPLEMENTATION 13 Adequate nutrition is critical to child development. The period from birth to two years of age is important to optimal growth, health, and development. This period is one marked for growth faltering, micronutrient deficiencies, and common childhood illnesses, such as diarrhea, that affect a child’s nutritional status. This chapter assesses a number of aspects of feeding practices that are important in ensuring adequate nutrition for infants and young children including early initiation of breastfeeding, exclusive breastfeeding during the first six months of life, continued breastfeeding for up to two years of age and beyond, timely introduction of complementary feeding at six months of age, frequency of feeding solid/semi-solid foods, and diet diversity. In addition, the chapter discusses the diversity of food groups consumed by mothers who gave birth in the last three years, providing important information on maternal eating patterns (e.g., foods rich in vitamin A). The chapter also considers consumption of foods rich in vitamin A and iron-rich foods, micronutrient supplementation for iron and vitamin A, and micronutrient fortification (iodized or iodated household cooking salt) for both women and children. 13.1 BREASTFEEDING AND SUPPLEMENTATION The pattern of infant feeding has an important influence on the health of children. Feeding practices are the principal determinant of a young child’s nutritional status, and poor nutritional status has been shown to increase the risk of illness and death among children. Breastfeeding practices also have an effect on the mother’s fertility. Frequent breastfeeding for long durations is associated with longer periods of postpartum amenorrhea and thus longer birth intervals and lower fertility. Initiation of Breastfeeding Early initiation of breastfeeding is important for both the mother and the child. Early suckling stimulates the release of hormones that help in the production of milk. It also stimulates the contraction of the uterus after childbirth. Colostrum, the first liquid to come from the breast after delivery, provides natural immunity to the infant. Prelacteal feeding is the practice of giving other liquids to a child during the period after birth before the mother’s milk is flowing freely. It is discouraged because it limits the frequency of suckling by the infant and exposes the baby to the risk of infection. The results in Table 13.1 indicate that almost all Egyptian children are breastfed for some period of time. Differentials in the proportion of children ever breastfed are small, with 94 percent or more of children in every subgroup reported as ever breastfed. Among Egyptian children who were ever breastfed, Table 13.1 shows that the majority began breastfeeding soon after birth; 83 percent of the children were put to the breast within the first day after delivery, and 43 percent within the first hour. Although breastfeeding is initiated early for the majority of children, prelacteal feeding is common; slightly more than half of all children born in the five years preceding the survey received prelacteal feeds during the first three days after birth. Children who received prelacteal feeds were most often given sugar or glucose water (65 percent) or tea and other infusions (41 percent); a relatively small proportion were given milk other than breast milk (7 percent) (not shown in table). 152 | Feeding Practices and Micronutrient Supplementation Table 13.1 Initial breastfeeding by background characteristics Percentage of children born in the five-year period before the survey who were ever breastfed, and, among ever breastfed last-born children, percentage who began breastfeeding within one hour and within one day of birth and percentage who received a prelacteal feed, by background characteristics, Egypt 2005 Percentage who started breastfeeding: Background characteristic Percentage ever breastfed Number of children Within 1 hour of birth Within 1 day of birth1 Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Assistance at delivery Doctor or nurse/midwife 94.7 10,084 38.5 81.8 52.7 7,175 Daya 96.6 3,110 56.7 86.9 47.8 2,057 Other/none 96.8 323 58.4 90.1 37.8 195 Place of delivery Public health facility 93.7 3,420 39.8 82.9 53.6 2,427 Private health facility/NGO 94.8 5,372 32.7 79.2 54.2 3,822 Home/other 96.7 4,797 57.5 88.0 46.1 3,216 Sex Male 95.1 6,954 42.5 83.2 50.9 4,967 Female 95.3 6,646 43.4 83.0 51.7 4,502 Urban-rural residence Urban 94.3 4,948 37.5 84.4 53.6 3,576 Rural 95.7 8,651 46.2 82.3 49.9 5,893 Place of residence Urban Governorates 94.2 1,879 38.1 85.2 53.9 1,391 Lower Egypt 95.0 5,399 40.7 79.2 47.4 3,913 Urban 93.2 1,297 36.2 80.1 48.4 942 Rural 95.6 4,101 42.1 78.9 47.1 2,970 Upper Egypt 95.7 6,153 46.3 85.9 54.1 4,051 Urban 95.3 1,669 36.9 86.3 57.2 1,176 Rural 95.9 4,484 50.1 85.7 52.8 2,876 Frontier Governorates 94.8 169 57.3 95.5 51.1 114 Mother's education No education 95.3 4,280 49.4 84.7 50.0 2,868 Some primary 94.0 1,218 46.2 80.3 53.3 836 Primary complete/some secondary 95.0 2,040 43.9 84.7 50.3 1,424 Secondary complete/higher 95.5 6,061 37.7 82.1 52.0 4,341 Work status Working for cash 95.0 1,614 36.9 81.7 52.5 1,211 Not working for cash 95.2 11,986 43.8 83.3 51.1 8,258 Wealth quintile Lowest 95.7 2,818 49.2 80.8 53.6 1,863 Second 96.0 2,829 50.9 85.1 48.8 1,927 Middle 94.9 2,939 43.5 84.2 48.3 2,022 Fourth 94.1 2,785 37.7 81.7 53.0 1,977 Highest 95.4 2,229 32.2 83.6 53.1 1,679 Total 95.2 13,600 42.9 83.1 51.3 9,469 Note: Total includes 42 children for whom information on assistance at delivery was missing and 4 children for whom information on place of delivery was missing. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life before the mother started to breastfeed regularly Both medical assistance at delivery and delivery at a health facility are associated with somewhat lower proportions of children for whom breastfeeding was initiated within the first day of birth and with somewhat higher proportions of prelacteal feeding. Urban residence, higher educational levels, and increased wealth are also associated with a lower probability of breastfeeding within one hour of birth. Feeding Practices and Micronutrient Supplementation | 153 Introduction of Complementary Feeding The Ministry of Health and Population has adopted the UNICEF recommendation that during the first six months of life, children should be exclusively breastfed; that is, they should be given only breast milk and not receive other complementary liquids (including plain water) or solids. Early complementary feeding is discouraged for a number of reasons. The early introduction of other liquids or foods increases the exposure of an infant to pathogens that may cause diarrheal disease. Malnutrition is another risk. The complementary foods given to a child may not provide all of the calories that the infant needs, particularly if they are watered down. Since the production of breast milk is influenced by the intensity and frequency of suckling, early complementary feeding may reduce breast milk output, again increasing the risk of malnutrition. Information was obtained in the 2005 EDHS on the current breastfeeding status of surviving children under the age three who were living with the mother and on what other (if any) liquids or solids had been given to the child during the 24-hour period preceding the survey. These data are used to derive the information on the age patterns of breastfeeding and supplementation presented in Table 13.2 and Figure 13.1. The results indicate that breastfeeding continues for the majority of Egyptian children well beyond the first year of life. At age 12-17 months, around 80 percent of children are still being breastfed, and four in ten children 18-23 months continue to be breastfed. Table 13.2 Breastfeeding status by age Percent distribution of children under age three by breastfeeding status and age, Egypt 2005 Breastfeeding and consuming: Months since birth Not breast- feeding Exclusively breastfed Plain water only Non-milk liquids/ juice Other milk Comple- mentary foods Total percent Number of children <2 2.5 65.6 11.5 11.8 7.9 0.7 100.0 348 2-3 6.2 41.3 19.8 11.1 9.8 11.8 100.0 418 4-5 5.0 15.7 28.2 12.4 6.9 31.8 100.0 475 6-8 10.5 3.2 14.5 2.4 5.6 63.9 100.0 698 9-11 12.6 0.7 4.3 1.8 1.9 78.8 100.0 651 12-17 21.8 0.0 1.3 0.4 0.1 76.3 100.0 1,367 18-23 63.0 0.0 0.1 0.0 0.0 37.0 100.0 1,313 24-35 96.9 0.0 0.0 0.0 0.0 3.1 100.0 2,671 0-3 4.5 52.4 16.0 11.4 9.0 6.7 100.0 766 0-5 4.7 38.3 20.7 11.8 8.2 16.3 100.0 1,242 6-9 10.9 2.5 12.2 2.4 4.8 67.3 100.0 941 10-11 13.1 0.8 3.5 1.3 1.7 79.6 100.0 409 12-23 42.0 0.0 0.7 0.2 0.1 57.0 100.0 2,680 Total 49.4 6.3 5.1 2.3 1.9 34.9 100.0 7,941 Note: Breastfeeding status refers to a 24-hour period (yesterday and last night). Children classified as breastfeeding and consuming plain water only consume no supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids/juice, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus children who receive breast milk and water-based liquids and who do not receive complementary foods are classified in the water-based liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. There are 30 children who are not the last born, but are the youngest child living with the mother. 154 | Feeding Practices and Micronutrient Supplementation Exclusive breastfeeding is common but not universal in very early infancy in Egypt. Table 13.2 shows that, among infants under two months of age, 66 percent received only breast milk. However, the proportion exclusively breastfed drops off rapidly among older infants. By age 4-5 months, around eight in ten babies are receiving some form of supplementation, with somewhat more than three in ten given complementary foods. In addition to information on the prevalence of exclusive breastfeeding, the results in Table 13.2 allow an assessment of whether or not complementary feeding is being introduced on a timely basis for older babies. WHO and UNICEF recommend that all children begin to receive complementary food by age six months because at that age the mother’s breast milk no longer provides adequate nutrition for the child. Table 13.2 shows that the majority of Egyptian children age 6 months and older are receiving other foods or milk in addition to breast milk. At 6-8 months, however, about one in four babies were not being given solid or semi-solid food and, at age 9-11 months, nine percent of children were not yet eating solid or semi-solid food. Median Durations and Frequency of Breastfeeding and Prevalence of Bottle-Feeding Table 13.3 presents information on the median duration of breastfeeding among births in the three-year period before the survey, the frequency of breastfeeding among children under six months of age, and the prevalence of bottle-feeding among children under age three. The median duration of breastfeeding is 18.6 months. On average, children are exclusively breastfed or predominantly breastfed for less than the recommended six months; the median duration for which children are exclusively breastfed is 1.7 months and the median duration of predominant breastfeeding, i.e., when children receive only nonmilk liquids in addition to breast milk, is 4.3 months. Figure 13.1 Breastfeeding Status and Child’s Age <2 2-3 4-5 6-8 9-11 12-17 18-23 24-35 0 20 40 60 80 100 Exclusively breastfed Plain water only Non-milk liquids/juice Complement any foods/ other milk Not breastfeeding EDHS 2005 Age in Months Feeding Practices and Micronutrient Supplementation | 155 Table 13.3 Median duration and frequency of breastfeeding and prevalence of bottlefeeding by background characteristics Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among births in the three years preceding the survey, percentage of last-born children under six months of age breastfed six or more times in the 24 hours preceding the interview and the mean number of feeds (day/night) among last-born breastfed children under age 6 months, and percentage bottlefed among children under age 3, by background characteristics, Egypt 2005 Median breastfeeding duration (months)1 Breastfeeding frequency2 Bottle-feeding Background characteristic Any breast- feeding Exclusive breast- feeding Pre- dominant breast- feeding3 Number of births Percentage breastfed 6+ times in past 24 hours Mean number of day feeds Mean number of night feeds Number of children under age 6 months Percentage who are bottlefed Number of children under age 3 Assistance at delivery Medically trained provider 18.5 1.6 4.1 6,266 95.9 6.2 5.4 897 10.7 6,045 Daya 19.2 2.1 5.1 1,750 96.8 6.9 5.7 242 5.7 1,691 Other/none 19.8 0.7 5.2 178 97.8 6.6 6.9 33 5.1 165 Place of delivery Public health facility 18.4 1.5 4.1 2,084 94.7 6.0 5.3 297 11.9 1,981 Private health facility/NGO 18.1 1.5 4.0 3,428 95.9 6.2 5.4 513 10.7 3,333 Home/other 19.3 1.9 5.0 2,722 97.6 6.8 5.8 367 6.3 2,625 Sex Male 19.2 1.6 4.4 4,233 96.3 6.3 5.6 629 10.4 4,063 Female 18.0 1.7 4.2 4,008 95.9 6.3 5.4 549 8.7 3,879 Urban-rural residence Urban 17.5 1.4 3.7 2,999 94.9 6.0 5.3 397 11.6 2,884 Rural 19.3 1.8 4.7 5,241 96.8 6.5 5.6 781 8.4 5,058 Place of residence Urban Governorates 16.8 0.6 3.3 1,156 94.2 6.2 5.6 135 12.9 1,120 Lower Egypt 18.3 1.9 4.1 3,270 95.9 5.7 5.0 481 10.3 3,158 Urban 16.9 1.9 3.7 768 96.9 5.5 4.9 128 11.6 731 Rural 18.7 1.9 4.2 2,502 95.5 5.8 5.0 353 9.9 2,428 Upper Egypt 19.5 1.7 4.9 3,715 96.8 6.9 5.9 547 7.9 3,567 Urban 18.2 1.7 4.0 1,013 93.5 6.0 5.3 125 10.2 973 Rural 20.1 1.7 5.3 2,702 97.8 7.1 6.0 423 7.0 2,594 Frontier Governorates 19.4 2.0 3.8 101 96.4 8.4 7.0 14 7.0 96 Mother's education No education 20.1 1.7 5.3 2,508 97.6 7.0 6.0 352 6.5 2,398 Some primary 19.3 2.3 4.7 695 100.0 6.5 5.5 100 7.7 655 Primary complete/some secondary 18.2 1.3 4.1 1,218 95.9 5.8 5.2 150 10.1 1,178 Secondary complete/higher 17.9 1.6 3.9 3,819 94.6 6.1 5.3 575 11.6 3,710 Work status Working for cash 18.6 1.3 3.5 911 93.8 6.0 4.8 135 11.9 875 Not working for cash 18.6 1.7 4.4 7,330 96.4 6.4 5.6 1,043 9.2 7,066 Wealth quintile Lowest 20.3 1.9 5.5 1,687 98.1 7.0 5.7 261 6.2 1,608 Second 19.3 1.7 4.4 1,705 94.5 6.1 5.6 245 7.8 1,659 Middle 18.6 1.9 4.3 1,815 95.8 6.3 5.4 274 10.8 1,751 Fourth 17.4 1.1 3.5 1,677 95.8 6.3 5.4 211 10.6 1,599 Highest 16.9 1.3 3.9 1,357 96.4 6.0 5.4 187 12.8 1,324 Total 18.6 1.7 4.3 8,241 96.1 6.3 5.5 1,178 9.5 7,941 Mean duration 18.0 3.0 5.4 na na na na na na na Note: Median durations are based on current status. Includes children living and deceased at the time of the survey. Totals include 47 children for whom information on assistance at delivery is missing and 7 children for whom information on place of delivery is missing. na = Not applicable 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfed. 2 Excludes children who do not have a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, and non-milk liquids. Children receiving milk other than breast milk or infant formula should be excluded. 156 | Feeding Practices and Micronutrient Supplementation The median amount of time that a child is breastfed is slightly shorter among children whose mothers were attended at delivery by a doctor or other health professionals and among children delivered in a health facility. Males are breastfed on average around one month longer than females. Residence clearly is related to breastfeeding durations. The median breastfeeding duration is just under two months longer for rural children than urban children, and it ranges from a low of 16.8 months in the Urban Governorates to 20.1 months in rural Upper Egypt. Children born to mothers who never attended school are breastfed around two months longer on average than children born to mothers who completed secondary school or higher. The median duration of breastfeeding among children in the highest wealth quintile is more than 3 months shorter than the duration for children in the lowest quintile. Variations in the median durations of exclusive breastfeeding and predominant breastfeeding, which are also shown in Table 13.3, are generally similar to the variations observed in the median durations of any breastfeeding although the size of the differentials are much smaller. The frequency of breastfeeding during a 24-hour period before the survey is also examined in Table 13.3. It is important for an infant to breastfeed frequently as this improves milk production. The duration of postpartum amenorrhea for a mother is also related to the frequency of breastfeeding. Among last-born children under age six months, 96 percent were breastfed at least six times during the 24-hour period before the survey. Mothers reported a mean number of 6.3 daytime feeds and 5.5 nighttime feeds. The largest differentials in the measures of breastfeeding frequency are by place of residence, with the highest mean feeding frequencies, particularly during the daytime, observed in the Frontier Governorates. Table 13.3 also provides information on the differentials in the percentage of children under age three who are being bottle-fed. A bottle with a nipple was used in feeding only 10 percent of the children less than three years of age during the 24 hours before the survey. Bottle-feeding is most common in the Urban Governorates and in the highest wealth quintile; 13 percent of children in these groups are bottlefed. 13.2 DIETARY DIVERSITY AMONG CHILDREN AND WOMEN In the 2005 EDHS, women who had at least one child under the age of three living with them were asked questions about the types of foods and liquids they and their youngest child had consumed during a 24-hour period preceding the survey. Mothers were also asked about the number of times the child had eaten solid or semi-solid food during the period. The results of these questions are subject to a number of limitations. First, the results do not apply to the full universe of young children. Approximately 10 percent of all children under age three are excluded from consideration because they were not the youngest child under age three or because they were not living with the mother. The data also represent only a minority of women. Women who have a child under age three living with them constitute only a little more than one-third of all EDHS respondents and about a quarter of all women in the reproductive ages 15-49. In addition, The dietary data for both women and children are subject to recall errors. Finally, the mother may not be able to report fully on the child’s intake of foods and liquids if the child was fed by other individuals during the period. Despite these problems, the information collected in the 2005 EDHS on the types of foods and liquids mothers and young children are consuming is useful in assessing the dietary diversity for these key subpopulations. Feeding Practices and Micronutrient Supplementation | 157 Foods and Liquids Consumed by Infants and Young Children Appropriate nutrition includes feeding children a variety of foods to ensure that nutrient requirements are met. Fruits and vegetables rich in vitamin A should be consumed daily. Although eating a range of fruits and vegetables, especially those rich in vitamin A is important, studies have shown that plant-based complementary foods by themselves are insufficient to meet the needs for certain micronutrients (WHO/UNICEF 1998). Therefore, it has been advised that meat, poultry, fish, or eggs should be eaten daily, or as often as possible. Fat is also important in the diets of infants and young children because it provides essential fatty acids, facilitates absorption of fat-soluble vitamins (such as vitamin A), and enhances dietary energy density and palatability. Tea and coffee contain compounds that inhibit iron absorption and are not recommended for children. Sugary drinks and excessive juice consumption should be avoided because other than energy, they contribute little to the diet and as a result decrease the child’s appetite for more nutritious foods (PAHO/WHO 2003). Table 13.4 is based on information from women about the foods and liquids consumed by their youngest child during the 24-hour period preceding the survey. As expected, the proportions of children who consumed foods or liquids included in the various groups shown in the table rises with the age of the child. Children who are still breastfed are less likely to consume the various types of foods than children who are not being breastfed. For example, 92 percent of nonbreastfeeding children age 6-23 months consumed foods made from grains in the 24-hour period before the survey compared to 79 percent of breastfeeding children in the age group. Of particular concern is the fact that the majority of children age 6-23 months, whether breastfeeding or not, did not consume any foods rich in vitamin A during the 24- hour period before the survey. Substantial minorities of children in the age group also did not consume meat, poultry or fish or food made with oil, fat or butter. 158 | Feeding Practices and Micronutrient Supplementation Table 13.4 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under three years of age living with the mother who consumed specific types of food groups in the day or night preceding the interview, by breastfeeding status and age, Egypt 2005 Age in months Infant formula Other milk1 Cheese/ yogurt/ other milk products Other liquids2,3 Food made from grains4 Fruits and vege- tables rich in vitamin A5 Other fruits/ vege- tables Food made from roots/ tubers Food made from legumes and nuts Meat/ fish/ shellfish/ poultry/ eggs Food made with oil/fat/ butter Sugary foods Any solid or semi- solid food Number of children BREASTFEEDING CHILDREN <2 4.2 5.2 0.7 15.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.7 340 2-3 4.3 11.0 6.8 23.8 4.9 1.7 1.8 1.1 0.9 1.5 0.8 1.0 12.0 392 4-5 3.0 18.9 21.7 30.4 20.2 3.5 5.8 6.1 4.2 6.9 6.5 6.0 33.1 451 6-8 4.2 41.6 45.2 44.9 52.7 16.4 24.2 28.4 18.0 32.1 33.6 14.4 71.1 625 9-11 4.1 44.1 61.1 60.6 75.7 32.0 46.2 47.2 29.4 52.5 56.7 24.7 90.0 569 12-17 4.0 52.4 66.6 71.2 89.4 45.7 59.8 57.0 44.5 72.2 75.6 30.3 97.5 1,069 18-23 2.7 59.9 70.1 76.1 95.4 50.3 66.8 61.4 54.3 76.9 84.7 35.6 99.6 486 24-35 3.4 49.2 63.3 66.4 91.9 57.2 65.1 67.4 56.4 79.5 80.0 36.1 100.0 82 6-23 months 3.9 49.5 61.2 63.9 79.3 37.0 50.1 49.3 37.1 59.8 63.8 26.5 90.3 2,749 Total 3.8 38.6 46.4 52.2 58.9 27.1 36.5 35.9 27.1 43.5 46.1 19.7 68.9 4,015 NONBREASTFEEDING CHILDREN 6-8 44.6 76.3 56.2 59.4 70.7 26.1 29.9 42.8 24.1 48.4 43.4 24.8 82.2 61 9-11 29.7 74.0 57.0 53.4 78.2 32.1 42.2 34.3 19.4 51.7 51.6 23.0 90.5 70 12-17 10.8 72.9 74.1 76.4 91.8 48.3 68.2 57.5 45.1 80.5 80.5 32.4 98.0 236 18-23 3.3 65.5 72.1 75.1 95.5 52.1 66.0 61.1 57.2 81.3 84.8 45.1 99.2 687 24-35 1.7 60.6 71.2 79.5 95.6 53.8 69.8 61.5 60.7 84.0 85.0 44.1 98.9 1,986 6-23 months 9.2 68.3 70.6 73.0 92.1 48.4 62.8 57.5 50.0 77.2 79.2 39.6 97.4 1,055 Total 4.9 63.1 70.3 76.8 93.4 51.3 66.6 59.4 56.4 80.7 82.0 42.1 97.6 3,078 Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and last night). There are 30 children who are not the last born, but are the youngest surviving child living with the mother. In addition, 38 nonbreastfeeding children under age 6 months are included in the totals but not shown separately. 1 Other milk includes fresh, tinned, and powdered milk from cows or other animals. 2 Does not include plain water 3 Includes sugary drinks 4 Includes fortified baby food and porridge or gruel 5 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, mangoes, canteloupe, dark green leafy vegetables, and other locally grown fruits and vegetables that are rich in vitamin A Infant and Young Child Feeding (IYCF) Practices Appropriate Infant and Young Child Feeding (IYCF) practices include breastfeeding through the age of two years, the introduction of solid and semisolid foods at age 6 months, and a gradual increase in the amount of food given and the frequency of feeding as the child gets older. The average, healthy breastfed child should receive solid and semisolid foods 2-3 times per day at age 6-8 months and 3-4 times per day at age 9-23 months, with an additional snack 1-2 times per day. The minimum frequencies for feeding children in developing countries are based on the energy output of complementary foods. The energy needs of children are based on age-specific total daily energy requirements, plus 2 SD (to cover almost all children), minus the average energy intake from breast milk. Infants with low breast-milk intake need to be fed more frequently than those with high breast-milk intake. However, care should be Feeding Practices and Micronutrient Supplementation | 159 taken that feeding frequencies do not exceed recommended input from complementary foods because excessive feeding can result in displacement of breast milk (PAHO/WHO, 2003). Although the World Health Organization recommends that infants be breastfed up to the age of two years, some infants are not breastfed at all, or stopped breastfeeding before their second birthday. Guidelines have been developed for these children, who may not have been breastfed because their mother was HIV-positive, or because their mother had died, or for other reasons (WHO, 2005). It is recommended that the nonbreastfed child be given solid and semisolid foods 4-5 times per day at age 6-23 months, with an additional snack 1-2 times per day. Appropriate nutrition includes feeding children a variety of foods to ensure that nutrient requirements are met. Studies have shown that plant-based complementary foods by themselves are not sufficient to meet the needs of some children for certain micronutrients (WHO/UNICEF, 1998). Therefore, it is advised that children eat meat, poultry, fish, or eggs daily, or as often as possible. Vegetarian diets may not meet children’s nutrient requirements unless supplements or fortified foods are also provided. Vitamin A-rich fruits and vegetables should be consumed daily, and the diets of children should include an adequate amount of fat. Fat is important in the diets of infants and young children because it provides essential fatty acids, facilitates absorption of fat-soluble vitamins (such as vitamin A), and enhances dietary energy density and palatability. Tea and coffee are not recommended for children because they contain compounds that inhibit iron absorption. Sugary drinks and excessive juice consumption should be avoided because other than energy they contribute little to the diet and decrease the child’s appetite for more nutritious foods (PAHO/WHO, 2003). In summary, ƒ Breastfed children age 6-23 months should receive animal-source foods and vitamin A-rich fruits and vegetables daily (PAHO/WHO, 2003). Because first foods almost always include a grain- or tuber-based staple, it is unlikely that young children who eat less than three food groups will receive both an animal-source food and a vitamin A-rich fruit or vegetable.1 Therefore, three food groups are considered the minimum number appropriate for breastfed children (Arimond and Ruel, 2004). ƒ Breastfed infants age 6-8 months should receive complementary foods 2-3 times per day, with 1-2 snacks; breastfed children age 9-23 months should be receive meals 3-4 times per day, with 1-2 snacks (PAHO/WHO, 2003). Table 13.5 shows the percentage of breastfed children who were fed at least the minimum number of times per day for their age (i.e., twice for infants age 6-8 months and three times for children age 9-23 months). ƒ Nonbreastfed children age 6-23 months should receive milk or milk products to ensure that their calcium needs are met. In addition, they need animal-source foods and vitamin A-rich fruits and vegetables. Four food groups are considered the minimum number appropriate for nonbreastfed young children. ƒ Nonbreastfed children age 12-23 months should be fed meals 4-5 times per day, with 1-2 snacks (WHO, 2005). The table shows the percentage of nonbreastfed children age 6-23 who were fed at least the minimum number of times per day (i.e., four times). 1 Food groups used in the assessment of appropriate feeding practices included: milk other than breast milk, cheese, yogurt; foods made from grains, roots, and tubers; fruits and vegetables rich in vitamin A; other fruits and vegetables; eggs; meat, poultry, fish, and shellfish (and organ meats); legumes and nuts; and foods made with oil, fat, or butter. 160 | Feeding Practices and Micronutrient Supplementation According to the results presented in the table below, 97 percent of (youngest) children age 6-23 months living with the mother received breast milk or breast milk substitutes during the 24-hour period before the survey, 78 percent had an adequately diverse diet—i.e. they had been fed foods from the appropriate number of food groups depending on their age and breastfeeding status—and 42 percent of the children were fed the minimum standard number of times appropriate for their age. Feeding practices for only 38 percent of children age 6-23 months met the minimum standard with respect to all three of these feeding practices (see Figure 13.2). Breastfed children were 50 percent more likely to be fed the minimum number of times but a lot less likely to receive foods from the minimum number of groups recommended than nonbreastfeeding children. Children in the age group of 12-17 years were most likely to comply with the recommended practice when looked at various age groups. Variations in feeding practices with the other characteristics shown in the table below are generally minor without any pattern. Figure 13.2 Infant and Young Child Feeding (IYCF) Practices 45 17 38 55 83 63 Breastfed Nonbreastfed All 6-23 months 0% 20% 40% 60% 80% 100% Fed with all three IYCF practices Not fed with all three IYCF practices EDHS Table 13.5 Infant and young child feeding (IYCF) practices in Egypt Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based upon number of food groups and times they are fed during the day or night preceding the survey by breastfeeding status and background characteristics, Egypt 2005 Among breastfed children 6-23 months, percentage fed: Among nonbreastfed children 6-23 months, percentage fed: Among all children 6-23 months, percentage fed: Background characteristic 3+ food groups1 Minimum times or more2 Both 3+ food groups and minimum times or more Number of children (weighted) Milk or milk products3 4+ food groups 4+ times or more With 3 IYCF practices4 Number of children (weighted) Breast milk or milk products 3+ or 4+ food groups5 Minimum times or more6 With all 3 IYCF practices Number of children (weighted) Age 6-8 42.8 49.4 34.7 625 93.5 44.9 16.8 16.5 61 99.4 43.0 46.5 33.0 686 9-11 72.2 32.4 30.7 569 92.1 58.4 18.3 10.0 70 99.1 70.7 30.9 28.4 639 12-17 87.4 52.4 50.5 1,069 91.5 86.3 18.2 16.4 236 98.5 87.2 46.2 44.4 1,305 18-23 94.9 67.2 65.3 486 86.3 89.2 22.4 17.9 687 92.0 91.5 41.0 37.5 1,174 Sex Male 76.0 50.2 45.4 1,434 89.7 84.7 22.6 18.3 518 97.3 78.3 42.9 38.2 1,952 Female 74.8 50.1 45.5 1,315 86.8 83.1 19.3 15.6 537 96.2 77.2 41.2 36.8 1,852 Residence Urban 75.9 51.5 46.0 908 92.0 85.1 22.5 19.5 482 97.2 79.1 41.4 36.8 1,390 Rural 75.2 49.5 45.2 1,841 85.1 82.9 19.5 14.8 573 96.5 77.1 42.4 38.0 2,414 Region Urban governorates 74.8 50.8 44.4 342 93.9 87.2 22.2 19.4 207 97.7 79.5 40.0 35.0 549 Urban LE 80.2 46.4 41.4 186 92.2 84.9 15.7 14.9 134 96.7 82.2 33.6 30.3 320 Rural LE 79.8 42.2 38.6 854 89.9 87.8 15.9 12.1 321 97.2 82.0 35.0 31.3 1,176 Urban UE 73.8 54.5 49.2 358 88.3 82.0 30.0 24.3 131 96.9 76.0 47.9 42.5 489 Rural UE 71.2 56.1 51.1 972 78.8 76.5 23.9 17.9 247 95.7 72.3 49.5 44.3 1,219 Frontier governorates 84.3 50.9 50.2 37 94.3 83.8 26.7 26.7 14 98.5 84.2 44.4 43.8 50 Mother’s education No education 74.0 51.8 48.1 868 83.7 76.1 21.4 17.6 236 96.5 74.4 45.3 41.6 1,103 Primary 71.7 43.8 41.2 328 86.5 79.0 22.8 15.7 119 96.4 73.6 38.2 34.4 447 Secondary 76.8 49.0 44.2 1,272 89.3 87.5 19.2 15.9 568 96.7 80.1 39.8 35.5 1,839 More than secondary 78.3 58.1 47.6 282 93.4 86.7 25.5 21.2 132 97.9 81.0 47.7 39.2 414 Wealth quintile Lowest 68.8 48.1 43.7 606 74.0 76.1 22.0 15.9 134 95.3 70.1 43.3 38.7 740 Second 76.9 51.1 46.3 618 87.5 83.7 20.4 17.9 169 97.3 78.4 44.5 40.2 787 Middle 77.7 48.7 45.2 607 87.3 80.7 22.7 16.5 255 96.2 78.6 41.0 36.7 862 Fourth 76.1 52.1 48.1 516 92.6 87.4 18.0 16.0 267 97.5 79.9 40.5 37.2 783 Highest 79.0 51.6 43.6 402 93.0 88.1 22.0 18.4 230 97.5 82.3 40.9 34.5 632 Total 75.5 50.2 45.4 2,749 88.2 83.9 20.9 16.9 1,055 96.7 77.8 42.1 37.5 3,804 1 Food groups: a) infant formula, milk other than breast milk, cheese or yogurt or other milk products; b) foods made from grains, roots, and tubers, including porridge and, fortified baby food from grains; c) vitamin A-rich fruits and vegetables (and red palm oil); d) other fruits and vegetables; e) eggs; f) meat, poultry, fish, and shellfish (and organ meats); g) legumes and nuts; h) foods made with oil, fat, butter. 2 At least twice a day for breastfed infants age 6-8 months and at least three times a day for breastfed children age 9-23 months 3 Includes commercial infant formula, fresh, tinned and powdered animal milk, and cheese, yogurt and other milk products 4 Nonbreastfed children age 6-23 months are considered to be fed with three IYCF practices if they receive other milk or milk products and are fed at least the minimum number of food groups, at least the minimum number of times per day. 5 3+ food groups for breastfed children and 4+ food groups for nonbreastfed children 6 Fed solid or semisolid food at least twice a day for infants age 6-8 months, 3+ times a day for other breastfed children, and 4+ times a day for nonbreastfed children Feeding Practices and M icronutrient Supplem entation | 161 162 | Feeding Practices and Micronutrient Supplementation Foods and Liquids Consumed by Women Adequate maternal nutrition is important for the health and reproductive outcomes of women, and child survival and development. Table 13.6 presents the data obtained from mothers of young children on the foods and liquids they consumed during a 24-hour period before the survey. The information on maternal eating patterns serves as a useful if imperfect proxy for assessing the quality of maternal diet. The results in Table 13.6 show that around nine in ten mothers consumed foods made from grains during the 24-hour period preceding the survey and more than eight in ten ate meat, fish, shellfish, poultry, or eggs, and foods made with oil, fat, or butter during the 24-hour period. The consumption of meat, fish, poultry, and eggs is important because these foods are important sources of protein and iron. Less encouraging is the finding that around one-third of mothers of young children did not consume milk or milk products (important sources of calcium) and that 45 percent did not have any fruits and vegetables rich in vitamin A during the 24-hour period preceding the survey. Considering the differentials in Table 13.6, there are only modest variations in the proportions of women consuming a number of the food groups including grains, roots, or tubers, legumes and nuts, oil, fat, or butter, and tea or coffee. These items are staples in the Egyptian diet. More marked variations are observed, particularly by wealth quintile, in the percentages consuming other food groups including milk and milk products, fruits and vegetables, particularly those rich in vitamin A, and meat, fish, shellfish, poultry, and eggs. Consumption of sugary foods and drinks also varies markedly with the wealth quintile, with women in the highest quintile being more than twice as likely as women in the lowest quintile to consume both sugary drinks and foods. Feeding Practices and Micronutrient Supplementation | 163 Table 13.6 Foods and liquids consumed by mothers in the day or night preceding the interview by background characteristics Percentage of mothers whose youngest child is under three years of age and living with them, who consumed specific types of food groups in the day or night preceding the interview, by background characteristics, Egypt 2005 Background characteristic Milk Coffee/ tea Sugary drinks Other liquids Cheese/ yogurt/ other milk products Sugary foods Food made from grains Fruits and vege- tables rich in vitamin A Other fruits/ vege- tables Food made from roots/ tubers Food made from legumes and nuts Meat/ fish/ shellfish/ poultry/ eggs Food made with oil/ fat/ butter Number of mothers Age 15-19 42.5 66.2 25.0 28.9 61.2 14.3 91.6 52.7 61.8 60.6 60.3 85.2 82.9 371 20-24 50.5 70.0 31.2 30.4 66.8 16.1 91.2 54.3 68.2 58.9 61.0 83.5 85.8 2,016 25-29 56.4 72.8 35.5 32.2 67.7 17.2 92.4 54.9 69.7 58.5 62.6 83.9 86.0 2,331 30-34 53.2 77.1 35.3 28.8 69.7 17.0 91.8 56.0 70.5 60.8 62.4 83.9 87.0 1,361 35-39 51.9 78.1 32.7 30.8 64.0 17.0 91.5 56.5 71.8 61.4 65.6 82.2 85.3 716 40-44 57.3 75.9 29.9 32.1 69.3 14.7 88.7 54.7 73.4 65.0 64.1 84.0 80.4 261 45-49 (46.7) (76.1) (40.7) (46.7) (60.4) (17.0) (79.7) (65.5) (53.0) (68.4) (60.4) (74.9) (76.8) 36 Urban-rural residence Urban 56.8 71.6 39.3 29.2 69.7 21.0 91.0 55.7 73.2 57.4 63.2 86.7 83.4 2,622 Rural 50.6 74.1 29.7 31.7 65.6 14.0 92.0 54.6 66.9 61.1 61.8 81.8 87.0 4,471 Place of residence Urban Governorates 63.7 72.3 44.2 30.4 73.9 24.2 90.5 57.6 76.0 62.9 69.9 86.5 84.0 1,025 Lower Egypt 56.9 69.8 39.0 27.7 69.5 13.7 90.8 59.9 68.7 64.9 55.2 85.7 88.4 2,856 Urban 55.4 68.6 43.0 26.8 69.5 17.8 88.6 62.3 71.2 57.3 50.9 87.7 88.5 662 Rural 57.4 70.1 37.8 28.0 69.5 12.5 91.4 59.2 67.9 67.2 56.5 85.1 88.4 2,194 Upper Egypt 45.0 76.5 24.4 33.6 62.4 16.6 92.9 49.5 67.5 54.0 66.6 80.5 83.7 3,124 Urban 48.3 72.6 30.7 29.5 64.2 19.5 93.6 48.1 71.6 50.8 65.1 86.0 78.8 881 Rural 43.6 78.0 21.9 35.1 61.8 15.5 92.6 50.1 65.9 55.2 67.1 78.4 85.6 2,244 Frontier Governorates 80.8 76.0 34.5 37.4 78.9 21.2 86.8 62.7 72.3 56.0 53.7 91.3 86.9 87 Education No education 46.7 76.7 24.7 35.4 62.3 12.7 91.7 50.0 66.2 58.9 64.7 78.7 84.6 2,113 Some primary 43.7 74.9 25.0 25.6 63.1 11.7 92.5 49.6 62.9 61.9 62.0 77.4 87.4 589 Primary complete/some secondary 51.2 72.2 32.3 29.2 65.0 15.8 90.6 52.8 71.4 61.2 63.7 82.3 82.2 1,069 Secondary complete/ higher 59.1 70.9 40.5 29.3 71.6 20.2 91.7 59.9 71.6 59.4 60.4 88.3 87.2 3,322 Work status Working for cash 60.0 70.9 41.9 34.3 72.2 23.2 89.7 58.7 71.8 61.1 61.1 86.0 84.3 793 Not working for cash 52.0 73.4 32.2 30.3 66.5 15.8 91.9 54.5 68.9 59.5 62.5 83.3 85.8 6,300 Wealth quintile Lowest 38.5 76.5 17.7 31.8 60.6 12.2 92.2 47.6 63.0 59.9 60.4 74.2 84.2 1,411 Second 49.5 73.6 27.9 32.6 62.3 12.5 92.0 50.7 67.3 58.1 64.1 80.5 87.0 1,464 Middle 55.1 70.4 33.9 30.5 67.1 14.5 90.5 55.0 68.4 62.6 63.8 84.7 86.5 1,565 Fourth 57.1 72.8 39.0 29.6 71.5 17.4 91.4 58.7 72.5 58.8 62.9 87.7 84.6 1,433 Highest 66.1 72.6 50.0 29.2 75.4 28.3 92.1 64.5 76.1 58.9 59.9 92.0 86.0 1,220 Total 52.9 73.2 33.2 30.8 67.1 16.6 91.6 55.0 69.2 59.7 62.3 83.6 85.7 7,093 Note: There are 30 children who are not the last born, but are the youngest surviving child living with the mother. Figures in parentheses are based on 25-49 unweighted cases. 13.3 MICRONUTRIENT SUPPLEMENTATION Micronutrient deficiencies are a major contributor to childhood morbidity and mortality. Micronutrient deficiencies result from inadequate intake of micronutrient-rich foods and inadequate utilization of available micronutrients because of infections, parasitic infestations, or other factors in the diet such as phytates and tannins. Measures of micronutrient fortification (iodized household cooking salt) and micronutrient supplementation (vitamin A for children and women and iron for women) were obtained in the 2005 EDHS survey. 164 | Feeding Practices and Micronutrient Supplementation Use of Iodized Salt Iodine is an important micronutrient. Dietary deficiency of iodine constitutes a major, global public health concern. A lack of sufficient iodine is known to cause goiter, cretinism (a severe form of neurological defect), spontaneous abortion, premature birth, infertility, stillbirth, and increased child mortality. Iodine deficiency disorder (IDD) is the single most common cause of preventable mental retardation and brain damage in the world. Egypt has adopted a program of fortifying salt with iodine to prevent iodine deficiency. In the 2005 EDHS, a rapid test was used to measure iodine content of the salt used for cooking in the household. The test kit consisted of ampoules of a stabilized starch solution and a weak acid-based solution. A drop of the starch solution was squeezed onto a salt sample obtained in the household, causing the salt to change color. The EDHS interviewer conducting the test matched the color of the salt to a color chart included with the test kit to determine the level of iodization. Table 13.7 shows the percentage of households using iodized salt. Overall, 78 percent of households which had salt were using adequately iodized salt, i.e., the iodine content of the salt exceeded 15 parts per million (ppm). Fifteen percent of the households cooked with salt that the test indicated lacked iodine. This is considerably lower than the level found in the 2000 EDHS, when 44 percent of households cooked with salt that was not iodized. Table 13.7 Presence of iodized salt in household by background characteristics Percent distribution of households with salt tested for iodine content, by level of iodine in salt (parts per million), percentage of households tested, and percentage of households with no salt, according to background characteristics, Egypt 2005 Level of iodine Percentage of households Background characteristic None (0 ppm) Inadequate (<15 ppm) Adequate (15+ ppm) Total Number of households with salt With salt tested With no salt Number of households Urban-rural residence Urban 5.1 3.3 91.7 100.0 10,182 96.7 1.9 10,533 Rural 23.9 10.7 65.4 100.0 10,928 95.5 3.5 11,439 Place of residence Urban Governorates 2.3 1.5 96.2 100.0 4,557 96.9 1.5 4,704 Lower Egypt 18.3 7.1 74.6 100.0 8,708 96.4 2.6 9,031 Urban 3.7 3.1 93.2 100.0 2,621 96.2 2.3 2,724 Rural 24.6 8.8 66.6 100.0 6,087 96.5 2.8 6,307 Upper Egypt 18.4 10.5 71.1 100.0 7,640 95.2 3.6 8,029 Urban 10.6 6.3 83.1 100.0 2,870 96.7 2.1 2,968 Rural 23.1 13.1 63.8 100.0 4,770 94.3 4.5 5,061 Frontier Governorates 7.7 7.1 85.2 100.0 206 98.7 1.1 208 Wealth quintile Lowest 34.0 13.0 52.9 100.0 3,525 92.5 6.2 3,811 Second 24.4 11.8 63.8 100.0 3,527 96.6 2.6 3,650 Middle 15.9 8.7 75.4 100.0 4,100 96.2 2.9 4,263 Fourth 6.5 4.0 89.4 100.0 4,849 96.5 1.9 5,024 Highest 1.8 1.5 96.7 100.0 5,109 97.8 0.9 5,224 Total 14.8 7.1 78.1 100.0 21,110 96.1 2.7 21,972 Urban households were much more likely than rural households to be using salt considered to be adequately iodized (92 percent and 65 percent, respectively). By place of residence, the proportion of households using adequately iodized salt ranged from 64 percent in rural Upper Egypt to 96 percent in the Urban Governorates. The percentage of households using adequately iodized salt also increased directly Feeding Practices and Micronutrient Supplementation | 165 with household wealth, from 53 percent among households in the lowest wealth quintile to 97 percent of households in the highest quintile. Micronutrient Intake among Young Children Data from the 2005 EDHS can be used to assess the extent to which young children are likely to be consuming adequate amounts of two important micronutrients, iodine and vitamin A. As discussed above, adequate levels of iodine are important to prevent mental retardation and to reduce child mortality. Vitamin A is another micronutrient considered essential for normal sight, growth, and development. Vitamin A protects the body against some infectious illnesses such as measles and diarrheal disease. Severe vitamin A deficiency (VAD) is associated with total loss of vision or with other vision impairments including night blindness. Ensuring that children have an adequate diet is one means of preventing vitamin A deficiency. Vitamin A is found naturally in breast milk, other milks, liver, eggs, fish, butter, mangoes, papayas, carrots, pumpkins, and dark green leafy vegetables. Because vitamin A is a fat-soluble vitamin, consump- tion of oils or fats is necessary for its absorption into the body. Vitamin A supplementation programs are another important tool in addressing VAD. Egypt has a program of vitamin A supplementation for young children. Beginning at age nine months (typically at the time the child receives the measles vaccination), young children are given one vitamin A capsule (100,000 international units). Two additional capsules (200,000 units) are given to children at age 18 months with the activated polio dose. Table 13.8 presents several indicators that are useful for assessing the likelihood that young children are receiving an adequate intake of vitamin A and iodine. They include the percentage of youngest children less than three years of age living with their mother who consumed fruits and vegetables rich in vitamin A, the percentage of children 6-59 months who received vitamin A supple- mentation in the six-month period before the survey, and the percentage of children under age five who live in households that use adequately iodized salt. The results suggest that less than half of children age 6-35 months are consuming foods rich in vitamin A on a daily basis. Consumption of foods rich in vitamin A rises with the age of the child and is greater among nonbreastfeeding than breastfeeding children, reflecting the increasing diversity of children’s diets as they are weaned. Urban-rural residence is not related to children’s consumption of foods rich in vitamin A but consumption levels do vary somewhat by place of residence, with Upper Egypt having the lowest level and the Frontier Governorates the highest level. The likelihood that a child will consume foods rich in vitamin A rises with the mother’s education and the wealth quintile, indicating that economic factors have a role in shaping children’s diets. The information on vitamin A supplementation are shown in Table 13.8. The figures were derived from children’s vaccination records or from the mothers’ recall when records were not available (see Chapter 12 for a discussion of vaccination record coverage). Overall, a comparatively small proportion of children age 6-59 months received a vitamin A capsule during the six-month period preceding the EDHS. The likelihood of supplementation is, however, strongly related with the child’s age. Approximately three in ten children age 9-23 months had received a capsule in the six-month period before the survey, double the rate among younger children and more than triple the rate among children age 24-59 months. The higher rates among children in the 9-23 month age group clearly reflect the effect of Egypt’s vitamin A supplementation program, which as noted above targets children in that age range. Table 13.8 also shows that 71 percent of children age 6-59 months live in households in which salt was tested and found to be adequately iodized. As noted above, availability of iodized salt is strongly related to urban residence and increases with both the mother’s education status and household wealth. 166 | Feeding Practices and Micronutrient Supplementation Table 13.8 Micronutrient intake among children by background characteristics Percentage of youngest children age 6-35 months living with the mother who consumed foods rich in vitamin A in the 24 hours preceding the survey, percentage of children age 6-59 months who were given vitamin A supplements in the six months preceding the survey, and percentage of children age 6- 59 months living in households with salt tested using adequately iodized salt, by background characteristics, Egypt 2005 Youngest children age 6-35 months living with the mother Children age 6-59 months Children age 6-59 living in households with salt tested Background characteristic Percentage consumed foods rich in vitamin A in last 24 hours1 Number of children Percentage given vitamin A supplement in past 6 months Number of children Percentage in households with adequately iodized salt2 Number of children Child's age 6-8 months 17.2 686 16.0 698 69.5 698 9-11 months 32.0 639 30.3 651 71.1 651 12-17 months 46.2 1,305 29.5 1,367 69.6 1,367 18-23 months 51.3 1,174 34.5 1,313 71.1 1,313 24-35 months 53.9 2,069 9.5 2,671 71.1 2,671 36-47 months na na 5.0 2,682 70.8 2,682 48-59 months na na 3.3 2,497 70.8 2,497 Sex Male 45.4 3,030 13.8 6,022 71.2 6,022 Female 44.7 2,842 13.7 5,856 70.2 5,856 Breastfeeding status Breastfeeding 37.6 2,832 27.2 2,902 69.0 2,902 Not breastfeeding 52.0 3,031 9.5 8,912 71.3 8,912 Missing * 9 5.3 64 71.0 64 Urban-rural residence Urban 45.5 2,206 13.8 4,355 87.5 4,355 Rural 44.8 3,666 13.8 7,523 61.0 7,523 Place of residence Urban Governorates 44.0 882 13.8 1,681 90.9 1,681 Lower Egypt 50.5 2,361 15.8 4,724 68.2 4,724 Urban 52.9 529 16.9 1,111 90.7 1,111 Rural 49.8 1,832 15.4 3,613 61.3 3,613 Upper Egypt 40.1 2,556 12.1 5,326 66.5 5,326 Urban 41.6 750 11.8 1,473 81.6 1,473 Rural 39.5 1,806 12.3 3,852 60.7 3,852 Frontier Governorates 50.8 73 8.8 147 73.5 147 Mother's education No education 39.9 1,746 11.5 3,717 58.3 3,717 Some primary 38.5 488 14.0 1,048 64.3 1,048 Primary complete/some secondary 43.3 907 15.4 1,805 69.6 1,805 Secondary complete/higher 50.1 2,732 14.7 5,309 81.0 5,309 Work status Working for cash 48.2 653 13.6 1,417 78.0 1,417 Not working for cash 44.6 5,220 13.8 10,461 69.7 10,461 Wealth quintile Lowest 36.4 1,139 14.2 2,408 49.8 2,408 Second 43.1 1,212 12.4 2,478 59.3 2,478 Middle 45.3 1,282 12.7 2,559 70.0 2,559 Fourth 46.5 1,213 14.5 2,445 84.8 2,445 Highest 54.7 1,027 15.4 1,988 93.8 1,988 Total 45.0 5,872 13.8 11,878 70.7 11,878 Note: Information on vitamin A supplements is based on health card and mother's recall. There are 30 children who are not the last born, but are the youngest surviving child living with the mother. An asterisk indicates a figure is based on less than 25 cases and has been suppressed. na = Not applicable 1 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mango, cantaloupe, and other locally grown fruits and vegetables that are rich in vitamin A 2 Salt containing 15 ppm of iodine or more. Excludes children in households in which salt was not tested Feeding Practices and Micronutrient Supplementation | 167 Micronutrient Intake among Women Adequate micronutrient intake by women has important benefits for both women and their children. Breastfeeding children benefit from micronutrient supplementation that mothers receive, especially vitamin A. Iron supplementation of women during pregnancy protects mother and infant against anemia. It is estimated that one-fifth of perinatal mortality and one-tenth of maternal mortality are attributable to iron deficiency anemia. Anemia also results in an increased risk of premature delivery and low birth weight. Finally, as noted above, iodine deficiency is related to a number of adverse pregnancy outcomes. Table 13.9 includes a number of measures that are useful in assessing the extent to which women are receiving adequate intake of vitamin A, iron during pregnancy, and iodine. The first indicators focused on the percentages of women with children under age three who reported that they consumed foods rich in vitamin A and iron during the 24-hour period prior to the DHS. The results indicate that eight in ten mothers of young children consumed iron-rich foods (i.e., meat, poultry, fish and eggs) in the 24 hours preceding the survey, and 55 percent consumed vitamin A-rich fruits and vegetables. As was the case with children, consumption of vitamin A-rich foods is influenced by the place of residence, the woman’s education status, and household wealth. Consumption of iron-rich foods also is related to these factors. Overall, the highest rate of consumption of iron-rich foods is observed among mothers in the highest wealth quintile (92 percent) and the lowest rate is found among women in the lowest wealth quintile (74 percent). Table 13.9 also looks at the extent to which women receive vitamin A supplements following delivery. Just under half of women reported that they had received a capsule in the two-month period following the delivery of their last-born child. Older women and women living in the Urban Governorates were the least likely to report receiving a supplement. With regard to iron supplementation during pregnancy, just under half of women who gave birth during the five-year period before the 2005 EDHS reported that they had taken iron tablets or syrup during the pregnancy preceding their last live birth. Among women reporting that they took supplements, the majority said that they took the supplements for less than 60 days. Urban residents, particularly those living in the Urban Governorates, women with a secondary or higher education, and women in the highest wealth quintile were considerably more likely to have taken iron tablets or syrup during pregnancy than other women. As was the case among young children, more than seven in ten women who gave birth during the five-year period preceding the survey live in households in which the salt used in cooking was tested and found to be adequately iodized. 168 | Feeding Practices and Micronutrient Supplementation Table 13.9 Micronutrient intake among mothers by background characteristics Among women with a surviving child under the age of 3 living with them, the percentage who consumed foods rich in vitamin A and iron-rich foods in the 24 hours preceding the survey, and among women who gave birth in the 5-year period preceding the survey, the percentage who received a vitamin A dose in the first two months after the delivery of their last birth, the percentage who took iron tablets or syrup for specific numbers of days during the pregnancy preceding the last birth, and the percentage who live in households using adequately iodized salt, by background characteristics, Egypt 2005 Percentage of women with child under age 3 living in household: Number of days iron tablets/ syrup taken during pregnancy Background characteristic Con- sumed foods rich in vitamin A1 Con- sumed iron- rich foods2 Number of women with child under age 3 living in household Received vitamin A dose post- partum3 None <60 60-89 90+ Don't know/ missing Number of women with birth in 5-year period before the survey Percentage of women with birth in 5-year period before the survey living in households with adequately iodized salt4 Number of women with birth in 5-year period before the survey living in households where salt was tested Age 15-19 52.7 85.2 371 49.9 47.3 32.9 5.2 10.3 4.3 380 68.1 358 20-24 54.3 83.5 2,016 50.6 43.1 32.9 6.5 12.7 4.8 2,290 70.0 2,212 25-29 54.9 83.9 2,331 50.5 43.3 29.4 7.3 15.1 4.9 3,089 74.5 2,993 30-34 56.0 83.9 1,361 47.7 44.7 26.9 6.5 16.2 5.7 2,109 77.2 2,031 35-39 56.5 82.2 716 43.9 51.3 23.5 5.7 12.7 6.9 1,321 77.8 1,273 40-44 54.7 84.0 261 42.8 53.4 23.5 6.4 12.1 4.6 540 73.6 526 45-49 (65.5) (74.9) 36 35.7 59.1 20.8 2.9 11.5 5.7 116 80.0 112 Urban-rural residence Urban 55.7 86.7 2,622 44.9 36.4 26.0 9.4 22.6 5.7 3,753 90.3 3,638 Rural 54.6 81.8 4,471 50.6 51.1 30.2 4.8 8.8 5.0 6,092 64.3 5,867 Place of residence Urban Governorates 57.6 86.5 1,025 38.2 29.7 22.8 10.7 34.0 2.8 1,460 94.0 1,418 Lower Egypt 59.9 85.7 2,856 56.4 41.8 32.5 6.7 14.2 4.8 4,066 72.1 3,947 Urban 62.3 87.7 662 56.5 35.6 29.8 8.5 20.3 5.8 987 93.2 958 Rural 59.2 85.1 2,194 56.4 43.8 33.4 6.2 12.2 4.4 3,079 65.3 2,989 Upper Egypt 49.5 80.5 3,124 44.3 54.5 27.1 4.9 6.7 6.7 4,200 69.4 4,022 Urban 48.1 86.0 881 43.5 44.7 27.1 8.5 10.5 9.2 1,235 84.1 1,191 Rural 50.1 78.4 2,244 44.7 58.6 27.1 3.4 5.2 5.7 2,965 63.2 2,831 Frontier Governorates 62.7 91.3 87 43.1 47.8 18.9 5.8 24.7 2.7 119 76.0 118 Education No education 50.0 78.7 2,113 44.0 60.1 25.7 3.7 5.9 4.6 2,983 62.0 2,854 Some primary 49.6 77.4 589 44.9 55.5 25.9 4.9 8.7 4.9 878 66.1 850 Primary complete/ some secondary 52.8 82.3 1,069 46.2 47.4 31.1 6.5 11.3 3.7 1,491 73.6 1,437 Secondary complete/ higher 59.9 88.3 3,322 52.8 33.2 30.3 8.7 21.4 6.3 4,494 84.1 4,363 Work status Working for cash 58.7 86.0 793 51.1 36.8 28.0 8.1 20.9 6.2 1,261 82.0 1,223 Not working for cash 54.5 83.3 6,300 48.0 46.8 28.7 6.3 13.1 5.2 8,584 73.1 8,282 Wealth quintile Lowest 47.6 74.2 1,411 44.1 63.6 25.2 2.9 4.0 4.3 1,929 53.1 1,819 Second 50.7 80.5 1,464 47.7 54.6 29.1 4.1 7.1 5.1 1,981 62.2 1,917 Middle 55.0 84.7 1,565 51.0 44.8 31.7 6.6 11.3 5.6 2,114 73.2 2,044 Fourth 58.7 87.7 1,433 50.6 36.7 31.1 8.1 17.7 6.4 2,078 87.6 2,017 Highest 64.5 92.0 1,220 48.3 26.5 25.1 11.3 32.1 4.9 1,742 95.8 1,708 Total 55.0 83.6 7,093 48.4 45.5 28.6 6.5 14.1 5.3 9,845 74.3 9,505 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, mango, cantaloupe, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat, (including organ meat), fish, poultry, and eggs 3 In the first two months after delivery 4 Salt containing 15 ppm of iodine or more. Excludes women in households in which salt was not tested Nutritional Status and Anemia Levels | 169 NUTRITIONAL STATUS AND ANEMIA LEVELS 14 This chapter looks at several important aspects of the nutritional status of Egyptian children and their mothers. Anthropometric data (height and weight) was collected in the survey for all EDHS respond- ents, children under age 6, and never-married youth and young adults age 10-19. These data are used to assess the current nutritional status of these populations. The chapter then considers information collected on the prevalence of anemia in these groups. 14.1 COLLECTION OF ANTHROPOMETRIC AND ANEMIA DATA Height and weight measures were collected in all households included in the EDHS survey for ever-married women age 15-49, children under age six, and never-married youth and young adults age 10-19. The measuring boards used for the collection of the height data are specially produced by Shorr Productions for use in survey settings. Children younger than 24 months were measured lying on a measuring board, while standing height was measured for older children, adolescents, and women. Weight data were obtained using lightweight, bathroom-type scales with a digital screen designed and manufactured under the authority of the United Nations Children’s Fund (UNICEF). The 2005 EDHS included direct measurement of hemoglobin levels in a subsample of one-third of all EDHS households for three groups: ever-married women age 15-49, children age 6-71 months, and never-married young adults and young adults age 10-19. Prior to the testing, ever-married women and never-married youth age 18-19 were asked to consent to the testing. In the case of young children or youth age 10-17, the consent of an adult or other caretaker also was obtained for the test. During the fieldwork, each respondent or parent/caretaker was given the results of the test immediately. In cases in which the hemoglobin reading was below 9.0 g/dl (grams per deciliter), the respondent or parent/caretaker was asked to visit the nearest Ministry of Health and Population facility for follow-up. The HemoCue system was used for hemoglobin testing. This system consists of a battery- operated photometer and a disposable microcuvette,1 coated with a dried reagent that serves as the blood- collection device. For the test, a drop of capillary blood taken from a person’s fingertip or heel was drawn into a microcuvette. The blood in the microcuvette was analyzed using the photometer, which displayed the hemoglobin concentration. As described in Chapter 1, medically trained personnel, primarily doctors, assigned to each of the EDHS teams conducted the testing. The personnel responsible for the testing received extensive classroom training and field practice prior to the survey. 14.2 NUTRITIONAL STATUS OF CHILDREN Nutritional status is a primary determinant of a child’s health and well-being. Both inadequate or unbalanced diets and chronic illness are associated with poor nutritional status among children. The anthropometric data collected in the 2005 EDHS permit an assessment of the nutritional status of young children in Egypt. Measurement of Nutritional Status among Young Children The anthropometric measurements as well as information on the ages of the children are used to construct the following three standard indices of physical growth: 1 A microcuvette is a small, transparent laboratory vessel. 170 | Nutritional Status and Anemia Levels • height-for-age • weight-for-height • weight-for-age As recommended by the World Health Organization (WHO), evaluation of nutritional status in this report is based on the comparison of these three indices for the population of children in the survey with those reported for a reference population of well-nourished children. The use of a reference population to identify malnourished children is based on the finding that well-nourished children in all population groups follow similar growth patterns and thus exhibit similar distributions of height and weight at given ages (Martorell and Habicht, 1986). One of the most commonly used reference populations, and the one used in this report, is the international reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by WHO and the U.S. Centers for Disease Control. Each of the three nutritional indicators is expressed in standard deviations (Z-scores) from the mean of the reference population.2 The indices measure somewhat different aspects of nutritional status. The height-for-age index provides an indicator of linear growth retardation. Children whose height-for- age is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age, or stunted. Children who are below minus three standard deviations (-3 SD) from the reference population are considered severely stunted. Stunting of a child’s growth may be the result of a failure to receive adequate nutrition over a long period of time or of the effects of recurrent or chronic illness. Height-for-age therefore represents a measure of the outcome of malnutrition in a population over a long period and does not vary appreciably with the season of data collection. The weight-for-height index measures body mass in relation to body length. Children whose weight-for-height measures are below minus two standard deviations (-2 SD) from the median of the reference population are too thin for their height, or wasted, while those whose measures are below minus three standard deviations (-3 SD) from the reference population median are severely wasted. Wasting represents the failure to receive adequate nutrition during the period immediately before the survey. It may be the result of recent episodes of illness or acute food shortages. Weight-for-age is a composite index of height-for-age and weight-for-height. Children whose weight-for-age measures are below minus two standard deviations (-2 SD) from the median of the reference population are underweight for their age, while those whose measures are below minus three standard deviations (-3 SD) from the reference population median are severely underweight. A child can be underweight for his age, because he is stunted, because he is wasted, or because he is both stunted and wasted. 2 The distribution of the standard reference population has been normalized and hence the mean and median coincide. Nutritional Status and Anemia Levels | 171 Results of Data Collection Measurements of height and weight were obtained for all children under age 6 living in the households selected for the EDHS sample. The results include children who were not biological offspring of the women interviewed in the survey. Although data were collected for all children under age six, for purposes of comparability with prior EDHS surveys, the analysis is limited to children under age five. Height and weight measurements were obtained for 99 percent of the 13,030 children in that age range present in EDHS households at the time of the survey. Of these children, six percent were considered to have implausibly high or low values for the height or weight measures or lacked data on the child’s age in months (not shown in table). The following analysis focuses on the 12,131 children for whom complete and plausible anthropometric and age data were collected. Levels of Child Malnutrition An examination of the data on height-for-age in Table 14.1 indicates that there is considerable chronic malnutrition among Egyptian children. Overall, 18 percent of children under age five are stunted, and six percent are severely stunted. A child’s age is associated with the likelihood of stunting. Stunting increases rapidly with age, from only 13 percent among children less than six months of age to 24 percent among children 18-23 months, before falling to 14 percent among children age four and older. Levels of stunting are slightly higher for male children than for female children. Stunting is higher among children of birth order six or higher compared to other children. The prevalence of stunting varies inversely with the length of the birth interval; a child born less than 24 months after an elder sibling is around 40 percent more likely to be stunted than a child born 48 months or longer after an elder sibling. 172 | Nutritional Status and Anemia Levels Table 14.1 Nutritional status of children by children’s characteristics Percentage of children under five who are classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by background characteristics of the child, Egypt 2005 Height-for-age Weight-for-height Weight-for-age Background characteristic Percentage below -3 SD Percentage below -2 SD1 Mean Z-score (SD) Percentage below -3 SD Percentage below -2 SD1 Mean Z-score (SD) Percentage below -3 SD Percentage below -2 SD1 Mean Z-score (SD) Number of children Child's age Under 6 months 2.5 13.0 (0.4) 1.2 6.7 0.6 0.4 4.7 (0.2) 1,066 6-9 6.5 20.3 (0.8) 1.5 4.8 0.4 2.7 9.8 (0.3) 852 10-11 5.4 22.0 (0.7) 0.5 6.1 0.4 3.3 8.7 (0.4) 360 12-17 6.9 21.3 (0.6) 0.7 4.5 0.3 0.9 7.0 (0.3) 1,222 18-23 10.3 24.2 (1.0) 1.1 4.9 0.1 1.3 9.3 (0.5) 1,184 24-35 8.3 18.6 (0.7) 1.2 3.9 0.1 1.3 6.4 (0.4) 2,520 36-47 6.8 16.1 (0.8) 0.7 2.8 0.3 0.7 4.2 (0.3) 2,519 48-59 3.5 13.6 (0.7) 0.3 2.3 0.2 0.3 4.9 (0.3) 2,409 Sex Male 6.7 18.8 (0.8) 0.7 4.0 0.2 1.1 6.8 (0.4) 6,150 Female 6.0 16.4 (0.6) 1.0 3.8 0.3 0.9 5.5 (0.2) 5,980 Birth order 1 6.2 16.6 (0.6) 1.0 4.1 0.3 1.1 5.9 (0.2) 3,648 2-3 6.4 17.5 (0.7) 0.9 4.0 0.3 0.9 5.6 (0.3) 5,458 4-5 6.1 17.7 (0.8) 0.6 3.2 0.2 1.0 7.0 (0.3) 1,932 6+ 7.2 22.1 (1.0) 0.5 3.1 0.2 1.3 8.2 (0.5) 960 Birth interval in months First birth2 6.3 16.7 (0.6) 1.0 4.0 0.3 1.1 5.8 (0.2) 3,717 Under 24 months 7.7 20.6 (0.9) 1.4 4.9 0.2 1.5 7.8 (0.5) 1,719 24-47 6.5 19.0 (0.8) 0.6 3.3 0.3 0.9 6.1 (0.3) 4,174 48+ 5.5 14.6 (0.5) 0.7 3.7 0.3 0.8 5.5 (0.2) 2,388 Size at birth3 Very small 8.6 23.2 (0.9) 1.4 5.9 0.1 2.3 12.2 (0.5) 416 Small 7.6 21.0 (0.9) 1.6 4.8 0.0 1.6 9.5 (0.6) 1,113 Average or larger 6.2 17.0 (0.7) 0.8 3.7 0.3 0.9 5.5 (0.2) 10,416 Mother’s interview status Interviewed 6.4 17.6 (0.7) 0.9 3.9 0.3 1.0 6.1 (0.3) 11,998 Not interviewed 5.0 16.5 (0.4) 0.1 8.0 0.3 0.0 8.4 (0.1) 133 In the household 7.0 17.3 (0.5) 0.3 7.7 0.3 0.0 7.0 (0.0) 62 Not in the household4 3.2 15.9 (0.4) 0.0 8.3 0.2 0.0 9.5 (0.2) 71 Total 6.4 17.6 (0.7) 0.9 3.9 0.3 1.0 6.2 (0.3) 12,131 Note: Table is based on children who stayed in the household the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO International Reference Population. The percentage of children who are more than three or more than two standard deviations below the median of the International Reference Population (-3 SD and -2 SD) are shown according to background characteristics. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. The total includes children whose mothers were not interviewed in the survey. Information on the background characteristics shown in the table is not available for these children. The total also includes 6 children for whom information on the child’s size at birth was not available. 1 Includes children who are below -3 standard deviations (SD) from the International Reference Population median. 2 First born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 3 Excludes children whose mothers were not interviewed or for whom size at birth information is not available. 4 Includes children whose mothers are deceased. Nutritional Status and Anemia Levels | 173 Table 14.2 shows that there are marked socioeconomic differentials in stunting. Children in rural areas are somewhat more likely to be stunted than urban children (18 percent and 16 percent, respectively). The percentage stunted varies more markedly by place of residence, ranging from only 13 percent in rural Lower Egypt to 23 percent in rural Upper Egypt. Table 14.2 Nutritional status of children by mother’s characteristics Percentage of children under five who are classified as malnourished according to three anthropometric indices of nutritional status: height-for- age, weight-for-height, and weight-for-age, by selected background characteristics, Egypt 2005 Height-for-age Weight-for-height Weight-for-age Background characteristic Percentage below -3 SD Percentage below -2 SD1 Mean Z-score (SD) Percentage below -3 SD Percentage below -2 SD1 Mean Z-score (SD) Percentage below -3 SD Percentage below -2 SD1 Mean Z-score (SD) Number of children Mother's age2 15-19 5.1 16.7 (0.8) 1.0 5.6 0.4 0.6 5.8 (0.3) 387 20-24 7.3 20.0 (0.8) 1.1 4.2 0.3 1.2 6.2 (0.3) 2,939 25-29 6.3 16.7 (0.7) 0.8 3.5 0.3 1.0 5.9 (0.3) 4,097 30-34 5.7 17.7 (0.6) 0.6 3.9 0.3 0.7 5.3 (0.2) 2,559 35-49 6.3 16.3 (0.7) 0.8 3.9 0.2 1.1 7.6 (0.3) 2,077 Urban-rural residence Urban 5.6 16.2 (0.6) 1.5 5.2 0.2 1.1 6.5 (0.3) 4,430 Rural 6.8 18.4 (0.8) 0.5 3.1 0.3 0.9 6.0 (0.3) 7,700 Place of residence Urban Governorates 6.1 16.9 (0.4) 2.8 7.7 0.1 1.8 8.2 (0.2) 1,668 Lower Egypt 5.4 13.7 (0.4) 0.6 2.9 0.4 0.9 4.0 (0.0) 4,837 Urban 5.7 15.1 (0.6) 0.6 2.7 0.3 1.1 4.2 (0.2) 1,160 Rural 5.3 13.3 (0.4) 0.6 3.0 0.4 0.9 3.9 0.0 3,677 Upper Egypt 7.3 21.4 (1.1) 0.5 3.5 0.2 0.8 7.5 (0.6) 5,482 Urban 5.0 16.6 (0.8) 0.7 4.2 0.1 0.4 6.5 (0.4) 1,514 Rural 8.2 23.2 (1.2) 0.5 3.3 0.2 1.0 7.8 (0.6) 3,968 Frontier Governorates 5.8 14.1 0.6 0.7 5.2 0.2 0.4 4.3 0.4 143 Mother's education2 No education 7.9 21.5 (0.9) 0.6 3.5 0.2 1.3 7.3 (0.5) 3,763 Some primary 6.7 19.7 (0.8) 0.3 2.5 0.3 0.9 7.4 (0.3) 1,047 Primary complete/some secondary 5.6 16.7 (0.7) 1.4 4.6 0.2 0.8 5.7 (0.4) 1,809 Secondary complete/ higher 5.5 14.8 (0.5) 1.0 4.1 0.3 0.9 5.2 (0.1) 5,439 Work status3 Working for cash 6.6 17.0 (0.5) 1.1 4.1 0.3 0.9 5.8 (0.1) 1,400 Not working for cash 6.3 17.7 (0.7) 0.8 3.8 0.3 1.0 6.2 (0.3) 10,598 Wealth quintile Lowest 8.7 23.6 (1.0) 0.9 3.7 0.3 0.8 7.7 (0.5) 2,452 Second 6.9 18.5 (0.8) 0.5 2.8 0.3 1.1 6.1 (0.4) 2,539 Middle 6.2 17.3 (0.8) 0.7 3.4 0.3 1.0 5.9 (0.3) 2,616 Fourth 4.3 13.8 (0.5) 1.0 3.9 0.2 0.8 4.7 (0.2) 2,498 Highest 5.6 14.4 (0.3) 1.3 6.2 0.3 1.4 6.4 (0.1) 2,025 Total 6.4 17.6 (0.7) 0.9 3.9 0.3 1.0 6.2 (0.3) 12,131 Note: Table is based on children who stayed in the household the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO International Reference Population. The percentage of children who are more than three or more than two standard deviations below the median of the International Reference Population (-3 SD and -2 SD) are shown according to background characteristics. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. 1 Includes children who are below -3 standard deviations (SD) from the International Reference Population median. 2 For women who were not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers were not listed in the household schedule. 3 Excludes children whose mothers were not interviewed. 174 | Nutritional Status and Anemia Levels The educational level of the mother is inversely related to the level of stunting. Among children whose mothers never attended school, 22 percent are stunted compared to 15 percent of mothers who completed the secondary level or higher. The rate of stunting among children in the lowest wealth quintile is 24 percent compared to 14 percent among children in the highest quintile. The weight-for-height index provides a measure of wasting, or acute malnutrition. As described above, the weight-for-height index reflects the effects on a child’s nutritional status of recent food shortages or recent episodes of diarrheal or other illness that contribute to malnutrition. Overall, around four percent of Egyptian children are wasted (Table 14.2). Wasting is more common among children under age two than among older children. Levels of wasting are highest for children in the Urban Governorates. Reflecting the effects of both chronic and short-term malnutrition, six percent of children under age five are underweight for their age. Low weight-for-age is more common among children 6-23 months than among older or younger children (Table 14.1). It generally increases with birth order and is higher among children born less than 24 months after a prior birth and children whose mothers considered them to be “very small” at the time of their birth. Considering socioeconomic characteristics, low weight-for-age is slightly more common among children from the Urban Governorates and children from rural Upper Egypt than other children (Table 14.2). Trends in Child Nutrition Table 14.3 looks at recent trends in the nutritional status of children in Egypt using anthro- pometric data from EDHS surveys undertaken between 1992 and 2005. There are a number of factors that should be kept in mind in looking at the trends in the indicators. The trends may be influenced by differences in the quality of the anthropometric data collected in the surveys or in the reporting of children’s ages. Particularly where they are small, the differences in the levels for the various indicators may be simply a result of sampling variability rather than of a genuine change in children’s nutritional status. Table 14.3 Trends in nutritional status of children Percentage of children under five classified as malnourished according to selected indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, Egypt 1992-2005 Index of nutritional status 1992 EDHS 1995 EDHS 1997 Interim EDHS 1998 Interim EDHS 2000 EDHS 2003 EIDHS 2005 EDHS Height-for-age 26.0 29.8 24.9 20.6 18.7 15.6 17.6 Weight-for-height 3.4 4.6 6.1 5.1 2.5 4.0 3.9 Weight-for-age 9.9 12.5 11.7 10.7 4.0 8.6 6.1 Note: Figures are based on children of respondents under age five. Source: El-Zanaty and Associates and Macro International Inc., 1999, Table 9.7 Although the changes are not uniform, the overall trend in the nutritional status indicators suggests that the nutritional status of young children in Egypt improved during the period between 1992 and 2005. Looking at the height-for-age measures, for example, there was a decrease in the percentage of children who were considered stunted, from 26 percent at the time of the 1992 EDHS to 18 percent in the 2005 EDHS (Table 14.3). Although exhibiting more fluctuation, the weight-for-age measure also has declined, with the levels observed for the 2005 EDHS being considerably lower than the level in surveys conducted during the 1990s. The trend in the weight-for-height indicator is the most erratic, as it reflects the influences of shorter-term dietary deficiency. Nutritional Status and Anemia Levels | 175 14.3 NUTRITIONAL STATUS OF NEVER-MARRIED YOUTH AND YOUNG ADULTS Height and weight measures were collected for never-married youth and young adults age 10-19 in the 2005 EDHS. Measurement of Nutritional Status among Youth and Young Adults The assessment of the nutritional status of adolescents using height and weight measures is complicated by the fact that adolescents undergo significant changes in their body stature and mass as they go through puberty. Moreover, body proportions may deviate more across populations for adolescents than for young children making it difficult to establish a reference population (Woodruff and Duffield 2000). Approaches to assessing adolescent nutritional status are, thus, less standardized than those for assessing the status of young children. However, WHO has recommended the use of body-mass index (BMI) for age to assess the nutritional status of adolescents (WHO 1995). This approach is adopted in this report using the 2000 CDC Growth Charts (CDC 2000). The body-mass index (BMI) is calculated by dividing the weight in kilograms by the height in meters squared (kg/m2). BMI is calculated using the same formula for children, adolescents, and adults, but the results for children and adolescents are interpreted differently. For adults, BMI is used to define nutritional status without reference to age or gender. For children and adolescents age 2-20, assessments of nutritional status using the CDC BMI growth charts are age- and gender-specific. The growth charts are used to rank individuals according to the percent of the reference population that the individual’s BMI equals or exceeds, i.e., according to the percentile in which the individual falls. For example, on the BMI- for-age growth charts, the BMI for a 10-year-old boy ranked in the 75th percentile, is the same or more than the BMI of 75 percent of the reference population of 10-year-old boys, and less than 25 percent of the 10-year-old boys in the reference population. The following established percentile cutoff points are used to identify underweight and overweight adolescents using the CDC Growth charts: Underweight BMI-for-age <5th percentile Normal BMI-for-age 5th percentile to <85th percentile At risk of overweight BMI-for-age 85th percentile to < 95th percentile Overweight BMI-for-age 95th percentile or higher Results of Data Collection Height and weight measurements were obtained for 97 percent of the 12,144 males age 10-19 and 98 percent of the 11,169 females age 10-19 who were eligible for the collection of the anthropometric data. The following analysis focuses on the 11,837 males and 10,990 females for whom complete anthropometric data were collected. Levels of Malnutrition among Never-Married Youth and Young Adults Tables 14.4.1 and 14.4.2 show the BMI-for-age percentile rankings for never-married male and female adolescents, respectively, according to selected background characteristics. The results indicate that six percent of never-married males age 10-19 and eight percent of never-married females age 10-19 in Egypt may be classified overweight, i.e., their BMI values at or above the 95th percentile on the age and sex-specific BMI growth charts. The BMI values for an additional 15 percent of males and 23 percent of females fall between the 85th and 95th percentiles, indicating 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 underweight, i.e., their BMI values fall below the 5th percentile on the growth charts. 176 | Nutritional Status and Anemia Levels Table 14.4.1 Nutritional status of never-married male youth and young adults by background characteristics Percentage with specific BMI levels among never-married males age 10-19 by background characteristics, Egypt 2005 Percentage of males Background characteristic Underweight (<5th percentile) Normal (5th-85th percentile) At risk of overweight (85th-<95th percentile) Overweight (≥95th percentile) Total percent Number of males Age 10-11 3.6 69.1 17.8 9.5 100.0 2,321 12-13 4.2 70.5 18.4 6.9 100.0 2,228 14-15 3.6 73.2 17.2 6.1 100.0 2,402 16-17 2.6 79.8 13.8 3.8 100.0 2,484 18-19 2.4 87.0 8.1 2.5 100.0 2,403 Mother’s age < 30 4.1 73.9 15.7 6.3 100.0 223 30-34 4.6 72.9 15.9 6.7 100.0 1,408 35-49 2.9 76.0 15.3 5.7 100.0 8,103 50+ 3.9 72.8 16.6 6.7 100.0 1,012 Mother not in household/ no information available 3.3 84.0 9.8 2.9 100.0 1,092 Urban-rural residence Urban 2.8 75.0 15.2 7.0 100.0 4,675 Rural 3.5 76.8 14.9 4.8 100.0 7,162 Place of residence Urban Governorates 3.5 77.9 11.7 6.9 100.0 1,897 Lower Egypt 2.2 74.7 18.1 5.0 100.0 4,757 Urban 1.4 69.7 22.1 6.8 100.0 1,223 Rural 2.5 76.4 16.8 4.3 100.0 3,533 Upper Egypt 4.2 77.0 12.9 5.9 100.0 5,056 Urban 3.3 76.3 13.2 7.2 100.0 1,480 Rural 4.6 77.2 12.8 5.3 100.0 3,575 Frontier Governorates 2.2 62.8 27.7 7.3 100.0 127 Mother’s education No education 3.6 75.8 15.0 5.6 100.0 5,351 Some primary 3.5 78.3 14.1 4.1 100.0 1,650 Primary complete/some secondary 3.7 75.6 13.8 6.9 100.0 1,192 Secondary complete/higher 2.2 71.9 18.3 7.6 100.0 2,552 Mother not in household/no information available 3.3 84.0 9.8 2.9 100.0 1,092 Work status Working for cash 2.8 76.1 15.7 5.4 100.0 1,874 Not working for cash 3.3 75.4 15.3 6.0 100.0 7,804 Mother not in household/no information available 3.5 78.5 13.3 4.7 100.0 2,160 Wealth quintile Lowest 4.0 78.4 13.9 3.7 100.0 2,698 Second 3.8 77.0 14.5 4.7 100.0 2,540 Middle 3.2 77.2 14.3 5.3 100.0 2,284 Fourth 2.5 74.6 15.6 7.3 100.0 2,124 Highest 2.7 72.3 16.9 8.1 100.0 2,191 Total 3.3 76.1 15.0 5.7 100.0 11,837 Note: Table is based on adolescents who stayed in the household the night before the interview. Nutritional Status and Anemia Levels | 177 Table 14.4.2 Nutritional status of never-married female youth and young adults by background characteristics Percentage with specific BMI levels among never-married females age 10-19 by background characteristics, Egypt 2005 Percentage of females Background characteristic Underweight (<5th percentile) Normal (5th-85th percentile) At risk of overweight (85th-<95th percentile) Overweight (≥95th percentile) Total percent Number of females Age 10-11 3.4 70.9 16.8 9.0 100.0 2,189 12-13 2.2 66.8 22.6 8.3 100.0 2,140 14-15 1.3 67.5 23.8 7.4 100.0 2,342 16-17 1.1 68.4 23.4 7.1 100.0 2,372 18-19 0.5 67.2 25.9 6.4 100.0 1,948 Mother’s age < 30 2.9 71.7 16.1 9.3 100.0 206 30-34 2.8 71.2 19.4 6.6 100.0 1,313 35-49 1.6 67.1 23.4 8.0 100.0 7,605 50+ 1.0 70.7 19.8 8.5 100.0 870 Mother not in household/no information available 1.6 69.9 23.4 5.1 100.0 996 Urban-rural residence Urban 1.4 67.0 23.4 8.3 100.0 4,389 Rural 1.9 69.0 21.9 7.2 100.0 6,601 Place of residence Urban Governorates 1.4 70.2 20.5 7.9 100.0 1,733 Lower Egypt 1.3 62.5 27.5 8.8 100.0 4,498 Urban 1.2 57.8 31.6 9.4 100.0 1,164 Rural 1.3 64.1 26.0 8.6 100.0 3,334 Upper Egypt 2.3 73.2 18.0 6.5 100.0 4,622 Urban 1.5 71.1 19.2 8.2 100.0 1,411 Rural 2.6 74.1 17.5 5.8 100.0 3,211 Frontier Governorates 1.1 60.9 34.8 3.2 100.0 136 Mother’s education1 No education 1.8 69.4 22.0 6.8 100.0 4,865 Some primary 2.3 69.6 21.6 6.4 100.0 1,528 Primary complete/Some secondary 1.1 67.2 22.1 9.6 100.0 1,149 Secondary complete/higher 1.4 64.7 23.8 10.1 100.0 2,452 Mother not in household/no information available 1.6 69.9 23.4 5.1 100.0 996 Work status Working for cash 1.5 67.3 23.3 8.0 100.0 1,843 Not working for cash 1.8 67.9 22.5 7.8 100.0 7,221 Mother not in household/no information available 1.3 70.2 21.8 6.7 100.0 1,926 Wealth quintile Lowest 2.2 74.4 17.0 6.4 100.0 2,451 Second 2.0 69.0 22.8 6.2 100.0 2,315 Middle 1.7 68.3 22.9 7.1 100.0 2,143 Fourth 1.4 62.7 26.2 9.7 100.0 2,008 Highest 1.0 65.2 24.6 9.3 100.0 2,072 Total 1.7 68.2 22.5 7.6 100.0 10,990 Note: Table is based on adolescents who stayed in the household the night before the interview. 178 | Nutritional Status and Anemia Levels The proportions of both males and female classified in the overweight and at risk of overweight categories are higher among urban residents, especially those living in urban areas in Lower Egypt, and among residents of the Frontier Governorates. These proportions also increase with mother’s education status and with wealth quintiles. For example, 34 percent of adolescent females in the highest wealth quintile are overweight or at risk of being overweight compared to 23 percent of adolescent females in the lowest wealth quintile. 14.4 NUTRITIONAL STATUS OF WOMEN The height and weight data collected for ever-married women 15-49 can be used to assess their nutritional status. Table 14.5 shows the distribution of women according to height, weight, and body mass (BMI) along with the means for these indicators. The BMI index used for classifying women is calculated from information on height and weight in the same manner as the index is calculated for adolescents. However, the cutoffs defining women’s status do not vary with the woman’s age. For the BMI, a cutoff of 18.5 has been recommended for assessing chronic energy deficiency among nonpregnant women. At the other end of the BMI scale, women are considered overweight if their BMI ranges between 25.0 and 29.9 and obese if their BMI exceeds 30.0. In looking at the results in Table 14.5, it is important to recognize that the anthropometric data are not representative of all women age 15-49 in Egypt. In particular, the results do not include information for women age 15-49 who were not married. Women who were pregnant or less than two months postpartum were also excluded from the analysis of women’s weight and body mass. Finally, maternal anthropometric measures are not available for 219 eligible women (0.9 percent of the sample) who were not home when the EDHS staff visited the household to collect the anthropometric measures. Maternal height is an outcome of nutrition during childhood and adolescence. It is useful in predicting the risk of difficult delivery, since small stature is frequently associated with small pelvis size. The risk of low birth weight babies is also higher for short women. The cutoff point, i.e., the height below which a woman is considered to be at nutritional risk, is defined as 145 centimeters. The mean height of mothers measured in the 2005 EDHS was 159 centimeters. One percent of women were shorter than 145 centimeters and, thus, classified as at nutritional risk. As Table 14.5 shows, excluding those who are pregnant or less than two months postpartum, the mean BMI of ever-married women in the reproductive ages is 30.1. The majority of women have a BMI of 25.0 or higher and are considered 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. Table 14.5 Anthropometric indicators of nutritional status of adult women Percent distribution of ever-married women 15-49 interviewed in the survey by selected anthropometric indicators, Egypt 2005 Anthropometric indicators Total Height's in centimeters 130.0-134.9 0.0 135.0-139.9 0.1 140.0-144.9 0.7 145.0-149.9 5.5 150.0-154.9 18.0 155.0-159.9 34.8 160.0-164.9 27.3 165.0-169.9 11.3 170.0-174.9 1.8 175.0-179.9 0.3 ≥180.0 0.1 Total percent 100.0 Number of women 19,308 Mean height 158.8 Weight in kilograms1 Mean 75.9 Standard deviation 15.7 35.0-39.9 0.1 40.0-49.9 2.6 50.0-59.9 12.9 60.0-69.9 23.8 ≥70.0 60.6 Total percent 100.0 Number of women 17,175 Mean 75.9 BMI1 Thin 12.0-15.9 (Severely) 0.1 16.0-16.9 (Moderately) 0.0 17.0-18.4 (Mildly) 0.4 Normal 18.5-20.4 (Normal) 2.1 20.5-22.9 (Normal) 7.3 23.0-24.9 (Normal) 10.4 Overweight 25.0-26.9 13.2 27.0-28.9 13.2 29.0-29.9 6.7 Obese ≥30.0 (Obese) 46.6 Total percent 100.0 Number of women 17,169 Mean 30.1 1 Excludes pregnant women and women with a birth in the preceding 2 months Nutritional Status and Anemia Levels | 179 Differentials in the maternal height and body mass measures for ever-married women in Egypt are shown in Table 14.6. There is little variation in women’s mean height. The proportions classified as obese rise directly with age, from a level of 12 percent among ever-married women age 15-19 to nearly 70 percent among women in the 45-49 age group. Urban women are more likely to be classified as obese than rural women, and the percentage classified as obese ranges from 28 percent in rural Upper Egypt to 62 percent in the Frontier Governorates. Women in the highest wealth quintile are almost twice as likely as women in the lowest quintile to be obese. Table 14.6 Nutritional status of ever-married women by background characteristics Mean height and percentage under 145 cm among ever-married women 15-49 and mean body mass index (BMI),and percentage with specific BMI levels among ever-married women who were not pregnant and had not given birth within two of the interview, by background characteristics, Egypt 2005 Height BMI (kg/m2)1 Background characteristic Mean height in cm Percent- age below 145 cm Number of women Mean BMI 18.5- 24.9 (normal) <18.5 (thin) 17.0- 18.4 (mildly thin) 16.0- 16.9 (moder- ately thin) <16.0 (severely thin) ≥25.0 (over- weight or obese) 25.0- 29.9 (over- weight) ≥30.0 (obese) Number of women Age 15-19 157.9 0.9 797 25.4 48.5 1.1 1.1 0.0 0.0 50.4 38.4 12.1 495 20-24 158.7 0.6 2,942 26.8 38.9 0.7 0.7 0.0 0.0 60.3 37.6 22.7 2,222 25-29 159.0 0.6 3,753 28.0 27.6 0.7 0.5 0.0 0.2 71.7 40.5 31.2 3,093 30-34 159.2 0.7 3,181 29.7 17.6 0.6 0.5 0.1 0.0 81.8 37.8 44.0 2,886 35-39 159.0 0.7 3,157 30.8 14.0 0.3 0.3 0.0 0.0 85.7 32.7 53.0 3,037 40-44 158.4 1.3 2,841 32.3 10.6 0.2 0.2 0.0 0.0 89.2 26.0 63.2 2,799 45-49 158.4 1.1 2,637 33.3 7.4 0.2 0.2 0.1 0.0 92.4 23.5 68.9 2,637 Urban-rural residence Urban 158.9 0.7 7,937 31.4 12.8 0.4 0.3 0.0 0.0 86.8 31.6 55.2 7,158 Rural 158.7 0.9 11,371 29.1 24.7 0.5 0.4 0.0 0.1 74.8 34.4 40.4 10,013 Place of residence Urban Governorates 159.2 0.7 3,251 32.3 11.3 0.3 0.3 0.0 0.0 88.4 28.9 59.5 2,949 Lower Egypt 159.9 0.5 8,354 30.6 14.8 0.2 0.2 0.0 0.0 85.0 32.9 52.1 7,456 Urban 159.9 0.3 2,174 31.2 10.2 0.2 0.2 0.0 0.0 89.6 33.2 56.4 1,959 Rural 159.8 0.6 6,181 30.4 16.4 0.2 0.2 0.0 0.0 83.4 32.8 50.6 5,496 Upper Egypt 157.3 1.3 7,485 28.5 29.4 0.9 0.6 0.1 0.1 69.7 35.7 34.0 6,580 Urban 157.5 1.1 2,383 30.4 17.5 0.7 0.5 0.2 0.1 81.8 34.2 47.5 2,138 Rural 157.2 1.3 5,102 27.5 35.2 0.9 0.7 0.1 0.2 63.9 36.4 27.5 4,442 Frontier Governorates 159.9 0.1 217 32.0 9.0 0.0 0.0 0.0 0.0 91.0 28.7 62.2 186 Education No education 158.0 1.1 6,692 29.7 23.1 0.5 0.4 0.0 0.1 76.4 31.9 44.5 6,142 Some primary 158.0 1.3 2,190 30.9 17.2 0.7 0.5 0.0 0.1 82.1 31.6 50.5 2,047 Primary complete/ some secondary 158.8 0.9 2,701 30.2 21.0 0.6 0.6 0.0 0.0 78.4 32.7 45.7 2,358 Secondary complete/ higher 159.6 0.4 7,726 30.2 16.9 0.4 0.3 0.0 0.0 82.7 35.1 47.6 6,623 Work status Working for cash 159.4 0.6 3,248 30.9 12.9 0.3 0.3 0.0 0.1 86.7 31.8 54.9 3,034 Not working for cash 158.7 0.9 16,060 29.9 21.2 0.5 0.4 0.0 0.1 78.3 33.5 44.8 14,136 Wealth quintile Lowest 157.5 1.3 3,548 27.9 33.9 1.1 1.0 0.0 0.1 65.0 33.1 31.8 3,153 Second 158.4 1.0 3,742 29.2 23.2 0.6 0.4 0.1 0.1 76.2 36.9 39.3 3,316 Middle 158.8 0.9 3,905 30.1 19.1 0.4 0.3 0.0 0.0 80.5 33.5 47.0 3,444 Fourth 159.2 0.6 4,098 31.1 14.1 0.1 0.1 0.0 0.0 85.7 31.3 54.4 3,602 Highest 159.8 0.5 4,015 31.7 10.4 0.3 0.2 0.1 0.0 89.3 31.6 57.8 3,654 Total 158.8 0.8 19,308 30.1 19.7 0.5 0.4 0.0 0.1 79.8 33.2 46.6 17,169 Note: The body mass index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2). 1 Excludes pregnant women and women with a birth in the preceding 2 months 180 | Nutritional Status and Anemia Levels 14.5 PREVALENCE OF ANEMIA Anemia is a condition characterized by a decrease in the concentration of hemoglobin in the blood. Hemoglobin is necessary for transporting oxygen to tissues and organs in the body. The reduction in oxygen available to organs and tissues when hemoglobin levels are low is responsible for many of the symptoms experienced by anemic persons. The consequences of anemia include general body weakness, frequent tiredness, and lowered resistance to disease. Anemia can be a particularly serious problem for pregnant women, leading to premature delivery and low birth weight. It is of concern in children since anemia is associated with impaired mental and physical development. Overall, morbidity and mortality risks increase for individuals suffering from anemia. Anemia is classified as mild, moderate, or severe based on the concentrations of hemoglobin in the blood. The cutoffs values used in defining each of these levels vary according to age and, for ever- married women, pregnancy status. The following summarizes the cutoffs used in the analysis of the anemia data: Mild (g/dl) Moderate (g/dl) Severe (g/dl) Any (g/dl) Children age 6-59 months 10.0-10.9 7.0-9.9 <7.0 <11.0 Ever-married women age 15-49 Not pregnant 10.0-11.9 7.0-9.9 <7.0 <12.0 Pregnant 10.0-10.9 7.0-9.9 <7.0 <11.0 Never-married youth and young adults Girls Age 10-11 10.5-11.4 7.5-10.4 <7.5 <11.5 Age 12-19 10.0-11.9 7.0-9.9 <7.0 <12.0 Boys Age 10-11 10.5-11.4 7.5-10.4 <7.5 <11.5 Age 12-14 10.0-11.9 7.0-9.9 <7.0 <12.0 Age 15-19 12.0-12.9 9.0-11.9 <9.0 <13.0 Prevalence of Anemia among Young Children Tables 14.7 and 14.8 present anemia levels for children 6-59 months by selected background characteristics. Overall, about one in two children suffer from some degree of anemia. A very small proportion (less than one percent) is classified as having severe anemia. However, around one in five children are moderately anemic. Nutritional Status and Anemia Levels | 181 Table 14.7 Prevalence of anemia in children by child’s characteristics Percentage of children age 6 to 59 months classified as having anemia, by background characteristics relating to the child, Egypt 2005 Background characteristic Mild Moderate Severe Any anemia Number of children Child's age Under 6 months 31.1 29.2 0.0 60.3 290 6-9 28.6 37.8 0.5 66.9 131 10-11 26.8 32.5 0.2 59.4 447 12-17 31.5 22.6 0.3 54.4 398 18-23 28.4 19.7 0.4 48.5 792 24-35 25.1 15.8 0.4 41.3 864 36-47 27.0 13.3 0.2 40.5 836 48-59 Sex 26.0 20.1 0.2 46.3 1,904 Male 29.4 21.1 0.4 50.9 1,855 Female Birth order 1 26.2 20.6 0.4 47.2 1,094 2-3 27.6 21.2 0.3 49.1 1,670 4-5 30.0 20.5 0.1 50.6 609 6+ 27.7 19.5 0.2 47.5 344 Birth interval in months First birth1 26.0 21.0 0.4 47.4 1,112 Under 24 months 29.9 24.4 0.4 54.7 552 24-47 27.1 20.4 0.3 47.8 1,363 48+ 29.4 18.1 0.0 47.6 691 Mother’s interview status Mother interviewed 27.6 20.8 0.3 48.6 3,718 Mother not interviewed2 (35.5) (3.8) (0.0) (39.4) 41 Total 27.7 20.6 0.3 48.5 3,759 Note: Table is based on children who stayed in the household the night before the interview. The cutoffs for specific anemia levels are: mild: 10.0-10.9 g/dl; moderate: 7.0-9.9 g/dl; severe: <7.0 g/dl; any: <11.0 g/dl 1 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 2 Includes children whose mothers are deceased. 182 | Nutritional Status and Anemia Levels Table 14.8 Prevalence of anemia in children by background characteristics Percentage of children age 6 to 59 months classified as having anemia, by selected background characteristics of the mother, Egypt 2005, and trends in percentage of children classified as having anemia, Egypt 2000 and 2005 Background characteristic Mild Moderate Severe Any anemia Number of children Mother's age1 15-19 29.2 36.5 0.1 65.9 101 20-24 29.2 24.8 0.8 54.7 861 25-29 27.1 19.7 0.2 47.0 1,262 30-34 26.0 20.3 0.0 46.3 793 35-49 27.7 15.9 0.2 43.8 713 Urban-rural residence Urban 28.5 15.1 0.1 43.7 1,380 Rural 27.2 23.7 0.4 51.3 2,379 Place of residence Urban Governorates 30.8 11.7 0.2 42.7 528 Lower Egypt 22.6 20.3 0.1 43.0 1,470 Urban 22.9 15.5 0.0 38.4 351 Rural 22.5 21.8 0.1 44.4 1,119 Upper Egypt 31.2 23.6 0.5 55.3 1,714 Urban 30.6 18.7 0.0 49.3 471 Rural 31.4 25.5 0.6 57.6 1,242 Frontier Governorates 24.5 17.9 0.7 43.1 47 Mother's education1 No education 30.3 24.8 0.4 55.5 1,221 Some primary 26.3 20.4 0.0 46.7 310 Primary complete/some secondary 30.2 20.6 0.2 51.0 539 Secondary complete/ higher 24.8 17.8 0.3 43.0 1,661 Work status2 Working for cash 28.2 14.7 0.4 43.3 453 Not working for cash 27.5 21.6 0.3 49.4 3,265 Wealth quintile Lowest 29.5 25.3 0.4 55.2 792 Second 30.3 25.1 0.4 55.8 741 Middle 26.6 21.4 0.6 48.6 797 Fourth 26.6 18.4 0.0 44.9 748 Highest 25.2 11.6 0.0 36.9 682 Total 2005 EDHS 27.7 20.6 0.3 48.5 3,759 Total 2000 EDHS 18.8 11.3 0.2 30.3 4,045 Note: Table is based on children who stayed in the household the night before the interview. The cutoffs for specific anemia levels are: mild: 10.0-10.9 g/dl; moderate: 7.0-9.9 g/dl; severe: < 7.0 g/dl; any: <11.0 g/dl 1 For women who were not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers were not listed in the Household Questionnaire. 2 Excludes children whose mothers were not interviewed. Table 14.1 shows that children under age two were more likely to be anemic than older children. Female children are slightly more likely than males to be anemic. Short birth intervals (less than 24 months) are also associated with a higher than average likelihood of being anemic. According to the results in Table 14.8, rural children are more likely to be anemic than urban children (51 percent and 44 percent, respectively). Considering place of residence, children in rural Upper Egypt have the highest anemia levels (58 percent), and children in urban Lower Egypt have the lowest levels (38 percent). Looking at the mother’s education level, children whose mothers never attended school have the highest anemia level and children whose mothers completed at least secondary school have the lowest level (56 and 43 percent, respectively). Slightly more than one-third of children in the highest wealth quintile are anemic compared to more than half of children in the two lowest wealth quintiles (Figure 14.1). Nutritional Status and Anemia Levels | 183 Information on anemia levels also was obtained in the 2005 EDHS, allowing for an assessment of the trend in the prevalence of anemia among young children since 2000. Table 14.8 shows that the level of anemia among children age 6-59 months was much higher in 2005 than in 2000 (49 percent and 30 percent, respectively). Changes are evident between the two surveys in the prevalence of both mild and moderate anemia; however, in both surveys, less than one percent of children were found to be severely anemic. Prevalence of Anemia among Never-Married Youth and Young Adults Tables 14.9.1 and 14.9.2 show the level of anemia among never-married adolescents age 10-19. Overall, around one-quarter of males age 10-19 and one-third of females age 10-19 are anemic. Most were considered to be mildly anemic, with six percent of males and five percent of females classified as moderately anemic. Anemia levels among males age 11-19 generally increase with age although there is a drop in the rate among males age 18-19. The age differentials for females are less marked than for males, with the level peaking among females age 12-15. Anemia levels are higher among rural than urban residents, especially among males. For both sexes, the levels generally declined with both the mother’s education and the wealth quintile. The decline across wealth quintiles is especially notable for males, with the rate for those in the highest quintile less than half the level for those in the lowest quintile. Tables 14.9.1 and 14.9.2 also show include information on the levels of anemia found among youth and young adults age 11-19 at the time of the 2000 EDHS and the 2005 EDHS. The results indicate that there was little change between the two surveys in the proportions of male youth and young adults classified as anemic. On the other hand, the level of anemia among female youth and young adults increased between the two surveys from 28 percent top 36 percent. Almost all of the change was due to an increase in the proportion of girls who are mildly anemic. 55 56 49 45 37 Lowest Second Middle Fourth Highest Figure 14.1 Anemia Prevalence among Young Children by Wealth Quintile EDHS 2005 Wealth quintile 184 | Nutritional Status and Anemia Levels Table 14.9.1 Prevalence of anemia in never-married male youth and young adults by background charac- teristics Percentage of never-married males age 10-19 classified as having anemia, by selected background characteristics, Egypt 2005, and trends in the percentage of never-married males age 11-19 classified as having anemia, Egypt 2000 and 2005 Background characteristic Mild Moderate Severe Any anemia Number of males Age 10-11 14.2 4.4 0.1 18.7 764 12-13 25.2 2.6 0.0 27.8 709 14-15 21.7 7.0 0.5 29.3 821 16-17 21.7 11.0 0.2 32.9 815 18-19 12.6 5.4 0.2 18.2 762 Mother’s age1 < 30 12.7 0.0 0.3 13.0 62 30-34 19.7 5.7 0.0 25.4 513 35-49 19.2 6.6 0.3 26.0 2,675 50+ 23.2 5.1 0.0 28.3 299 Mother not in household/no information available 14.7 6.2 0.5 21.4 322 Urban-rural residence Urban 14.8 3.6 0.2 18.7 1,492 Rural 21.7 7.8 0.2 29.7 2,380 Place of residence Urban Governorates 15.9 4.4 0.0 20.2 581 Lower Egypt 18.0 4.4 0.0 22.4 1,587 Urban 10.4 2.9 0.0 13.2 419 Rural 20.7 5.0 0.0 25.7 1,167 Upper Egypt 21.4 8.4 0.5 30.2 1,656 Urban 17.6 2.9 0.7 21.3 465 Rural 22.8 10.5 0.4 33.7 1,191 Frontier Governorates 14.8 12.8 0.4 28.0 48 Mother's education1 No education 22.5 6.7 0.3 29.6 1,752 Some primary 20.0 8.0 0.3 28.3 566 Primary complete/some secondary 16.3 6.7 0.0 23.0 378 Secondary complete/higher 14.2 3.7 0.0 17.9 853 Mother not in household/no information available 14.7 6.2 0.5 21.4 322 Work status Working for cash 18.2 5.1 0.0 23.3 652 Not working for cash 19.4 6.6 0.3 26.3 2,582 Mother not in household/no information available 18.6 5.5 0.3 24.4 639 Wealth quintile Lowest 23.9 10.4 0.2 34.5 888 Second 21.2 6.9 0.6 28.7 811 Middle 19.2 5.9 0.2 25.3 767 Fourth 15.9 4.2 0.0 20.2 723 Highest 13.3 2.3 0.0 15.7 683 Total age 10-19 2005 EDHS 19.1 6.2 0.2 25.5 3,872 Total age 11-19 2005 EDHS 19.5 6.3 0.2 26.0 3,481 Total age 11-19 2000 EDHS 18.9 7.5 0.1 26.6 4,848 Note: Table is based on male adolescents who stayed in the household the night before the interview. The cutoffs for anemia levels for male youth and young adults vary by age as follows:: (1) 10-11 years: mild 10.5-11.4 g/dl; moderate 7.5-10.4 g/dl; severe <7.5 g/dl; any <11.5 g/dl (2) 12-14 years:: mild 10.0-11.9 g/dl; moderate 7.0-9.9 g/dl; severe <7.0 g/dl; any <12.0 g/dl (3) 15-19 years: mild 12.0-12.9 g/dl; moderate 9.0-11.9 g/dl; severe <9.0 g/dl; any <13.0 g/dl. 1 For women who are not interviewed, information is taken from the Household Questionnaire. Nutritional Status and Anemia Levels | 185 Table 14.9.2 Prevalence of anemia in never-married female youth and young adults by background charac- teristics Percentage of never-married females age 10-19 classified as having anemia, by selected background characteristics, Egypt 2005, and trends in percentage of never-married females age 11-19 classified as having anemia, Egypt 2000 and 2005 Background characteristic Mild Moderate Severe Any anemia Number of females Age 10-11 19.7 8.3 0.0 28.0 734 12-13 31.8 5.2 0.0 37.0 694 14-15 33.5 3.7 0.0 37.2 756 16-17 30.9 4.1 0.4 35.4 760 18-19 31.8 3.5 0.3 35.6 621 Mother’s age1 < 30 29.6 4.2 0.0 33.8 70 30-34 21.1 8.3 0.0 29.4 439 35-49 30.3 4.7 0.2 35.1 2,491 50+ 33.7 4.1 0.0 37.8 263 Mother not in household/no information available 31.3 3.8 0.0 35.1 303 Urban-rural residence Urban 29.2 3.6 0.1 32.9 1,346 Rural 29.6 5.8 0.2 35.6 2,219 Place of residence Urban Governorates 27.1 3.8 0.3 31.2 505 Lower Egypt 31.9 3.5 0.1 35.5 1,503 Urban 33.8 0.8 0.0 34.6 365 Rural 31.3 4.3 0.1 35.8 1,138 Upper Egypt 27.2 6.8 0.1 34.1 1,509 Urban 26.4 5.5 0.0 32.0 452 Rural 27.6 7.3 0.2 35.1 1,057 Frontier Governorates 48.4 7.6 0.0 56.0 49 Mother's education1 No education 28.9 6.0 0.1 35.0 1,519 Some primary 32.2 4.7 0.3 37.2 511 Primary complete/some secondary 26.7 6.0 0.4 33.1 389 Secondary complete/higher 29.5 3.3 0.0 32.7 844 Mother not in household/no information available 31.3 3.8 0.0 35.1 303 Work status Working for cash 34.4 4.7 0.2 39.3 624 Not working for cash 27.4 5.3 0.1 32.9 2,360 Mother not in household/no information available 32.5 3.9 0.0 36.4 581 Wealth quintile Lowest 33.5 6.1 0.0 39.6 818 Second 28.5 5.9 0.5 34.9 716 Middle 27.9 5.6 0.2 33.7 693 Fourth 27.1 3.7 0.0 30.8 686 Highest 29.6 3.2 0.0 32.9 653 Total age 10-19 2005 EDHS 29.5 5.0 0.1 34.6 3,566 Total age 11-19 2005 EDHS 30.8 4.6 0.2 35.6 3,169 Total age 11-19 2000 EDHS 24.1 3.2 0.1 27.5 4,402 Note: Table is based on female adolescents who stayed in the household the night before the interview. The cutoffs for anemia levels for female youth and young adults vary by age as follows: (1) 10-11 years: mild 10.5-11.4 g/dl; moderate 7.5-10.4 g/dl; severe <7.5 g/dl; any <11.5 g/dl (2) 12-19 years: mild 10.0-11.9 g/dl; moderate 7.0-9.9 g/dl; severe <7.0 g/dl; any <12.0 g/dl. 1 For women who are not interviewed, information is taken from the Household Questionnaire. 186 | Nutritional Status and Anemia Levels Prevalence of Anemia among Ever-Married Women age 15-49 Table 14.10 shows anemia levels among the ever-married women 15-49 interviewed in the 2005 EDHS. Around four in ten women had some degree of anemia. The level of anemia was severe in less than one percent of the women, while seven percent were moderately anemic. Pregnant women who provide the developing fetus with iron are at greater risk of anemia than nonpregnant women. Anemia during pregnancy increases the risks of maternal and infant death, premature delivery, and low birth weight. Table 14.10 shows anemia levels were highest for breastfeeding mothers and lowest for women pregnant at the time of the survey. Studies also suggest that IUD use can lead to iron depletion and iron deficiency anemia. There is an association between IUD use and anemia among Egyptian women; 43 percent of IUD users were at least mildly anemic compared to 37 percent of other women. The other differentials presented in Table 14.10 are generally modest. The largest differences are observed by place of residence, with the prevalence of anemia varying from a low of 35 percent among women living in urban Lower Egypt to a high of 47 percent among women from the Frontier Gover- norates. Table 14.10 also compares the prevalence of anemia among women age 15-49 at the time of the 2000 EDHS and the 2005 EDHS. Anemia levels rose from 28 percent in 2000 to 39 percent in 2005. Almost all of the change in anemia prevalence during the period between the two surveys was due to an increase in the percentage of women who were mildly anemic. Nutritional Status and Anemia Levels | 187 Table 14.10 Prevalence of anemia in ever-married women by background characteristics Percentage of ever-married women age 15-49 classified as having anemia, by selected background characteristics, Egypt 2005, and trends in the percentages of ever-married women age 15-49 classified as having anemia, Egypt 2000 and 2005 Background characteristic Mild Moderate Severe Any anemia Number of women Age 15-19 36.3 8.6 0.0 44.9 281 20-24 33.7 6.5 0.3 40.5 949 25-29 33.3 6.2 0.2 39.7 1,197 30-34 31.9 6.8 0.4 39.0 1,048 35-39 30.7 7.6 0.2 38.5 1,031 40-44 34.6 5.6 0.4 40.5 911 45-49 30.6 5.4 0.3 36.3 873 Children ever born None 27.1 6.8 0.0 33.9 618 1 35.2 7.4 0.6 43.2 873 2-3 33.6 6.3 0.2 40.1 2,564 4-5 32.8 5.7 0.3 38.8 1,400 6+ 31.0 7.1 0.2 38.3 835 Maternity status Pregnant 19.7 14.2 0.3 34.2 596 Breastfeeding (not pregnant) 38.4 5.1 0.2 43.6 1,326 Neither 32.7 5.8 0.3 38.8 4,367 Using IUD Yes 36.7 6.3 0.2 43.2 2,150 No 30.6 6.6 0.3 37.4 4,139 Urban-rural residence Urban 34.1 5.5 0.2 39.7 2,620 Rural 31.7 7.2 0.3 39.2 3,669 Place of residence Urban Governorates 34.5 5.6 0.1 40.1 1,037 Lower Egypt 29.7 6.1 0.3 36.1 2,733 Urban 31.0 3.7 0.0 34.7 737 Rural 29.2 7.0 0.4 36.6 1,997 Upper Egypt 35.0 7.2 0.3 42.6 2,446 Urban 36.0 7.1 0.4 43.4 802 Rural 34.6 7.3 0.2 42.1 1,643 Frontier Governorates 39.0 7.8 0.4 47.2 73 Education No education 32.7 7.5 0.2 40.5 2,156 Some primary 32.9 7.1 0.4 40.4 708 Primary complete/some secondary 30.0 6.8 0.5 37.3 874 Secondary complete/higher 33.4 5.3 0.2 38.9 2,551 Work status Working for cash 35.0 4.3 0.2 39.6 1,065 Not working for cash 32.2 6.9 0.3 39.4 5,224 Wealth quintile Lowest 32.6 7.8 0.7 41.0 1,171 Second 32.9 7.7 0.2 40.8 1,151 Middle 31.1 6.5 0.1 37.7 1,264 Fourth 33.9 6.6 0.2 40.7 1,378 Highest 32.7 4.0 0.2 37.0 1,325 Total 2005 EDHS 32.7 6.5 0.3 39.4 6,289 Total 2000 EDHS 22.7 4.6 0.3 27.7 7,575 Note: Table is based on women who stayed in the household the night before the interview. The cutoffs for anemia levels vary by pregnancy status as follows: (1) non-pregnant: mild 10.0-11.9 g/dl; moderate 7.0- 9.9 g/dl; severe <7.0 g/dl; any <12.0 g/dl (2) pregnant: mild 10.0-10.9 g/dl; moderate 7.0-9.9 g/dl; severe <7.0 g/dl; any <11.0 g/dl. Knowledge of Infectious Diseases and Other Health Issues | 189 KNOWLEDGE OF INFECTIOUS DISEASES AND OTHER HEALTH ISSUES 15 The 2005 EDHS included questions to ascertain women’s knowledge about HIV/AIDS and hepatitis C. The survey also elicited information relating to knowledge about other sexually transmitted diseases, tuberculosis, injection safety and the dangers of exposure to second-hand smoke. IEC efforts are being directed at increasing awareness of these issues, and the EDHS data will be useful in shaping these initiatives. The chapter also presents information obtained in the survey on other health issues including the barriers women may be experiencing in obtaining health care for themselves and on the coverage of health insurance. 15.1 HIV/AIDS KNOWLEDGE AND ATTITUDES Acquired immunodeficiency syndrome (AIDS) is one of the most serious public health and development challenges facing the world today. Although the rate of HIV infection is low in Egypt, there is a need to educate Egyptians about the disease. The 2005 EDHS collected information to assess the prevalence of knowledge of modes of HIV/AIDS transmission and prevention and attitudes towards persons living with AIDS. Knowledge of HIV/AIDS To obtain information on the extent of HIV/AIDS knowledge, EDHS respondents were asked a general question about whether they had heard of the illness. Those who knew about HIV/AIDS were asked additional questions about modes of prevention including whether it is possible to reduce the chance of getting the AIDS virus by having just one faithful sexual partner, using a condom at every sexual encounter, and abstaining from sex. To get at possible misconceptions, respondents also were asked whether they think it is possible for a healthy-looking person to have the AIDS virus and whether a person can get AIDS from mosquito bites or sharing food with a person who has AIDS. The responses to these questions are used to assess the extent to which EDHS respondents have comprehensive knowledge of HIV/AIDS. Comprehensive knowledge of HIV/AIDS is defined as: 1) knowing that both condom use and limiting sex partners to one uninfected partner are HIV prevention methods, 2) being aware that a healthy-looking person can have HIV, and 3) rejecting the two common local misconceptions—that HIV/AIDS can be transmitted through mosquito bites and by sharing food. Table 15.1 shows that more than eight in ten ever-married women age 15-49 in Egypt have heard about HIV/AIDS. The proportions aware of HIV/AIDS are lowest for women living in rural areas, especially in Upper Egypt, women with no education, and women in the lowest wealth quintile. Although many women have a basic knowledge of AIDS, the proportions aware of ways in which the risk of infection can be reduced are generally low. Women are most likely to see limiting sex to one uninfected partner as a means of reducing the risk of transmission (63 percent) and least likely to agree that consistent use of condoms would reduce the chances of infection (26 percent). More than half of the women are unaware that a healthy-looking person can have AIDS, and less than half know that the AIDS virus cannot be transmitted through mosquito bites (47 percent) or through sharing food with an infected person (43 percent). 190 | Knowledge of Infectious Diseases and Other Health Issues Table 15.1 Knowledge of AIDS by background characteristics Percentage of ever-married women who have heard of AIDS, percentage who responded to prompted questions by saying that people can reduce the risk of getting the AIDS virus by using condom, by having sex with just one uninfected, faithful partner, and by abstaining from sex, percentage who responded to prompted questions by saying that a healthy-looking person can have the AIDS virus, percentage who know the AIDS virus cannot be transmitted by mosquito bites or sharing food with an infected person, and percentage with comprehensive knowledge about AIDS by background characteristics, Egypt 2005 Percentage who say people can reduce the risk of getting the AIDS virus by: Percentage who know the AIDS virus cannot be transmitted by: Background characteristic Percent- age who have heard of AIDS Using a condom every time they have sex Limiting sex to one unin- fected partner Abstaining from sexual inter- course By using a condom and having one unin- fected faithful partner Percent- age who know a healthy- looking person can have AIDS Mosquito bites Sharing food with an infected person Percentage who reject two common miscon- ceptions and know that a healthy person can have the AIDS virus Percentage with compre- hensive knowledge about AIDS1 Number of women Age 15-19 78.4 17.7 55.6 34.6 15.3 42.2 35.3 28.1 10.5 2.6 803 20-24 85.1 23.5 64.2 42.8 20.8 48.1 45.3 39.0 16.6 4.8 2,968 25-29 88.5 28.9 67.2 47.0 25.9 50.6 51.9 49.0 22.9 7.2 3,785 30-34 87.9 27.9 67.9 48.5 25.8 49.8 51.5 48.3 21.9 7.4 3,209 35-39 84.1 27.4 62.4 47.1 25.1 45.8 46.7 42.7 18.4 5.8 3,191 40-44 81.8 28.0 61.2 45.4 25.6 46.4 46.3 43.9 19.6 6.7 2,859 45-49 78.6 23.9 56.0 43.3 21.5 44.1 41.2 36.0 16.4 4.8 2,659 Urban-rural residence Urban 94.2 33.1 74.4 53.5 30.3 53.6 60.4 57.5 26.2 9.1 8,033 Rural 77.6 21.7 55.3 39.6 19.4 43.1 37.6 32.7 14.2 4.0 11,441 Place of residence Urban Governorates 96.1 34.3 75.0 51.3 31.2 54.4 63.5 62.9 28.0 10.2 3,293 Lower Egypt 87.0 30.5 68.6 50.1 28.1 52.7 46.8 43.0 21.3 6.9 8,410 Urban 95.7 37.6 82.0 58.0 35.3 61.7 61.3 56.7 30.9 10.9 2,199 Rural 84.0 28.0 63.8 47.4 25.5 49.5 41.7 38.1 18.0 5.5 6,211 Upper Egypt 76.5 18.2 52.5 37.8 16.0 38.8 40.0 34.1 12.8 3.2 7,552 Urban 90.6 27.0 67.4 53.4 24.4 45.6 55.5 51.1 19.4 5.5 2,411 Rural 69.8 14.1 45.5 30.4 12.1 35.7 32.7 26.2 9.7 2.1 5,141 Frontier Governorates 81.9 31.7 49.1 35.0 24.4 37.5 47.5 47.1 21.4 10.3 218 Education No education 66.4 15.1 40.6 32.5 12.8 33.4 24.9 20.5 7.5 1.3 6,740 Some primary 82.2 22.9 57.0 45.8 20.2 42.1 34.3 29.2 9.2 2.3 2,197 Primary complete/some secondary 91.3 27.3 68.0 50.9 24.1 50.4 49.7 46.3 19.3 5.6 2,719 Secondary complete/ higher 98.2 36.7 82.7 54.4 34.4 60.0 68.7 65.0 31.9 11.4 7,818 Work status Working for cash 90.5 35.2 74.1 49.4 32.7 56.7 61.1 59.6 30.6 11.5 3,288 Not working for cash 83.2 24.6 61.0 44.5 22.1 45.6 44.1 39.6 16.8 5.0 16,186 Wealth quintile Lowest 59.5 11.5 36.0 26.0 9.4 29.4 22.0 17.7 6.8 1.2 3,565 Second 78.5 20.2 52.0 39.7 17.4 42.0 32.7 28.4 10.9 2.6 3,778 Middle 86.5 26.2 64.7 47.4 23.6 45.9 44.4 39.5 15.4 4.3 3,931 Fourth 95.1 33.6 75.3 55.4 31.0 55.8 58.1 55.1 24.8 7.9 4,137 Highest 98.9 37.9 83.7 55.4 35.7 61.2 73.4 69.5 35.6 13.5 4,063 Total 84.4 26.4 63.2 45.4 23.9 47.4 47.0 43.0 19.1 6.1 19,474 1 Comprehensive knowledge means knowing that use of condom and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions. Table 15.1 shows that the percentage of ever-married women with comprehensive knowledge of AIDS is low. Overall, six percent of women are classified as having comprehensive knowledge. The proportion of women with comprehensive knowledge is greatest among women in the highest wealth quintile (14 percent). Knowledge of Infectious Diseases and Other Health Issues | 191 Knowledge of Mother-to-Child Transmission To assess the extent to which women are aware of the ways in which AIDS can be transmitted from a mother to her child, EDHS respondents were asked if the virus that causes AIDS can be transmitted during pregnancy, at delivery, or when breastfeeding. As Table 15.2 shows, around seven in ten women believe that the virus can be transmitted from mother to child during pregnancy and at the time of delivery while about half think that it can be transmitted by breastfeeding. Knowledge of pregnancy and delivery as modes of transmission is higher among urban than rural women and increases sharply with both educational attainment and wealth quintile. These characteristics are also associated with a somewhat greater awareness of breastfeeding as a mode of transmission. Table 15.2 Knowledge of prevention of mother-to-child transmission of HIV by background charac- teristics Percentage of ever-married women who know that HIV can be transmitted from mother to child during pregnancy, delivery, or by breastfeeding, by background characteristics, Egypt 2005 HIV can be transmitted from a mother to her baby during: Background characteristics Pregnancy Delivery Breastfeeding Number of women Age 15-19 69.8 61.4 51.4 803 20-24 75.1 69.6 53.7 2,968 25-29 80.3 74.2 54.9 3,785 30-34 80.5 74.7 53.5 3,209 35-39 75.3 70.7 50.2 3,191 40-44 73.3 68.4 49.6 2,859 45-49 69.7 64.8 46.8 2,659 Urban-rural residence Urban 85.0 78.0 54.1 8,033 Rural 69.4 65.0 50.0 11,441 Place of residence Urban Governorates 86.1 77.7 50.2 3,293 Lower Egypt 79.3 75.5 54.7 8,410 Urban 87.6 84.7 56.2 2,199 Rural 76.3 72.3 54.2 6,211 Upper Egypt 67.6 61.5 49.3 7,552 Urban 81.4 72.6 58.4 2,411 Rural 61.1 56.4 45.0 5,141 Frontier Governorates 72.4 65.8 39.4 218 Education No education 57.9 53.4 43.1 6,740 Some primary 71.3 67.3 55.7 2,197 Primary complete/some secondary 82.4 74.9 56.6 2,719 Secondary complete/higher 90.3 84.3 56.2 7,818 Work status Working for cash 82.3 78.0 50.3 3,288 Not working for cash 74.5 68.8 52.0 16,186 Wealth quintile Lowest 50.8 47.0 39.7 3,565 Second 70.3 66.5 52.6 3,778 Middle 77.1 71.7 54.2 3,931 Fourth 86.2 79.4 58.8 4,137 Highest 91.1 84.0 51.5 4,063 Total 75.8 70.4 51.7 19,474 192 | Knowledge of Infectious Diseases and Other Health Issues Stigma Associated with AIDS In the 2005 EDHS, women who had heard of AIDS were asked questions to assess the extent of stigma associated with HIV/AIDS. The results shown in Table 15.3 indicate that few women would be willing to care for a relative with AIDS at home (26 percent), buy fresh vegetables from a shopkeeper with AIDS (11 percent), or allow a female teacher with AIDS to keep teaching (11 percent). Less than half say they would be open about having an HIV-positive family member. Accepting attitudes are expressed on all four indicators by only one percent of women, indicating that some degree of stigma is almost universally associated with HIV/AIDS within Egyptian society. Table 15.3 Accepting attitudes toward those living with HIV by background characteristics Among women who have heard of HIV/AIDS, percentage expressing accepting attitudes toward people with HIV, by background characteristics, Egypt 2005 Percentage of women who: Background characteristic Are willing to care for a family member with HIV at home Would buy fresh vegetables from shopkeeper who has HIV Believe HIV- positive female teacher should be allowed to keep teaching Would not want HIV+ status of a family member to remain a secret Percentage expressing accepting attitudes on all four indicators Number of women who have heard of HIV/AIDS Age 15-19 32.7 12.6 9.9 48.8 1.1 630 20-24 28.6 12.2 10.0 48.2 0.8 2,527 25-29 24.3 12.4 10.3 49.4 1.2 3,348 30-34 24.6 11.2 11.2 48.4 1.2 2,822 35-39 25.6 12.2 11.5 48.5 0.9 2,683 40-44 26.1 10.2 11.1 50.3 1.0 2,338 45-49 26.6 8.5 10.1 46.9 0.9 2,091 Urban-rural residence Urban 24.6 12.2 11.3 48.2 1.3 7,565 Rural 27.3 10.6 10.1 49.1 0.8 8,874 Place of residence Urban Governorates 19.2 11.5 11.5 48.2 1.5 3,164 Lower Egypt 25.3 11.7 8.9 46.8 0.6 7,321 Urban 26.3 13.9 11.3 46.4 1.2 2,104 Rural 24.8 10.8 8.0 46.9 0.4 5,217 Upper Egypt 31.3 10.8 12.6 51.3 1.3 5,776 Urban 31.5 11.6 11.3 49.9 1.1 2,185 Rural 31.2 10.4 13.4 52.2 1.4 3,590 Frontier Governorates 12.8 9.5 5.2 51.9 0.2 179 Education No education 27.1 8.6 8.0 48.2 0.6 4,473 Some primary 30.2 7.5 8.5 45.3 0.9 1,805 Primary complete/some secondary 26.3 10.0 10.1 46.6 1.1 2,482 Secondary complete/higher 24.4 14.2 12.9 50.5 1.3 7,680 Work status Working for cash 24.9 16.0 14.2 50.3 1.5 2,977 Not working for cash 26.3 10.3 9.9 48.3 0.9 13,462 Wealth quintile Lowest 32.4 9.1 10.8 46.6 1.1 2,122 Second 27.3 10.1 8.6 48.3 0.8 2,964 Middle 26.4 10.7 8.9 50.0 1.0 3,400 Fourth 24.7 12.5 11.7 46.9 0.9 3,935 Highest 23.0 12.9 12.7 50.7 1.4 4,017 Total 26.1 11.3 10.7 48.7 1.0 16,439 Knowledge of Infectious Diseases and Other Health Issues | 193 Knowledge of a Source for HIV Testing Table 15.4 shows that less than one in five ever-married women in Egypt is aware of a place where an HIV test is available. Knowledge of a source where HIV testing is available is highest among women working for cash (32 percent) and women in the highest wealth quintile (31 percent) and lowest among women with no education (8 percent). Sources of Information About AIDS Women reporting that they had heard about AIDS were asked about whether they had received any information about AIDS during the six months prior to the EDHS. Table 15.5 shows that 65 percent of women had received information about AIDS during the period. Urban women are more likely than rural women to have received information about AIDS, and the likelihood of having seen or heard information about AIDS during the period increases with both education and wealth. When asked about the source(s) from which they had obtained information during the period, virtu- ally all of the women cited television broadcasts. Ten percent of the women mentioned other media as a source of information while three percent received in- formation from a health worker and a similar per- centage cited relatives or friends as the source of the information they had received about AIDS. Table 15.4 Knowledge of a place where HIV testing available by background characteristics Percentage of ever-married women age 15-49 who know a place where HIV testing is available by background characteristics, Egypt 2005 Background characteristic Percentage knowing place where HIV testing is available Number of women Age 15-19 12.4 803 20-24 16.4 2,968 25-29 19.6 3,785 30-34 20.4 3,209 35-39 18.4 3,191 40-44 18.4 2,859 45-49 17.8 2,659 Urban-rural residence Urban 24.0 8,033 Rural 14.3 11,441 Place of residence Urban Governorates 27.4 3,293 Lower Egypt 17.4 8,410 Urban 23.6 2,199 Rural 15.2 6,211 Upper Egypt 15.6 7,552 Urban 20.0 2,411 Rural 13.5 5,141 Frontier Governorates 13.2 218 Education No education 8.4 6,740 Some primary 12.3 2,197 Primary complete/some secondary 15.8 2,719 Secondary complete/higher 29.4 7,818 Work status Working for cash 31.8 3,288 Not working for cash 15.6 16,186 Wealth quintile Lowest 9.3 3,565 Second 12.7 3,778 Middle 14.9 3,931 Fourth 21.7 4,137 Highest 31.3 4,063 Total 18.3 19,474 194 | Knowledge of Infectious Diseases and Other Health Issues Table 15.5 Sources of information about AIDS by background characteristics Percentage of all ever-married women knowing about AIDS who heard, saw or received any information about AIDS in the six months prior to the survey and percentage of women receiving information about AIDS within the last months naming various sources of information, according to selected background characteristics, Egypt 2005 Percentage who saw/heard/received information about AIDS from: Health worker Background characteristic Percentage of women knowing about AIDS saying they had received information about AIDS recently Number of ever- married women knowing about AIDS TV Other media1 Any contact Home visit Facility visit Husband/ other relatives/ friends/ neighbors Com- munity meeting/ other Number of ever- married women receiving infor- mation about AIDS recently Current age 15-19 55.5 630 98.9 7.3 2.4 0.0 2.4 3.3 0.0 349 20-24 63.7 2,527 97.6 7.5 1.8 0.3 1.6 3.0 0.0 1,609 25-29 65.9 3,348 99.0 10.0 2.5 0.3 2.2 2.5 0.1 2,207 30-34 65.1 2,822 98.5 8.5 2.8 0.2 2.7 2.8 0.4 1,838 35-39 65.1 2,683 97.7 11.8 2.8 0.5 2.4 4.0 0.0 1,748 40-44 65.0 2,338 98.1 11.2 2.4 0.5 2.3 4.2 0.5 1,519 45-49 65.1 2,091 96.6 11.9 3.8 0.5 3.5 4.1 0.3 1,360 Urban-rural residence Urban 68.0 7,565 98.1 11.6 3.6 0.4 3.3 3.4 0.2 5,146 Rural 61.8 8,874 98.0 8.5 1.8 0.3 1.5 3.3 0.1 5,485 Place of residence Urban Governorates 64.4 3,164 97.5 12.4 4.0 0.6 3.7 4.1 0.5 2,039 Lower Egypt 62.1 7,321 98.5 14.4 2.3 0.1 2.3 2.9 0.1 4,548 Urban 64.4 2,104 98.2 19.3 3.7 0.0 3.7 3.1 0.1 1,354 Rural 61.2 5,217 98.6 12.3 1.8 0.1 1.7 2.7 0.1 3,194 Upper Egypt 68.5 5,776 97.9 3.6 2.2 0.6 1.8 3.4 0.1 3,957 Urban 77.3 2,185 98.9 4.3 2.8 0.6 2.4 2.7 0.0 1,689 Rural 63.2 3,590 97.2 3.1 1.8 0.6 1.3 3.9 0.1 2,268 Frontier Governorates 48.0 179 94.5 16.8 5.8 1.1 4.6 7.6 0.6 86 Education No education 59.1 4,473 97.9 3.4 1.5 0.4 1.2 4.1 0.1 2,644 Some primary 60.4 1,805 98.8 5.9 1.4 0.2 1.3 3.0 0.0 1,091 Primary complete/some secondary 62.7 2,482 98.5 6.5 1.8 0.2 1.6 3.5 0.0 1,555 Secondary complete/ higher 69.5 7,680 97.8 15.1 3.7 0.5 3.5 3.0 0.3 5,340 Work status Working for cash 68.5 2,977 95.5 19.5 8.8 1.0 8.4 4.0 0.6 2,038 Not working for cash 63.8 13,462 98.6 7.7 1.2 0.2 1.0 3.2 0.0 8,593 Wealth quintile Lowest 59.5 2,122 97.3 3.4 1.4 0.2 1.2 3.3 0.1 1,262 Second 60.3 2,964 98.9 5.7 1.4 0.4 1.2 2.6 0.1 1,787 Middle 62.3 3,400 97.7 7.3 2.7 0.5 2.4 4.7 0.1 2,119 Fourth 66.9 3,935 98.0 11.1 2.7 0.1 2.6 2.9 0.0 2,632 Highest 70.4 4,017 98.0 16.7 3.9 0.6 3.6 3.3 0.6 2,830 Total 64.7 16,439 98.0 10.0 2.7 0.4 2.4 3.3 0.0 10,630 1 Includes radio, newspaper, magazine, pamphlet, brochure, or poster Knowledge of Infectious Diseases and Other Health Issues | 195 15.2 REPORTS OF RECENT SEXUALLY TRANSMITTED INFECTIONS The 2005 EDHS collected information on respondents’ awareness of sexually transmitted diseases other than HIV/AIDS. Respondents were asked whether they had had an STI in the past 12 months. In addition, they were asked whether, in the past year, they had experienced a genital sore or ulcer and whether they had any genital discharge. Women who had had an infection or experienced STI symptoms were asked additional questions relating to any treatment that they may have sought for the infection or symptoms. In interpreting the results of these questions, it must be cautioned that the reporting of an abnormal discharge or genital sore or ulcer does not definitively identify STI infection in women. However, the results provide some insight into the extent to which women are aware of and seeking medical assistance for abnormal reproductive tract symptoms. The results in Table 15.6 indicate that around one in five currently married women have heard about sexually transmitted infections other than HIV/AIDS. Knowledge of other STIs varies considerably by background characteristic. For example, urban women are more than twice as likely as rural women to know about STIs other than AIDS (32 percent and 15 percent, respectively) and women in the highest wealth quintile are more than four times as likely as those in the lowest quintile to be aware of other STIs. According to the results in Table 15.6, less than one percent of women had had an infection which they had gotten through sexual contact during the 12 months prior to the survey. However, one in five women had had a bad-smelling abnormal genital discharge (13 percent) and/or a genital sore or ulcer (15 percent). Around six in ten women experiencing these symptoms sought medical treatment. Women who sought treatment were more than twice as likely to consult a private medical provider as a public health facility. Generally the differentials in the percentages reporting they had experienced STI symptoms are not large, except for the somewhat lower percentage among women age 45-49 compared to other women. There are clear differences in the percentages of women seeking medical assistance when they had an STI or STI symptoms. The likelihood that treatment was sought decreases with a woman’s age, increases with education and wealth status and is somewhat greater among urban than rural women. 196 | Knowledge of Infectious Diseases and Other Health Issues Table 15.6 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms by background characteristics Among currently married women, percentage who have heard of infections other than AIDS that can be transmitted through sexual contact and percentage with self-reported STI and/or symptoms of an STI in the past 12 months, and, among women with self-reported STI or STI symptoms, the percentage seeking treatment by the type of provider, according to selected background characteristics, Egypt 2005 Percentage with self-reported STI/STI symptoms who sought treatment from: Percentage of ever-married women with self-reported STI/STI symptoms in past 12 months Background characteristic Percentage of currently married women who have heard of infections other than AIDS that can be transmitted through sexual contact STI Abnormal genital discharge Genital sore or ulcer STI, genital discharge, sore or ulcer Number of currently married women Any medical provider Any public medical provider Any private/ nongovern- mental medical provide Number of women with STI/STI symptoms Age 15-19 14.8 0.4 11.2 16.2 20.3 792 69.9 13.9 56.0 161 20-24 19.3 0.3 14.7 16.9 22.4 2,898 61.8 14.9 47.2 650 25-29 22.9 0.5 13.5 15.9 21.3 3,653 65.3 16.4 49.2 777 30-34 23.0 0.3 12.6 16.1 20.1 3,077 65.0 20.4 45.8 618 35-39 24.3 0.3 13.1 15.4 19.6 3,010 55.4 22.1 33.7 589 40-44 23.2 0.2 12.9 15.2 19.6 2,525 56.9 16.4 40.7 494 45-49 19.4 0.2 7.1 10.9 13.1 2,233 54.4 25.4 31.3 292 Urban-rural residence Urban 32.1 0.4 15.7 17.3 22.1 7,490 63.5 18.5 45.7 1,654 Rural 14.6 0.3 10.2 13.9 18.0 10,697 59.1 18.2 41.4 1,927 Place of residence Urban Governorates 35.6 0.2 14.4 15.7 19.4 3,078 62.2 23.1 39.6 596 Lower Egypt 15.1 0.2 11.1 12.1 17.5 7,884 58.5 18.2 40.6 1,379 Urban 21.7 0.3 13.0 13.0 19.1 2,057 64.6 16.6 48.0 392 Rural 12.8 0.2 10.4 11.8 16.9 5,826 56.1 18.8 37.7 987 Upper Egypt 23.2 0.5 13.4 18.9 22.6 7,019 62.9 16.5 47.3 1,585 Urban 36.9 0.6 20.6 24.1 29.2 2,230 63.8 15.1 50.1 652 Rural 16.8 0.4 10.1 16.4 19.5 4,789 62.3 17.5 45.4 933 Frontier Governorates 27.2 0.7 6.4 8.0 10.5 206 66.9 36.3 31.6 22 Education No education 9.6 0.3 10.1 14.3 17.3 6,116 51.9 22.1 30.3 1,056 Some primary 12.2 0.1 13.6 17.5 21.4 2,019 59.4 20.6 40.3 433 Primary complete/some secondary 17.0 0.3 15.0 16.7 22.8 2,564 60.3 19.2 41.7 586 Secondary complete/ higher 36.1 0.4 13.3 15.0 20.1 7,488 68.4 14.8 54.1 1,507 Work status Working for cash 42.3 0.3 11.2 13.5 18.0 2,920 63.2 21.0 43.5 526 Not working for cash 17.9 0.3 12.8 15.6 20.0 15,267 60.8 17.9 43.3 3,056 Wealth quintile Lowest 10.6 0.4 10.4 15.6 19.0 3,266 52.7 20.7 32.7 622 Second 12.1 0.2 10.3 14.2 17.7 3,509 54.4 19.8 35.2 621 Middle 16.4 0.2 11.8 15.7 19.7 3,675 61.0 22.1 39.0 723 Fourth 22.6 0.4 15.3 16.2 22.0 3,897 64.3 15.6 49.2 856 Highest 44.7 0.3 14.2 14.8 19.8 3,840 70.1 14.9 56.3 760 Total 21.8 0.3 12.5 15.3 19.7 18,187 61.1 18.4 43.4 3,581 Knowledge of Infectious Diseases and Other Health Issues | 197 15.3 HEPATITIS C KNOWLEDGE Hepatitis C is a viral infection of the liver. Infection with the hepatitis C virus (HCV) is a major public health problem in Egypt. The high levels of HCV infection are largely attributed to the use of inadequately sterilized needles during mass campaigns undertaken to treat schistosomiasis (Rao et al. 2002 and Nafeh et al. 2000). The 2005 EDHS included a number of questions to assess awareness of hepatitis C and modes of transmission among ever-married women and to identify the principal channels through which women have received information about hepatitis C recently. Table 15.7 shows both the level of awareness of hepatitis C among EDHS respondents and the sources from which respondents have recently received information about the illness. The results indicate that eight in ten ever-married women are aware of hepatitis C. Among the women who have heard about hepatitis C, 83 percent had received information about the illness within the six-month period before the survey. Television is the main channel through which these women received information about hepatitis C (88 percent) followed by personal contacts (husband, other relative, friends, or neighbors) (17 percent) and other media (10 percent). Table 15.8 presents information on the avenues of transmission named by women who had heard about hepatitis C. The percentages naming various transmission routes add to more than 100 percent because women were asked to name all of the ways in which hepatitis C may be spread from one person to another. The results in 15.8 indicate that two-thirds of the women knowing about hepatitis C were able to name a way the illness is transmitted. Of the women able to name an avenue of transmission for hepatitis C, 70 percent said that it could be contracted through a blood transfusion, 52 percent mentioned unclean needles, and 11 percent cited other contact with the blood of an infected person. Other avenues of transmission mentioned by respondents include having sexual relations with an infected person (17 per- cent) and having other casual physical contact including shaking hands or sharing food (20 percent). Table 15.8 also shows that knowledge about ways in which hepatitis C can be transmitted is more widespread among urban women than rural women and among women working for cash than other women. The percentages knowing about at least one way hepatitis C can be contracted increase with education and wealth. 198 | Knowledge of Infectious Diseases and Other Health Issues Table 15.7 Knowledge of hepatitis C by background characteristics Percentage of ever-married women age 15-49 knowing about hepatitis C; among women knowing about hepatitis C, percentage receiving information about hepatitis C during the six-month prior to the survey, and percentage of women receiving any information naming various sources of information, according to background characteristics, Egypt 2005 Percentage who saw/heard about hepatitis C from: Medical provider Background characteristic Percentage knowing about hepatitis C Number of ever- married women Percentage receiving information recently about hepatitis C Number of ever- married women knowing about hepatitis C TV Other media1 Any contact Home visit Facility visit Husband/ other relatives/ friends/ neighbors Community meeting/ other Number of ever-married women receiving information about hepatitis C recently Age 15-19 67.0 803 80.0 538 90.4 6.7 3.8 0.4 3.4 14.7 0.5 430 20-24 76.9 2,968 80.8 2,284 89.2 6.9 5.7 1.6 4.0 16.4 0.2 1,846 25-29 82.3 3,785 82.7 3,115 90.5 10.5 6.7 1.0 5.9 14.2 0.3 2,575 30-34 83.8 3,209 83.3 2,690 90.3 9.0 6.7 0.6 6.1 15.5 0.4 2,242 35-39 82.5 3,191 84.4 2,634 87.5 11.0 6.9 0.8 6.3 16.7 0.1 2,223 40-44 82.5 2,859 83.5 2,358 86.1 12.4 7.6 0.7 7.0 19.4 0.3 1,968 45-49 78.1 2,659 83.6 2,076 84.9 10.7 9.8 1.2 8.8 20.2 0.4 1,735 Urban-rural residence Urban 90.1 8,033 83.3 7,238 89.4 12.4 8.6 0.6 8.3 16.1 0.4 6,028 Rural 73.9 11,441 82.7 8,457 87.4 7.9 5.6 1.2 4.4 17.3 0.2 6,992 Place of residence Urban Governorates 91.0 3,293 80.7 2,995 87.9 15.4 11.3 0.1 11.2 18.1 0.5 2,417 Lower Egypt 80.2 8,410 81.7 6,745 88.2 11.3 6.3 0.6 5.8 17.3 0.2 5,509 Urban 91.3 2,199 81.8 2,008 91.0 15.4 8.0 0.5 7.7 15.5 0.2 1,642 Rural 76.3 6,211 81.6 4,737 87.0 9.6 5.5 0.6 5.0 18.1 0.2 3,866 Upper Egypt 76.5 7,552 86.0 5,780 88.8 5.9 5.7 1.8 4.2 15.6 0.3 4,972 Urban 87.9 2,411 88.9 2,120 90.2 5.9 5.7 1.4 4.8 14.3 0.3 1,884 Rural 71.2 5,141 84.3 3,660 88.0 5.8 5.8 2.0 3.8 16.3 0.3 3,087 Frontier Governorates 80.0 218 70.7 174 83.0 12.6 10.2 0.9 9.6 15.9 0.4 123 Education No education 64.7 6,740 82.0 4,359 86.3 4.8 5.2 1.4 3.9 17.3 0.2 3,576 Some primary 75.9 2,197 79.3 1,668 87.4 5.8 4.4 0.5 4.1 19.6 0.2 1,323 Primary completed./ some secondary 82.5 2,719 82.0 2,242 89.3 6.5 5.2 0.7 4.5 15.7 0.3 1,839 Secondary completed/ higher 95.0 7,818 84.6 7,425 89.4 14.9 9.2 0.9 8.5 16.2 0.4 6,283 Work status Working for cash 89.8 3,288 87.3 2,951 84.7 18.0 16.2 1.0 15.5 18.3 0.8 2,575 Not working for cash 78.7 16,186 82.0 12,744 89.2 8.0 4.8 1.0 3.9 16.4 0.2 10,446 Wealth quintile Lowest 58.4 3,565 81.5 2,081 84.7 4.3 5.4 1.2 4.4 19.6 0.2 1,696 Second 73.7 3,778 82.2 2,783 87.1 5.7 4.9 1.3 3.7 17.5 0.2 2,288 Middle 80.3 3,931 82.7 3,158 88.3 7.2 6.6 1.2 5.5 15.4 0.3 2,612 Fourth 90.8 4,137 83.2 3,756 91.3 11.0 6.7 0.5 6.2 15.2 0.1 3,124 Highest 96.4 4,063 84.3 3,917 88.3 17.1 10.0 0.9 9.5 17.4 0.6 3,301 Total 80.6 19,474 83.0 15,695 88.3 10.0 7.0 1.0 6.2 16.8 0.3 13,021 1 Includes radio, newspaper, magazine, pamphlet, brochure or poster Knowledge of Infectious Diseases and Other Health Issues | 199 Table 15.8 Knowledge of the ways a person can contract hepatitis C by background characteristics Percentage of ever-married women age 15-49 knowing about hepatitis C who can name at least one way in which an individual can contract hepatitis C and percentage of women knowing about a way hepatitis C can be contracted who named various routes of transmission, according to selected background characteristics, Egypt 2005 Percentage naming various routes of transmission Background characteristic Percentage of ever-married women knowing about hepatitis C who can name at least one way the illness can be contracted Number of ever- married women knowing about hepatitis C Hetero- sexual relations Homo- sexual Blood trans- fusion Unclean needle Other contact with blood of infected person1 Mother- to-child trans- mission Smoke cigarettes/ hisha Other casual physical contact with infected person Mos- quito/ other insect bites/ other2 Number of ever- married women who know one way hepatitis C can be contracted Age 15-19 50.7 538 18.4 1.0 58.5 49.7 5.6 0.6 9.5 21.7 1.5 273 20-24 62.4 2,284 16.5 2.4 70.5 50.7 9.3 1.7 3.3 17.1 1.7 1,425 25-29 68.8 3,115 18.8 2.4 73.6 53.3 9.9 2.2 2.9 17.3 1.8 2,142 30-34 68.4 2,690 17.5 3.0 69.2 50.8 12.6 2.0 2.5 22.1 0.9 1,839 35-39 70.8 2,634 16.2 2.3 69.4 53.5 13.0 2.3 2.6 20.7 1.8 1,865 40-44 68.5 2,358 15.9 3.6 70.5 53.1 12.0 1.3 2.4 20.8 0.9 1,615 45-49 68.3 2,076 17.0 2.4 70.7 53.3 12.8 1.6 2.3 23.5 1.6 1,418 Urban-rural residence Urban 75.1 7,238 19.9 3.6 75.7 52.9 12.8 1.7 1.5 20.2 1.1 5,437 Rural 60.8 8,457 14.2 1.6 64.8 51.9 10.0 2.1 4.3 20.2 1.9 5,139 Place of residence Urban Governorates 77.6 2,995 20.1 5.0 80.6 53.3 16.2 1.8 0.8 20.0 0.8 2,323 Lower Egypt 68.5 6,745 15.5 1.9 71.3 53.1 11.1 1.4 1.6 18.0 1.8 4,618 Urban 77.6 2,008 17.7 2.8 75.3 53.7 10.6 1.0 0.9 17.2 1.7 1,559 Rural 64.6 4,737 14.3 1.4 69.3 52.8 11.3 1.6 1.9 18.4 2.0 3,060 Upper Egypt 60.6 5,780 17.7 1.8 62.0 50.8 8.4 2.6 6.0 23.6 1.4 3,502 Urban 68.9 2,120 22.7 1.8 67.8 51.0 9.1 2.2 3.2 24.4 0.7 1,461 Rural 55.8 3,660 14.2 1.9 57.9 50.6 7.9 2.8 7.9 23.1 1.8 2,041 Frontier Governorates 76.0 174 6.3 9.7 81.1 55.5 19.9 1.3 0.9 13.0 1.6 133 Education No education 52.3 4,359 14.7 1.3 57.2 47.3 8.1 2.7 6.9 21.4 2.9 2,279 Some primary 55.0 1,668 18.4 0.8 57.8 45.9 8.7 1.5 5.1 27.7 1.6 917 Primary complete/ Some secondary 65.5 2,242 16.5 2.2 65.9 50.9 12.2 1.7 2.7 21.6 1.6 1,468 Secondary complete/higher 79.6 7,425 18.0 3.5 78.6 55.8 13.0 1.7 0.9 18.3 0.9 5,911 Work status Working for cash 82.6 2,951 16.9 3.7 80.4 56.4 13.8 2.1 0.9 19.4 1.1 2,436 Not working for cash 63.9 12,744 17.2 2.3 67.4 51.2 10.7 1.8 3.4 20.5 1.5 8,140 Wealth quintile Lowest 47.8 2,081 13.6 2.3 44.4 43.5 6.6 2.3 11.0 26.3 2.3 995 Second 56.8 2,783 14.5 1.5 59.2 49.0 9.0 2.5 4.0 22.4 2.6 1,581 Middle 64.7 3,158 15.8 1.1 70.0 53.3 9.7 1.7 3.0 18.1 1.4 2,044 Fourth 71.6 3,756 17.0 2.4 73.6 53.6 11.8 1.4 1.8 18.9 1.3 2,690 Highest 83.4 3,917 20.3 4.5 81.5 55.2 14.8 1.9 0.5 19.7 0.7 3,266 Total 67.4 15,695 17.1 2.6 70.4 52.4 11.4 1.9 2.8 20.2 1.4 10,576 1 Includes sharing razors, etc. 2 Includes shaking hands, sharing food and drink, etc. 200 | Knowledge of Infectious Diseases and Other Health Issues 15.4 INJECTIONS Failure to follow safe injection practices increases the risk of transmission of blood-borne pathogens. To obtain information on the prevalence of injections, EDHS respondents were asked about the total number of injections that they had had in the six months prior to the survey, how many of those injections were administered by a health care provider, and where they had received the last medical injection. Table 15.9 presents data on the prevalence of injections among EDHS respondents. The results indicate that slightly more than one in four women had had at least one injection during the six-month period prior to the survey. Among women who had an injection, eight in ten said that they received at least one medical injection, i.e., an injection administered by a doctor, nurse, pharma- cist or other health care provider. Two out of three women who received a medical injection indicated that they had gotten the injection at a public health facility (not shown in table). Table 15.10 shows how the percentages receiving any injection and any medical injection in the six months prior to the survey vary by background characteristics. Although there are not large variations in either of the indicators, the results show that injection prevalence levels tend to decline with age, education, and wealth and to be somewhat lower among urban than rural women. In addition to the basic information on injection prevalence, the 2005 EDHS included several items concerned with injection safety. Respondents who had a recent medical injection were asked if the provider had taken the syringe and needle used for the injection from a new unopened package; 95 percent reported that the provider had followed this basic injection safety procedure (not shown in table). Table 15.9 Prevalence of injections Percent distribution of ever-married women age 15-49 by the number of injections and the number of medical injections and the average number of injections and medical injections received during the past six months, Egypt 2005 Injection safety Total Number of injections No injections 73.2 1 6.6 2 7.8 3-4 4.7 5-9 3.7 10-19 2.1 20-29 0.6 30-59 0.4 60-94 0.2 95+ 0.8 Total percent 100.0 Number of women 19,474 Mean number received1 2.0 Number of medical injections2 No injections 73.2 No medical injections 5.7 1 6.1 2 7.0 3-4 3.2 5-9 2.4 10-19 1.3 20-29 0.4 30-59 0.2 60-94 0.1 95+ 0.3 Total percent 100.0 Number of women 19,474 Mean number received3 4.4 1 Mean number among women receiving any injection(s) during the six-month period. 2 Includes injections given by a doctor, nurse, pharmacist, dentist or other health worker 3 Mean number among women receiving any medical injection(s) during the six- month period Knowledge of Infectious Diseases and Other Health Issues | 201 Table 15.10 Injection prevalence by background characteristics Percentage of ever-married women age 15-49 who received at least one injection and at least one injection from a health care provider in the past six months according to background characteristics, Egypt 2005 Background characteristic Percentage who received an injection in the past 6 months Percentage who received an injection from a health care provider in the past 6 months Number of ever- married women Age 15-19 35.0 30.6 803 20-24 28.6 23.8 2,968 25-29 26.4 21.8 3,785 30-34 26.3 20.3 3,209 35-39 26.0 20.6 3,191 40-44 25.9 18.7 2,859 45-49 25.3 17.8 2,659 Urban-rural residence Urban 24.9 18.7 8,033 Rural 28.1 22.6 11,441 Place of residence Urban Governorates 25.1 18.6 3,293 Lower Egypt 26.4 20.3 8,410 Urban 24.6 17.8 2,199 Rural 27.1 21.1 6,211 Upper Egypt 28.0 22.9 7,552 Urban 25.0 19.6 2,411 Rural 29.4 24.4 5,141 Frontier Governorates 25.2 20.8 218 Education No education 26.7 21.4 6,740 Some primary 30.3 23.2 2,197 Primary complete/Some secondary 29.3 23.1 2,719 Secondary complete/higher 25.0 19.4 7,818 Work status Working for cash 25.0 19.3 3,288 Not working for cash 27.1 21.4 16,186 Wealth quintile Lowest 30.7 25.6 3,565 Second 27.3 21.8 3,778 Middle 26.2 20.4 3,931 Fourth 27.4 21.0 4,137 Highest 22.7 16.8 4,063 Total 26.8 21.0 19,474 The EDHS also collected information from all respondents to assess the coverage of recent IEC efforts designed to increase population awareness about safe injection practices. Table 15.11 presents these results. Around six in ten EDHS respondents reported that they had received information about what people should do to be sure that injections are given safely in the six months prior to the survey. The percentage of women reporting they had received information relating to safe injection practices tended to rise with the woman’s education and wealth status and to be higher among urban than rural women. As Table 15.11 shows, television was by far the principal source of information for women who had heard about injection safety issues (89 percent) followed by health workers (17 percent). 202 | Knowledge of Infectious Diseases and Other Health Issues Table 15.11 Exposure to information regarding injection safety by background characteristics Percentage of ever-married women age 15-49 receiving information about injection safety during the six-month prior to the survey, and percentage of women receiving any information naming various sources of information, according to background characteristics, Egypt 2005 Percentage who saw/heard about injection safety from: Health worker Background characteristic Percentage receiving information recently about injection safety Number of ever- married women TV Other media1 Any contact Home visit Facility visit Husband/ other relatives/ friends/ neighbors Com- munity meeting/ other Number of ever-married women receiving information about injection safety recently Age 15-19 53.1 803 84.4 5.8 19.9 1.9 18.3 9.9 0.0 426 20-24 58.9 2,968 87.9 5.5 17.4 1.9 15.6 6.9 0.0 1,748 25-29 58.3 3,785 91.0 7.4 16.1 1.6 15.0 6.8 0.2 2,208 30-34 58.4 3,209 89.8 8.1 16.6 1.2 15.4 6.3 0.3 1,873 35-39 58.4 3,191 89.1 8.1 16.0 2.2 14.1 7.9 0.2 1,864 40-44 60.3 2,859 89.1 9.4 16.5 2.1 14.7 6.8 0.5 1,724 45-49 58.2 2,659 89.5 9.2 17.4 1.9 15.7 6.4 0.2 1,546 Urban-rural residence Urban 62.8 8,033 90.5 9.3 17.1 1.5 15.8 6.8 0.2 5,042 Rural 55.5 11,441 88.3 6.7 16.5 2.1 14.7 7.1 0.2 6,348 Place of residence Urban Governorates 58.9 3,293 89.6 10.1 19.5 0.8 18.9 6.6 0.4 1,939 Lower Egypt 57.7 8,410 89.2 11.6 14.8 1.8 13.1 6.4 0.2 4,856 Urban 61.2 2,199 91.1 15.4 14.0 0.8 13.2 6.2 0.0 1,346 Rural 56.5 6,211 88.5 10.2 15.1 2.1 13.1 6.5 0.3 3,510 Upper Egypt 59.6 7,552 89.3 2.8 17.6 2.3 15.7 7.7 0.1 4,498 Urban 70.1 2,411 91.4 3.6 16.4 2.7 14.3 7.7 0.2 1,689 Rural 54.6 5,141 88.1 2.3 18.2 2.0 16.6 7.8 0.1 2,809 Frontier Governorates 44.4 218 82.7 8.0 20.4 1.4 19.2 7.8 0.6 97 Education No education 53.1 6,740 87.5 3.9 15.8 1.9 14.0 8.1 0.1 3,581 Some primary 55.1 2,197 87.5 5.4 18.3 2.8 15.7 6.2 0.1 1,210 Primary complete/some secondary 56.8 2,719 91.5 6.7 15.7 1.3 14.6 7.3 0.1 1,544 Secondary complete/ higher 64.7 7,818 90.3 11.6 17.3 1.6 16.1 6.3 0.4 5,055 Work status Working for cash 64.9 3,288 86.5 14.1 24.0 2.3 22.4 8.5 0.7 2,133 Not working for cash 57.2 16,186 89.9 6.4 15.1 1.7 13.5 6.6 0.1 9,257 Wealth quintile Lowest 50.5 3,565 81.9 3.8 21.4 2.6 18.9 9.1 0.0 1,802 Second 53.6 3,778 89.0 5.4 14.5 1.6 13.0 6.1 0.3 2,026 Middle 57.5 3,931 90.2 5.2 16.0 1.9 14.3 6.6 0.1 2,262 Fourth 62.5 4,137 91.5 9.2 16.4 1.3 15.5 6.7 0.1 2,585 Highest 66.8 4,063 91.4 13.2 16.2 1.9 14.8 6.8 0.4 2,716 Total 58.5 19,474 89.3 7.8 16.7 1.8 15.2 7.0 0.2 11,390 1 Includes radio, newspaper, magazine, pamphlet, brochure or poster Knowledge of Infectious Diseases and Other Health Issues | 203 15.5 SMOKING Smoking during pregnancy increases the risk of having a small or low birth weight baby. Smoking or other use of tobacco also affects women’s health and may adversely affect their children’s health, especially in terms of vulnerability to respiratory illness. If the woman herself does not smoke tobacco but other household members do within the home, all members of the household presumably are exposed to second-hand tobacco smoke or “environmental” tobacco smoke (ETS), which contributes to a number of adverse health effects including increased risk of respiratory and cardiovascular illnesses, especially for young children (WHO 1999). The 2005 EDHS collected information on women’s use of tobacco and on use of tobacco by other household members. Questions were also included on whether women had received information about the effects of second-hand smoke within a six-month period prior to the EDHS and, if so, the sources from which they had received the information. Table 15.12 presents these findings. 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 member smokes or uses another form of tobacco. The likelihood that another household member uses tobacco is highest (more than 60 percent) among women with no education or who attended school but did not complete secondary school and those in the two lowest wealth quintiles. Slightly more than three in four EDHS respondents had received information about the health effects of second-had smoke during the six months prior to the survey. Women living in the Frontier Governorates (60 percent) are least likely to have heard about the problem of second-hand smoke during the period. The percentages receiving information about the topic are greatest among women in the highest quintile on the wealth index (86 percent) and among women with a secondary or higher education (85 percent). As was the case with other health-related information, television was the primary source of information about second-hand smoke among almost all of the women who had seen or heard about the subject recently (96 percent). 204 | Knowledge of Infectious Diseases and Other Health Issues Table 15.12 Prevalence of smoking and exposure to information about health effects of second-hand smoke by background characteristics Percentage of ever-married women age 15-49 who currently smoke or use any form of tobacco, percentage living in household where at least one member smokes or uses other form of tobacco, percentage receiving information about health effects of second-hand smoke during the six-moth prior to the survey, and, among women receiving information about second-hand smoke, percentage receiving information from various sources, according to background characteristics, Egypt 2005 Percentage who saw/heard about health effects of second-hand smoke from: Percentage currently smoking /using other form of tobacco Health worker Background characteristic Woman herself Other household member Percentage receiving information recently about health effects of second- hand smoke Number of ever- married women TV Other media1 Any contact Home visit Facility visit Husband/ other relatives/ friends/ neighbors Com- munity meeting/ other Number of ever-married women receiving information about second- hand smoke recently Age 15-19 0.5 56.3 73.7 803 96.3 8.6 4.0 0.3 4.0 9.1 0.4 592 20-24 0.4 57.2 76.1 2,968 95.4 9.1 4.6 0.5 4.2 8.1 0.0 2,259 25-29 0.4 55.4 78.8 3,785 96.3 11.2 4.2 0.4 3.9 7.6 0.1 2,981 30-34 0.8 55.2 79.1 3,209 95.7 10.5 5.3 0.3 5.1 7.2 0.5 2,537 35-39 0.9 56.2 76.5 3,191 95.9 9.9 5.0 0.5 4.5 7.3 0.3 2,441 40-44 0.9 55.3 75.9 2,859 95.0 12.4 4.8 0.1 4.6 8.0 0.4 2,169 45-49 0.6 55.5 75.3 2,659 95.9 12.0 5.8 0.4 5.4 7.7 0.3 2,003 Urban-rural residence Urban 0.9 52.9 81.4 8,033 95.9 12.4 5.3 0.3 5.1 7.2 0.4 6,537 Rural 0.5 57.8 73.8 11,441 95.7 9.4 4.5 0.4 4.1 8.0 0.4 8,445 Place of residence Urban Governorates 1.0 52.6 78.5 3,293 94.0 14.0 6.6 0.3 6.4 9.3 0.2 2,585 Lower Egypt 0.4 55.5 79.3 8,410 96.8 15.2 4.1 0.3 3.8 6.6 0.3 6,668 Urban 0.6 52.4 83.7 2,199 97.3 19.6 4.9 0.2 4.7 6.2 0.5 1,842 Rural 0.4 56.6 77.7 6,211 96.6 13.5 3.8 0.4 3.5 6.8 0.2 4,826 Upper Egypt 0.7 57.7 74.1 7,552 95.4 4.0 5.0 0.5 4.6 8.2 0.2 5,599 Urban 0.9 54.2 83.8 2,411 96.9 4.1 3.9 0.4 3.8 5.4 0.4 2,020 Rural 0.6 59.4 69.6 5,141 94.5 4.0 5.5 0.5 5.1 9.7 0.1 3,579 Frontier Governorates 0.6 48.6 59.8 218 94.7 9.0 5.3 0.2 5.1 6.9 0.5 130 Education No education 0.5 61.9 68.5 6,740 95.2 5.5 3.9 0.3 3.6 8.6 0.2 4,615 Some primary 0.8 62.3 73.8 2,197 96.5 5.8 4.3 0.5 3.9 8.0 0.0 1,622 Primary complete/some secondary 0.8 62.6 76.7 2,719 95.9 8.2 4.6 0.2 4.4 8.4 0.3 2,085 Secondary complete/ higher 0.6 46.4 85.2 7,818 95.9 16.4 5.7 0.4 5.4 6.7 0.4 6,659 Work status Working for cash 0.9 46.0 82.0 3,288 94.1 18.9 9.9 0.8 9.5 7.9 0.8 2,696 Not working for cash 0.6 57.8 75.9 16,186 96.1 8.9 3.7 0.3 3.5 7.6 0.2 12,286 Wealth quintile Lowest 0.6 62.3 66.3 3,565 92.4 5.6 4.9 0.4 4.5 12.2 0.2 2,365 Second 0.4 60.5 72.1 3,778 96.7 6.3 3.5 0.2 3.4 7.3 0.2 2,723 Middle 0.5 56.9 77.0 3,931 96.8 8.7 4.7 0.7 4.1 6.1 0.1 3,028 Fourth 0.5 54.7 81.8 4,137 96.6 13.1 5.0 0.2 4.9 7.4 0.2 3,383 Highest 1.1 45.8 85.7 4,063 95.6 17.2 5.9 0.4 5.6 6.6 0.7 3,483 Total 0.6 55.8 76.9 19,474 95.8 10.7 4.9 0.4 4.6 7.7 0.3 14,982 1 Includes radio, newspaper, magazine, pamphlet, brochure or poster Knowledge of Infectious Diseases and Other Health Issues | 205 15.6 TUBERCULOSIS Tuberculosis (TB) is considered to be among the top public health problems in Egypt. The 2005 EDHS obtained information from respondents about whether they had heard about TB and, if so, how it was transmitted. Respondents who knew about TB were also asked if they believed it could be cured and, to assess attitudes toward the illness, whether they would want to keep it secret if a family member had TB. According to the results in Table 15.13, more than three in four ever-married women age 15-49 in Egypt have heard about TB. Knowledge of TB is lowest among women age 15-19 (66 percent), those who had never attended school (64 percent) or had attended but not completed primary school (70 percent), and women in the lowest wealth quintile (59 percent). Only around half of those who had heard of TB correctly identify that it can be spread through the air when an infected individual coughs or sneezes. Many women are unable to name a way in which TB can be spread. Others have misconceptions about the ways in which the TB is spread; for example, 15 percent believe that TB can be contracted by sharing eating utensils with an infected person. Older women are more likely than women under age 25 to be aware that the TB bacterium is airborne. Urban residence is associated with greater awareness of the way in which TB is spread and correct knowledge of the mode by which TB is transmitted generally increased with education and wealth. Among women knowing about TB, the majority believe it can be cured (72 percent). The perception that TB can be cured is most strongly associated with increasing education and especially wealth. Some degree of stigma is clearly attached to TB as evidenced by the fact that, if a family member had TB, four in ten women say they would prefer to keep it a secret. There was little variation in this percentage by background characteristics. 206 | Knowledge of Infectious Diseases and Other Health Issues Table 15.13 Awareness and attitudes about tuberculosis by background characteristics Percentage of ever-married women age 15-49 who have heard about tuberculosis (TB), and, among those who have heard about TB, percentage believing TB can be cured, percentage saying that they would not want others to know if a family member had TB, and percentage naming various routes of transmission, according to background characteristics, Egypt 2005 Percentage knowing about TB who say it can be spread through: Background characteristic Percent- age having heard about TB Number of ever- married women The air when coughing/ sneezing Sharing utensils Touching person with TB Food Sexual contact Mos- quito bites Contami- nated blood transfer/ syringe Smoking cigar- ettes/ water pipe Percent- age of women knowing about TB who believe it can be cured Percentage of women knowing about TB saying that they would like a family member's TB kept secret Number of ever- married women knowing about TB Age 15-19 66.2 803 41.1 9.8 5.6 4.3 4.0 0.4 1.7 0.8 65.9 44.5 532 20-24 73.3 2,968 47.6 11.3 6.0 4.7 4.0 1.3 3.0 1.3 68.8 40.1 2,176 25-29 78.3 3,785 54.7 13.9 4.5 4.4 4.2 1.5 2.3 1.4 74.3 39.9 2,965 30-34 80.0 3,209 53.7 14.9 6.8 6.1 3.8 1.3 2.9 1.8 73.1 39.6 2,568 35-39 79.4 3,191 56.8 17.3 6.5 4.6 3.4 2.0 2.3 1.9 74.8 40.8 2,534 40-44 77.6 2,859 55.5 17.7 5.5 6.1 3.5 1.0 1.9 1.4 72.4 41.2 2,218 45-49 75.3 2,659 53.1 15.3 7.2 6.8 4.1 1.5 2.3 1.7 70.4 42.4 2,002 Urban-rural residence Urban 86.5 8,033 61.1 17.4 5.5 5.1 4.2 1.0 2.2 1.8 74.1 41.0 6,951 Rural 70.3 11,441 46.5 12.7 6.4 5.5 3.6 1.8 2.6 1.3 70.8 40.5 8,045 Place of residence Urban Governorates 89.4 3,293 65.8 20.6 4.1 3.9 4.8 0.8 1.7 1.6 71.4 39.8 2,945 Lower Egypt 71.8 8,410 52.8 12.2 6.5 6.8 4.9 1.9 3.1 0.8 74.4 45.4 6,038 Urban 81.3 2,199 62.4 14.8 7.5 8.0 5.6 1.0 3.8 0.9 75.5 44.8 1,788 Rural 68.4 6,211 48.7 11.2 6.1 6.3 4.6 2.3 2.7 0.7 73.9 45.6 4,251 Upper Egypt 77.1 7,552 47.1 14.6 6.4 4.5 2.2 1.2 2.2 2.4 71.0 36.7 5,826 Urban 87.1 2,411 52.8 15.0 5.7 4.3 1.8 1.2 1.5 2.8 77.1 40.1 2,100 Rural 72.5 5,141 43.9 14.4 6.8 4.6 2.4 1.3 2.5 2.1 67.5 34.8 3,726 Frontier Governorates 85.1 218 63.9 18.8 7.3 5.2 5.6 0.4 0.3 0.6 60.6 29.2 186 Education No education 64.0 6,740 40.6 13.0 7.3 5.0 2.4 2.0 2.3 1.7 62.7 42.0 4,316 Some primary 69.7 2,197 39.6 12.6 5.6 5.0 3.6 2.0 3.4 1.5 65.7 41.0 1,530 Primary complete/ some secondary 78.3 2,719 49.4 12.5 5.2 4.9 3.4 1.4 2.5 1.7 69.1 45.2 2,130 Secondary complete/ higher 89.8 7,818 65.2 17.3 5.5 5.7 4.9 0.9 2.2 1.4 80.6 38.6 7,019 Work status Working for cash 85.2 3,288 69.2 19.9 5.7 6.8 5.7 1.4 1.7 1.0 82.1 38.1 2,802 Not working for cash 75.3 16,186 49.6 13.7 6.1 5.0 3.4 1.4 2.6 1.7 70.0 41.3 12,194 Wealth quintile Lowest 58.8 3,565 33.1 11.6 6.5 4.7 2.2 2.3 3.0 1.8 59.6 39.6 2,096 Second 69.3 3,778 42.6 12.7 7.2 5.8 4.1 1.8 2.9 1.6 69.0 41.1 2,617 Middle 75.9 3,931 50.9 12.2 6.5 4.8 3.2 1.3 2.0 1.7 70.9 40.8 2,984 Fourth 85.9 4,137 56.4 15.0 5.7 5.3 3.6 1.3 2.6 1.0 73.1 41.7 3,553 Highest 92.2 4,063 70.9 20.3 4.7 5.8 5.3 0.8 1.9 1.8 82.0 40.1 3,745 Total 77.0 19,474 53.3 14.9 6.0 5.3 3.8 1.4 2.4 1.5 72.3 40.7 14,996 Knowledge of Infectious Diseases and Other Health Issues | 207 15.7 WOMEN’S ACCESS TO HEALTH CARE Another important topic explored in the 2005 EDHS was the type of barriers women may face in accessing health care for themselves. To obtain this information, EDHS respondents were asked whether each of the following factors would be a big problem for them in obtaining medical advice or treatment if they were sick: getting permission to go, getting money for treatment, the distance to the health facility, having to take transportation, concern about going alone to the facility, lack of a female health care provider, lack of any health care provider, and concern about the availability of drugs. Table 15.14 shows that around eight in ten women identify at least one of these obstacles to getting health care as potentially a major problem in accessing health care for themselves. Women most frequently cite the lack of a health care provider (60 percent) and lack of drugs (58 percent) as potentially big problems followed by concern that no female health care provider would be available (40 percent), difficulties in getting the money to pay for treatment (32 percent), and not wanting to go alone (30 percent). Twenty percent or less of women mention as potential barriers the need to arrange for transport, the distance to the provider, or the need to get permission from the husband or someone else before they could go for care. Urban women are somewhat less likely than rural women to report at least one potential obstacle. Women from Upper Egypt are considerably more likely than those from Lower Egypt and the Urban Governorates to mention at least one potential obstacle. As expected, highly educated women and women who work for cash are less likely than other women to perceive any big problems in accessing health care. The percentage of women who identified at least one potential problem in accessing health care also decreased with increasing wealth. There are differences by background characteristics, particularly by residence, education, and wealth, in the types of obstacles that women regard as big problems. For example, women in Lower Egypt were much less likely than other women to say that lack of a female provider would be a barrier for them. Getting permission to go and not wanting to go alone were acknowledged much more often as potential obstacles by women from the Frontier Governorates than by women in other residential categories. The percentage saying that getting the money to pay for care would be a big problem declined with the wealth quintile, from half of women in the lowest wealth quintile citing this as a serious problem compared to 14 percent of women in the highest quintile. 208 | Knowledge of Infectious Diseases and Other Health Issues Table 15.14 Problems in accessing health care by background characteristics Percentage of ever-married women who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Egypt 2005 Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern no female provider available Concern no provider available Concern no drugs available At least one problem in accessing health care Number of women Age 15-19 15.2 30.5 20.5 18.8 38.3 46.6 62.9 61.4 83.0 803 20-24 14.1 29.3 17.2 18.5 32.6 41.1 59.7 56.3 78.2 2,968 25-29 11.1 29.2 15.1 17.0 31.1 38.8 59.6 56.9 77.4 3,785 30-34 12.4 31.4 15.1 16.6 27.8 40.6 60.8 58.9 77.6 3,209 35-39 11.9 31.6 17.4 18.9 28.7 40.1 60.2 57.9 77.7 3,191 40-44 9.3 35.7 17.2 18.7 27.9 39.8 58.0 57.9 76.9 2,859 45-49 9.6 34.2 18.5 20.1 30.3 38.1 61.1 59.3 78.2 2,659 Number of living children 0 11.9 24.4 15.5 16.3 34.6 39.4 59.1 55.6 76.7 1,936 1-2 11.7 28.5 16.0 16.9 28.6 38.2 57.8 55.2 75.4 7,208 3-4 11.0 33.0 16.0 17.8 28.6 39.0 60.4 59.3 78.1 7,053 5+ 12.3 40.2 21.2 23.1 34.1 46.6 64.3 62.4 83.3 3,277 Urban-rural residence Urban 10.5 29.9 17.6 19.3 29.9 42.9 56.0 52.7 74.8 8,033 Rural 12.4 32.9 16.3 17.5 30.3 38.0 62.8 61.6 80.0 11,441 Place of residence Urban Governorates 10.3 31.3 22.4 25.3 36.4 51.3 53.1 50.0 74.0 3,293 Lower Egypt 12.8 27.0 11.3 12.7 22.8 25.5 59.9 59.2 73.5 8,410 Urban 10.7 20.0 9.0 11.1 21.2 24.2 60.1 57.7 71.7 2,199 Rural 13.5 29.4 12.0 13.3 23.4 26.0 59.8 59.7 74.1 6,211 Upper Egypt 10.5 37.3 20.1 20.7 35.0 50.7 63.4 60.1 84.4 7,552 Urban 10.0 37.5 18.3 18.1 28.4 48.1 57.0 52.3 78.9 2,411 Rural 10.7 37.2 20.9 22.0 38.0 51.9 66.4 63.8 87.1 5,141 Frontier Governorates 26.0 24.2 33.6 34.9 49.4 59.8 52.6 53.8 76.3 218 Education No education 13.6 44.3 21.4 22.5 34.8 47.3 66.4 65.7 85.9 6,740 Some primary 14.4 44.2 20.9 23.0 33.5 43.2 60.8 60.5 82.3 2,197 Primary complete/ some secondary 14.2 33.0 18.0 19.9 34.0 43.1 62.4 59.0 80.4 2,719 Secondary complete/ higher 8.2 16.8 11.3 12.6 23.8 31.8 53.5 50.2 68.8 7,818 Work status Working for cash 7.8 23.5 13.3 14.4 22.4 31.2 52.6 50.3 69.1 3,288 Not working for cash 12.4 33.3 17.5 19.0 31.7 41.8 61.5 59.5 79.6 16,186 Wealth quintile Lowest 14.5 49.4 24.0 24.1 35.5 46.7 66.8 68.4 88.5 3,565 Second 13.0 39.0 18.5 19.7 32.1 41.9 63.3 61.9 82.0 3,778 Middle 12.8 32.5 16.6 17.8 30.8 39.6 61.1 58.4 77.0 3,931 Fourth 11.3 26.4 14.8 17.0 29.8 40.0 59.6 57.6 76.8 4,137 Highest 6.9 14.0 11.2 13.2 23.2 32.9 50.4 45.0 66.5 4,063 Total 11.6 31.7 16.8 18.2 30.1 40.0 60.0 58.0 77.9 19,474 Knowledge of Infectious Diseases and Other Health Issues | 209 15.8 HEALTH INSURANCE COVERAGE Women’s access to care for themselves and for their children improves if they are covered by some form of health insurance. Table 15.15 shows that a minority of ever-married women age 15-49 in Egypt (12 percent) are covered by any type of health insurance. Insurance is clearly associated with employment; nine percent of women have insurance through an employer and three percent are insured through another family member’s employer. Among women who work for cash, around half report they have health insurance through their employer. With respect to other characteristics, health insurance coverage is concentrated among older women, urban residents, women with a secondary or higher education, and women in the fourth and highest wealth quintiles. Table 15.15 Health insurance coverage by background characteristics Percentage of ever-married women by type of health insurance coverage, according to background characteristics, Egypt 2005 Background characteristic Women's employer Another family member's employer Other1 No insurance Number of women Age 15-19 0.3 0.2 0.5 98.9 803 20-24 1.6 1.4 0.2 96.6 2,968 25-29 5.1 2.6 0.8 91.4 3,785 30-34 9.6 4.1 1.2 85.2 3,209 35-39 10.1 2.8 1.4 85.8 3,191 40-44 15.2 3.0 1.6 80.5 2,859 45-49 13.9 3.1 1.7 82.0 2,659 Number of living children 0 5.9 2.1 0.7 91.5 1,936 1-2 9.3 2.8 1.2 86.6 7,208 3-4 11.1 3.3 1.4 84.6 7,053 5+ 3.4 1.7 0.3 94.4 3,277 Urban-rural residence Urban 13.8 3.7 2.2 80.5 8,033 Rural 5.0 2.1 0.3 92.7 11,441 Place of residence Urban Governorates 13.0 5.1 3.9 78.4 3,293 Lower Egypt 10.4 3.7 0.3 86.0 8,410 Urban 19.1 4.5 0.6 76.3 2,199 Rural 7.3 3.4 0.2 89.4 6,211 Upper Egypt 4.7 0.7 0.8 93.7 7,552 Urban 9.8 1.0 1.7 87.4 2,411 Rural 2.3 0.5 0.4 96.6 5,141 Frontier Governorates 11.4 2.9 0.8 85.1 218 Education No education 0.3 0.9 0.1 98.5 6,740 Some primary 0.8 2.1 0.2 96.8 2,197 Primary complete/some secondary 1.2 2.1 0.4 96.0 2,719 Secondary complete/higher 20.6 4.7 2.5 72.9 7,818 Work status Working for cash 50.0 2.9 3.5 45.2 3,288 Not working for cash 0.2 2.7 0.7 96.3 16,186 Wealth quintile Lowest 0.6 0.4 0.1 98.7 3,565 Second 1.8 1.4 0.1 96.5 3,778 Middle 5.2 2.3 0.4 92.2 3,931 Fourth 11.7 3.5 1 84.2 4,137 Highest 22.2 5.6 3.7 69.0 4,063 Total 8.6 2.7 1.1 87.7 19,474 1 Includes coverage from health insurance agency or syndicate Female Circumcision | 211 FEMALE CIRCUMCISION 16 The practice of female circumcision (also re- ferred to as female genital cutting) has been a tradition in Egypt since the Pharonic period, and adherence to the custom remains widespread. The 2005 Egypt DHS survey included questions designed to assess the current prevalence of circumcision among survey respondents and their daughters. Questions were included about the daughter’s age at circumcision and the person who performed the circumcision. The survey also investi- gated attitudes toward the practice. 16.1 PREVALENCE OF FEMALE CIRCUMCISION CIRCUMCISION OF EDHS RESPONDENTS Results from the 2005 EDHS show that the practice of female circumcision is virtually universal among women of reproductive age in Egypt. Table 16.1 shows that 96 percent of the ever-married women interviewed in the 2005 EDHS reported that they had been circumcised. Only in the Urban Governorates (89 percent) and the Frontier Governorates (72 percent) does the prevalence of circumcision fall below 90 per- cent. Circumcision Prevalence among Girls The procedure for collecting information about daughters’ circumcision status in the 2005 EDHS differed from the approach used in the earlier surveys. In the 1995 and 2000 EDHS surveys, respondents who had surviving daughters were asked about the number of their daughters who had been circumcised. If the woman had at least one daughter circumcised, addi- tional questions were asked about the age at circum- cision and the person performing the circumcision for the daughter who had been circumcised most recently. If a respondent’s daughter(s) was (were) not yet circum- cised, she was asked about whether she intended to have her daughter(s) circumcised in the future. In contrast to the two earlier surveys, the 2005 EDHS included a complete circumcision history for daughters under age 18, i.e., women with surviving daughters were asked about the circumcision status of each of their daughters age 0-17 years. For each daughter who was circumcised, information was collected on the age at which the daughter was circumcised and the person performing the circumcision. Table 16.1 Prevalence of female circumcision among ever- married women 15-49 by background characteristics Percentage of ever-married women 15-49 who have been circumcised according to selected background character- istics, Egypt 2005 Background characteristic Percentage of ever-married women age 15-49 who have been circumcised Number of ever-married women age 15-49 Age 15-19 96.4 803 20-24 95.8 2,968 25-29 95.1 3,785 30-34 95.9 3,209 35-39 95.9 3,191 40-44 96.0 2,859 45-49 96.3 2,659 Urban-rural residence Urban 92.2 8,033 Rural 98.3 11,441 Place of residence Urban Governorates 89.4 3,293 Lower Egypt 98.0 8,410 Urban 95.2 2,199 Rural 99.0 6,211 Upper Egypt 96.9 7,552 Urban 94.5 2,411 Rural 98.0 5,141 Frontier Governorates 71.5 218 Education No education 98.4 6,740 Some primary 99.0 2,197 Primary complete/some 97.3 2,719 Secondary complete/higher 92.2 7,818 Work status Working for cash 92.7 3,288 Not working for cash 96.4 16,186 Wealth quintile Lowest 97.8 3,565 Second 99.1 3,778 Middle 98.3 3,931 Fourth 97.1 4,137 Highest 87.3 4,063 Total 95.8 19,474 212 | Female Circumcision Similar to the procedure in the earlier surveys, a woman whose daughter(s) was (were) not circumcised was asked about her intention to have her daughter(s) circumcised in the future. The inclusion of a complete circumcision history provides the basis for a direct estimate of the prevalence of circumcision among girls, which was not possible using the data from the two earlier DHS surveys. This estimate is not based on the entire population of girls 0-17 years since information is not available for girls whose mothers were not interviewed in the survey, either because they were age 50 and older or had died. However, the estimate is based on a large proportion of the female population in the age group. Overall, EDHS respondents reported on the circumcision status of 20,628 girls age 0-17 years; this represented 93 percent of the 21,864 females in the age range living in EDHS households (not shown in table). Using the circumcision history data, Table 16.2 presents information on the preva- lence of circumcision among girls under age 18 in Egypt. The results indicate that slightly more than one-quarter of girls age 0-17 years have been circumcised. Girls age 9-10 are more than twice as likely as girls age 7-8 to have been circumcised (24 percent and 10 percent, respec- tively). This reflects the fact that, in Egypt, traditionally girls are circumcised slightly before or at puberty (El-Gibaly et al. 2002). The preva- lence of circumcision increases rapidly from age 11 onward to a peak of 77 percent among girls age 15-17. The percentage already circumcised may be combined with the percentage of girls whose mother expressed an intention to circumcise her 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 time, from a level of around 80 percent among girls age 15-17 to around 60 percent among girls currently under age 3. The cohort differences indicate that over the next decade in Egypt, there will be a steady decline in the proportions of young adult women who are circumcised. However, they also suggest that, in 2015, around six in ten girls will continue to be circumcised by their 18th birthday unless further changes occur in the attitudes supporting the practice. Table 16.3 presents the variation in the current prevalence of circumcision, the mother’s intention with regard to circumcision, and expected prevalence of circumcision at age 18 by the girl’s current age and selected demographic and socio-economic background characteristics. Overall, the results show that residence is strongly associated with the likelihood a daughter will be circumcised now or in the future. The percentage of women who have at least one daughter who had been circumcised or who intend to have their daughter circumcised in the future is 53 percent in urban areas compared to nearly 80 percent in rural areas. The percentage of daughters who are or are likely to be circumcised in the future is lowest in the Urban Governorates (45 percent) and the Frontier Governorates (43 percent) and highest in rural Upper Egypt (83 percent). Table 16.2 Current and expected prevalence of female circumcision among girls Percentage of girls age 0-17 years who are currently circumcised, percentage who are not yet circumcised but whose mothers intend that the girl will be circumcised in the future, and percentage expected to be circumcised by age 18 taking into account the current circumcision status and mother’s intention, by the girl’s current age, Egypt 2005 Age Percentage circumcised Percentage whose mothers intend the daughter to be circumcised in the future Percentage expected to be circumcised by age 18 Number of daughters < 3 0.5 60.7 61.2 3,879 3-4 1.9 65.0 66.9 2,553 5-6 4.2 58.0 62.2 2,544 7-8 9.6 54.2 63.8 2,284 9-10 23.8 45.7 69.5 2,236 11-12 51.4 21.6 73.0 2,038 13-14 68.8 8.7 77.5 1,957 15-17 76.5 3.3 79.8 3,137 Total 27.7 41.0 68.7 20,628 Table 16.3 Current and expected prevalence of female circumcision among girls by background characteristics Percentage of girls age 0-17 years who are currently circumcised, percentage who are not yet circumcised but whose mothers intend that the girl will be circumcised in the future, and percentage expected to be circumcised by age 18 taking into account the current circumcision status and mother’s intention by the girl’s current age, according to selected background characteristics, Egypt 2005 < 9 years 9-12 years 12-17 years Total 0-17 years Background characteristic Cir- cumcised Mother intends to circumcise Expected to be circumcised by age 18 Cir- cumcised Mother intends to circumcise Expected to be circumcised by age 18 Cir- cumcised Mother intends to circumcise Expected to be circumcised by age 18 Cir- cumcised Mother intends to circumcise Expected to be circumcised by age 18 Number of girls Mother’s age 15-19 0.0 69.0 69.0 na na na na na na 0.0 69.0 69.0 217 20-24 1.7 65.9 67.6 55.3 41.9 97.2 na na na 2.0 65.8 67.8 1,841 25-29 2.5 60.6 63.1 29.2 45.6 74.8 51.7 27.3 79.0 5.3 59.0 64.3 3,847 30-34 4.0 57.6 61.6 36.5 38.7 75.2 79.1 9.1 88.2 21.6 46.8 68.4 4,471 35-39 5.2 56.9 62.1 35.5 32.3 67.8 76.2 5.5 81.7 37.9 32.5 70.4 4,897 40-44 5.7 54.9 60.6 38.8 28.4 67.2 71.5 4.8 76.3 46.5 23.5 70.0 3,315 45-49 7.2 56.1 63.3 44.1 30.2 74.3 70.8 4.0 74.8 54.9 18.1 73.0 2,041 Urban-rural residence Urban 2.1 45.7 47.8 27.6 26.5 54.1 57.8 4.6 62.4 21.2 31.5 52.7 7,803 Rural 4.3 68.2 72.5 42.7 38.9 81.6 83.3 5.9 89.2 31.7 46.8 78.5 12,825 Place of residence Urban Governorates 1.1 38.8 39.9 19.7 25.2 44.9 50.4 4.6 55.0 16.8 27.8 44.6 3,015 Lower Egypt 0.9 61.2 62.1 33.9 37.2 71.1 74.3 5.1 79.4 26.4 41.9 68.3 8,385 Urban 0.4 42.3 42.7 22.8 26.3 49.1 51.4 5.7 57.1 18.6 29.3 47.9 1,996 Rural 1.0 66.8 67.8 37.6 40.8 78.4 81.7 4.9 86.6 28.8 45.9 74.7 6,388 Upper Egypt 6.7 66.3 73.0 45.8 35.1 80.9 81.1 6.0 87.1 32.8 45.2 78.0 8,963 Urban 4.4 57.2 61.6 40.6 29.4 70.0 71.2 3.8 75.0 28.3 38.3 66.6 2,636 Rural 7.6 70.0 77.6 47.8 37.4 85.2 85.4 6.9 92.3 34.7 48.1 82.8 6,327 Frontier Governorates 3.0 32.4 35.4 34.1 12.1 46.2 55.4 2.7 58.1 22.6 20.7 43.3 265 Education No education 5.6 73.4 79.0 45.8 39.5 85.3 83.8 6.0 89.8 39.1 44.7 83.8 8,204 Some primary 3.4 72.2 75.6 38.2 43.8 82.0 77.4 5.9 83.3 36.0 43.6 79.6 2,393 Primary complete/some secondary 3.9 64.5 68.4 37.4 33.0 70.4 76.2 5.1 81.3 24.8 46.5 71.3 2,750 Secondary complete/higher 1.7 44.4 46.1 24.0 23.5 47.5 47.9 3.9 51.8 13.3 34.0 47.3 7,281 Work status Working for cash 2.5 49.2 51.7 26.7 29.1 55.8 56.9 5.0 61.9 24.4 31.3 55.7 3,470 Not working for cash 3.7 61.5 65.2 39.5 35.5 75.0 77.7 5.5 83.2 28.4 43.0 71.4 17,158 Wealth quintile Lowest 4.5 76.2 80.7 40.0 47.5 87.5 82.9 8.0 90.9 33.1 51.9 85.0 4,592 Second 5.2 69.9 75.1 47.9 35.1 83.0 85.7 5.1 90.8 34.1 46.6 80.7 4,203 Middle 4.2 64.9 69.1 44.3 34.5 78.8 81.8 4.1 85.9 30.3 44.6 74.9 4,162 Fourth 2.0 51.1 53.1 31.2 34.1 65.3 69.7 5.8 75.5 23.6 37.2 60.8 4,017 Highest 1.1 31.6 32.7 20.3 15.9 36.2 41.7 3.1 44.8 15.3 21.1 36.4 3,653 Total 3.5 59.7 63.2 37.0 34.2 71.2 73.6 5.4 79.0 27.7 41.0 68.7 20,628 na = Not applicable Fem ale C ircum cision | 213 214 | Female Circumcision The proportion of girls who are currently circumcised or expected to be circumcised in the future decreases with the mother’s educational attainment and with wealth status. Notably, 36 percent of girls in the highest wealth quintile are expected to be circumcised by the time they reach age 18 compared to 85 percent of girls in the lowest wealth quintile. The results in Table 16.3 also show that there are marked differences within subgroups by cohort in the expected prevalence of circumcision, i.e., the sum of the percentage already circumcised and the percentage whose mothers express an intention to circumcise the girls in the future. For all groups, however, the expected prevalence is highest among girls age 12-17 and lowest among girls less than 9 years of age. For example, the expected prevalence declines from a level of 62 percent among urban girls age 12-17 to 48 percent among urban girls under age 9. Cohort trends in circumcision levels are evident even for groups where the prevalence of circumcision remains high, e.g., among girls in rural Upper Egypt, the expected prevalence decreases from 92 percent among girls 12-17 years to 78 percent among girls under age 9. 16.2 CIRCUMCISION EXPERIENCE OF DAUGHTERS As part of the circumcision history, EDHS respondents were asked about the age at which the daughter had been circumcised and the person who performed the circumcision for each of the daughters reported as circumcised. Table 16.4 presents the distribution of the circumcised girls 0-17 years according to the age at circumcision. More than half of the girls were between seven and ten years of age at the time of circumcision, and virtually all girls were circumcised before age 13. The median age at the time of the circumcision for daughters is 10 years, with girls tending to be circumcised at a somewhat younger age in Upper Egypt and a somewhat older age in Lower Egypt than this average. Table 16.4 Age at circumcision among girls by residence Percent distribution of girls age 0-17 years reported by their mother to have been circumcised by age at circumcision, according to urban-rural residence and place of residence Egypt 2005 Lower Egypt Upper Egypt Age at circumcision Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total <3 2.0 3.6 0.6 0.3 0.4 0.3 5.8 3.8 6.4 0.4 3.1 3-4 2.0 4.1 0.7 0.5 0.6 0.5 6.3 3.7 7.1 3.9 3.5 5-6 9.4 11.6 6.5 4.0 2.2 4.3 17.0 14.9 17.8 9.2 11.0 7-8 17.5 16.4 17.3 13.5 11.7 13.8 18.8 19.8 18.5 28.3 16.7 9-10 42.7 38.7 51.3 50.3 44.0 51.6 29.9 35.9 27.9 46.0 39.9 11-12 21.6 19.1 19.1 24.9 36.0 22.7 16.3 16.9 16.0 11.2 19.8 13-14 3.4 4.8 4.1 5.3 4.1 5.5 3.9 2.7 4.3 0.4 4.4 15-17 0.4 0.7 0.0 0.4 0.0 0.5 0.8 1.0 0.8 0.3 0.6 Don’know/missing 1.0 1.0 0.3 0.8 1.1 0.7 1.2 1.4 1.2 0.2 1.0 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 1,658 4,062 507 2,213 371 1,843 2,940 747 2,193 60 5,720 Median age 10.0 10.0 10.0 10.4 10.7 10.4 9.1 9.4 9.0 9.5 10.0 Regarding the person performing the circumcision, Table 16.5 shows that trained medical personnel performed almost three-quarters of the circumcisions. Dayas (traditional birth attendants) performed the majority of the remaining circumcisions. Dayas performed more circumcisions in rural Upper Egypt than in other areas; however, even in rural Upper Egypt, the majority of all circumcisions were performed by medical personnel. Female Circumcision | 215 Table 16.5 Person performing circumcisions among girls by residence Percent distribution of girls age 0-17 years reported by their mother to have been circumcised by persons performing the circumcision, according to urban-rural residence and place of residence Egypt 2005 Lower Egypt Upper Egypt Person performing circumcision Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Doctor 72.5 65.6 69.9 71.1 75.6 70.2 64.7 72.5 62.0 62.2 67.6 Nurse/other health worker 8.1 6.4 10.1 8.2 9.9 7.9 5.3 5.9 5.1 12.6 6.9 Daya 17.5 24.4 19.2 16.2 12.2 17.0 27.7 19.4 30.5 22.0 22.4 Barber 0.4 1.5 0.0 2.3 0.4 2.7 0.6 0.6 0.6 1.1 1.2 Ghagaria 0.0 0.6 0.0 0.9 0.0 1.1 0.1 0.1 0.1 1.2 0.4 Other 0.2 0.1 0.0 0.2 0.0 0.2 0.1 0.3 0.0 0.0 0.1 Don't know 1.2 1.3 0.8 1.1 1.9 0.9 1.5 1.2 1.6 0.9 1.3 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 1,658 4,062 507 2,213 371 1,843 2,940 747 2,193 60 5,720 16.3 SUPPORT FOR FEMALE CIRCUMCISION The 2005 EDHS obtained information about whether the practice of circumcision was perceived to be required by religious precepts or not, whether women themselves believed the practice of female circumcision should be continued or not, and whether they think men support continuation of the practice. Table 16.6 shows six in ten ever-married women age 15-49 believe that female circumcision is a religious requirement. The percentage of women considering circumcision to be required by religion tends to increase with age, and it is higher among rural than urban women. Women who have a secondary or higher education are much less likely than less educated women to believe that circumcision is mandated by religion. Women in the highest wealth quintile are the least likely to consider circumcision to be required by religion. According to results of the 2005 EDHS, two-thirds of ever-married women age 15-49 feel that the practice of circumcision should continue. Fifty-four percent of women believe that men support continuation of the practice of circumcision. Marked differences in these indicators are evident according to the woman’s background characteristics. Urban residents are less likely than rural residents to believe circumcision should be continued or to feel men support continuation of the practice. Both a woman’s educational level and wealth status are negatively related to the likelihood that she supports the continuation of the practice of circumcision or believes that men want the practice to be continued. Although support for circumcision is still widespread among women, Figure 16.1 shows there has been some change over time in women’s attitudes about circumcision. Fewer women supported continua- tion of the practice at the time of the 2005 survey than in 2000 or in 1995. Women also were less likely to believe that men wanted the practice to continue in 2005 than in 2000. 216 | Female Circumcision Table 16.6 Attitude about continuation of female circumcision by background characteristics Percentage of women age 15-49 who believe circumcision is required by religious precepts and percent distributions of ever-married women age 15-49 by the woman’s own attitude and their perceptions about men's attitude toward the continuation of the practice of female circumcision, according to selected background characteristics, Egypt 2005 Women's attitude about practice Women's perception about men's attitudes Background characteristic Percentage saying circumcision is required by religious precepts Continue Be stopped Not sure Total percent Continue Be stopped Not sure Total percent Number of ever- married women Age 15-19 57.8 70.0 17.7 12.3 100.0 54.1 13.4 32.5 100.0 803 20-24 59.1 67.3 22.3 10.5 100.0 53.7 16.8 29.5 100.0 2,968 25-29 59.1 66.0 24.0 10.0 100.0 53.6 19.9 26.5 100.0 3,785 30-34 60.3 65.9 24.6 9.5 100.0 55.1 20.7 24.2 100.0 3,209 35-39 61.5 68.0 23.1 8.9 100.0 53.5 21.0 25.5 100.0 3,191 40-44 63.0 67.8 24.5 7.8 100.0 53.3 23.0 23.7 100.0 2,859 45-49 63.1 70.4 22.5 7.1 100.0 56.8 20.5 22.7 100.0 2,659 Urban-rural residence Urban 52.6 55.3 35.0 9.6 100.0 44.3 30.4 25.2 100.0 8,033 Rural 66.5 76.1 15.0 8.8 100.0 61.2 12.7 26.1 100.0 11,441 Place of residence Urban Governorates 50.2 49.3 41.6 9.0 100.0 37.1 39.8 23.1 100.0 3,293 Lower Egypt 63.1 67.6 22.5 9.8 100.0 55.9 16.4 27.8 100.0 8,410 Urban 52.0 52.6 35.8 11.6 100.0 45.6 25.3 29.1 100.0 2,199 Rural 67.0 73.0 17.8 9.2 100.0 59.5 13.2 27.3 100.0 6,211 Upper Egypt 63.1 75.9 15.5 8.6 100.0 60.3 14.8 24.9 100.0 7,552 Urban 56.8 66.7 24.5 8.8 100.0 53.4 21.5 25.1 100.0 2,411 Rural 66.1 80.2 11.3 8.5 100.0 63.5 11.6 24.9 100.0 5,141 Frontier Governorates 48.7 48.7 44.9 6.5 100.0 41.8 43.3 14.9 100.0 218 Education No education 68.1 80.6 11.3 8.1 100.0 64.4 11.1 24.5 100.0 6,740 Some primary 68.4 77.6 13.2 9.3 100.0 59.0 14.1 26.8 100.0 2,197 Primary complete/some secondary 62.1 69.9 21.9 8.2 100.0 56.8 18.0 25.2 100.0 2,719 Secondary complete/higher 51.8 52.7 37.0 10.3 100.0 43.3 30.0 26.7 100.0 7,818 Work status Working for cash 54.3 55.9 35.5 8.6 100.0 44.7 31.0 24.3 100.0 3,288 Not working for cash 62.1 69.9 20.8 9.3 100.0 56.2 17.8 26.0 100.0 16,186 Wealth quintile Lowest 68.1 81.9 9.2 8.9 100.0 64.1 9.4 26.5 100.0 3,565 Second 67.3 78.6 12.6 8.8 100.0 63.2 11.8 25.0 100.0 3,778 Middle 64.9 73.3 17.5 9.2 100.0 59.2 15.4 25.4 100.0 3,931 Fourth 59.0 62.9 27.3 9.8 100.0 50.8 21.8 27.4 100.0 4,137 Highest 46.0 43.7 47.2 9.1 100.0 36.1 39.6 24.3 100.0 4,063 Total 60.8 67.5 23.3 9.2 100.0 54.3 20.0 25.7 100.0 19,474 Female Circumcision | 217 16.4 REASONS FOR SUPPORT OF FEMALE CIRCUMCISION To gain a better understanding of Egyptian women’s reasons for supporting the practice of circumcision, the EDHS included several statements about circumcision with which women were asked to agree or disagree. Table 16.7 shows that around 60 percent of ever-married women age 15-49 think that the husband prefers the wife to be circumcised. Furthermore, many women see circumcision as ensuring that a woman will remain faithful to her husband; around half of women agree that circumcision prevents adultery. The results in Table 16.7 also suggest that comparatively few women recognize potential adverse consequences of the practice for women. For example, 32 percent of women agree with the statement that circumcision can cause severe complications that may lead to a girl’s death. An even smaller proportion of women believe that childbirth is more difficult for circumcised women than for other women (13 percent). Table 16.7 shows that women living in rural areas in Upper Egypt and women in the lowest wealth quintile are most likely to believe that men prefer wives to be circumcised (75 percent and 74 percent, respectively). Women in the highest wealth quintile and women living in the Urban Governorates are least likely to share this belief; however even among these groups, around four in ten women agree that men prefer their wives to be circumcised. Except for women in the highest wealth quintile, more than four in ten women in all of the subgroups shown in Table 16.7 believe that circumcision prevents adultery. 82 75 68 61 54 1995 2000 2005 Wants practice to continue Believes men want practice to continue Figure 16.1 Trends in Attitudes toward Female Circumcision, Egypt 1995-2005 EDHS 2005 1995 218 | Female Circumcision Table 16.7 Beliefs about female circumcision by background characteristics Percentage of ever-married women age 15-49 who agree with various statements about female circumcision, according to selected background characteristics, Egypt 2005 Background characteristic Husbands prefer Prevents adultery Can lead to girl's death Makes childbirth difficult Number of ever-married women Age 15-19 62.9 52.0 28.1 14.1 803 20-24 61.9 54.6 30.1 13.4 2,968 25-29 61.2 52.5 33.2 12.7 3,785 30-34 60.9 54.7 36.2 13.5 3,209 35-39 61.3 54.9 32.8 12.9 3,191 40-44 59.0 54.1 32.1 13.6 2,859 45-49 62.9 55.7 30.5 12.4 2,659 Urban-rural residence Urban 49.4 47.2 38.6 12.1 8,033 Rural 69.6 59.1 28.1 13.8 11,441 Place of residence Urban Governorates 42.5 42.3 45.6 13.5 3,293 Lower Egypt 61.5 54.9 39.9 15.4 8,410 Urban 49.2 46.4 47.5 12.7 2,199 Rural 65.8 57.9 37.3 16.4 6,211 Upper Egypt 69.7 59.0 18.1 10.3 7,552 Urban 59.5 55.3 20.5 9.3 2,411 Rural 74.5 60.7 17.0 10.8 5,141 Frontier Governorates 44.2 43.4 40.1 14.5 218 Education No education 72.8 61.0 22.1 13.4 6,740 Some primary 67.8 62.0 25.1 13.3 2,197 Primary complete/some secondary 63.1 56.6 29.7 14.0 2,719 Secondary complete/Higher 48.9 45.3 44.3 12.5 7,818 Work status Working for cash 49.0 45.9 44.2 13.5 3,288 Not working for cash 63.8 55.9 30.0 13.0 16,186 Wealth quintile Lowest 74.3 57.9 21.4 14.6 3,565 Second 71.9 64.0 24.6 13.6 3,778 Middle 65.2 60.0 29.3 13.8 3,931 Fourth 56.5 51.8 36.3 11.8 4,137 Highest 40.9 38.8 48.5 12.1 4,063 Total 61.3 54.2 32.4 13.1 19,474 The belief that circumcision may lead to a girl’s death is more prevalent among urban women, highly educated women, women working for cash, and women in the highest wealth quintile than among other women in Egypt. However, even in these groups, the majority of women do not believe that circumcision has this adverse consequence. 16.5 EXPOSURE TO INFORMATION ABOUT CIRCUMCISION Table 16.8 summarizes findings from the EDHS concerning women’s exposure to information about female circumcision and the channels through which women received information about circumcision during the six-month period prior to the survey. Eight in ten women had received information about female circumcision during the six months prior to the survey. Urban women, highly educated women, women working for cash, and women in the highest wealth quintile were more likely than other women to have received information about circumcision during the period. Female Circumcision | 219 Regarding sources of information about circumcision, television was the primary source of information. Among ever-married women, 93 percent reported that they received information about female circumcision on television, and 19 percent had received information from their husband, other relatives or friends and neighbors. Relatively few women cited other media or contacts with health providers as a source from which they had received information about circumcision. Table 16.8 Exposure to information regarding female circumcision by background characteristics Percentage of ever-married women age 15-49 receiving information about female circumcision during the six-month period prior to the survey, and percentage of women receiving any information naming various sources of information, according to background characteristics, Egypt 2005 Source from which women saw/heard about female circumcision Health worker Background characteristic Percentage receiving information recently about female circumcision Number of ever- married women TV Other media1 Any contact Home visit Facility visit Husband/ other relatives/ friends/ neighbors Other2 Number of ever-married women receiving information about female circumcision recently Age 15-19 71.8 803 92.8 3.8 0.8 0.0 0.8 16.7 0.8 577 20-24 76.5 2,968 93.1 4.2 3.0 0.3 2.8 19.4 0.9 2,272 25-29 80.6 3,785 93.5 6.6 3.6 0.5 3.3 18.1 0.6 3,052 30-34 82.5 3,209 92.8 7.1 4.7 0.4 4.3 21.4 1.4 2,646 35-39 81.1 3,191 92.8 7.5 3.8 0.5 3.4 19.7 0.9 2,587 40-44 80.2 2,859 91.1 8.8 4.0 0.3 3.8 19.1 1.5 2,294 45-49 77.9 2,659 93.7 6.6 3.4 0.5 2.9 17.8 0.9 2,070 Urban-rural residence Urban 86.0 8,033 94.4 8.1 4.4 0.3 4.2 17.6 1.1 6,905 Rural 75.1 11,441 91.6 5.6 3.0 0.4 2.7 20.5 0.9 8,592 Place of residence Urban Governorates 88.3 3,293 93.3 8.9 5.7 0.3 5.4 17.9 1.3 2,908 Lower Egypt 76.9 8,410 92.6 9.8 3.4 0.4 3.1 20.6 0.8 6,471 Urban 82.4 2,199 95.0 12.8 4.3 0.4 4.1 18.8 1.1 1,812 Rural 75.0 6,211 91.6 8.7 3.1 0.4 2.7 21.3 0.6 4,659 Upper Egypt 79.0 7,552 93.0 2.3 2.9 0.4 2.6 18.3 1.1 5,965 Urban 86.6 2,411 95.3 3.0 2.7 0.3 2.5 16.2 0.8 2,087 Rural 75.4 5,141 91.8 1.9 3.0 0.5 2.6 19.4 1.2 3,878 Frontier Governorates 70.5 218 90.5 3.7 4.7 0.1 4.6 20.0 0.9 154 Education No education 71.5 6,740 90.3 3.4 2.4 0.4 2.1 19.8 1.0 4,818 Some primary 76.7 2,197 91.3 3.2 3.2 0.3 2.9 20.8 0.7 1,686 Primary complete/some secondary 80.7 2,719 92.4 4.2 2.3 0.2 2.1 22.3 1.0 2,193 Secondary complete/higher 87.0 7,818 95.3 10.7 5.1 0.4 4.8 17.3 1.1 6,800 Work status Working for cash 84.3 3,288 92.2 12.2 8.9 1.0 8.2 19.8 1.3 2,773 Not working for cash 78.6 16,186 93.0 5.5 2.5 0.3 2.3 19.0 0.9 12,724 Wealth quintile Lowest 68.4 3,565 88.1 3.2 3.3 0.5 2.8 22.9 0.9 2,438 Second 75.5 3,778 91.4 3.5 2.3 0.4 1.9 20.1 0.7 2,851 Middle 77.8 3,931 93.0 4.6 3.3 0.4 2.9 18.3 0.8 3,060 Fourth 85.2 4,137 94.9 7.5 3.9 0.3 3.7 18.4 1.3 3,527 Highest 89.2 4,063 95.2 12.5 5.1 0.3 4.8 17.5 1.2 3,622 Total 79.6 19,474 92.9 6.7 3.7 0.4 3.3 19.2 1.0 15,497 1 Includes radio, newspaper, magazine, pamphlet, brochure or poster 2 Includes community meeting, religious leader and other responses Domestic Violence | 221 DOMESTIC VIOLENCE 17 17.1 INTRODUCTION Domestic violence against women has been acknowledged worldwide as a violation of basic human rights, and an increasing amount of research highlights the health burdens, intergenerational effects, and demographic consequences of such violence (United Nations General Assembly, 1991; Heise et al., 1994, 1998; Jejeebhoy, 1998). The 2005 EDHS included a special module designed to obtain information on the extent to which women in Egypt experience domestic violence. The domestic violence module was administered in interviews conducted with eligible women in the households included in the subsample selected for the anemia-testing component of the survey. To ensure confidentiality, only one woman in each household in the subsample was selected to be asked questions about domestic violence. The module included a series of questions to collect information on various forms of marital violence including physical and emotional violence. Although the module focused on the extent of marital violence, information also was obtained on any physical violence involving perpetrators other than the current (last) husband that the woman experienced since her fifteenth birthday. Women who reported recent marital violence were asked about assistance they may have sought at the time the most recent episode of violence occurred. The chapter also considers information collected from EDHS respondents about their attitudes toward marital violence. 17.2 PHYSICAL VIOLENCE Prevalence of Physical Violence Nearly half of ever-married women age 15-49 reported that they had been hit, slapped, kicked, or subjected to some other form of physical violence at some point after their fifteenth birthday (Table 17.1). About one-fifth of the women reported that they had been subjected to some form of physical violence within the 12-month period before the survey interview, including seven percent who reported that they had often experienced some form of physical violence during the period. Women age 20 and older were somewhat more likely than women age 15-19 to report ever experiencing physical violence. Women age 45-49 were the least likely to have been subject to violence in the year preceding the survey. A woman’s marital status was strongly related to the likelihood that she had ever experienced physical violence; 75 percent of divorced or separated women reported at least one episode of physical violence after age 15 compared to 43 percent of women who were widowed and 47 percent of currently married women. Currently married women were more likely to have been subjected to acts of violence within the 12-month period before the survey than other women. Although urban and rural women were equally likely to have ever experienced physical violence, rural women were somewhat more likely than urban women to report a recent episode, i.e., within the 12-month period before the survey (25 percent and 19 percent, respectively). Women living in the Frontier Governorates were less likely than women living in the Urban Governorates or in the governorates in Lower and Upper Egypt to report having ever or recently experienced physical violence. 222 | Domestic Violence Table 17.1 Experience of physical violence since age 15 by background characteristics Percentage of ever-married women who have ever experienced physical violence since age 15 and percentage who experienced physical violence during the 12 months preceding the survey, by background characteristics, Egypt 2005 Percentage who have experienced physical violence since age 15 In past 12 months Background characteristic Ever Often Sometimes Number of women Age 15-19 40.0 7.4 14.1 251 20-29 47.1 7.4 19.2 1,871 30-39 49.3 7.7 16.2 1,876 40-49 46.7 5.4 11.5 1,614 Marital status Married 46.8 7.2 16.5 5,240 Divorced/separated 75.0 6.7 10.0 158 Widowed 42.9 0.0 1.5 215 Urban-rural residence Urban 47.4 6.0 13.2 2,339 Rural 47.4 7.5 17.6 3,274 Place of residence Urban Governorates 49.9 6.5 14.5 931 Lower Egypt 49.9 6.8 17.0 2,456 Urban 47.6 4.4 12.9 666 Rural 50.7 7.8 18.5 1,789 Upper Egypt 43.8 7.2 15.0 2,161 Urban 44.2 7.0 11.8 703 Rural 43.6 7.3 16.5 1,458 Frontier Governorates 38.8 4.7 11.9 66 Education No education 51.6 9.4 19.0 1,923 Some primary 58.6 8.9 17.1 649 Primary complete/some secondary 52.3 8.0 19.0 780 Secondary complete/higher 39.0 3.8 11.5 2,262 Work status Working for cash 44.3 6.1 11.3 973 Not working for cash 48.1 7.1 16.7 4,640 Wealth quintile Lowest 51.0 9.2 19.9 1,048 Second 52.8 8.1 20.7 1,018 Middle 47.5 7.8 16.2 1,129 Fourth 48.7 6.2 13.6 1,226 Highest 38.4 3.8 9.6 1,192 Total 47.4 6.9 15.7 5,613 The prevalence of physical violence was just under 40 percent among women with a secondary or higher education compared to more than 50 percent among less-educated women. Women who worked for cash were slightly less likely than other women to report physical violence. The prevalence of physical violence decreased with the wealth quintile. Domestic Violence | 223 Perpetrators of Physical Violence Table 17.2 shows the proportions of women who ever experienced violence according to the persons identified as perpetrators of the violence. Husbands were named most frequently; more than seven in ten women identified their current or a previous husband as the perpetrator in at least one episode of physical violence. More than four in ten women had been hit, slapped, kicked, or subjected to some other form of physical violence by male perpetrators other than a husband. The woman’s father and brother(s) were most frequently mentioned as the perpetrators, with fathers named twice as often as brothers by the women reporting the violence (53 percent and 23 percent, respectively) (not shown in table). Thirty-six percent indicated that a female—most often the woman’s mother—was responsible for at least one episode of physical violence. Table 17.2 Perpetrators of physical violence Percentage of women reporting physical violence by perpetrator of the violence and current marital status, Egypt 2005 Marital status Current/ previous husband Male perpetrator other than husband Female perpetrator Number of women ever experiencing violence Currently married 71.2 45.8 37.1 2,452 Divorced/separated 91.2 29.2 18.8 118 Widowed 71.1 30.7 25.1 92 Total 72.1 44.6 35.9 2,662 Violence during Pregnancy Violence during pregnancy may threaten not only a woman’s well-being but that of her unborn child. Table 17.3 presents information on the proportion of Egyptian women who have experienced some form of physical violence during pregnancy. Among women who had ever been pregnant, the table shows that six percent were hit, slapped, kicked, or subjected to some other form of physical violence at least once during a pregnancy. Women who were divorced were most likely to report violence during pregnancy. Women with a secondary or higher education and women in the highest wealth quintile were least likely to have experienced an episode of violence when they were pregnant. Among the women who reported violence during pregnancy, around 81 percent identified the husband (current/previous) as the perpetrator of the violent act(s) experienced during pregnancy (not shown in table). Besides the husband, in-laws were named most often as perpetrators of the violence; five percent named the mother-in-law and three percent the father-in-law as responsible for the violent acts they suffered during pregnancy. 224 | Domestic Violence Table 17.3 Violence during pregnancy Among women who have ever been pregnant, percentage ever experiencing physical violence during pregnancy, by background characteristics, Egypt 2005 Background characteristic Percentage ever experiencing physical violence during pregnancy Number of ever- pregnant women Age 15-29 6.3 1,925 30-39 6.2 1,813 40-49 5.9 1,549 Marital status Married 5.6 4,954 Divorced 27.6 136 Separated/widowed 4.8 198 Urban-rural residence Urban 5.5 2,222 Rural 6.7 3,066 Place of residence Urban Governorates 6.0 875 Lower Egypt 5.7 2,311 Urban 4.3 639 Rural 6.2 1,672 Upper Egypt 6.8 2,041 Urban 5.9 672 Rural 7.2 1,369 Frontier Governorates 4.6 61 Education No education 8.2 1,831 Some primary 10.1 622 Primary complete/some secondary 5.5 724 Secondary complete/higher 3.4 2,111 Work status Working for cash 6.7 923 Not working for cash 6.0 4,365 Wealth quintile Lowest 8.8 1,003 Second 8.2 954 Middle 6.7 1,065 Fourth 4.5 1,142 Highest 3.2 1,124 Total 6.2 5,288 17.3 MARITAL VIOLENCE Prevalence of Various Forms of Marital Violence The domestic violence module obtained more detailed information on the forms of violence ever- married women had experienced in the relationships with their current husband or, in the case of widowed, divorced, or separated women, their most recent husband. Table 17.4 shows the proportions of women reporting they had ever and recently experienced episodes of emotional, physical, and sexual violence in their relationship with their husband. Domestic Violence | 225 Physical violence is the most common form of violence, with one-third of ever-married women reporting being subjected to some form of physical violence at least once by their current or most recent husband, and 20 percent reporting the most recent episodes of violence had taken place within the 12 months preceding the survey. Among six percent of the women, episodes of violence occurred often during that period. Table 17.4 Forms of marital violence Percentage of ever-married women reporting that they ever or recently experienced various forms of violence in their relationship with their current/most recent husband, Egypt 2005 In past 12 months Forms of violence Ever Often Sometimes Physical violence Any1 33.2 5.9 14.5 Any moderately violent act(s)1 33.2 5.9 14.4 Pushed or shook woman or threw something at her 25.7 4.1 10.0 Slapped her or twisted her arm 28.1 4.2 10.6 Punched her with fist or other object 12.9 2.5 4.5 Kicked or dragged her 5.9 1.4 1.8 Any severely violent act(s)1 1.6 0.3 0.4 Tried to strangle/burn her 1.0 0.2 0.3 Threatened her with a knife, gun, or other weapon 0.9 0.2 0.1 Attacked her with a knife, gun, or other weapon 0.5 0.1 0.0 Sexual violence Physically forced to have sex 6.6 1.8 2.0 Emotional violence Any1 17.5 4.1 6.6 Said or did something to humiliate woman 17.1 3.9 6.1 Threatened harm to woman herself/person close to her 6.2 1.4 2.0 Any form of physical and/or sexual violence1 33.7 6.5 15.2 Any form of emotional, physical, and/or sexual violence1 35.9 7.7 17.0 Number of ever-married women 5,613 5,613 5,613 1 Composite violence indicators are considered to have taken place often in the 12-month period if any of the component acts of violence occurred often. The indicators are considered to have taken place “sometimes” if all of the component acts took place only sometimes. The results indicate that the most common forms of physical violence included being slapped or having her arm twisted (28 percent), being pushed or shaken or having objects thrown at her by the husband (26 percent); and being punched with the fist or another object (13 percent). Around two percent of the women were the subject of extremely violent acts including being burned or strangled, or threatened or attacked with some type of weapon. 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. Table 17.4 also indicates that 18 percent of ever-married women reported they had ever experienced emotional violence, and 11 percent had experienced a recent episode of emotional 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 threatened them or someone close to them with physical harm. 226 | Domestic Violence Violence by husbands against wives is not the only form of spousal violence; women may sometimes be the perpetrators of violence. To measure spousal violence by women, the 2005 EDHS asked ever-married women, “Have (did) you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband?” This line of questioning may result in some underreporting if women find it difficult to admit that they themselves initiated violence. Results show that less than one percent of ever- married women report initiating violence against their husbands (not shown in table). Differentials in Prevalence of Marital Violence Table 17.5 presents differences in the levels of various forms of marital violence by background characteristics, and Table 17.6 shows differences in the levels of violence by spousal characteristics. Table 17.5 Marital violence by background characteristics Percentage of ever-married women who have experienced emotional, physical, or sexual violence at the hands of their current or most recent husband and who recently have been physically violent towards their current/most recent husband, by background characteristics, Egypt 2005 Form of violence Emotional Physical Sexual Any Background characteristic Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Number of ever-married women Age 15-19 8.7 6.5 19.7 15.8 2.8 2.8 20.9 17.2 251 20-29 16.3 10.9 31.6 21.4 6.3 4.2 34.5 23.5 1,871 30-39 18.5 11.2 35.9 19.1 7.3 4.7 38.8 22.3 1,876 40-49 19.0 8.9 34.1 13.9 6.9 2.7 36.7 15.9 1,614 Marital status Married 16.6 10.6 32.4 19.1 6.2 4.1 35.1 21.6 5,240 Divorced/separated 51.9 11.9 67.5 13.5 23.0 1.8 69.1 15.4 158 Widowed 14.0 0.3 28.9 0.9 5.5 0.0 31.3 0.9 215 Urban-rural residence Urban 15.4 8.6 31.0 15.2 5.5 2.8 33.8 17.5 2,339 Rural 19.0 11.5 34.8 20.4 7.5 4.6 37.5 22.9 3,274 Place of residence Urban Governorates 14.9 7.8 32.6 15.3 5.5 2.6 34.8 16.9 931 Lower Egypt 19.7 11.6 35.6 19.6 8.9 5.5 38.4 22.8 2,456 Urban 17.3 9.1 31.4 15.0 6.7 3.2 35.2 18.9 666 Rural 20.6 12.5 37.1 21.4 9.8 6.4 39.7 24.2 1,789 Upper Egypt 16.2 9.8 31.0 18.0 4.5 2.5 33.8 20.1 2,161 Urban 14.5 9.0 28.6 15.3 4.2 2.6 31.4 17.2 703 Rural 17.1 10.2 32.1 19.2 4.6 2.4 35.0 21.4 1,458 Frontier Governorates 12.5 7.5 27.8 13.8 7.0 5.2 29.1 14.9 66 Education No education 23.4 13.7 40.0 22.5 7.2 4.1 42.9 25.1 1,923 Some primary 24.5 13.6 42.8 20.8 9.1 4.8 45.6 24.6 649 Primary complete/some secondary 16.6 11.4 38.7 22.0 8.1 4.7 42.0 25.2 780 Secondary complete/higher 10.7 6.0 22.8 12.5 4.9 3.1 25.1 14.2 2,262 Work status Working for cash 16.6 8.6 28.8 13.4 6.6 2.9 31.3 15.3 973 Not working for cash 17.7 10.6 34.2 19.2 6.6 4.1 36.9 21.8 4,640 Wealth quintile Lowest 23.8 15.3 38.9 22.9 6.8 4.4 42.1 26.3 1,048 Second 21.3 12.7 38.5 22.3 8.9 5.0 41.2 25.8 1,018 Middle 19.4 11.4 36.1 20.3 7.3 4.9 39.6 22.7 1,129 Fourth 14.7 7.7 32.2 16.3 7.1 3.9 34.0 18.1 1,226 Highest 9.6 5.2 22.0 10.6 3.5 1.5 24.6 12.0 1,192 Total 17.5 10.2 33.2 18.2 6.6 3.9 35.9 20.7 5,613 Domestic Violence | 227 The results in Table 17.5 indicate that women age 15-19, women with a secondary or higher education, and women in the highest wealth quintile were less likely to have ever experienced any form of marital violence than other women. As Table 17.6 shows, violence was somewhat more common if the couple was close in age, i.e., the difference in their age was less than two years. Marital violence was somewhat less likely if the woman’s husband was a first or second cousin, particularly a paternal cousin, than if the woman and her husband were more distantly related or not related by blood at all. Marital violence tended to be more likely if the husband had less than a secondary education. Marital violence was least common among couples who have achieved the same level of education and most common among couples where both the husband and the wife never attended school. Table 17.6 Marital violence by spousal characteristics Percentage of ever-married women who have recently experienced emotional, physical, or sexual violence at the hands of their current or most recent husband and who recently have been physically violent towards their current/most recent husband, by selected spousal characteristics, Egypt 2005 Form of violence Emotional Physical Sexual Any Spousal characteristics Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Ever Within past 12 months Percentage who have recently been physically violent towards husband Number of ever- married women Age difference < 2 years 20.9 13.5 38.9 23.3 8.3 5.4 42.2 28.2 0.3 537 2-4 years 17.3 10.4 32.9 19.2 6.3 3.3 35.6 21.4 0.3 1,282 5-9 years 14.7 9.6 31.1 18.5 5.8 4.4 33.6 21.1 0.5 2,087 10 years or more 17.2 11.2 31.2 18.0 5.8 3.9 34.1 20.1 0.5 1,334 Age unknown 30.1 5.3 45.2 6.2 12.9 0.7 47.3 7.0 0.2 373 Relationship to current (last) husband1 Paternal cousin 12.9 8.4 28.4 15.2 6.3 4.6 31.0 17.1 0.3 394 Maternal cousin 17.1 9.4 32.5 17.8 4.9 2.0 34.9 20.1 0.1 962 Other blood relative 18.9 12.4 37.6 23.3 10.4 6.1 40.4 26.3 0.7 420 Related by marriage 13.7 3.2 35.1 24.8 2.2 1.8 35.9 25.2 0.0 85 Not related 18.0 10.6 33.4 17.9 6.8 4.0 36.2 20.4 0.5 3,745 Husband's education No education 26.3 15.0 42.7 23.9 8.3 4.5 45.1 26.1 0.2 1,309 Some primary 20.9 12.3 35.6 16.7 7.7 4.7 39.4 21.0 0.2 727 Primary complete/some secondary 18.4 12.1 41.8 23.7 8.5 5.2 45.0 27.1 0.6 974 Secondary complete/higher 11.7 6.5 24.6 13.8 4.8 2.8 27.0 15.4 0.6 2,590 Educational differences Husband higher than wife 18.3 11.3 36.7 20.3 7.3 4.2 39.8 23.2 0.6 1,879 Wife higher than husband 19.6 12.0 37.7 20.6 9.2 4.8 40.3 22.9 0.2 866 Husband-wife same level 11.0 6.0 23.4 12.1 4.3 2.8 25.9 14.3 0.5 1,885 Both no education 26.6 14.9 41.8 24.1 7.4 4.6 44.2 26.1 0.2 969 Total 17.5 10.2 33.2 18.2 6.6 3.9 35.9 20.7 0.4 5,613 Note: Total includes 5 cases for which information on relationship to the husband is missing and 13 cases for which information on the husband’s educational level was missing. 228 | Domestic Violence Adverse Physical Consequences of Marital Violence Around one-third of women experiencing at least one episode of physical violence at the hands of their husbands reported that they suffered from bruises or aches as an outcome of the violence, and 10 percent reported they had a broken bone or suffered other injury as a result of the violence (not shown in table). Five percent of the women indicated that they sought medical assistance as a result of the violence. Help-Seeking Behavior The 2005 EDHS collected information to assess the extent to which women seek help to deal with domestic violence episodes. To obtain these data, women who had experienced an episode of physical or sexual violence at the hands of their husband within the 12-month period before the survey were asked whether they had sought any help at any time during the year when their husband had done something to physi- cally hurt them and, if so, from whom they had sought help. The results in Table 17.7 indicate that around one-third of women sought assistance to deal with the violence. Women were more likely to seek help if the violence had occurred often rather than sometimes. Most of the women who asked for help looked to relatives for assistance. Less than one percent reported seeking assistance from religious leaders, doctors or other medical personnel, the police, or a lawyer. Women who did not seek assistance to deal with the violence were asked about the main reason they did not ask anyone for help. Nearly half said that they had not sought assistance because the violence was “not important” (Table 17.8). Around 20 percent gave responses sug- gesting a fatalistic attitude toward the violence, i.e., they did not seek help because it was “no use” (6 percent) or the violence was simply “part of life” (15 percent). Around 15 percent said they had not sought help because they were embarrassed or did not want to disgrace the family. Fear of divorce or desertion (4 percent), of additional beatings (4 percent), of getting the husband into trouble (5 percent), and lack of knowledge of where to get help (5 percent) were reasons cited by the other women who did not seek assistance. The reasons women gave for not seeking help varied according to the frequency of the violence. Women who experienced at least one form of violence often were less likely to say that they had not sought help because the violence was “not important” and more likely to express a fatalistic attitude about the violence or concern about the consequences of reporting the violence, compared to women who only sometimes experienced violence. Table 17.7 Help-seeking behavior by women experiencing physi- cal or sexual violence Percentage of ever-married women reporting that they had experienced physical or sexual violence in their relationship with their current/most recent husband within the past 12 months who reported seeking assistance to prevent or stop violence, by persons from whom assistance was sought, according to frequency of violence, Egypt 2005 Frequency of violence within past 12 months Help-seeking behavior At least once Often Sometimes Sought any assistance 34.5 49.8 26.4 Sought assistance from: Male relative(s) 20.9 32.3 14.8 Father 8.1 9.7 7.2 Brother 6.2 12.9 2.7 Father-in-law 4.1 6.3 2.9 Other male relative 5.6 10.0 3.3 Female relative(s) 20.7 30.8 15.3 Mother 9.3 12.6 7.6 Sister 2.7 5.6 1.2 Mother-in-law 6.7 11.2 4.3 Other female relative 5.6 9.6 3.5 Friend/neighbor 5.6 11.0 2.7 Employer 0.1 0.2 0.0 Religious leader 0.7 0.4 0.9 Doctor/medical personnel 0.1 0.4 0.0 Police 0.6 1.3 0.2 Lawyer 0.2 0.6 0.0 Number of women 1,059 366 693 Domestic Violence | 229 Table 17.8 Reason for not seeking assistance to prevent violence Percent distribution of ever-married women reporting that they had experienced violence within past 12 months and did not seek assistance by main reason for not seeking assistance, according to frequency of violence, Egypt 2005 Frequency of violence within past 12 months Main reason fo r not seeking assistance At least once Often Sometimes Don't know where to go 4.5 4.8 4.3 No use 6.3 10.1 4.9 Part of life 14.6 19.7 12.9 Afraid of divorce/desertion 3.5 8.3 1.8 Afraid of further beatings 3.6 7.2 2.3 Afraid of getting husband in trouble 5.2 5.8 4.9 Embarrassed 13.5 15.3 12.8 Did not want to disgrace family 1.5 3.2 0.9 Not important 46.8 25.3 54.4 Other 0.6 0.2 0.7 Total percent 100.0 100.0 100.0 Number of women 681 177 504 17.4 WOMEN’S ATTITUDES TOWARDS WIFE BEATING The 2005 EDHS results indicate that many Egyptian women experience incidents of marital violence. If violence against women by husbands is tolerated and accepted in a society, its eradication is made more difficult. To gauge the acceptability of domestic violence, all ever-married women interviewed in the survey were asked whether they thought a husband 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 without telling him, if she neglects the children, and if she refuses to have sexual relations with him. Table 17.9 shows that many women find wife beating to be justified in certain circumstances. Overall, 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. The most widely accepted reason for wife beating is going out without telling the husband (40 percent) and neglecting the children (40 percent), followed closely by arguing with the husband (37 percent) and refusing to have sex (34 percent). About one-fifth of women believed that burning the food is a justifiable reason for a husband to hit or beat his wife. The table also shows attitudes towards wife beating by background characteristics. Acceptance of wife beating for at least one of the specified reasons was generally lower among women who were divorced or separated than those who were currently married or widowed. Women who had themselves been beaten by their husbands were more likely than other women to accept wife beating as justified in some circumstances. 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 least likely to accept wife beating as justified. The likelihood that women will consider wife beating to be justified decreased with education and wealth and was lower among women working for cash than other women. The differentials by wealth quintile 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, respectively). 230 | Domestic Violence Table 17.9 Attitudes towards wife beating by background characteristics Percentage of ever-married women who agree that a husband is justified in beating his wife, by selected background characteristics, Egypt 2005 Percentage agreeing husband justified in beating his wife if she: Background characteristic Goes out without telling him Neglects the children Argues with him Refuses to have sex with him Burns the food Percentage agreeing that husband justified in beating for at least one reason Percentage agreeing that husband justified in beating for all five reasons Number of ever- married women Age 15-19 46.2 43.1 42.7 38.8 21.8 55.8 18.9 803 20-29 39.1 38.5 35.2 32.0 17.6 49.1 14.9 6,753 30-39 39.1 38.9 36.7 32.8 18.6 48.8 16.1 6,400 40-49 42.5 41.9 40.3 35.5 20.7 51.7 18.8 5,518 Marital status Married 40.7 39.9 37.7 33.7 19.0 50.4 16.6 18,187 Divorced/separated 26.1 27.1 23.8 22.8 15.4 34.4 11.2 522 Widowed 41.9 45.1 41.3 37.7 21.1 51.8 18.3 765 Experience with physical violence Ever experienced 43.4 43.2 41.0 36.3 18.7 55.1 15.8 2,662 Husband only 48.7 48.8 45.9 44.3 25.2 61.2 22.4 953 Husband and other persons 47.4 47.8 45.7 36.9 18.3 59.4 14.3 924 Other persons only 32.3 31.0 29.5 26.1 11.3 42.5 9.5 784 Never experienced 34.0 34.8 31.7 29.4 16.3 43.5 14.4 2,990 Not in domestic violence subsample 41.1 40.2 38.0 33.9 19.6 50.4 17.2 13,822 Urban-rural residence Urban 27.4 27.1 23.8 20.1 10.4 37.0 8.4 8,033 Rural 49.4 48.6 47.0 43.0 25.0 59.1 22.3 11,441 Place of residence Urban Governorates 24.4 23.8 19.2 16.9 7.9 33.7 6.3 3,293 Lower Egypt 39.5 41.1 37.0 33.7 20.2 48.9 18.2 8,410 Urban 25.6 26.7 23.2 20.5 11.4 34.4 10.0 2,199 Rural 44.5 46.2 41.9 38.4 23.2 54.1 21.1 6,211 Upper Egypt 48.2 45.3 46.0 40.9 22.7 58.4 19.3 7,552 Urban 32.9 32.0 30.5 24.1 12.8 43.9 9.7 2,411 Rural 55.4 51.5 53.2 48.7 27.3 65.2 23.8 5,141 Frontier Governorates 41.5 36.7 31.8 25.1 11.7 45.8 10.7 218 Education No education 59.0 56.6 57.0 51.2 30.8 67.7 27.9 6,740 Some primary 51.8 51.1 48.7 43.8 25.2 63.4 22.0 2,197 Primary complete/some secondary 41.4 41.3 36.3 31.7 17.9 53.4 14.6 2,719 Secondary complete/higher 20.7 21.6 17.8 16.1 7.4 29.8 5.9 7,818 Work status Working for cash 23.7 25.4 22.4 21.3 12.3 32.6 10.7 3,288 Not working for cash 43.7 42.7 40.5 36.0 20.3 53.5 17.7 16,186 Wealth quintile Lowest 65.2 63.5 62.8 55.9 34.7 74.4 30.7 3,565 Second 52.8 51.5 50.6 46.6 26.4 62.3 23.8 3,778 Middle 44.7 43.3 40.6 37.1 21.6 54.2 18.8 3,931 Fourth 28.9 29.4 25.5 22.0 10.6 40.6 8.6 4,137 Highest 14.5 15.1 11.9 10.2 4.3 22.7 3.3 4,063 Total 40.4 39.8 37.4 33.5 19.0 50.0 16.5 19,474 Child Welfare | 231 CHILD WELFARE 18 Information obtained in the 2005 EDHS allow for an assessment of several key aspects of the welfare of Egypt’s children. Questions were included on children’s living arrangements and survival status of the parents that can be used to estimate the extent of orphanhood among Egyptian children. The survey also collected information on current school attendance and participation in work or domestic chores. Finally, the 2005 EDHS obtained information on the prevalence of child disciplinary practices. 18.1 ORPHANHOOD AND CHILDREN’S LIVING ARRANGMENTS Questions were included in the 2005 EDHS household questionnaire on the living arrangements and the survival status of the biological parents for all children under age 18. Table 18.1 shows that 91 percent of children under age 18 (93 percent of children under age 15) were living with both parents at the time of the survey. Five percent of children under age 18 (4 percent of children under age 15) were orphaned, that is, one or both parents had died. In cases where a single parent had died, it was more often the father than the mother. This is related to the fact that, among 80 percent of couples in Egypt, the husband is at least ten years older than the wife (not shown in table). Table 18.1 Children's living arrangements and orphanhood by background characteristics Percent distribution of de jure children under age 18 by children's living arrangements and survival status of parents, according to background characteristics, Egypt 2005 Living with mother but not father Living with father but not mother Not living with either parent Background characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Total percent Percentage with one or both parents dead Number of children Age <2 years 98.0 1.4 0.4 0.0 0.1 0.0 0.0 0.0 0.0 100.0 0.6 4,874 2-4 years 96.3 2.2 0.8 0.2 0.2 0.2 0.0 0.1 0.0 100.0 1.1 7,514 5-9 years 93.6 2.3 2.4 0.3 0.6 0.4 0.1 0.0 0.1 100.0 3.2 11,992 10-14 years 89.1 2.3 5.3 0.7 1.3 0.5 0.2 0.1 0.2 100.0 7.1 11,246 15-17 years 82.5 2.4 8.8 0.6 1.7 2.0 0.3 0.2 0.5 100.0 11.5 7,746 Sex Male 91.6 2.4 3.8 0.4 0.9 0.4 0.1 0.1 0.1 100.0 5.0 22,164 Female 91.2 2.1 3.8 0.4 0.8 0.9 0.2 0.1 0.2 100.0 5.0 21,207 Urban-rural residence Urban 91.0 2.6 3.7 0.4 1.0 0.5 0.1 0.2 0.2 100.0 5.1 16,209 Rural 91.7 2.0 3.8 0.4 0.8 0.7 0.2 0.0 0.2 100.0 5.0 27,162 Place of residence Urban Governorates 90.2 2.8 3.8 0.7 1.1 0.5 0.1 0.2 0.2 100.0 5.3 6,351 Lower Egypt 92.6 1.6 3.5 0.3 0.7 0.6 0.1 0.1 0.2 100.0 4.6 17,185 Urban 91.8 2.1 3.7 0.2 0.9 0.4 0.0 0.4 0.1 100.0 5.1 4,160 Rural 92.9 1.4 3.5 0.4 0.6 0.7 0.1 0.0 0.2 100.0 4.5 13,025 Upper Egypt 90.7 2.6 4.0 0.4 0.9 0.7 0.2 0.0 0.1 100.0 5.3 19,292 Urban 91.2 2.7 3.6 0.3 1.0 0.5 0.1 0.0 0.1 100.0 4.9 5,381 Rural 90.5 2.6 4.2 0.5 0.9 0.8 0.2 0.1 0.1 100.0 5.5 13,910 Frontier Governorates 92.6 1.1 3.9 0.4 0.8 0.6 0.1 0.1 0.3 100.0 5.3 543 Wealth index Lowest 90.5 2.0 4.5 0.4 0.8 0.9 0.2 0.1 0.2 100.0 5.8 9,835 Second 90.5 2.4 4.3 0.4 1.0 0.7 0.2 0.1 0.2 100.0 5.7 9,119 Middle 91.4 2.4 3.7 0.5 0.8 0.7 0.1 0.0 0.2 100.0 4.8 8,726 Fourth 91.9 2.3 3.3 0.4 1.1 0.5 0.1 0.1 0.1 100.0 4.7 8,093 Highest 93.3 2.0 2.9 0.4 0.6 0.3 0.1 0.1 0.1 100.0 3.8 7,596 Children <age 18 91.4 2.2 3.8 0.4 0.9 0.6 0.1 0.1 0.2 100.0 5.0 43,371 Children <age 15 93.3 2.2 2.7 0.4 0.7 0.3 0.1 0.1 0.1 100.0 3.6 35,625 232 | Child Welfare The likelihood that one or both of a child’s parents has died rises with the child’s age, from less than one percent among children under age 2 to 12 percent among children age 15-17 years. Although the differences are small, the percentage of children who have experienced the death of one or both parents also declines with the wealth quintile. 18.2 CURRENT SCHOOL ATTENDANCE The 2005 EDHS collected information on current school attendance for the population age 6-24 years. Table 18.2 presents the percentages in this population reported as currently attending school by sex, age, and residence. In constructing Table 18.2, the results for children age 6 were adjusted to take into account the child’s exact age on October 1, 2004. Children who were not age 6 on that date were not eligible to start school during the 2004-2005 school year; thus, children born on or after October 1, 2004 were removed from the population on which Table 18.2 is based. Because of this adjustment, the figures on current school attendance for the population age 6-10 and the total population age 6-24 are not comparable to the figures on current school attendance presented in the reports for earlier DHS surveys. The adjustment was possible in the 2005 survey and not in the earlier surveys because the upper bound of the age range for the anthropometric data collection, which includes a question on the child’s birth date, was raised from age 5 to age 6 in the 2005 survey. Table 18.2 School attendance by residence Percentage of the de facto household population age 6-24 years who were attending school during the 2004-2005 school year by sex and age group, according to 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 MALE 6-15 93.9 92.3 93.0 94.4 95.8 93.9 91.7 93.5 91.0 91.1 92.9 6-10 96.6 95.2 95.2 97.6 98.3 97.3 94.3 97.0 93.3 95.0 95.7 11-15 91.5 89.7 91.0 91.5 93.6 90.7 89.3 90.5 88.9 87.4 90.4 16-20 65.5 49.6 64.5 55.5 73.3 49.6 53.3 61.0 49.7 50.3 56.2 16-17 78.2 70.3 76.6 75.3 84.4 71.8 70.7 74.5 69.0 73.6 73.5 18-20 56.6 35.1 56.7 42.6 64.3 36.1 39.9 51.6 34.0 30.3 44.0 21-24 21.6 11.8 23.0 14.2 20.1 12.0 15.0 21.5 11.6 8.9 16.0 FEMALE 6-15 93.5 87.6 93.4 94.3 96.6 93.6 84.6 91.3 81.8 84.6 89.9 6-10 95.7 92.5 95.4 96.2 97.0 96.0 90.8 95.3 89.0 89.4 93.7 11-15 91.4 83.1 91.2 92.6 96.2 91.3 79.0 87.7 75.2 80.5 86.3 16-20 59.2 37.2 61.0 50.6 62.3 46.7 35.6 54.7 27.6 38.5 45.9 16-17 76.7 58.0 76.0 74.0 82.7 71.3 53.4 73.7 44.9 49.3 65.4 18-20 48.0 23.5 51.2 35.7 50.5 30.6 24.0 42.2 16.3 29.7 33.3 21-24 13.1 5.7 15.8 9.2 13.7 7.5 5.4 8.8 3.7 4.6 9.0 TOTAL 6-15 93.7 90.0 93.2 94.4 96.2 93.8 88.3 92.4 86.6 88.0 91.4 6-10 96.1 93.9 95.3 96.9 97.7 96.6 92.6 96.1 91.2 92.4 94.8 11-15 91.4 86.5 91.1 92.0 94.9 91.0 84.4 89.1 82.4 84.0 88.4 16-20 62.3 43.2 62.7 53.1 67.7 48.1 44.0 57.8 38.0 44.1 50.9 16-17 77.5 64.0 76.3 74.6 83.6 71.5 62.0 74.1 57.0 61.0 69.4 18-20 52.2 29.0 53.9 39.1 56.8 33.4 31.3 46.9 24.2 30.0 38.4 21-24 17.0 8.5 19.1 11.6 16.7 9.7 9.7 14.6 7.2 6.7 12.2 Note: Children age 6 were included in the table only if they were born before October 1, 1998, and thus were age 6 and eligible to enter school during the 2004-2005 school year. Child Welfare | 233 Overall, the majority of children of both sexes age 6-15 were attending school. School attendance rates were slightly higher among boys than among girls in the 6-15 age group. The gender gap in school attendance increases with age, particularly among those in the 16-24 age range. Table 18.2 also presents school attendance rates by residence. For boys under age 16, residential differences in school attendance rates are quite small; more than nine in ten boys age 15 and under are in school regardless of where they reside. At older ages, however, boys living in urban areas, particularly in urban Lower Egypt, are more likely to attend school than boys from rural areas. For example, 66 percent of boys age 16-20 are currently attending school in urban areas compared to 50 percent of boys in the same age group in rural areas. Residential differentials in school attendance rates are more evident for girls than boys at all ages. For example, there is a gap of 6 percentage points in the current school attendance rates for girls age 6-15 between urban and rural areas (94 percent and 88 percent, respectively). In general, school attendance rates are lowest for girls living in rural Upper Egypt, followed by girls living in the Frontier Governorates. 18.3 CHILD LABOR The 2005 EDHS included a special module that has been developed by UNICEF to assess the prevalence of child labor. The module included questions on children’s work for an external employer, work on a family farm or in a family business, and involvement in domestic chores. The information collected in the module on children’s participation in economic activities and domestic chores is used to construct several child labor indicators. Participation in Economic Activities and Domestic Chores Table 18.3 shows that seven percent of Egyptian children age 5-14 were reported as engaged in economic activities in the seven-day period before the survey interview. Most children involved in formal work were employed on a family farm or in family business (6 percent). Table 18.3 Children's involvement in economic activities or domestic chores Percentage of de facto household population age 5-14 involved in economic activities or performing domestic chores, by sex and type of activity, Egypt 2005 Activity Male Female Total Worked for external employer1 1.8 0.4 1.1 Worked in past 7 days 1.3 0.3 0.8 Paid 1.2 0.3 0.8 Unpaid 0.0 0.0 0.0 Worked in past year but not in past 7 days 0.5 0.2 0.3 Paid 0.4 0.1 0.3 Unpaid 0.1 0.0 0.1 Missing 2.3 2.3 2.3 Worked on family farm/business in past 7 days 8.1 3.3 5.8 Engaged in any economic activity in past 7 days2 9.6 3.7 6.7 Performed domestic chores in past 7 days 45.0 57.1 50.9 Engaged in any economic activity2 and/or performed chores in past 7 days 49.7 58.0 53.7 Children age 5-14 12,018 11,454 23,471 1 Worked for someone who is not a household member 2 Worked for an external employer or on a family farm or business 234 | Child Welfare The results in Table 18.3 also show that many children, while not engaged in the formal work force, are responsible for domestic chores; 51 percent of children age 5-14 performed at least some domestic chores during the seven-day period preceding the survey. Overall, 54 percent of children age 5- 14 were involved in formal work and/or domestic chores during the period. Looking at gender patterns, boys were more than twice as likely as girls to have participated in formal economic activities (10 percent and 4 percent, respectively). On the other hand, girls performed domestic chores more often than boys (57 percent and 45 percent, respectively). Table 18.4 looks at the number of hours that children age 5-14 were engaged in economic activities or domestic chores during the seven-day period before the survey. Among those working for an external employer, nine in ten worked at least 8 hours during the seven days preceding the survey, and six in ten worked at least 24 hours or more. Children working for a family business or on a family farm tended to work fewer hours than those working for an external employer; 71 percent of children involved in work for a family enterprise worked at least 8 hours during the week before the survey, and 23 percent worked for at least 24 hours. The majority of children performing domestic chores spent less than 8 hours during the seven days before the survey on those chores (68 percent), with only four percent spending 24 or more hours on chores during the period. Table 18.4 Hours children engaged in economic activities or chores Percent distribution of de-facto household population age 5-14 engaged in any economic activities or who performed domestic chores in the 7 days before the survey by number of hours involved, according to sex, Egypt 2005 Activity/hours involved Male Female Total Work for external employer1 1-7 7.1 2.7 6.3 8-15 19.9 30.7 21.8 16-23 9.0 8.2 8.9 24 or more 61.6 58.4 61.0 Don't know/missing 2.4 0.0 2.0 Total 100.0 100.0 100.0 Number of children 153 32 185 Worked on family farm/business 1-7 27.1 28.4 27.4 8-15 31.5 32.8 31.9 16-23 15.5 17.3 16.0 24 or more 24.5 20.0 23.2 Don't know/missing 1.5 1.6 1.5 Total 100.0 100.0 100.0 Number of children 974 380 1,354 Performed domestic chores 1-3 39.7 29.1 33.9 4-7 31.8 31.6 31.7 8-15 18.7 23.7 21.5 16-23 3.9 7.5 5.8 24 or more 1.9 5.7 4.0 Don't know/missing 4.0 2.4 3.1 Total 100.0 100.0 100.0 Number of children 5,411 6,545 11,956 1 Worked for someone who is not a household member Child Welfare | 235 Table 18.5 considers the variation in children’s participation in economic activities and domestic chores according to selected background characteristics. Rates of participation in formal economic activities rise with a child’s age, are higher in rural areas, particularly in Upper Egypt, than in other areas, and decrease markedly with the wealth quintile. Levels of participation in domestic chores also rise with age but exhibit only minor variations by wealth quintile and residence, except for the much higher participation rate among children in the Frontier Governorates than in other areas. Table 18.5 Children's Involvement in economic activities or domestic chores by background characteristics Percentage of de facto children age 5-14 involved in economic activities in the past 7 days, and percentage responsible for domestic chores in the past 7 days, by background characteristics, Egypt 2005 Background characteristics Percentage working for an external employer in past 7 days 1 Percentage working for family business or on family farm in past 7 days Percentage who are responsible for domestic chores in past 7 days Number of children age 5-14 Sex Male 1.3 8.1 45.0 12,018 Female 0.3 3.3 57.1 11,454 Age of child 5-9 0.1 3.4 40.8 12,193 10-14 1.5 8.3 61.9 11,278 Urban-rural residence Urban 0.8 1.1 51.8 8,930 Rural 0.8 8.6 50.4 14,542 Place of residence Urban Governorates 0.7 0.9 55.0 3,540 Lower Egypt 0.7 4.7 49.8 9,237 Urban 0.4 1.0 51.5 2,293 Rural 0.7 5.9 49.3 6,944 Upper Egypt 0.9 8.5 50.1 10,392 Urban 1.1 1.5 47.4 2,919 Rural 0.9 11.2 51.1 7,473 Frontier Governorates 0.5 2.9 66.9 303 Wealth index Lowest 1.8 12.9 49.2 5,417 Second 0.8 8.7 51.1 4,911 Middle 0.7 3.6 49.0 4,560 Fourth 0.3 1.2 56.6 4,320 Highest 0.1 0.3 49.3 4,264 Total 0.8 5.8 50.9 23,471 1 Worked for someone who is not a household member Child Labor Indicators Table 18.6 looks at three child labor indicators for children age 6-14: 1) the percentage of children engaged in child labor activities; 2) the percentage of children currently attending school who are involved in child labor activities; and 3) the percentage of children involved in child labor activities who are currently attending school. Children age 6-11 are considered to be involved in child labor activities if, during the week before the interview, they had worked for an external employer or were engaged in work for a family business or on a family farm for at least 1 hour or they performed domestic chores for 28 236 | Child Welfare hours or more. Children age 12-14 are considered to be involved in child labor activities if, during the week before the interview, they had worked for an external employer or were engaged in family work for at least 14 hours or they performed domestic chores for 28 hours or more. Table 18.6 shows that eight percent of children age 6-14 in the households sampled in the 2005 EDHS were engaged in activities classified as child labor. Boys were somewhat more likely than girls to be engaged in child labor activities (9 percent and 6 percent, respectively), and children age 10-14 were twice as likely as children age 6-9 (10 percent and 5 percent, respectively) to be involved in child labor activities. Child labor is concentrated in rural areas; 11 percent of rural children are engaged in child labor compared to 3 percent of urban children. The percentage of children engaged in child labor activities decreases from 17 percent among children in the lowest wealth quintile to less than one percent of children in the highest quintile. Table 18.6 Child labor by background characteristics Percentage of de facto children age 6-14 engaged in child labor activities and percentages of children age 6-14 who are laborer students and student laborers, by background characteristics, Egypt 2005 Background characteristic Percentage engaged in child labor activities Number of children 6-14 Percentage of children age 6-14 who are laborer students1 Number of children 6-14 attending school Percentage of children age 6-14 who are student laborers2 Number of children 6-14 involved in child labor Sex Male 9.4 10,035 8.2 9,451 83.0 939 Female 6.0 9,632 4.2 8,792 63.4 577 Age of child 6-9 4.8 8,389 4.4 7,939 87.7 402 10-14 9.9 11,278 7.7 10,303 71.1 1,113 Urban-rural residence Urban 2.7 7,590 1.8 7,181 65.0 202 Rural 10.9 12,077 9.2 11,062 77.1 1,313 Place of residence Urban Governorates 1.8 3,040 1.0 2,854 50.8 56 Lower Egypt 5.6 7,750 4.5 7,401 77.5 433 Urban 1.3 1,966 0.9 1,908 (68.3) 26 Rural 7.0 5,784 5.8 5,493 78.1 407 Upper Egypt 11.8 8,623 9.9 7,760 76.1 1,014 Urban 4.7 2,432 3.5 2,278 70.6 114 Rural 14.6 6,191 12.6 5,482 76.7 901 Frontier Governorates 4.6 254 3.8 228 * 12 Wealth index Lowest 17.4 4,535 14.5 3,799 69.9 790 Second 11.0 4,105 9.8 3,777 81.5 453 Middle 4.7 3,761 3.9 3,607 79.7 178 Fourth 1.8 3,606 1.6 3,467 87.7 64 Highest 0.8 3,660 0.7 3,593 (81.5) 29 Total 7.7 19,667 6.3 18,242 75.5 1,515 Note: The child labor category includes: 1) children age 6-11 who worked for an external employer or were engaged in family work for at least 1 hour or who performed domestic chores for 28 hours or more during the week before the survey interview, and 2) children age 12-14 who worked for an external employer or was engaged in family work for at least 14 hours or who performed domestic chores for 28 hours or more during the week before the survey interview. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 1 Children attending school who are engaged in child labor activities 2 Children engaged in child labor activities who are attending school Child Welfare | 237 Table 18.6 also considers the relationship between school attendance and child labor. First, from the perspective of the population attending school, six percent of children age 6-14 were laborer students, i.e., they were currently attending school and also engaged in child labor activities. Laborer students were concentrated in rural areas, especially in Upper Egypt where about one in eight children was a laborer student, and in the lowest two quintiles of the wealth index. In addition, Table 18.6 looks at the extent to which children who were involved in child labor activities were attending school, i.e., were student laborers. The results indicate that about three in four children age 6-14 engaged in child labor activities were also going to school. The proportion of children engaged in child labor activities and not attending school was higher among girls than boys, among children age 10-14 than younger children, and among urban than rural children. The household’s economic well-being again plays a role with the proportion of children who were involved in child labor activities and not attending school generally falling with the wealth quintile. 18.4 CHILD DISCIPLINARY ACTIVITIES The 2005 EDHS respondents who had children age 3-17 years were asked questions 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 interview. Specifically they were asked if they had used each of the following approaches at any time during the month: 1) explained why the behavior was wrong; 2) shouted, yelled, or screamed at the children; 3) hit or slapped the child on the body with a hard object; or 4) hit or slapped the child on the face, head, or ears. Table 18.7 shows the prevalence of use of each of these disciplinary practices during the month. Nine in ten respondents with children age 3-17 years indicated that they had addressed behavior problems by explaining why the behavior was wrong. A similar proportion also said that they had at times shouted, yelled, or screamed at the child when there was a behavior problem. 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. The likelihood that hitting or slapping occurred when disciplining a child rose with the number of children age 3-17 the mother had and decreased with the mother’s age. Rural women were slightly more likely than urban women to indicate that they had hit or slapped a child either on the body or face, head, or ear. The proportions reporting that they had hit or slapped a child on the body did not vary in a consistent fashion with the woman’s educational level, but the proportion reporting they had hit or slapped a child on the face, head, or ear was much lower among women with a secondary education than other woman. The use of both of these practices decreased with the wealth quintile. 238 | Child Welfare Table 18.7 Child disciplinary practices by background characteristics Percentage of mothers of children age 3-17 years who reported using various practices in disciplining their child(ren) in the past month, by background characteristics, Egypt 2005 Background characteristic Explained why behavior was wrong Shouted/ yelled/ screamed at child(ren) Hit or slapped child(ren) on body Hit or slapped child(ren) on face, head, or ear Number of mothers of children age 3-17 Number of children One 91.2 85.9 60.9 32.7 3,838 2-3 94.6 91.3 70.3 41.0 7,934 4 or more 92.5 93.5 78.6 50.0 2,394 Mother's age 15-24 88.3 92.4 83.4 51.4 1,036 25-34 93.4 93.4 79.2 47.5 5,642 35-49 93.9 87.5 59.6 33.3 7,488 Urban-rural residence Urban 94.1 89.6 65.5 35.6 5,890 Rural 92.7 90.7 71.8 43.6 8,277 Place of residence Urban Governorates 93.3 90.7 64.1 34.5 2,386 Lower Egypt 94.9 91.5 67.7 37.1 6,048 Urban 94.9 89.1 62.7 31.0 1,609 Rural 94.8 92.3 69.5 39.2 4,439 Upper Egypt 91.4 88.6 72.8 46.3 5,574 Urban 94.1 88.5 69.5 41.4 1,801 Rural 90.1 88.7 74.4 48.6 3,773 Frontier Governorates 98.2 93.8 72.7 38.7 158 Education No education 91.2 90.3 71.1 45.8 5,215 Some primary 93.3 89.8 67.4 43.3 1,764 Primary complete/some secondary 93.3 92.2 74.6 43.4 1,957 Secondary complete/higher 95.3 89.6 65.8 32.5 5,231 Wealth index Lowest 89.6 89.4 76.3 52.2 2,696 Second 93.1 91.9 72.8 45.6 2,779 Middle 93.4 91.4 71.5 42.0 2,814 Fourth 95.2 91.1 69.4 37.3 2,949 Highest 94.8 87.5 56.5 25.4 2,928 Total 93.3 90.2 69.1 40.3 14,167 References | 239 REFERENCES Abdel-Azeem, F., Farid, S., and Khalifa, A. 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Appendix A | 243 PERSONS INVOLVED IN THE 2005 EGYPT DEMOGRAPHIC AND HEALTH SURVEY Appendix A Technical and Administrative Staff Senior Technical Staff Fatma Hassan El-Zanaty, Technical Director Noha Ahmed El-Ghazaly, Assistant Director for All Survey Activities Dina Magdy Armanious, Assistant Director for Training Rashad Hamed, Assistant Director for Data Processing Mohamed Ahmed El-Ghazaly, Sampling Coordinator Senior Field Staff Mounir Mohamed Ibrahim, Field coordinator Yasser Khalifa Metwaly, Assistant Wael Mahmoud Ibrahim, Assistant Senior Data Processing Staff Mohamed Ahmed El-Ghazaly, Data Processing Coordinator Mahmoud Mohsen, Assistant for Data Processing Coordinator Anthropometric Consultants Ibrahim Ismail Ibrahim Magdy Mohamed Shehata Mohamed Kamal Mansour Research Assistants Sameh Said Amin, Senior Fatma Samy El-Beih Macro International Staff Ann Way, Country Monitor Alfredo Aliaga, Sampling Specialist Jasbir Sangha, Health Specialist Jeanne Cushing, Data Processing Specialist Sidney Moore, Senior Editor Kaye Mitchell, Document Production Specialist John Chang, Graphics Designer Office Staff Mohamed Farag Allah, Supervisor Mohamed Ahmed Ismail, Assitant Supervisor Ahmed Gomaa Abd El-Aal, Topographer Mohamed Hussien Awad Allah Nagwa Metwaly Fahmy Mai Ahmed Khalifa Mohamed Azab Gouda 244 | Appendix A Administrative Staff Wegdan Yehia, accountant Azza Saad Abou El Eyoun, Secretary Quick Count and Re-Quick Count Staff Supervisors Anwar Mahmoud Ibrahim Fatiany Abou El-Makarm El-Said Ehab Zakaria Goumaa Mohamed Salem Hussien Gamal Hashim Said Mohamed Mahros Mahros Housam El-Deen Mohamed Rada Mahmoud Shehata Hassanin Hamdy Farag Allah Roghby Hany Mohamed Abd El-Monem Osman Awad Osman Wael Abd El-Karim Mohamed Emad El-Deen Moustafa Hussien Wael Mahmoud Ibrahim Amr Shokry Mohamed Waleid El-Gameel El-Sayed Counters El-Habashi Kamel Mahmoud Abd El-Wahab Hassan Abd El-Wahab Ahmed Gomaa Ahmed Amr Awad Ali Ahmed Abd El-Gawd Shahat Mohamed Hghazi Noaaman Ahmed Abd El-Maaboud Ahmed Mohamed Hassan Abd El-Aal Ahmed Mohamed El-Nagar Mohamed Hussni Attia Islam Ibrahim Ibrahim Mohamed Sayed Abd El-Hay Hussni Moubark Mahdi Mohamed Adel Abd El-Monem Hussien Farag Allah Roghby Mohamed Abd El-Rihem Hassan Khalid Abo El Alla Abdo Mohamed Abd El-Hadi Amer Zaen El-Abedeen Omar Mohamed Mohamed Hany Mohamed Saad Mohamed Saad Mahmoud Mohamed Yassin Sayed Mahmoud Ahmed Morad Refat Mahmoud Sherif Mohamed Ibrahim Moustafa Farag Allah Roghby Abd El-Baset El-Sayed Salama Hany Said Amin Abd El-Hameed Hefni Hussien Hisham Ahmed Ahmed Abd El-Monem Hussien Ali Waleid Moustafa Hashim Listing and Re-listing Staff Supervisors Anwar Mahmoud Ibrahim Mohamed Salem Hussien Ehab Zakaria Goumaa Mohamed Mahros Mahros Gamal Hashim Said Mahmoud Shehata Hassanin Hamdy Farag Allah Roghby Hany Mohamed Abd El-Monem Osman Awad Osman Wael Abd El-Karim Mohamed Amr Shokry Mohamed Waleid El-Gameel El-Sayed Fatiany Abou El-Makarm El-Said Appendix A | 245 Listers El-Habashi Kamel Mahmoud Abd El-Monem Hussien Ali Ahmed Gomaa Ahmed Abd El-Wahab Hassan Abd El-Wahab Ahmed Abd El-Gawd Shahat Emad El-Deen Moustafa Hussien Ahmed Abd El-Maaboud Ahmed Amr Awad Ali Ahmed Mohamed El-Nagar Mohamed Hghazi Noaaman Islam Ibrahim Ibrahim Mohamed Hassan Abd El-Aal Hussni Moubark Mahdi Mohamed Sayed Abd El-Hay Hussien Fafag Allah Roghby Mhamed Adel Abd El-Monem Halmi Abd El-Hai Mohamed Mohamed Abd El-Hadi Amer Khalid Abo El Alla Abdo Mahmoud Mohamed Yassin Zaen El-Abedeen Omar Mohamed Morad Rfat Mahmoud Saad Mohamed Saad Moustafa Farag Allah Roghby Abd El-Hameed Hefni Hussien Hany Said Amin Interviewing and Reinterviewing Staff Supervisors Ehab Zakaria Goumaa Mohamed Salem Hussien Gamal Hashim Said Mohamed Abd El-Kader Mohamed Hamdy Farag Allah Roghby Mohamed Mahros Mahros Osman Awad Osman Mahmoud Shehata Hassanin Amr Shokry Mohamed Hany Mohamed Abd El-Monem Fatiany Abou El-Makarm Wael Abd El-Karim Mohamed Mohamed Ahmed El-Dabaa Waleid El-Gameel El-Sayed Field Editors Ashgan Ramadan Abd El- Aziz Fatma El-Sayed Abd El-Salam Amani Mohamed Mabrouk Fatma Shabaan Mohamed Amal Abd El-Halim Abd Allah Marwa Hassan Mahmoud Amira Hussni Ahmed Mona Hassan Shaker Ranya Hamdy Ali Nahla Ali Ahmed Reham Wasfi Aziz Hayam Abd El-Salam Saafan Shimaa Omr Sayed Yasmen Hassan Ali Interviewers Ebtesam Hassan Ahmed Samah Abo Zed Mohamed Ebtesam Said Abd El-Rahman Samah Farouk Minasi Ebtesam Moustafa Sayed Souhir Saad Osman Asmaa Kamal Sayed Shandh Mahmoud Mohamed Amani Soliman Hafaz Shereen Imam Abd El-Razek Amani El-Sayed Ali Shimaa Farouk Mohamed Eman Ahmed Mohamed Shimaa Mamdouh Abd El-Tawab Eman Ezzat Hassan Sabah Mohamed Said Eman Mohamed Abd El-Wanis Afaf Abd El-Fattah Ahmed Eman Meawad Sayed Ola Ahmed Helmi Asmaa Kamal Amin Fatma Mokhtar Mohamed Khadega Senosi Abd El-Moez Marwa Fared Mohamed Doaa Hussien Mohamed Marwa Mohamed Samy Rana Ahmed Moustafa Marwa Morad Mahmoud Ranya Hussni Abo Hamed Mona Helmi Mohamed 246 | Appendix A Rabab Fawzy Mohamed Mona Hameed Nasr Rasha Ibrahim Ali Mai Mohamed Ismail Rasha El-Msalami Ali Maiada Fawzy El-Sayed Rasha Galal Taha Nermeen Abd El-Salam Mohamed Rasha Mohamed Said Hala Shawky Abd Elmongy Radwa Samir Ahmed Hanem Tolbah Mohamed Roqia Mohamed El-Mahdi Hoda Abd El-Moati Sayed Reham Sayed Attia Hanaa Moustafa Hasaballah Zenab Ibrahim Sayed Howaida Ali Mohamed Zenab Mohamed Reda Hayam Khamis Shehata Samia Qnaui Mohamed Wafaa Farouk Abd El-Maqsoud Samia Mohamed Ali Wlaa Mohamed Afifi Salwa Ahmed Hussien Anemia Testing and Anthropometric Staff Dr. Ahamed Abd El-Fattah Mohamed Ahmed Mohamed El-Nagar Dr. Elham Mahmoud Ismail Anwar Mahmoud Ibrahim Dr. Rasha Ahmed Abd El-Ati Enas Abd El-Gani Mohamed Dr. Safaa Mohamed Ali Tamir Mohamed El-Shabrawy Dr. Fatma Moustafa Hassanin Rabab Yehia Abd El-Maqsoud Dr. Mohamed Hassan Saad Mohamed Saad Dr. Mohamed Abd El-Azim Abd El-Megid Abd El-Monem Hussien Ali Dr. Maiada Saleh Abd El-Aziz Emad El-Deen Moustafa Hussien Dr. Nisreen Mohamed Ahamed Fatma Kamal Abd El-Hameed Dr. Nashwa Mahros Mohamed Mohamed Abd El-Hadi Amer Dr. Heba Abd El-Salam El-Said Moustafa Farag Allah Roghby Dr. Hayam Fathy Mohamed Moustafa Mahmoud Abd Allah Sanaa Ismail Desoki Hany Said Amin Karima Mohamed Ata Waleid Moustafa Hashim Office Editing Editors Coders Amani El-Sayed Ali Ahmed Gomaa Abd El-Aal Amaal Refaat Mahmoud Eman Mohamed Fouaad Asmaa Ali Hassan Hanaan Ahmed Fawzy Amal Abd El-Rehim Hassan Sara Asim Mahmoud Doaa Ibrahim Mohamed Sameh Said Amin Ranya Hussni Abo Hamed Fatma Samy El-Beih Rasha El-Msalami Ali Mohamed Ahmed Ismail Rihab Fawzy Mahmoud Mohamed Hussien Awad Allah Shereen Ayman Abd Allah Mohamed Abd El-Rehim Hassan Shimaa Omr Sayed Mohamed Azab Gouda Shimaa Mamdouh Abd El-Tawab Mohamed Farag Allah Roghby Fatma El-Sayed Abd El-Salam Mahmoud Mohamed Mohsen Mai Ahmed Khalifa Wael Mahmoud Ibrahim Nagwa Metwaly Fahmy Yasser Khalifa Metwaly Hanaa Ibrahim Mohamed Hanaa Soliman Abd El-Razek Appendix A | 247 Data Processing Staff Ahmed Mohamed El-Nagar Amr Shokry Mohamed Osama Metwaly Fahmy Mohamed Hussien Awad Allah Ibrahim Hussien Mohamed Abd El-Rehim Hassan Hamdy Abd El-Badia Ahmed Mohamed Azab Gouda Hanaan Ahmed Fawzy Mohamed Farouk Ali Rabab Fawzy Mohamed Medhat Moustafa Ahmed Suzan Mahmoud Mohamed Nahed Abd El-Razik Mohamed Sherif Mohamed Ibrahim Nagwa Metwaly Fahmy Shahira Hamdy Mohamed Waleid Mahros Mohamed Appendix B | 249 SAMPLE DESIGN Appendix B The major objective of the 2005 Egypt Demographic and Health Survey sample design was to provide estimates with acceptable precision for key population and health indicators for the country as a whole and for six major subdivisions (Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt and the Frontier Governorates1). In addition, the sample was planned to allow for separate estimates of key indicators for seven governorates that are focal governorates for USAID-supported population, health and nutrition programs (Fayoum, Beni Suef, Menya, Qena, and Aswan in Upper Egypt and Cairo and Alexandria). In addition, with the exception of the Frontier Governorates, the sample included a sufficient number of households in most other governorates to allow for governorate-level estimates of major variables, with the exception of fertility and mortality rates and anemia levels. To achieve the above objectives, a three stage probability sample was designed. The following is a detailed description of the 2000 EDHS sample design. A description of the field activities involved in the implementation of the sample design is included in Chapter 1 of this report. B.1 SAMPLE DESIGN The main concern in developing the sample design for the 2005 EDHS was to secure a sufficient number of cases in each domain in order to reduce sampling error and provide estimates of adequate precision for the purposes of the survey. Sampling error has two components, one corresponding to the variation between primary sampling units (PSUs) and the other to the variation within PSUs, with the major component usually being the variation between PSUs. Thus, the total number of PSUs is an important factor in controlling the size of the sampling error since the variation between PSUs depends on this number, i.e., generally the smaller the number of PSUs, the greater will be the variation. Standard DHS sampling policy recommends a minimum of 1,000-1,200 women per major domain. As noted above, however, the 2005 EDHS sample had to be selected in such fashion as to also allow for estimation of contraceptive prevalence rates and other basic health indicators for 21 separate governorates. DHS sampling policy recommends that a minimum of 450 completed interviews with eligible women be obtained to provide reliable estimates for these types of variables. This principle was used in determining the size and distribution of the target sample for the 2005 EDHS presented in Table B.1. 1 The Frontier Governorates were not included in 1988 and 1992 DHS surveys nor in the 1997, 1998 and 2003 interim surveys. However, they were part of the 1995 and 2000 EDHS samples. The inclusion of the Frontier Governorates in the 2005 EDHS will not affect comparisons of the 2005 results with the results of earlier surveys in which these governorates were not part of the samples since only around one percent of the Egyptian population resides in the Frontier Governorates. 250 | Appendix B Table B.1 Sample allocation for the 2005 Egypt DHS survey Urban Rural Total Governorate Target number of house- holds Target number of eligible women Percent urban Number of PSUs Number of segments Number of PSUs Number of segments Number of PSUs Number of segments Urban Governorates Cairo 2,015 1,500 100 50 100 - - 50 100 Alexandria 1,615 1,200 100 40 80 - - 40 80 Port Said 740 550 100 18 36 - - 18 36 Suez 740 550 100 18 36 - - 18 36 Subtotal 5,110 3,800 100 126 252 - - 126 252 Lower Egypt Damietta 503 450 27 4 8 11 22 15 30 Dakahlia 894 799 28 7 14 19 38 26 52 Sharkia 866 783 23 6 12 20 40 26 52 Kalyubia 829 722 41 10 20 14 28 24 48 Kafr El-Sheikh 605 546 23 4 8 14 28 18 36 Gharbia 806 715 31 7 14 17 34 24 48 Menoufia 676 614 20 4 8 17 34 21 42 Behera 792 715 23 6 12 18 36 24 48 Ismailia 527 450 50 8 16 7 14 15 30 Subtotal 6,498 5,794 28 56 112 137 274 193 386 Upper Egypt Giza 1,060 1,000 54 18 36 17 34 35 70 Beni Suef 1,500 1,400 24 10 20 40 80 50 100 Fayoum 1,500 1,400 23 10 20 40 80 50 100 Menya 1,500 1,400 19 10 20 40 80 50 100 Assiut 640 600 27 10 20 12 24 22 44 Souhag 640 600 22 10 20 12 24 22 44 Qena1 1,500 1,400 28 11 22 39 78 50 100 Aswan 1,500 1,400 43 17 34 33 66 50 100 Subtotal 9,840 8,100 31 96 192 233 466 329 658 Frontier Governorates Red Sea 181 201 75 5 10 2 4 7 14 New Valley 168 186 48 3 6 4 8 7 14 Matrouh 214 237 56 5 10 3 6 8 16 North Sinai 234 259 59 5 10 3 6 8 16 South Sinai 105 117 50 2 4 2 4 4 8 Subtotal 902 1,000 59 20 40 14 28 34 68 Total 22,350 18,694 298 596 384 768 682 1,364 1 Luxor was grouped with Qena governorate for purposes of selecting the sample. B.2 SAMPLE FRAME The sample for the 2005 EDHS was selected in three stages. A list of shiakhas/towns constituted the primary sampling frame for urban areas, and a list of villages served as the frame for rural areas. The Central Agency of Public Mobilization and Statistics (CAPMAS) updated these lists, which had been originally prepared for the 1996 census, to reflect the situation in 2004. Appendix B | 251 B.3 SAMPLE SELECTION In order to provide for implicit geographic stratification, the lists of shiakhas/towns and villages in each governorate were arranged in serpentine order according to their location from north to south within the governorate. During the first stage selection, a total of 682 primary sampling units (289 shiakhas/towns and 393 villages) were chosen for the 2005 EDHS sample. A list of the PSUs selected during the first stage of the sampling for the 2005 EDHS is provided below. The second stage of selection in the 2005 EDHS involved several steps. First, for each of the primary sampling units (PSU), maps were obtained and divided into a number of parts of roughly equal size (assuming approximately 5000 persons per part). In large shiakhas/towns or villages (approximately 20,000 and more population), two parts were selected from each PSU. In the remaining smaller shiakhas/towns and villages, one part was selected. A quick count was carried out in the selected parts in each PSU to provide the information needed to divide the parts into a number of segments of roughly equal size. After the quick count was completed, two segments were then selected from each PSU. In large shiakhas/towns and villages where there were two parts, one segment was chosen from each part. In small shiakhas/towns and villages where only one part had been selected, two segments were chosen from that part. A household listing was obtained for each segment. Using the household lists, a systematic sample of 22,807 households was chosen for the 2005 EDHS. All ever-married women 15-49 who were present in the sampled households on the night before the interview were eligible for the survey. A subsample of one-third of all households in each segment was selected for the anemia-testing component. In this subsample, information on anemia levels was collected for all eligible women, children under age 6, and youth and young adults age 10-19. One woman in each household in the subsample in which anemia testing was carried out was selected to be asked questions about domestic violence. B.4 SAMPLE IMPLEMENTATION Results of the sample implementation are presented in Table B.2. The results indicate that households were selected for the 2000 EDHS sample. The EDHS field staff successfully interviewed 22,807 of the sample households, for a response rate of 98.9 percent. In the interviewed households, 19,565 eligible women were interviewed with a response rate 99.5 percent. This gives an overall response rate of 98.5 percent. 252 | Appendix B Table B.2 Sample implementation Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women and overall response rates, according to urban-rural residence and place of residence, Egypt 2005 Lower Egypt Upper Egypt Result Urban Rural Urban Gover- norates Total Urban Rural Total Urban Rural Frontier Gover- norates Total Selected households Completed (C) 94.5 98.1 94.1 97.0 94.9 97.9 97.2 95.3 98.2 94.6 96.3 Household present but no competent respondent at home (HP) 1.3 0.3 1.6 0.5 0.8 0.3 0.6 1.2 0.3 0.8 0.8 Postponed (P) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Refused (R) 0.3 0.0 0.3 0.2 0.4 0.1 0.2 0.5 0.0 0.0 0.2 Dwelling not found (DNF) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0 Household absent (HA) 1.2 0.5 1.5 0.8 1.4 0.6 0.5 0.6 0.4 1.6 0.8 Dwelling vacant/address not a dwelling (DV) 2.1 1.0 2.1 1.3 2.2 0.9 1.4 2.1 1.0 2.6 1.6 Dwelling destroy (DD) 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Other (O) 0.3 0.1 0.3 0.2 0.4 0.1 0.1 0.2 0.1 0.2 0.2 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 sampled households 11,164 11,643 5,231 6,656 2,071 4,585 9,998 3,247 6,751 922 22,807 Household response rate (HRR) 98.2 99.6 98.0 99.3 98.8 99.5 99.2 98.1 99.6 99.0 98.9 Eligible women Completed (EWC) 99.4 99.7 99.2 99.7 99.6 99.8 99.5 99.4 99.6 99.9 99.5 Not at home (EWNH) 0.5 0.2 0.8 0.2 0.4 0.1 0.3 0.4 0.3 0.1 0.3 Postponed (EWP) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Refused (EWR) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.0 0.0 Partly completed (EWPC) 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 Incapacitated (EWI) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 Other (EWO) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 8,147 11,418 3,568 5,918 1,560 4,358 9,177 2,486 6,691 902 19,565 Eligible women response rate (EWRR) 99.4 99.7 99.2 99.7 99.6 99.8 99.5 99.4 99.6 99.9 99.5 Overall response rate (ORR) 97.6 99.2 97.2 99.0 98.4 99.3 98.7 97.5 99.2 98.9 98.5 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as:: 100 * C C + HP + P + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: 100 * EWC EWC + EWNH + EWP + EWR + EWPC + EWI + EWO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR/100 Appendix B | 253 URBAN GOVERNORATES Cairo Al-Salam Al-Sharkia Al-Salam Al-Gharbia Berket El-Nasr El-Marg El-Baharia Berket El-Hag El-Matar Al-Zahraa and Masaken El-Helmeya Tolombat Ein-Shams Mansheyet El-Tahrir El-Ezab (El-Mataria) Shagaret Maryam Arab Abo Taweela El-Barad El-Sahel Menyet El-Seerg El-Zawya El-Hamra Masaken El-Zaytoon El-Gharbia Masaken El-Ameeria Al-Shamalia El-Bostan El-Khasa Hadaek El-Koba Al-Sharabia El-Ezab (El-Sharabia) Al-Mabyada Kasooret El-Shawam El-Abasseya El-Gharbia El-Manteka Al-Oula Sharq Al-Manteka Al-Sadessa El-Ganzoury Sharkas+Eshash El Nakhl El-Shaarany Monshaat Naser Rahbet Abdeen El-Hanafy Abo El-Seoud & El-Madabegh El-Manial El-Gharby Al-Abagia El-Katameya+El Tagamoe El Khames+Eskan Moubarak El-Basateen El-Gharbia Dar El-Salam Ezbet Nafea Maadi El-Khabeery El- Gharbia Mansheyet El-Masry El-Maasara El-Balad Helwan El-Balad Helwan El-Keblia+Ain Helwan El-Sheyakha Al-Oula Alexandria El-Seioufe Bahary El-Seioufe Kebly El-Amrawy El-Mandara Kebly El-Mouhagrine Sidi Beshr Bahary Sidi Beshr Kibly El-Zahiria & Ezbet El-Safieh El-Kasea (Bahary Seket Hadid Abou Kir) El-Mahrousa Hagar El-Nouatia Dana El-Gidida & Ezbet El-Wastania Sain-Estefanou El-Riadieh Ezbet El-Nouzha El-Ibrahimia Bahary El-Hadra Kebly Ezbet El-Gameea El-Manshia El-Koubra El-Babe El-Gidid Shark Ambruze & Mouharam Bek Ragheb Basha Haret El-Farhda El-Metrasse El-Woardianne Gharb El-Mafrouza Gharb Babe Sedret El-Barany Gharb Karmouz Shark El-Dekheila El-Agamy El-Baharia El-Amriah Shark Zaowyat Abd El-Kader Kattea Mariout El-Zeraa El-Bahary+El-Sanakra Port Said El-Zouhour El-Galaa El-Sarai El-Manakh Abou El-Hassan El-Arab Mountazah Saad Moustafa Hamzah+El-Daera El-Gomrokia Port Fouad+Thani Port Fouad El-Salam El-Kabouty El-Ganoub+Moubarak (Shark El- Tafreea) Thani El-Ganoub Suez Fessal & El-Sabah Sheiakha Khames Kism Thaleth Kism Rabea Kism Awal Kism Thany+ El-Daera El-Gomrokia LOWER EGYPT Damietta Urban Ezbet El-Borg Kism Thaleth Kafr El Battikh Meat Abou Ghalab City Rural El-Adelia Shat El-Shouara Shat Ezbet El-Lahm Shat Mouhab & El-Saiala El-Badrawy El-Mahamadia Kafr El-Wastany El-Horany Abou Garida Meet El-Sheukh Meet El-Khouly Abd El-Allah+Ezbet El-Baz Continued. 254 | Appendix B Dakahlia Urban El-Mataria Sherbien El-Manzala Dekernes Kism Than El-Hwar Kism Kafr El-Badamas El-Senbelawein Rural El-Ramla Monshaat Shouman Kafr Abou Zaher &, it’s Ezabs El-Gammala+El-Orban El-Bagalat El-Kobab El-Soghra Orman Talkha Meet Antar Nesha (includes Kafr El-Bashabsha & Kafr El-Halawani) Telbana Meet Badr Khamees Meet Fares & it’s Kafr El-Hegayza Tookh El-Aklam+El-Fanan Borg Nour El-Homos Menyet Samanoud El-Rahmaneya+Kafr Hegazy+Kafr Atallah Soliman Sentemay Meet Abou Khaled & Kafr Aly Badra Sharkia Urban Al-Ebrahimia Al-Salhia El-Gadida+ Al-Manteka Al-Senaea Al-Hosainia Al-Gameea Belbes Ashra Ramadan City Rural El-Akhewa Samakeen El-Gharb El-Sofeya El-Soora El-Beroum+El-Salatna El-Ghazaly Kafr El-Hag Omar Manzel Maymoun Derb El-Sook Tal Mohamed Kafr Ageeba Bardeen Sefeeta Neshwa El Naamna Kafr Shalshalamon El-Sanagra+El-Omara Kafr El-Azazy El-Mansheya Kafr Ayoub Soliman Kalyubia Urban Kafr Shokr Kafr Manaker El Kanater El Khairia Kalyub Bahtim Shobra El Khima Bigam Rural Kafr Sharaf El-Deen Demloo Monshaat Banha El-Abadla Karkashanda El-Gaafra Kafr El-Shobak El Nasereya Basoos El-Sabah Koom Eshfeen Al-Qalg El-Gabal El-Asfar El-Khosoos Kafr El-Sheikh Urban Baltiem Sidi Salim Desouk Meet Elwan Rural El-Hamad Koum El-Hagar El-Baria El-Hadady & it’s Ezabs Shalma+Monshaat Al-Masry El-Komysion Gharb Ebshan Koum El-Hagna El-Merabeen Kafr El-Manshy El- Bahary+Helis El-Nawayga Ezab Abou Mandour El-Salimia Shabassy Omeir Continued. Appendix B | 255 Gharbia Urban Hussien said Ahmad Aly Emam El-Hoseiny Mohamed Hussien El Sehly Kafr El-Zayat Kobry El-Mahatta El-Malgaa Zifta Rural El-Hayatem Shobra Babel Mahalat Abo Aly El-Kantara El-Nasereya Meet Assas Segeen El-Koum Genag Abyar Kasr Nasr El-Dine El-Ragdeya Shabsheer El-Hessa Kaneeset Damsheet Nawag Shobrabeel Kananeya Meet Yazeed Shobra El-Yaman Meet El-Rakha Menoufia Urban Tla Said Ahmed Hassan El-Kot Menouf El-Bagour Rural Zanara Kafr Meet Abo Al-Koom+Kafr Zarkan Tookh Tanbasha Om Khanan+Monshaat Om Khanan Kafr El-Sheikh Ibrahim Al-Batanon & Hesattha Shanwan Meet Masoud Shemyates + Kafr El-Gamala Dabraky Feesha El-Kobra Al-Makatee Koom El-Dabea Abou Rakaba+Kafr Abou Rakaba Ramlat Al-Angab Shaashaa Kafr El-Tarayna Behera Urban Edco Kafr El-Dawar Shobra Nakrha Abo El-Matamier Badr City Rural Debi El-Malkah Kom Asho El-Saarania El-Karawi Sahali Ezab Besentawy Abaadiat Damanhour Ezab Saknida Nadebyah Monshaat Ganakles Shaltoot Mahalat Sa Demisna El-Bostaan Mahmoud Abu Wafya Al-Kabera Dist El-Ashraf Omar Shahin Ismailia Urban El-Tomsah El-Hekr Monshaat El-Shohadaa Hai El-Sheik Zaid El-Tall El-Kebeer Faid Rural Abou Khalifa+El-Nasr El-Sabea Abar El-Sharkeya El-Manaif Nafisha El-Kassassien El- Kadima+Abou Ashour Abou Soultan Fanara Continued. 256 | Appendix B UPPER EGYPT Giza Urban Ousiem El-Warrak El-Mounira Matar Embaba Meit Aokba Abo Qatada Boulak El-Dakrour Kafr Tohormos El-Shiakha El-Thaltha Monshaat El-Bakary Gezeret El-Dahab El-Talbia El-Keblia El-Omrania El-Gharbia Oula El-Haram El-Badrashein Rural El-Manashy Zat El-Koum El-Baragil Abou Rawash Saft El-Laban Kafr Hakim Ard Al-Lewa El-Manawat Nazlet El-Ashter+Beni Youssef El-Tarfaia Monshaat Dahshour El-Shorafa&El-Attiat Negoue El-Arab El-Mateneia Kafr Barakat+Kafr Abou Abas El-Kebabat Manial El-Soultan Beni Suef Urban Nasser Ehnassia El-Gezira El-Bahary El-Mermah Kebly Moqbel Beba El-Fashn Rural Abweet El-Hooma El-Haram Bany Nussier Saft El-Sharkia Kamn El-Aaroos Monshaat Abou Seer Ashmant+Monshaat El-Sherka El-Zaytoon Bahbasheen Tahha Boosh Monshaat Hadeeb+Gheit El Bahary El-Noweera Tama Fayoum Maasaret Naasan Monshaat kasab Nazlet El-Mamaleek El-Hakamna Ahnasia El Khadraa Baha El-Agouz Bany Hamad Tazmant El-Sharkia Riad Nazlet Abo Selim El Dabaana Bany Kasem Sods El-Omaraa Tarshoob Kanbash El-Hamraa Nazlet El-Sherif El-Aasakra Dashasha Koom El-Ramly El-Kebly Monshaat Abo Maleeh El-Gafadon El-Fant Beni saleh Shenry Saft El-Nour Nazlet Akfahs Fayoum Urban Tamia Sanores Apshaway+Youssef El-Sedek Kism Thani Kism Thaleth Kism Rabea Ettsa Rural El-Roda El-Mazatly Sarsenah Kasser Rashwan Maessaret Sawy El-Akhssass El-Kaeabi El-Gadeeda Nekalifia Sanhour Fadeemine Mattartaress Monshaat Sanores Abo Kessae El-Khalidia El-Nassaria Senro El-Keblya Tobhar El-Hamouly Ghidan (El-Mashrek) El-Nazlah & El-Morabea Shaelane Karoun+Wadi El-Rayan Kahke El-Basyonia El-Adawa El-Nasseriah Dassiah Sanofer+Monshaat Al-Gazaer Koufour El-Sheikh Fadel Monshaat Abd Allah Haoaret Adlaen El-Hagar El-Gharek El-Mahmoudia El-Wanaysa Gardo Ezbet Kalmasha Kalmasha Monshaat El-Amir Monshaat Fessal Continued. Appendix B | 257 Menya Urban Maghagha Beni Mazar Smallout Kism Taleth El-Menya Kism Khames Kafr El-Mansoura El-Kebly Kism Awal Malawy Kism Thaleth Malawy Deir Mowas Rural El-Sheik Masoud El-Safanya Aba El-Wakf Bertbat Dahamro Abad Sharouna Nazlet Bany Khalef Aatou El-Wakf El-Saedia Beni Samet Tanbo Abouan Beni Amar Monshaat Lotf Allah El-Gazaer El-Tiba Dakouf Shousha Kom El-Loufy Admo Beni Ahmed Damarress Sawada Tahnasha Monshaat El-Dahab El-Baharia Abou Korkasse El-Sheikh Temy Bany Ebead Safae+El-Senbelawein+El-Zaafrana Monshaat Deabess Abou Kaltah El-Bayadiah El-Sheikh Ebadah Bany Rohe Deer Abou Hanasse Kasr Houre Nazlet Hamzawy El-Rahmanieh Tal Bany Omran Assuit Urban El-Kossia Abnoub Sheyakha Kamesa El-Hamra El-Thania Sahel Selim El-Badary Rural El-Riad Dairout El-Sherief Nazlet Sourkna+Sourkna Bany Korah Nezally Ganoube Bany Rafea Nazlet Romeh Bany Mohamadiatte El-Motiah Refa Nagea Abd El-Rasoul Abou Hassouba Bany Elleg El-Nazla El-Moustagadah Bany Semae El-Naoarra Awlad Elyasse Souhag Urban Gohaina El Sherif Akhmiem Gerga El Baliana Rural El Gabab Faw Gharb Banga Abo Bakr El Sedeek Aksas Bahaleel El Gezeera Bany Wassel Gezeret Mahrous El-Mahamda El-Baharia Gezeeret Shandaweel El-Danakla Koom Badar El Balabeesh Kebly Awlad Yehia Bahary El Magabra Al Eslah El Ghoneimia Qena Urban Deshna Kism Awal Kism Thaleth El-Wakf Naga Hamady Qous Luxor Gezeret El-Awamia Armant Esna Rural El-Habilatte El-Gharbia El-Soulyemate El-Karah Bakhanes Ezbet El-Boussa Abou Manae Bahary Abou Manae Kebly El-Attiate Nagea El-Sheik Ali El-Ashraf El-Keblia El-Deer El-Sharky El-Ghossa El-Mkhadma Dandarah El-Helfaia Bahary El-Rahmania Kebly El-Sayad El-Komana Awlad Negm El-Keblia How El-Arky Continued. 258 | Appendix B Rural Qena Kom El-Baga El-Barahma El-Kalahine El-Khatara Toukhe El-Okbe El-Masside Gezeret Mattira Khouzam El-Boghdady El-Edaissate El-Dabeaia El-Domokratte El-Marisse El-Homaidate+El-Hanady El-Adaima Al-Negoa Kebly Kiman El-Mattaana Aswan Urban El Sebeaia Gharb Edfo Koum-Ombou Draw Shiakha Oula Shiakha Thania Sٍhiakha Thaletha Khazan Aswan+Abo Sombol El-Siahia City Rural Edfo Kebly El-Hagz Bahary El-Hagz Kebly El-Radeesia Bahary El-Ramady Bahary El-Ramady Kebly El-Saayda El-Kanan El-Kalh Gharb Akleet El Aabasseya El Aatmour El Kagoug El Mansheya El Gedeeda Selwah Bahary Faress Kofoor Koum-Ombou Nemra 7 Bahary Nemra 7 Kebly Armana Balana Dahmeet+Dar El-Salam+Sayala El-Gaafra El-Mansouria Benban Kebly Negoea El-Shatb+Masaken Draw Abo El-Reesh Kebly El-Aakab Sahara city FRONTIER GOVERNORATES Red Sea Urban Ras Ghareb Hurgada Safaga El-Koseir+Marsa Alam Rural Hurgada Port+El-Zaafarana Om El Huwaitat & El Gawasees New Valley Urban El-Farafra El-Kharga Rural Naser El Thawra El-Kasr Taniedah Baghdad+El-Max El- Kebly+El-Oula+El- Thania Bedarb El-Arbaeen Matrouh Urban El-Negyla Marsa Matrouh El-Dabaa Sewa Rural Om El-Rakhm+Awlad Maree Awlad Elwany+El-Sharnabeya+El-Tarabeya Kora El-Kherregen Continued. Appendix B | 259 North Sinai Urban Rafah Kism Awal El-Areish Kism Thani El-Ariesh El-Ahtam Beir El-Abd Rural El-Gorah El-Nagah Om Katfe+Al-Monbateh South Sinai Urban Abo Znema city+Ras Sedr Tor Sinai Rural Al-Heswa+Feran Al-Kora Al-Seyaheya (Neama)+Ras Mohamed+Ras Nasrany+Al-Gobeil (Tor Sinai) Appendix C | 261 ESTIMATES OF SAMPLING ERRORS Appendix C The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data col- lection and data processing, such as failure to locate and interview the correct household, misunderstand- ing of the questions on the part of either the interviewer or the respondent, and data entry errors. Al- though numerous efforts were made during the implementation of the 2005 Egypt DHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents se- lected in the 2005 EDHS is only one of many samples that could have been selected from the same popu- lation, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. If the sample of EDHS respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2005 EDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulae, specifically the Taylor linearization method of variance estimation, to calculate sam- pling errors for means or proportions from the survey. The Jacknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. Sampling errors for the 2005 EDHS were calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for each of the residential categories: Urban Governorates, total Lower Egypt, urban Lower Egypt, rural Lower Egypt, total Upper Egypt, urban Upper Egypt, rural Upper Egypt, and Frontier Gover- norates. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table C.1. Tables C.2 to C.12 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (+/-2SE), for each variable. In these tables, sampling errors are pre- sented in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic cal- culated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. In addition to the standard error, the design effect (DEFT) is estimated for each estimate; DEFT is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. The DEFT is considered undefined when the standard error considering simple ramdom sample is zero (when the estimate is close to 0 or 1). 262 | Appendix C In general, the relative standard errors for most variables are small at the level of the country as a whole, except for estimates involving very small proportions. For estimates for subpopulations, however, there is more variability in the size of the relative standard error for the variables. For example, for the variable contraceptive use for currently married women age 15-49, the relative standard errors as a per- cent of the estimated mean for the whole country, for urban areas, and for rural areas are 0.7 percent, 1.0 percent, and 1.0 percent, respectively. The confidence interval as calculated for contraceptive use for cur- rently married women age 15-49 is interpreted as follows: the overall national sample proportion is 0.592 and its standard error is .007. Therefore, to obtain the 95 percent confidence limits, one adds and sub- tracts twice the standard error to the sample contraceptive use for currently married women age 15 to 49 is between 0.583 and 0.601. Table C.1 List of selected variables for sampling errors, 2005 Egypt DHS –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Variable Estimate Base population –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban Proportion Ever-married women 15-49 Literate Proportion Ever-married women 15-49 No education Proportion Ever-married women 15-49 Completed secondary/higher Proportion Ever-married women 15-49 Currently married Proportion Ever-married women 15-49 Children ever born to women 40-49 Mean All women 15-49 Children surviving Mean All women 15-49 Children ever born to women 40-49 Mean All women 15-49 Ever used any contraceptive method Proportion Currently married women 15-49 Currently using any contraceptive method Proportion Currently married women 15-49 Currently using any modern method Proportion Currently married women 15-49 Currently using pills Proportion Currently married women 15-49 Currently using IUD Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using condom Proportion Currently married women 15-49 Currently using female sterilization Proportion Currently married women 15-49 Currently using periodic abstinence Proportion Currently married women 15-49 Using public sector source Proportion Currently married women 15-49 Want no more children Proportion Currently married women 15-49 Want to delay birth least two years Proportion Currently married women 15-49 Ideal family size Mean Ever-married women 15-49 Mothers received tetanus injection for last birth Proportion Births in last 5 years Mothers received medical assistance at delivery Proportion Births in last 5 years Child had diarrhea in last two weeks Proportion Children 0-59 months Treated with oral rehydration salts (ORS) Proportion Children under 5 with diarrhea in last 2 weeks Taken to a health provider Proportion Children under 5 with diarrhea in last 2 weeks Had immunization record Proportion Children 12-23 months Received BCG Proportion Children 12-23 months Received DPT (3 doses) Proportion Children 12-23 months Received polio (3 doses) Proportion Children 12-23 months Received measles Proportion Children 12-23 months Fully immunized Proportion Children 12-23 months Had heard about HIV/AIDS Proportion Ever-married women 15-49 Height-for-age (below -2SD) Proportion Children 0-59 months Weight-for-height (below -2SD) Proportion Children 0-59 months Weight-for-age (below -2SD) Proportion Children 0-59 months Anemia among ever-married women Proportion Ever-married women 15-49 Severe anemia among ever-married women Proportion Ever-married women 15-49 Anemia among children 6-59 months Proportion Children 6-59 months Severe anemia among children 6-59 months Proportion Children 6-59 months Anemia among male adolescents 10-19 Proportion Male youth and young adults 10-19 Severe anemia among male adolescents 10-19 Proportion Male youth and young adults 10-19 Anemia among female adolescents 10-19 Proportion Female youth and young adults 10-19 Severe anemia among female adolescents 10-19 Proportion Female youth and young adults 10-19 Total fertility rate (0-3 years) Rate Women-years of exposure to childbearing Neonatal mortality rate Rate Number of births Postneonatal mortality rate Rate Number of births Infant mortality rate Rate Number of births Child mortality rate Rate Number of births Under-five mortality rate Rate Number of births Appendix C | 263 Table C.2 Sampling errors for National sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.413 0.006 19474 19474 1.825 0.016 0.400 0.425 Literate 0.591 0.005 19474 19474 1.551 0.009 0.580 0.602 No education 0.346 0.005 19474 19474 1.479 0.015 0.336 0.356 Completed secondary education/higher 0.401 0.006 19474 19474 1.717 0.015 0.389 0.414 Currently married 0.934 0.002 19474 19474 1.183 0.002 0.930 0.938 Currently pregnant 0.061 0.002 30011 29270 1.160 0.029 0.058 0.065 Children ever born 2.046 0.039 30011 29270 1.144 0.019 1.969 2.123 Children surviving 1.872 0.035 30011 29270 1.152 0.019 1.802 1.943 Children ever born to women age 40-49 4.480 0.037 5573 5639 1.162 0.008 4.406 4.554 Ever using contraceptive method 0.812 0.004 18134 18187 1.257 0.004 0.804 0.819 Currently using any contraceptive method 0.592 0.004 18134 18187 1.202 0.007 0.583 0.601 Currently using a modern method 0.565 0.004 18134 18187 1.218 0.008 0.556 0.574 Currently using pill 0.099 0.003 18134 18187 1.255 0.028 0.093 0.104 Currently using IUD 0.365 0.005 18134 18187 1.281 0.013 0.355 0.374 Currently using injectables 0.070 0.002 18134 18187 1.293 0.035 0.066 0.075 Currently using condom 0.010 0.001 18134 18187 1.194 0.089 0.008 0.012 Currently using female sterilization 0.013 0.001 18134 18187 1.172 0.077 0.011 0.015 Currently using periodic abstinence 0.007 0.001 18134 18187 1.356 0.118 0.006 0.009 Public sector source 0.566 0.007 9960 10285 1.412 0.012 0.552 0.580 Want no more children 0.645 0.004 18134 18187 1.204 0.007 0.637 0.654 Want to delay birth at least 2 years 0.162 0.003 18134 18187 1.181 0.020 0.155 0.168 Ideal family size 2.882 0.011 17972 17940 1.137 0.004 2.859 2.904 Mothers received tetanus injection for last birth 0.773 0.006 9991 9845 1.344 0.007 0.762 0.784 Mothers received medical assistance at delivery 0.742 0.006 13851 13600 1.397 0.009 0.729 0.754 Had diarrhea in two weeks before survey 0.184 0.005 13351 13120 1.269 0.025 0.175 0.193 Treated with oral rehydration salts (ORS) 0.335 0.011 2472 2411 1.122 0.034 0.313 0.358 Taken to a health provider 0.479 0.013 2472 2411 1.248 0.028 0.452 0.506 Had vaccination card 0.733 0.010 2746 2680 1.165 0.014 0.713 0.753 Received BCG 0.980 0.003 2746 2680 1.069 0.003 0.974 0.986 Received DPT (3 doses) 0.935 0.006 2746 2680 1.141 0.006 0.924 0.946 Received polio (3 doses) 0.966 0.004 2746 2680 1.125 0.004 0.957 0.974 Received measles 0.966 0.004 2746 2680 1.052 0.004 0.958 0.973 Fully immunized 0.887 0.007 2746 2680 1.139 0.008 0.873 0.901 Has heard of HIV/AIDS 0.844 0.003 19474 19474 1.310 0.004 0.837 0.851 Height-for-age (below -2SD) 0.176 0.004 12434 12131 1.143 0.024 0.168 0.185 Weight-for-height (below -2SD) 0.039 0.002 12434 12131 1.267 0.060 0.034 0.044 Weight-for-age (below -2SD) 0.061 0.003 12434 12131 1.226 0.045 0.056 0.067 BMI <18.5 0.005 0.001 17071 17169 1.153 0.127 0.004 0.006 Anemia among ever-married women 0.394 0.007 6317 6289 1.153 0.018 0.380 0.408 Severe anemia among ever-married women 0.003 0.001 6317 6289 1.082 0.262 0.001 0.004 Anemia among children under five 0.485 0.009 3882 3759 1.116 0.018 0.468 0.503 Severe anemia among children under five 0.003 0.001 3882 3759 1.159 0.342 0.001 0.005 Anemia among adolescent boys 10-19 0.255 0.008 4014 3872 1.187 0.032 0.239 0.271 Severe anemia among adolescent boys 10-19 0.002 0.001 4014 3872 1.514 0.503 0.000 0.005 Anemia among adolescent girls 10-19 0.346 0.009 3725 3566 1.185 0.027 0.328 0.364 Severe anemia amonmg adolescent girls 10-19 0.001 0.001 3725 3566 1.307 0.577 0.000 0.003 Total fertility rate 0-3 years 3.129 0.042 na 82054 1.389 0.013 3.045 3.213 Neonatal mortality (5 years) 19.745 1.676 13905 13640 1.258 0.085 16.393 23.097 Post-neonatal mortality (5 years) 13.493 1.224 13922 13658 1.222 0.092 10.857 15.723 Infant mortality (5 years) 33.238 2.110 13926 13662 1.266 0.063 28.798 37.124 Child mortality (5 years) 8.071 0.875 13952 13684 1.147 0.118 5.296 8.572 Under 5 mortality (5 years) 41.041 2.246 13977 13709 1.242 0.055 35.371 44.168 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 264 | Appendix C Table C.3 Sampling errors for Urban sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 1.000 0.000 8095 8033 na 0.000 1.000 1.000 Literate 0.758 0.009 8095 8033 1.949 0.012 0.739 0.776 No education 0.197 0.008 8095 8033 1.766 0.040 0.181 0.212 Completed secondary education/higher 0.550 0.012 8095 8033 2.128 0.021 0.527 0.574 Currently married 0.932 0.003 8095 8033 1.213 0.004 0.926 0.939 Currently pregnant 0.052 0.003 13200 12706 1.267 0.063 0.045 0.058 Children ever born 1.735 0.076 13200 12706 1.146 0.044 1.582 1.887 Children surviving 1.625 0.073 13200 12706 1.179 0.045 1.478 1.772 Children ever born to women age 40-49 3.654 0.047 2689 2709 1.245 0.013 3.559 3.749 Ever using contraceptive method 0.848 0.005 7537 7490 1.236 0.006 0.837 0.858 Currently using any contraceptive method 0.626 0.006 7537 7490 1.136 0.010 0.613 0.639 Currently using a modern method 0.598 0.007 7537 7490 1.174 0.011 0.585 0.611 Currently using pill 0.110 0.005 7537 7490 1.307 0.043 0.101 0.120 Currently using IUD 0.405 0.007 7537 7490 1.240 0.017 0.391 0.419 Currently using injectables 0.045 0.003 7537 7490 1.220 0.065 0.039 0.051 Currently using condom 0.017 0.002 7537 7490 1.140 0.101 0.013 0.020 Currently using female sterilization 0.013 0.002 7537 7490 1.164 0.117 0.010 0.016 Currently using periodic abstinence 0.014 0.002 7537 7490 1.346 0.132 0.010 0.017 Public sector source 0.480 0.010 4446 4485 1.366 0.021 0.460 0.501 Want no more children 0.658 0.007 7537 7490 1.269 0.011 0.644 0.672 Want to delay birth at least 2 years 0.149 0.005 7537 7490 1.158 0.032 0.140 0.159 Ideal family size 2.731 0.018 7569 7454 1.270 0.007 2.694 2.767 Mothers received tetanus injection for last birth 0.685 0.011 3814 3753 1.411 0.016 0.663 0.706 Mothers received medical assistance at delivery 0.887 0.008 5042 4948 1.499 0.009 0.871 0.904 Had diarrhea in two weeks before survey 0.171 0.008 4880 4778 1.451 0.048 0.155 0.188 Treated with oral rehydration salts (ORS) 0.283 0.019 813 818 1.154 0.067 0.245 0.321 Taken to a health provider 0.537 0.023 813 818 1.261 0.043 0.491 0.583 Had vaccination card 0.714 0.017 1019 972 1.171 0.024 0.679 0.749 Received BCG 0.988 0.004 1019 972 1.084 0.004 0.980 0.996 Received DPT (3 doses) 0.935 0.010 1019 972 1.212 0.010 0.915 0.955 Received polio (3 doses) 0.967 0.007 1019 972 1.211 0.008 0.952 0.982 Received measles 0.968 0.007 1019 972 1.190 0.007 0.954 0.981 Fully immunized 0.891 0.012 1019 972 1.132 0.013 0.868 0.914 Has heard of HIV/AIDS 0.942 0.004 8095 8033 1.640 0.005 0.933 0.950 Height-for-age (below -2SD) 0.162 0.007 4541 4430 1.288 0.046 0.147 0.177 Weight-for-height (below -2SD) 0.052 0.005 4541 4430 1.389 0.096 0.042 0.062 Weight-for-age (below -2SD) 0.065 0.005 4541 4430 1.303 0.076 0.055 0.075 BMI <18.5 0.004 0.001 7184 7158 1.113 0.208 0.002 0.006 Anemia among ever-married women 0.397 0.011 2672 2620 1.208 0.029 0.375 0.420 Severe anemia among ever-married women 0.002 0.001 2672 2620 1.262 0.580 0.000 0.004 Anemia among children under five 0.437 0.015 1445 1380 1.185 0.035 0.406 0.468 Severe anemia among children under five 0.001 0.001 1445 1380 0.842 0.723 0.000 0.002 Anemia among adolescent boys 10-19 0.187 0.011 1533 1492 1.073 0.057 0.166 0.208 Severe anemia among adolescent boys 10-19 0.002 0.002 1533 1492 1.832 0.942 0.000 0.007 Anemia among adolescent girls 10-19 0.329 0.013 1463 1346 1.071 0.040 0.303 0.356 Severe anemia amonmg adolescent girls 10-19 0.001 0.001 1463 1346 1.284 0.999 0.000 0.003 Total fertility rate 0-3 years 2.749 0.055 na 36010 1.297 0.020 2.640 2.858 Neonatal mortality (10 years) 21.445 2.388 9856 9697 1.355 0.111 16.668 26.221 Postneonatal mortality (10 years) 10.259 1.194 9862 9703 1.186 0.116 7.872 12.646 Infant mortality (10 years) 31.704 2.735 9863 9705 1.341 0.086 26.233 37.174 Child mortality (10 years) 7.628 1.068 9863 9705 1.167 0.140 5.492 9.764 Under 5 mortality (10 years) 39.089 2.932 9871 9714 1.321 0.075 33.226 44.953 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 265 Table C.4 Sampling errors for Rural sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.000 0.000 11379 11441 na na 0.000 0.000 Literate 0.474 0.006 11379 11441 1.314 0.013 0.462 0.486 No education 0.451 0.006 11379 11441 1.333 0.014 0.439 0.463 Completed secondary education/higher 0.297 0.006 11379 11441 1.396 0.020 0.285 0.309 Currently married 0.935 0.003 11379 11441 1.160 0.003 0.930 0.940 Currently pregnant 0.069 0.002 17004 16588 1.148 0.036 0.064 0.074 Children ever born 2.281 0.051 17004 16588 1.147 0.022 2.179 2.384 Children surviving 2.059 0.046 17004 16588 1.142 0.022 1.968 2.150 Children ever born to women age 40-49 5.238 0.053 2886 2933 1.138 0.010 5.133 5.343 Ever using contraceptive method 0.787 0.005 10597 10697 1.244 0.006 0.777 0.796 Currently using any contraceptive method 0.568 0.006 10597 10697 1.223 0.010 0.557 0.580 Currently using a modern method 0.542 0.006 10597 10697 1.228 0.011 0.530 0.554 Currently using pill 0.091 0.003 10597 10697 1.195 0.037 0.084 0.097 Currently using IUD 0.336 0.006 10597 10697 1.305 0.018 0.324 0.348 Currently using injectables 0.088 0.004 10597 10697 1.315 0.041 0.081 0.095 Currently using condom 0.005 0.001 10597 10697 1.289 0.173 0.003 0.007 Currently using female sterilization 0.012 0.001 10597 10697 1.178 0.103 0.010 0.015 Currently using periodic abstinence 0.003 0.001 10597 10697 1.437 0.264 0.001 0.004 Public sector source 0.632 0.009 5514 5799 1.435 0.015 0.613 0.651 Want no more children 0.636 0.005 10597 10697 1.154 0.008 0.626 0.647 Want to delay birth at least 2 years 0.170 0.004 10597 10697 1.189 0.025 0.162 0.179 Ideal family size 2.989 0.014 10403 10486 1.051 0.005 2.960 3.018 Mothers received tetanus injection for last birth 0.827 0.006 6177 6092 1.283 0.008 0.815 0.840 Mothers received medical assistance at delivery 0.658 0.008 8809 8651 1.354 0.013 0.641 0.675 Had diarrhea in two weeks before survey 0.191 0.005 8471 8342 1.169 0.028 0.180 0.202 Treated with oral rehydration salts (ORS) 0.362 0.014 1659 1593 1.074 0.038 0.335 0.389 Taken to a health provider 0.449 0.016 1659 1593 1.230 0.036 0.417 0.482 Had vaccination card 0.744 0.012 1727 1708 1.166 0.017 0.719 0.769 Received BCG 0.976 0.004 1727 1708 1.060 0.004 0.968 0.984 Received DPT (3 doses) 0.935 0.007 1727 1708 1.098 0.007 0.922 0.949 Received polio (3 doses) 0.965 0.005 1727 1708 1.074 0.005 0.955 0.975 Received measles 0.965 0.004 1727 1708 0.974 0.005 0.956 0.974 Fully immunized 0.885 0.009 1727 1708 1.141 0.010 0.867 0.903 Has heard of HIV/AIDS 0.776 0.005 11379 11441 1.205 0.006 0.766 0.785 Height-for-age (below -2SD) 0.184 0.005 7893 7700 1.069 0.028 0.174 0.194 Weight-for-height (below -2SD) 0.031 0.002 7893 7700 1.113 0.072 0.027 0.036 Weight-for-age (below -2SD) 0.060 0.003 7893 7700 1.174 0.055 0.053 0.066 BMI <18.5 0.005 0.001 9887 10011 1.173 0.160 0.004 0.007 Anemia among ever-married women 0.392 0.009 3645 3669 1.113 0.023 0.374 0.410 Severe anemia among ever-married women 0.003 0.001 3645 3669 1.005 0.287 0.001 0.005 Anemia among children under five 0.513 0.011 2437 2379 1.085 0.021 0.491 0.535 Severe anemia among children under five 0.004 0.002 2437 2379 1.191 0.375 0.001 0.007 Anemia among adolescent boys 10-19 0.297 0.011 2481 2380 1.197 0.037 0.275 0.319 Severe anemia among adolescent boys 10-19 0.002 0.001 2481 2380 1.224 0.534 0.000 0.004 Anemia among adolescent girls 10-19 0.356 0.012 2262 2219 1.237 0.035 0.331 0.381 Severe anemia amonmg adolescent girls 10-19 0.002 0.001 2262 2219 1.311 0.705 0.000 0.004 Total fertility rate 0-3 years 3.410 0.062 na 46213 1.366 0.018 3.285 3.534 Neonatal mortality (10 years) 23.532 1.555 17170 16782 1.232 0.066 20.422 26.642 Postneonatal mortality (10 years) 21.695 1.580 17191 16800 1.330 0.073 18.536 24.854 Infant mortality (10 years) 45.227 2.359 17194 16802 1.372 0.052 40.509 49.945 Child mortality (10 years) 11.403 1.111 17212 16823 1.267 0.097 9.182 13.625 Under 5 mortality (10 years) 56.115 2.698 17239 16845 1.414 0.048 50.719 61.510 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 266 | Appendix C Table C.5 Sampling errors for Urban Governorates, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 1.000 0.000 3538 3293 na 0.000 1.000 1.000 Literate 0.782 0.018 3538 3293 2.539 0.023 0.747 0.817 No education 0.180 0.014 3538 3293 2.171 0.078 0.152 0.208 Completed secondary education/higher 0.560 0.022 3538 3293 2.587 0.039 0.517 0.603 Currently married 0.935 0.004 3538 3293 1.072 0.005 0.926 0.944 Currently pregnant 0.048 0.005 5830 5417 1.263 0.097 0.039 0.057 Children ever born 1.568 0.110 5830 5417 1.235 0.070 1.347 1.788 Children surviving 1.485 0.106 5830 5417 1.256 0.071 1.273 1.697 Children ever born to women age 40-49 3.325 0.056 1294 1186 1.105 0.017 3.212 3.437 Ever using contraceptive method 0.858 0.007 3304 3078 1.231 0.009 0.843 0.873 Currently using any contraceptive method 0.639 0.009 3304 3078 1.102 0.014 0.620 0.657 Currently using a modern method 0.612 0.011 3304 3078 1.240 0.017 0.591 0.633 Currently using pill 0.082 0.006 3304 3078 1.182 0.069 0.071 0.094 Currently using IUD 0.439 0.011 3304 3078 1.301 0.026 0.417 0.462 Currently using injectables 0.044 0.004 3304 3078 1.197 0.097 0.035 0.052 Currently using condom 0.025 0.003 3304 3078 1.082 0.116 0.020 0.031 Currently using female sterilization 0.011 0.002 3304 3078 1.111 0.184 0.007 0.015 Currently using periodic abstinence 0.015 0.002 3304 3078 1.077 0.152 0.010 0.020 Public sector source 0.542 0.016 2024 1890 1.422 0.029 0.511 0.574 Want no more children 0.674 0.010 3304 3078 1.191 0.014 0.655 0.694 Want to delay birth at least 2 years 0.138 0.006 3304 3078 1.077 0.047 0.125 0.151 Ideal family size 2.593 0.022 3278 3074 1.109 0.009 2.548 2.637 Mothers received tetanus injection for last birth 0.639 0.017 1545 1460 1.441 0.027 0.604 0.673 Mothers received medical assistance at delivery 0.907 0.015 1979 1879 1.888 0.017 0.877 0.937 Had diarrhea in two weeks before survey 0.153 0.012 1929 1826 1.437 0.079 0.129 0.177 Treated with oral rehydration salts (ORS) 0.216 0.027 299 280 1.126 0.124 0.163 0.270 Taken to a health provider 0.556 0.033 299 280 1.118 0.060 0.489 0.622 Had vaccination card 0.720 0.029 424 402 1.312 0.040 0.662 0.778 Received BCG 0.990 0.006 424 402 1.204 0.006 0.978 1.002 Received DPT (3 doses) 0.946 0.013 424 402 1.182 0.014 0.920 0.972 Received polio (3 doses) 0.961 0.011 424 402 1.175 0.012 0.939 0.984 Received measles 0.970 0.009 424 402 1.150 0.010 0.951 0.989 Fully immunized 0.903 0.017 424 402 1.159 0.019 0.869 0.937 Has heard of HIV/AIDS 0.961 0.006 3538 3293 1.779 0.006 0.949 0.972 Height-for-age (below -2SD) 0.169 0.012 1807 1668 1.276 0.074 0.144 0.193 Weight-for-height (below -2SD) 0.077 0.010 1807 1668 1.540 0.137 0.056 0.098 Weight-for-age (below -2SD) 0.082 0.009 1807 1668 1.292 0.108 0.064 0.099 BMI <18.5 0.003 0.001 3168 2949 1.149 0.364 0.001 0.005 Anemia among ever-married women 0.401 0.019 1135 1037 1.322 0.048 0.363 0.440 Severe anemia among ever-married women 0.001 0.001 1135 1037 0.999 1.000 0.000 0.003 Anemia among children under five 0.427 0.022 573 528 1.080 0.052 0.382 0.471 Severe anemia among children under five 0.002 0.002 573 528 0.979 0.994 0.000 0.005 Anemia among adolescent boys 10-19 0.202 0.015 629 581 0.906 0.072 0.173 0.231 Severe anemia among adolescent boys 10-19 0.000 0.000 629 581 na na 0.000 0.000 Anemia among adolescent girls 10-19 0.312 0.022 577 505 1.136 0.070 0.268 0.356 Severe anemia amonmg adolescent girls 10-19 0.003 0.003 577 505 1.314 0.996 0.000 0.009 Total fertility rate 0-3 years 2.499 0.083 na 16143 1.394 0.033 2.334 2.664 Neonatal mortality (10 years) 16.469 2.917 3937 3741 1.268 0.177 10.635 22.303 Postneonatal mortality (10 years) 9.560 1.895 3940 3745 1.252 0.198 5.771 13.349 Infant mortality (10 years) 26.029 3.572 3940 3745 1.249 0.137 18.885 33.172 Child mortality (10 years) 8.210 1.932 3940 3745 1.312 0.235 4.346 12.073 Under 5 mortality (10 years) 34.025 4.296 3943 3749 1.343 0.126 25.433 42.617 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 267 Table C.6 Sampling errors for Lower Egypt, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.261 0.010 5903 8410 1.687 0.037 0.242 0.281 Literate 0.617 0.008 5903 8410 1.225 0.013 0.602 0.633 No education 0.302 0.007 5903 8410 1.183 0.023 0.288 0.316 Completed secondary education/higher 0.445 0.009 5903 8410 1.329 0.019 0.428 0.463 Currently married 0.937 0.003 5903 8410 1.000 0.003 0.931 0.944 Currently pregnant 0.060 0.003 8737 12311 1.022 0.049 0.054 0.066 Children ever born 1.973 0.067 8737 12311 1.101 0.034 1.840 2.107 Children surviving 1.836 0.062 8737 12311 1.102 0.034 1.712 1.960 Children ever born to women age 40-49 4.298 0.047 1679 2427 0.974 0.011 4.204 4.393 Ever using contraceptive method 0.856 0.005 5542 7884 1.082 0.006 0.846 0.866 Currently using any contraceptive method 0.659 0.007 5542 7884 1.041 0.010 0.646 0.672 Currently using a modern method 0.642 0.006 5542 7884 0.983 0.010 0.629 0.655 Currently using pill 0.100 0.005 5542 7884 1.122 0.045 0.091 0.109 Currently using IUD 0.440 0.007 5542 7884 1.102 0.017 0.425 0.454 Currently using injectables 0.071 0.004 5542 7884 1.254 0.061 0.062 0.079 Currently using condom 0.008 0.001 5542 7884 1.180 0.181 0.005 0.010 Currently using female sterilization 0.017 0.002 5542 7884 0.978 0.100 0.014 0.020 Currently using periodic abstinence 0.005 0.001 5542 7884 1.209 0.230 0.003 0.007 Public sector source 0.572 0.011 3534 5063 1.269 0.018 0.551 0.593 Want no more children 0.669 0.007 5542 7884 1.055 0.010 0.656 0.682 Want to delay birth at least 2 years 0.154 0.005 5542 7884 1.052 0.033 0.144 0.164 Ideal family size 2.736 0.015 5587 7923 1.036 0.006 2.705 2.767 Mothers received tetanus injection for last birth 0.814 0.009 2875 4066 1.194 0.011 0.797 0.831 Mothers received medical assistance at delivery 0.816 0.009 3804 5399 1.196 0.011 0.798 0.833 Had diarrhea in two weeks before survey 0.166 0.006 3690 5235 0.906 0.035 0.154 0.178 Treated with oral rehydration salts (ORS) 0.339 0.019 578 869 0.950 0.056 0.301 0.377 Taken to a health provider 0.486 0.024 578 869 1.127 0.050 0.438 0.535 Had vaccination card 0.713 0.017 765 1071 1.020 0.024 0.679 0.748 Received BCG 0.984 0.005 765 1071 1.019 0.005 0.975 0.994 Received DPT (3 doses) 0.944 0.009 765 1071 1.047 0.010 0.926 0.962 Received polio (3 doses) 0.981 0.006 765 1071 1.059 0.006 0.969 0.992 Received measles 0.976 0.006 765 1071 0.994 0.006 0.965 0.987 Fully immunized 0.909 0.011 765 1071 1.058 0.012 0.886 0.931 Has heard of HIV/AIDS 0.870 0.005 5903 8410 1.199 0.006 0.860 0.881 Height-for-age (below -2SD) 0.137 0.006 3440 4837 1.011 0.045 0.125 0.150 Weight-for-height (below -2SD) 0.029 0.003 3440 4837 0.938 0.095 0.024 0.035 Weight-for-age (below -2SD) 0.040 0.004 3440 4837 1.077 0.094 0.033 0.048 BMI <18.5 0.002 0.001 5210 7456 1.019 0.301 0.001 0.003 Anemia among ever-married women 0.361 0.011 1924 2733 0.999 0.030 0.339 0.383 Severe anemia among ever-married women 0.003 0.001 1924 2733 0.804 0.324 0.001 0.005 Anemia among children under five 0.430 0.015 1050 1470 0.991 0.035 0.399 0.460 Severe anemia among children under five 0.001 0.001 1050 1470 1.090 1.002 0.000 0.003 Anemia among adolescent boys 10-19 0.224 0.012 1138 1587 0.994 0.055 0.199 0.248 Severe anemia among adolescent boys 10-19 0.000 0.000 1138 1587 na na 0.000 0.000 Anemia among adolescent girls 10-19 0.355 0.016 1075 1503 1.119 0.046 0.322 0.388 Severe anemia amonmg adolescent girls 10-19 0.001 0.001 1075 1503 1.085 0.996 0.000 0.003 Total fertility rate 0-3 years 2.924 0.066 na 35507 1.187 0.022 2.793 3.055 Neonatal mortality (10 years) 22.603 2.466 7394 10499 1.220 0.109 17.672 27.534 Postneonatal mortality (10 years) 10.117 1.314 7396 10503 1.143 0.130 7.489 12.745 Infant mortality (10 years) 32.720 2.773 7396 10503 1.213 0.085 27.174 38.267 Child mortality (10 years) 5.846 0.927 7401 10509 1.042 0.159 3.991 7.701 Under 5 mortality (10 years) 38.375 2.939 7403 10512 1.199 0.077 32.497 44.252 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 268 | Appendix C Table C.7 Sampling errors for Lower Egypt Urban sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 1.000 0.000 1553 2199 na 0.000 1.000 1.000 Literate 0.788 0.012 1553 2199 1.194 0.016 0.763 0.813 No education 0.154 0.011 1553 2199 1.225 0.073 0.132 0.177 Completed secondary education/higher 0.605 0.019 1553 2199 1.501 0.031 0.568 0.642 Currently married 0.936 0.006 1553 2199 0.959 0.006 0.924 0.947 Currently pregnant 0.051 0.005 2407 3371 1.035 0.104 0.040 0.061 Children ever born 1.741 0.107 2407 3371 0.964 0.062 1.526 1.955 Children surviving 1.647 0.102 2407 3371 0.969 0.062 1.444 1.850 Children ever born to women age 40-49 3.603 0.080 534 770 1.084 0.022 3.443 3.763 Ever using contraceptive method 0.860 0.010 1454 2057 1.070 0.011 0.840 0.879 Currently using any contraceptive method 0.641 0.012 1454 2057 0.974 0.019 0.617 0.666 Currently using a modern method 0.623 0.011 1454 2057 0.897 0.018 0.600 0.646 Currently using pill 0.123 0.009 1454 2057 1.081 0.076 0.104 0.141 Currently using IUD 0.423 0.013 1454 2057 1.036 0.032 0.397 0.450 Currently using injectables 0.043 0.007 1454 2057 1.239 0.154 0.030 0.056 Currently using condom 0.010 0.003 1454 2057 1.085 0.280 0.004 0.016 Currently using female sterilization 0.017 0.003 1454 2057 0.909 0.179 0.011 0.024 Currently using periodic abstinence 0.010 0.003 1454 2057 1.180 0.301 0.004 0.017 Public sector source 0.415 0.019 899 1282 1.177 0.047 0.376 0.454 Want no more children 0.655 0.015 1454 2057 1.243 0.024 0.624 0.686 Want to delay birth at least 2 years 0.147 0.010 1454 2057 1.060 0.067 0.127 0.167 Ideal family size 2.734 0.038 1494 2108 1.265 0.014 2.657 2.810 Mothers received tetanus injection for last birth 0.722 0.021 709 987 1.247 0.029 0.680 0.765 Mothers received medical assistance at delivery 0.929 0.010 925 1297 1.086 0.011 0.908 0.950 Had diarrhea in two weeks before survey 0.152 0.012 891 1248 0.914 0.076 0.129 0.176 Treated with oral rehydration salts (ORS) 0.393 0.047 132 190 1.070 0.120 0.299 0.487 Taken to a health provider 0.571 0.043 132 190 0.956 0.075 0.486 0.656 Had vaccination card 0.609 0.040 172 235 1.025 0.066 0.528 0.689 Received BCG 1.000 0.000 172 235 na 0.000 1.000 1.000 Received DPT (3 doses) 0.923 0.023 172 235 1.030 0.025 0.877 0.969 Received polio (3 doses) 0.957 0.019 172 235 1.076 0.020 0.919 0.996 Received measles 0.971 0.013 172 235 1.005 0.014 0.944 0.997 Fully immunized 0.895 0.026 172 235 1.017 0.029 0.844 0.947 Has heard of HIV/AIDS 0.957 0.007 1553 2199 1.404 0.008 0.942 0.971 Height-for-age (below -2SD) 0.151 0.013 837 1160 1.042 0.087 0.125 0.178 Weight-for-height (below -2SD) 0.027 0.005 837 1160 0.889 0.187 0.017 0.037 Weight-for-age (below -2SD) 0.042 0.007 837 1160 0.931 0.159 0.029 0.055 BMI <18.5 0.002 0.001 1379 1959 1.024 0.615 0.000 0.004 Anemia among ever-married women 0.347 0.020 527 737 0.943 0.056 0.307 0.386 Severe anemia among ever-married women 0.000 0.000 527 737 na na 0.000 0.000 Anemia among children under five 0.384 0.029 258 351 0.958 0.076 0.326 0.442 Severe anemia among children under five 0.000 0.000 258 351 na na 0.000 0.000 Anemia among adolescent boys 10-19 0.132 0.021 302 419 1.092 0.161 0.090 0.175 Severe anemia among adolescent boys 10-19 0.000 0.000 302 419 na na 0.000 0.000 Anemia among adolescent girls 10-19 0.346 0.029 273 365 0.994 0.083 0.289 0.403 Severe anemia amonmg adolescent girls 10-19 0.000 0.000 273 365 na na 0.000 0.000 Total fertility rate 0-3 years 2.663 0.119 na 10654 1.197 0.045 2.425 2.900 Neonatal mortality (10 years) 24.114 6.495 1796 2505 1.344 0.269 11.124 37.104 Postneonatal mortality (10 years) 5.846 1.774 1796 2505 0.981 0.303 2.298 9.394 Infant mortality (10 years) 29.960 6.491 1796 2505 1.265 0.217 16.978 42.942 Child mortality (10 years) 4.630 1.623 1797 2507 0.983 0.351 1.383 7.876 Under 5 mortality (10 years) 34.451 6.478 1797 2507 1.214 0.188 21.495 47.406 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 269 Table C.8 Sampling errors for Lower Egypt Rural sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.000 0.000 4350 6211 na na 0.000 0.000 Literate 0.557 0.009 4350 6211 1.156 0.016 0.540 0.574 No education 0.354 0.008 4350 6211 1.120 0.023 0.338 0.370 Completed secondary education/higher 0.389 0.009 4350 6211 1.268 0.024 0.370 0.408 Currently married 0.938 0.004 4350 6211 1.015 0.004 0.931 0.945 Currently pregnant 0.064 0.003 6337 8947 1.039 0.055 0.057 0.071 Children ever born 2.059 0.074 6337 8947 1.100 0.036 1.912 2.207 Children surviving 1.906 0.068 6337 8947 1.101 0.036 1.770 2.042 Children ever born to women age 40-49 4.622 0.057 1145 1657 0.963 0.012 4.507 4.737 Ever using contraceptive method 0.854 0.006 4088 5826 1.084 0.007 0.843 0.866 Currently using any contraceptive method 0.665 0.008 4088 5826 1.074 0.012 0.650 0.681 Currently using a modern method 0.648 0.008 4088 5826 1.023 0.012 0.633 0.664 Currently using pill 0.092 0.005 4088 5826 1.125 0.055 0.082 0.102 Currently using IUD 0.445 0.009 4088 5826 1.127 0.020 0.428 0.463 Currently using injectables 0.080 0.005 4088 5826 1.263 0.067 0.070 0.091 Currently using condom 0.007 0.002 4088 5826 1.226 0.234 0.004 0.010 Currently using female sterilization 0.017 0.002 4088 5826 1.001 0.120 0.013 0.021 Currently using periodic abstinence 0.003 0.001 4088 5826 1.264 0.359 0.001 0.005 Public sector source 0.626 0.012 2635 3781 1.286 0.019 0.601 0.650 Want no more children 0.674 0.007 4088 5826 0.983 0.011 0.659 0.688 Want to delay birth at least 2 years 0.157 0.006 4088 5826 1.048 0.038 0.145 0.169 Ideal family size 2.737 0.016 4093 5816 0.924 0.006 2.706 2.768 Mothers received tetanus injection for last birth 0.843 0.009 2166 3079 1.122 0.010 0.826 0.861 Mothers received medical assistance at delivery 0.780 0.011 2879 4101 1.210 0.014 0.758 0.801 Had diarrhea in two weeks before survey 0.170 0.007 2799 3987 0.901 0.039 0.157 0.184 Treated with oral rehydration salts (ORS) 0.323 0.021 446 678 0.921 0.064 0.282 0.365 Taken to a health provider 0.462 0.028 446 678 1.168 0.061 0.406 0.519 Had vaccination card 0.743 0.019 593 836 1.022 0.025 0.706 0.780 Received BCG 0.980 0.006 593 836 1.013 0.006 0.968 0.992 Received DPT (3 doses) 0.950 0.010 593 836 1.060 0.010 0.930 0.969 Received polio (3 doses) 0.987 0.005 593 836 1.031 0.005 0.978 0.997 Received measles 0.977 0.006 593 836 0.988 0.006 0.965 0.989 Fully immunized 0.912 0.013 593 836 1.074 0.014 0.887 0.937 Has heard of HIV/AIDS 0.840 0.006 4350 6211 1.140 0.008 0.827 0.853 Height-for-age (below -2SD) 0.133 0.007 2603 3677 1.005 0.053 0.119 0.147 Weight-for-height (below -2SD) 0.030 0.003 2603 3677 0.949 0.110 0.024 0.037 Weight-for-age (below -2SD) 0.039 0.004 2603 3677 1.123 0.113 0.030 0.048 BMI <18.5 0.002 0.001 3831 5496 1.017 0.345 0.001 0.004 Anemia among ever-married women 0.366 0.013 1397 1997 1.017 0.036 0.340 0.392 Severe anemia among ever-married women 0.004 0.001 1397 1997 0.802 0.324 0.002 0.007 Anemia among children under five 0.444 0.018 792 1119 1.006 0.040 0.408 0.479 Severe anemia among children under five 0.001 0.001 792 1119 1.086 1.002 0.000 0.004 Anemia among adolescent boys 10-19 0.257 0.014 836 1167 0.952 0.056 0.228 0.285 Severe anemia among adolescent boys 10-19 0.000 0.000 836 1167 na na 0.000 0.000 Anemia among adolescent girls 10-19 0.358 0.020 802 1138 1.152 0.054 0.319 0.397 Severe anemia amonmg adolescent girls 10-19 0.001 0.001 802 1138 1.076 0.995 0.000 0.004 Total fertility rate 0-3 years 3.008 0.078 na 26027 1.156 0.026 2.852 3.164 Neonatal mortality (10 years) 22.132 2.546 5598 7994 1.166 0.115 17.039 27.225 Postneonatal mortality (10 years) 11.446 1.615 5600 7998 1.155 0.141 8.216 14.676 Infant mortality (10 years) 33.578 3.056 5600 7998 1.204 0.091 27.467 39.689 Child mortality (10 years) 6.237 1.114 5604 8002 1.063 0.179 4.009 8.466 Under 5 mortality (10 years) 39.606 3.318 5606 8006 1.206 0.084 32.970 46.242 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 270 | Appendix C Table C.9 Sampling errors for Upper Egypt, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.319 0.010 9132 7552 2.119 0.032 0.299 0.340 Literate 0.478 0.009 9132 7552 1.627 0.018 0.461 0.495 No education 0.467 0.009 9132 7552 1.663 0.019 0.450 0.484 Completed secondary education/higher 0.284 0.009 9132 7552 1.820 0.030 0.267 0.302 Currently married 0.929 0.004 9132 7552 1.363 0.004 0.922 0.937 Currently pregnant 0.069 0.003 13739 11216 1.254 0.044 0.063 0.075 Children ever born 2.355 0.061 13739 11216 1.155 0.026 2.234 2.476 Children surviving 2.095 0.054 13739 11216 1.162 0.026 1.988 2.203 Children ever born to women age 40-49 5.394 0.077 2374 1972 1.370 0.014 5.239 5.549 Ever using contraceptive method 0.744 0.006 8437 7019 1.319 0.008 0.731 0.756 Currently using any contraceptive method 0.499 0.007 8437 7019 1.294 0.014 0.485 0.513 Currently using a modern method 0.461 0.007 8437 7019 1.335 0.016 0.446 0.475 Currently using pill 0.103 0.004 8437 7019 1.344 0.043 0.094 0.112 Currently using IUD 0.252 0.006 8437 7019 1.289 0.024 0.239 0.264 Currently using injectables 0.082 0.004 8437 7019 1.215 0.044 0.075 0.089 Currently using condom 0.005 0.001 8437 7019 1.237 0.181 0.003 0.007 Currently using female sterilization 0.008 0.001 8437 7019 1.380 0.162 0.006 0.011 Currently using periodic abstinence 0.006 0.001 8437 7019 1.712 0.231 0.003 0.009 Public sector source 0.568 0.012 4009 3234 1.519 0.021 0.544 0.592 Want no more children 0.608 0.007 8437 7019 1.274 0.011 0.594 0.621 Want to delay birth at least 2 years 0.180 0.005 8437 7019 1.264 0.029 0.170 0.191 Ideal family size 3.171 0.021 8229 6729 1.220 0.007 3.129 3.213 Mothers received tetanus injection for last birth 0.782 0.008 5081 4200 1.418 0.011 0.766 0.799 Mothers received medical assistance at delivery 0.626 0.010 7375 6153 1.496 0.017 0.606 0.647 Had diarrhea in two weeks before survey 0.210 0.008 7065 5897 1.505 0.036 0.195 0.225 Treated with oral rehydration salts (ORS) 0.362 0.015 1502 1239 1.167 0.042 0.331 0.393 Taken to a health provider 0.459 0.018 1502 1239 1.329 0.040 0.423 0.496 Had vaccination card 0.754 0.014 1406 1169 1.186 0.018 0.727 0.782 Received BCG 0.973 0.005 1406 1169 1.093 0.005 0.963 0.982 Received DPT (3 doses) 0.925 0.008 1406 1169 1.182 0.009 0.908 0.942 Received polio (3 doses) 0.954 0.007 1406 1169 1.178 0.007 0.940 0.968 Received measles 0.957 0.006 1406 1169 1.102 0.006 0.944 0.969 Fully immunized 0.863 0.011 1406 1169 1.195 0.013 0.841 0.886 Has heard of HIV/AIDS 0.765 0.006 9132 7552 1.324 0.008 0.753 0.777 Height-for-age (below -2SD) 0.214 0.007 6598 5482 1.237 0.032 0.200 0.227 Weight-for-height (below -2SD) 0.035 0.003 6598 5482 1.323 0.089 0.029 0.042 Weight-for-age (below -2SD) 0.075 0.004 6598 5482 1.282 0.056 0.066 0.083 BMI <18.5 0.009 0.001 7927 6578 1.239 0.150 0.006 0.011 Anemia among ever-married women 0.426 0.011 2958 2446 1.166 0.025 0.404 0.447 Severe anemia among ever-married women 0.003 0.001 2958 2446 1.366 0.469 0.000 0.006 Anemia among children under five 0.553 0.012 2066 1714 1.134 0.022 0.528 0.578 Severe anemia among children under five 0.005 0.002 2066 1714 1.260 0.400 0.001 0.009 Anemia among adolescent boys 10-19 0.302 0.014 2050 1656 1.351 0.045 0.275 0.330 Severe anemia among adolescent boys 10-19 0.005 0.003 2050 1656 1.667 0.512 0.000 0.010 Anemia among adolescent girls 10-19 0.341 0.012 1874 1509 1.130 0.036 0.317 0.366 Severe anemia amonmg adolescent girls 10-19 0.001 0.001 1874 1509 1.466 0.998 0.000 0.003 Total fertility rate 0-3 years 3.656 0.067 na 31052 1.420 0.018 3.521 3.791 Neonatal mortality (10 years) 24.841 1.714 14380 11914 1.229 0.069 21.413 28.268 Postneonatal mortality (10 years) 26.747 1.915 14403 11930 1.345 0.072 22.917 30.576 Infant mortality (10 years) 51.587 2.787 14406 11934 1.406 0.054 46.013 57.161 Child mortality (10 years) 14.364 1.430 14420 11949 1.332 0.100 11.505 17.223 Under 5 mortality (10 years) 65.210 3.144 14449 11972 1.422 0.048 58.923 71.497 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 271 Table C.10 Sampling errors for Upper Egypt Urban sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 1.000 0.000 2471 2411 na 0.000 1.000 1.000 Literate 0.698 0.016 2471 2411 1.709 0.023 0.667 0.730 No education 0.255 0.014 2471 2411 1.606 0.055 0.227 0.283 Completed secondary education/higher 0.491 0.020 2471 2411 1.971 0.040 0.452 0.531 Currently married 0.925 0.008 2471 2411 1.459 0.008 0.910 0.941 Currently pregnant 0.057 0.005 4048 3719 1.223 0.092 0.046 0.067 Children ever born 1.959 0.095 4048 3719 0.933 0.049 1.768 2.150 Children surviving 1.796 0.093 4048 3719 0.995 0.052 1.611 1.981 Children ever born to women age 40-49 4.227 0.122 729 721 1.418 0.029 3.984 4.470 Ever using contraceptive method 0.826 0.010 2268 2230 1.235 0.012 0.807 0.846 Currently using any contraceptive method 0.600 0.012 2268 2230 1.176 0.020 0.576 0.624 Currently using a modern method 0.561 0.012 2268 2230 1.171 0.022 0.537 0.585 Currently using pill 0.135 0.011 2268 2230 1.478 0.079 0.114 0.156 Currently using IUD 0.350 0.011 2268 2230 1.143 0.033 0.327 0.373 Currently using injectables 0.048 0.005 2268 2230 1.092 0.102 0.038 0.058 Currently using condom 0.010 0.003 2268 2230 1.325 0.276 0.004 0.016 Currently using female sterilization 0.012 0.003 2268 2230 1.374 0.261 0.006 0.018 Currently using periodic abstinence 0.015 0.004 2268 2230 1.666 0.285 0.006 0.023 Public sector source 0.449 0.017 1265 1251 1.225 0.038 0.415 0.484 Want no more children 0.641 0.012 2268 2230 1.236 0.019 0.616 0.666 Want to delay birth at least 2 years 0.165 0.009 2268 2230 1.214 0.057 0.146 0.184 Ideal family size 2.902 0.038 2271 2143 1.316 0.013 2.825 2.978 Mothers received tetanus injection for last birth 0.708 0.018 1270 1235 1.446 0.026 0.671 0.745 Mothers received medical assistance at delivery 0.838 0.015 1718 1669 1.388 0.018 0.807 0.868 Had diarrhea in two weeks before survey 0.208 0.018 1654 1604 1.693 0.087 0.172 0.244 Treated with oral rehydration salts (ORS) 0.280 0.029 324 333 1.116 0.105 0.221 0.338 Taken to a health provider 0.508 0.043 324 333 1.459 0.084 0.423 0.593 Had vaccination card 0.783 0.022 329 312 0.927 0.028 0.740 0.826 Received BCG 0.977 0.009 329 312 1.119 0.010 0.958 0.996 Received DPT (3 doses) 0.931 0.018 329 312 1.290 0.020 0.895 0.968 Received polio (3 doses) 0.982 0.010 329 312 1.327 0.010 0.962 1.002 Received measles 0.966 0.014 329 312 1.382 0.015 0.937 0.994 Fully immunized 0.875 0.021 329 312 1.134 0.024 0.833 0.917 Has heard of HIV/AIDS 0.906 0.009 2471 2411 1.614 0.010 0.887 0.925 Height-for-age (below -2SD) 0.166 0.014 1538 1514 1.410 0.082 0.139 0.193 Weight-for-height (below -2SD) 0.042 0.008 1538 1514 1.353 0.182 0.027 0.058 Weight-for-age (below -2SD) 0.065 0.009 1538 1514 1.392 0.132 0.048 0.082 BMI <18.5 0.007 0.002 2178 2138 1.083 0.274 0.003 0.011 Anemia among ever-married women 0.434 0.020 832 802 1.188 0.047 0.394 0.475 Severe anemia among ever-married women 0.004 0.003 832 802 1.379 0.729 0.000 0.011 Anemia among children under five 0.493 0.030 495 471 1.319 0.060 0.434 0.552 Severe anemia among children under five 0.000 0.000 495 471 0.451 1.001 0.000 0.001 Anemia among adolescent boys 10-19 0.213 0.022 489 465 1.170 0.102 0.169 0.256 Severe anemia among adolescent boys 10-19 0.007 0.007 489 465 1.891 0.987 0.000 0.022 Anemia among adolescent girls 10-19 0.320 0.019 511 452 0.933 0.060 0.281 0.358 Severe anemia amonmg adolescent girls 10-19 0.000 0.000 511 452 na na 0.000 0.000 Total fertility rate 0-3 years 3.124 0.098 na 10930 1.298 0.031 2.927 3.320 Neonatal mortality (10 years) 24.731 3.871 3347 3260 1.250 0.157 16.990 32.473 Postneonatal mortality (10 years) 14.609 2.334 3350 3261 1.151 0.160 9.941 19.278 Infant mortality (10 years) 39.341 5.021 3351 3263 1.377 0.128 29.298 49.384 Child mortality (10 years) 9.462 1.930 3350 3261 1.088 0.204 5.601 13.323 Under 5 mortality (10 years) 48.431 5.369 3355 3267 1.332 0.111 37.693 59.168 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 272 | Appendix C Table C.11 Sampling errors for Upper Egypt Rural sample, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.000 0.000 6661 5141 na na 0.000 0.000 Literate 0.375 0.009 6661 5141 1.557 0.025 0.356 0.393 No education 0.566 0.010 6661 5141 1.703 0.018 0.545 0.587 Completed secondary education/higher 0.187 0.007 6661 5141 1.477 0.038 0.173 0.201 Currently married 0.931 0.004 6661 5141 1.275 0.004 0.924 0.939 Currently pregnant 0.074 0.004 9796 7500 1.221 0.049 0.067 0.082 Children ever born 2.550 0.077 9796 7500 1.181 0.030 2.395 2.705 Children surviving 2.243 0.067 9796 7500 1.167 0.030 2.110 2.377 Children ever born to women age 40-49 6.055 0.091 1647 1253 1.333 0.015 5.874 6.237 Ever using contraceptive method 0.705 0.008 6169 4789 1.355 0.011 0.690 0.721 Currently using any contraceptive method 0.452 0.009 6169 4789 1.342 0.019 0.435 0.469 Currently using a modern method 0.414 0.009 6169 4789 1.416 0.021 0.396 0.432 Currently using pill 0.088 0.004 6169 4789 1.139 0.047 0.080 0.097 Currently using IUD 0.206 0.007 6169 4789 1.395 0.035 0.191 0.220 Currently using injectables 0.098 0.005 6169 4789 1.257 0.049 0.088 0.107 Currently using condom 0.003 0.001 6169 4789 0.884 0.193 0.002 0.005 Currently using female sterilization 0.007 0.001 6169 4789 1.333 0.205 0.004 0.010 Currently using periodic abstinence 0.003 0.001 6169 4789 1.526 0.384 0.001 0.005 Public sector source 0.643 0.014 2744 1983 1.577 0.022 0.614 0.672 Want no more children 0.592 0.008 6169 4789 1.277 0.013 0.577 0.608 Want to delay birth at least 2 years 0.187 0.006 6169 4789 1.276 0.034 0.174 0.200 Ideal family size 3.296 0.025 5958 4586 1.161 0.007 3.247 3.346 Mothers received tetanus injection for last birth 0.813 0.009 3811 2965 1.401 0.011 0.795 0.831 Mothers received medical assistance at delivery 0.548 0.012 5657 4484 1.464 0.022 0.524 0.572 Had diarrhea in two weeks before survey 0.211 0.008 5411 4292 1.406 0.038 0.195 0.227 Treated with oral rehydration salts (ORS) 0.392 0.018 1178 906 1.172 0.045 0.357 0.427 Taken to a health provider 0.441 0.019 1178 906 1.249 0.044 0.403 0.480 Had vaccination card 0.744 0.017 1077 857 1.277 0.023 0.710 0.777 Received BCG 0.971 0.005 1077 857 1.089 0.006 0.960 0.982 Received DPT (3 doses) 0.922 0.009 1077 857 1.146 0.010 0.904 0.941 Received polio (3 doses) 0.944 0.009 1077 857 1.178 0.009 0.927 0.962 Received measles 0.953 0.007 1077 857 1.008 0.007 0.940 0.967 Fully immunized 0.859 0.013 1077 857 1.223 0.015 0.833 0.885 Has heard of HIV/AIDS 0.698 0.007 6661 5141 1.258 0.010 0.684 0.712 Height-for-age (below -2SD) 0.232 0.008 5060 3968 1.173 0.033 0.217 0.248 Weight-for-height (below -2SD) 0.033 0.003 5060 3968 1.267 0.097 0.026 0.039 Weight-for-age (below -2SD) 0.078 0.005 5060 3968 1.262 0.062 0.069 0.088 BMI <18.5 0.009 0.002 5749 4440 1.304 0.178 0.006 0.013 Anemia among ever-married women 0.421 0.012 2126 1643 1.136 0.029 0.397 0.446 Severe anemia among ever-married women 0.002 0.001 2126 1643 1.276 0.594 0.000 0.005 Anemia among children under five 0.576 0.013 1571 1242 1.060 0.023 0.549 0.602 Severe anemia among children under five 0.006 0.003 1571 1242 1.305 0.409 0.001 0.012 Anemia among adolescent boys 10-19 0.337 0.016 1561 1191 1.373 0.049 0.304 0.370 Severe anemia among adolescent boys 10-19 0.004 0.002 1561 1191 1.370 0.532 0.000 0.009 Anemia among adolescent girls 10-19 0.351 0.016 1363 1057 1.201 0.044 0.320 0.382 Severe anemia amonmg adolescent girls 10-19 0.002 0.002 1363 1057 1.493 0.997 0.000 0.005 Total fertility rate 0-3 years 3.918 0.084 na 20821 1.309 0.022 3.749 4.087 Neonatal mortality (10 years) 24.882 1.875 11033 8654 1.221 0.075 21.131 28.633 Postneonatal mortality (10 years) 31.329 2.342 11053 8669 1.334 0.075 26.644 36.013 Infant mortality (10 years) 56.210 3.219 11055 8670 1.382 0.057 49.772 62.649 Child mortality (10 years) 16.253 1.813 11070 8688 1.399 0.112 12.626 19.880 Under 5 mortality (10 years) 71.550 3.636 11094 8706 1.403 0.051 64.277 78.822 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 273 Table C.12 Sampling errors for Frontier Governorates, Egypt 2005 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban 0.596 0.017 901 218 1.026 0.028 0.563 0.630 Literate 0.605 0.017 901 218 1.033 0.028 0.571 0.638 No education 0.378 0.017 901 218 1.032 0.044 0.345 0.412 Completed secondary education/higher 0.374 0.022 901 218 1.335 0.058 0.331 0.417 Currently married 0.943 0.007 901 218 0.913 0.007 0.929 0.957 Currently pregnant 0.073 0.006 1402 341 0.898 0.088 0.061 0.086 Children ever born 2.020 0.112 1402 341 1.064 0.055 1.796 2.244 Children surviving 1.919 0.109 1402 341 1.093 0.057 1.700 2.137 Children ever born to women age 40-49 4.480 0.171 230 56 1.063 0.038 4.137 4.823 Ever using contraceptive method 0.745 0.018 851 206 1.183 0.024 0.710 0.780 Currently using any contraceptive method 0.507 0.023 851 206 1.315 0.044 0.462 0.552 Currently using a modern method 0.472 0.022 851 206 1.291 0.047 0.428 0.516 Currently using pill 0.144 0.014 851 206 1.201 0.100 0.115 0.173 Currently using IUD 0.219 0.018 851 206 1.302 0.084 0.182 0.256 Currently using injectables 0.071 0.010 851 206 1.131 0.140 0.051 0.091 Currently using condom 0.015 0.005 851 206 1.144 0.315 0.006 0.025 Currently using female sterilization 0.009 0.002 851 206 0.777 0.285 0.004 0.014 Currently using periodic abstinence 0.004 0.001 851 206 0.605 0.320 0.002 0.007 Public sector source 0.596 0.033 393 97 1.328 0.055 0.530 0.662 Want no more children 0.592 0.021 851 206 1.235 0.035 0.550 0.633 Want to delay birth at least 2 years 0.176 0.013 851 206 0.978 0.073 0.150 0.201 Ideal family size 3.332 0.087 878 213 1.641 0.026 3.158 3.505 Mothers received tetanus injection for last birth 0.695 0.034 490 119 1.623 0.049 0.627 0.762 Mothers received medical assistance at delivery 0.718 0.036 693 169 1.693 0.050 0.646 0.791 Had diarrhea in two weeks before survey 0.148 0.017 667 162 1.181 0.117 0.113 0.183 Treated with oral rehydration salts (ORS) 0.217 0.050 93 24 1.106 0.231 0.116 0.317 Taken to a health provider 0.380 0.071 93 24 1.353 0.188 0.237 0.522 Had vaccination card 0.777 0.037 151 37 1.091 0.047 0.703 0.851 Received BCG 0.989 0.011 151 37 0.947 0.011 0.966 1.011 Received DPT (3 doses) 0.909 0.026 151 37 1.139 0.029 0.856 0.962 Received polio (3 doses) 0.955 0.018 151 37 1.061 0.019 0.919 0.990 Received measles 0.927 0.027 151 37 1.111 0.029 0.873 0.981 Fully immunized 0.856 0.034 151 37 1.115 0.039 0.789 0.924 Has heard of HIV/AIDS 0.819 0.015 901 218 1.173 0.018 0.789 0.849 Height-for-age (below -2SD) 0.141 0.021 589 143 1.337 0.147 0.100 0.183 Weight-for-height (below -2SD) 0.052 0.007 589 143 0.764 0.129 0.039 0.066 Weight-for-age (below -2SD) 0.043 0.011 589 143 1.237 0.244 0.022 0.064 BMI <18.5 0.000 0.000 766 186 na na 0.000 0.000 Anemia among ever-married women 0.472 0.036 300 73 1.264 0.077 0.399 0.545 Severe anemia among ever-married women 0.004 0.004 300 73 1.092 0.989 0.000 0.012 Anemia among children under five 0.431 0.047 193 47 1.328 0.110 0.336 0.526 Severe anemia among children under five 0.007 0.005 193 47 0.873 0.740 0.000 0.018 Anemia among adolescent boys 10-19 0.280 0.042 197 48 1.301 0.149 0.196 0.363 Severe anemia among adolescent boys 10-19 0.004 0.004 197 48 0.950 1.037 0.000 0.013 Anemia among adolescent girls 10-19 0.560 0.043 199 49 1.213 0.076 0.475 0.646 Severe anemia amonmg adolescent girls 10-19 0.000 0.000 199 49 na na 0.000 0.000 Total fertility rate 0-3 years 3.338 0.139 na 958 0.929 0.042 3.060 3.616 Neonatal mortality (10 years) 24.526 4.279 1315 325 0.924 0.174 15.967 33.084 Postneonatal mortality (10 years) 8.727 2.695 1314 325 0.919 0.309 3.337 14.118 Infant mortality (10 years) 33.253 5.517 1315 325 0.962 0.166 22.219 44.287 Child mortality (10 years) 9.116 2.969 1314 325 1.117 0.326 3.178 15.053 Under 5 mortality (10 years) 42.065 6.804 1315 325 1.082 0.162 28.458 55.672 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix D | 275 DATA QUALITY TABLES Appendix D Table D.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Egypt 2005 Female Male Female Male Age Number Per- centage Number Per- centage Age Number Per- centage Number Per- centage 0 1,359 2.6 1,258 2.3 36 507 1.0 543 1.0 1 1,321 2.5 1,260 2.3 37 559 1.1 570 1.1 2 1,333 2.5 1,273 2.4 38 544 1.0 653 1.2 3 1,300 2.5 1,314 2.4 39 453 0.9 523 1.0 4 1,310 2.5 1,270 2.4 40 938 1.8 907 1.7 5 1,467 2.8 1,292 2.4 41 460 0.9 429 0.8 6 1,221 2.3 1,188 2.2 42 627 1.2 624 1.2 7 1,122 2.1 1,180 2.2 43 507 1.0 525 1.0 8 1,198 2.3 1,113 2.1 44 437 0.8 382 0.7 9 1,238 2.4 1,174 2.2 45 901 1.7 843 1.6 10 1,143 2.2 1,144 2.1 46 346 0.7 386 0.7 11 1,147 2.2 1,049 1.9 47 409 0.8 455 0.8 12 1,210 2.3 1,145 2.1 48 467 0.9 500 0.9 13 1,089 2.1 1,027 1.9 49 338 0.6 482 0.9 14 1,183 2.2 1,140 2.1 50 638 1.2 412 0.8 15 1,281 2.4 1,250 2.3 51 305 0.6 348 0.6 16 1,273 2.4 1,245 2.3 52 433 0.8 599 1.1 17 1,296 2.5 1,340 2.5 53 397 0.8 398 0.7 18 1,368 2.6 1,385 2.6 54 350 0.7 341 0.6 19 1,154 2.2 1,238 2.3 55 530 1.0 752 1.4 20 1,151 2.2 1,364 2.5 56 302 0.6 275 0.5 21 965 1.8 1,143 2.1 57 301 0.6 205 0.4 22 1,019 1.9 1,172 2.2 58 278 0.5 254 0.5 23 966 1.8 1,118 2.1 59 227 0.4 161 0.3 24 855 1.6 970 1.8 60 525 1.0 741 1.4 25 1,009 1.9 1,345 2.5 61 158 0.3 106 0.2 26 741 1.4 885 1.6 62 254 0.5 177 0.3 27 887 1.7 815 1.5 63 200 0.4 114 0.2 28 772 1.5 820 1.5 64 155 0.3 105 0.2 29 568 1.1 634 1.2 65 466 0.9 606 1.1 30 941 1.8 1,033 1.9 66 92 0.2 76 0.1 31 495 0.9 598 1.1 67 147 0.3 90 0.2 32 654 1.2 655 1.2 68 92 0.2 59 0.1 33 466 0.9 613 1.1 69 64 0.1 43 0.1 34 524 1.0 507 0.9 70+ 1,289 2.4 1,337 2.5 35 917 1.7 1,020 1.9 Don’t know/ missing 0 0.0 2 0.0 Total 52,638 100.0 53,998 100.0 276 | Appendix D Table D.2 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted), by five-year age groups, Egypt 2005 Household population Ever-married women age 15-49 interviewed Age All women age 10-54 Ever-married women age 10-54 Number Percent Percentage interviewed (weighted) 10-14 5,506 0 na na na 15-19 6,458 795 790 4.1 99.3 20-24 5,767 2,970 2,955 15.4 99.5 25-29 4,499 3,701 3,685 19.2 99.6 30-34 3,405 3,205 3,185 16.6 99.4 25-39 3,309 3,193 3,180 16.6 99.6 40-44 2,867 2,795 2,776 14.5 99.3 45-49 2,665 2,616 2,604 13.6 99.6 50-54 2,097 2,061 na na na 15-49 28,971 19,274 19,174 100.0 99.5 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. na = Not applicable Table D.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Egypt 2005 Subject Reference population Percentage with missing information Number of cases Birth date Births in last 15 years Month only 5.9 37,935 Month and year <0.1 37,935 Age at death Deaths among births in last 15 years <0.5 2,123 Age and year at first union Ever-married women <1.0 19,474 Respondent's education Ever-married women 0.01 19,474 Diarrhea in last 2 weeks <0.5 13,120 Anthropometric measure Height Living children 0-59 months 1.1 13,030 Weight Living children 0-59 months 1.0 13,030 Height or weight Living children 0-59 months 1.1 13,030 Anemia Children Living children 0-59 months 3.1 3,878 Women Ever-married women 2.3 6,339 Appendix D | 277 Table D.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living (L), dead (D), and total (T) children (weighted), Egypt 2005 Number of births Percentage with complete birth date1 Sex ratio at birth Calendar year ratio Calendar year L D T L D T L D T L D T 2005 1,048 34 1,081 100.0 100.0 100.0 111.9 124.6 112.2 na na na 2004 2,676 100 2,776 100.0 100.0 100.0 108.4 142.9 109.4 na na na 2003 2,606 108 2,714 100.0 100.0 100.0 100.1 136.4 101.3 96.4 109.6 96.8 2002 2,733 97 2,830 100.0 100.0 100.0 103.7 127.1 104.4 103.6 102.3 103.5 2001 2,673 81 2,754 100.0 100.0 100.0 101.0 79.3 100.3 103.0 85.3 102.4 2000 2,458 93 2,551 100.0 100.0 100.0 109.3 114.2 109.5 89.3 74.2 88.7 1999 2,830 170 3,000 98.6 76.6 97.3 106.4 106.0 106.4 114.8 138.2 115.9 1998 2,472 153 2,626 95.0 66.3 93.3 100.6 95.6 100.3 96.4 90.1 96.0 1997 2,301 170 2,471 91.4 60.6 89.2 98.5 131.9 100.4 97.5 113.7 98.5 1996 2,246 146 2,392 89.7 60.9 87.9 106.1 131.1 107.5 97.4 89.3 96.9 2001-2005 11,736 419 12,156 100.0 100.0 100.0 104.0 121.2 104.5 na na na 1996-2000 12,306 733 13,039 95.2 70.6 93.8 104.2 114.9 104.8 na na na 1991-1995 10,668 832 11,500 91.5 57.0 89.0 105.8 107.7 105.9 na na na 1986-1990 10,166 1,094 11,259 92.2 51.9 88.3 104.1 108.2 104.4 na na na <1986 9,926 2,004 11,930 84.6 47.2 78.3 105.7 112.4 106.8 na na na All 54,802 5,081 59,884 93.0 57.5 90.0 104.7 111.8 105.3 na na na na = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x 278 | Appendix D Table D.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey (weighted), Egypt 2005 Number of years preceding the survey Age at death (days) 0-4 5-9 10-14 15-19 Total 0-19 <1 69 71 77 50 267 1 35 65 70 49 219 2 27 26 26 26 105 3 27 43 37 28 135 4 10 7 12 15 44 5 16 12 16 16 60 6 2 6 8 15 30 7 31 41 58 114 245 8 2 7 6 4 18 9 6 6 5 2 19 10 7 4 5 12 28 11 4 1 6 2 12 12 2 3 2 1 7 13 1 0 4 3 7 14 3 3 4 0 11 15 12 14 13 16 54 16 0 2 1 0 3 17 2 1 3 2 8 18 2 5 1 2 9 20 4 2 8 5 19 22 0 0 1 2 3 23 2 0 0 0 2 25 2 2 0 0 4 26 2 0 0 0 2 27 2 0 2 0 4 28 2 2 0 2 7 29 1 0 0 0 1 30 1 1 1 0 3 Total 0-30 272 325 365 366 1,328 Percent early neonatal1 68.2 71.2 67.0 54.4 64.8 1 (6 days/0-30 days) Appendix D | 279 Table D.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for five-year periods of birth preceding the survey, Egypt 2005 Number of years preceding the survey Age at death (months) 0-4 5-9 10-14 15-19 Total 0-19 <11 272 325 365 366 1,328 1 30 41 52 61 184 2 28 33 31 40 133 3 22 27 30 37 115 4 19 34 35 49 137 5 10 21 22 28 81 6 16 34 41 60 151 7 9 22 25 31 86 8 9 23 20 25 77 9 8 20 30 43 101 10 4 5 6 7 23 11 6 3 6 8 23 12 6 13 34 48 101 13 1 1 3 2 8 14 4 9 6 2 21 15 5 2 0 4 11 16 0 1 3 0 4 17 0 0 2 1 3 18 9 24 34 43 110 19 2 2 2 3 9 20 0 2 5 0 7 21 0 4 0 0 4 22 1 0 0 1 2 23 1 0 0 0 1 1 year 3 9 20 19 51 Total 0-11 433 589 666 754 2,441 Percent neonatal2 63.0 55.2 54.8 48.5 54.4 1 Includes deaths under one month reported in days 2 Under one month/under one year Appendix E | 281 QUESTIONNAIRES Appendix E ARAB REPUBLIC OF EGYPT MINISTRY OF HEALTH AND POPULATION NATIONAL POPULATION COUNCIL EL- ZANATY & ASSOCIATES Questionnaire Number DATA COLLECTED FROM THIS STUDY IS CONFIDENTIAL AND WILL BE USED FOR SCIENTIFIC PURPOSES ONLY EGYPT DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD QUESTIONNAIRE 2005 283Appendix E | HOUSEHOLD QUESTIONNAIRE IDENTIFICATION GOVERNORATE GOVERNORATE PSU/SEGMENT NO. KISM/MARKAZ BUILDING NO. PSU/SEGMENT NO. SHIAKHA/VILLAGE HOUSING UNIT NO. HOUSEHOLD NUMBER HOUSEHOLD NO. URBAN/RURAL URBAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 RURAL . . . . . . . . . . . . . . . . . . . . . . . 2 LARGE CITY . . . . . . 1 2 TOWN . . . . . . 3 VILLAGE . . . . . . 4 LOCALITY SUBSAMPLE ANEMIA SUBSAMPLE: YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . 2 NAME OF HOUSEHOLD HEAD ADDRESS IN DETAIL INTERVIEWER VISITS FINAL VISIT DAY MONTH YEAR DATE TEAM TEAM . . . . . . . . . . INTERVIEWER INT. NUMBER . . . SUPERVISOR . RESULT RESULT . . . . . . . . . . . . NEXT VISIT: DATE TOTAL NUMBER TIME OF VISITS RESULT CODES: 1 COMPLETED TOTAL PERSONS 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT IN HOUSEHOLD HOME AT TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME TOTAL ELIGIBLE 4 POSTPONED WOMEN 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING LINE NO. OF 7 DWELLING DESTROYED RESPONDENT TO 8 DWELLING NOT FOUND HOUSEHOLD 9 OTHER QUESTIONNAIRE (SPECIFY) YES NO ADDRESSED CHECKED BY: 1 2 REINTERVIEW: 1 2 FIELD EDITOR OFFICE EDITOR CODER KEYER NAME DATE / / 2005 / / 2005 / / 2005 / / 2005 SIGNATURE 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 SUP. NUMBER 3 0 SMALL CITY . . . 1 2 285Appendix E | HOUSEHOLD SCHEDULE Now we would like some information about the people who usually live in your household or who are staying with you now. LINE USUAL RESIDENTS AND RELATIONSHIP RESIDENCE NO. VISITORS IF AGE 15 OR OLDER 001 002 Please give me the names of What is the Does Did Is How old was What is (NAME'S) the persons who usually live in your relationship of (NAME) (NAME) (NAME) (NAME)? current marital household and guests of the (NAME) to the head usually sleep here male or at his/her status? household who slept here last night, of the household? live here? last female? last starting with the head of the night? birthday? household. (SEE CODES RECORD BELOW) IN COMPLETED YEARS 1 MARRIED 2 WIDOWED AFTER LISTING NAMES, 3 DIVORCED ASK QUESTIONS 003-005 TO BE 4 SEPARATED SURE THAT THE LISTING IS COMPLETE. 5 SIGNED THEN GO ON TO QUESTION 006. CONTRACT 6 NEVER MARRIED YES NO YES NO M F 01 HEAD 1 2 1 2 1 2 02 1 2 1 2 1 2 03 1 2 1 2 1 2 04 1 2 1 2 1 2 05 1 2 1 2 1 2 06 1 2 1 2 1 2 07 1 2 1 2 1 2 08 1 2 1 2 1 2 09 1 2 1 2 1 2 10 1 2 1 2 1 2 Just to make sure that I have a complete household listing: CODES FOR Q006 003 Are there any other persons such as small children YES ADD TO 002 NO RELATIONSHIP TO HEAD OF HOUSEHOLD: or infants that we have not listed? 01 = HEAD 08 = BROTHER/SISTER 02 = WIFE/HUSBAND 09 = BROTHER-IN-LAW/ 004 In addition, are there any other people who may not be 03 = SON/DAUGHTER SISTER-IN-LAW members of your family, such as domestic servants, lodgers 04 = SON-IN-LAW/ 10 = OTHER RELATIVE or friends who usually live here? YES ADD TO 002 NO DAUGHTER-IN-LAW 11 = ADOPTED/FOSTER 05 = GRANDCHILD CHILD 005 Are there any guests or temporary visitors staying here, 06 = PARENT 12 = STEPCHILD or anyone else who slept here last night, who have not been 07 = PARENT-IN-LAW 13 = NOT RELATED listed? YES ADD TO 002 NO 98 = DON'T KNOW MARITAL STATUS AGE 010 SEX 006 007 011 0 1 IN YEARS 008 009 286 | Appendix E LINE ELIGIBILITY NO. ADOLES- WOMEN CHILDREN CENTS 012 013 014 CIRCLE CIRCLE CIRCLE Is Does Is Does LINE LINE LINE (NAME)'s (NAME)'s (NAME)'s (NAME)'s NUMBER NUMBER NUMBER natural mother natural mother natural natural father OF ELIGIBLE OF ALL OF ALL alive? live in this father alive? live in this WOMEN CHILDREN MALE household? household? (I.E., AGE 0-5. ADOLESCNETS QUESTION QUESTION EVER-MARRIED AGE 10-19 REFERS IF YES: REFERS IF YES: WOMEN AGE AND NEVER- TO What is TO What is 15-49 WHO MARRIED CHILD'S her name? CHILD'S his name? ARE USUAL FEMALE BIOLOGICAL BIOLOGICAL RESIDENTS OR ADOLESCENTS MOTHER. RECORD FATHER. RECORD SLEPT THERE AGE 10-19 MOTHER'S FATHER'S ON THE NIGHT WHOSE MARITAL LINE LINE BEFORE THE STATUS IS NUMBER. NUMBER. INTERVIEW). NEVER MARRIED OR SIGNED IF NO: RECORD IF NO: RECORD CONTRACT. 00. 00. YES NO DK YES NO DK 01 01 01 01 1 2 8 1 2 8 GO TO 017 GO TO 019 02 02 02 02 1 2 8 1 2 8 GO TO 17 GO TO 019 03 03 03 03 1 2 8 1 2 8 GO TO 017 GO TO 019 04 04 04 04 1 2 8 1 2 8 GO TO 017 GO TO 019 05 05 05 05 1 2 8 1 2 8 GO TO 017 GO TO 019 06 06 06 06 1 2 8 1 2 8 GO TO 017 GO TO 019 07 07 07 07 1 2 8 1 2 8 GO TO 017 GO TO 019 08 08 08 08 1 2 8 1 2 8 GO TO 017 GO TO 019 09 09 09 09 1 2 8 1 2 8 GO TO 017 GO TO 019 10 10 10 10 1 2 8 1 2 8 GO TO 017 GO TO 019 016 017 IF AGE 0-17 YEARS 015 018 SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS 287Appendix E | LINE NO. 01 02 03 04 05 06 07 08 09 10 Has (NAME) What is the Did During this/that Did During that Has (NAME) ever ever attended highest level of (NAME) school year, (NAME) school year, attended school? school (NAME) attend school what level and attend school what kindergarten, private has attended? at any time grade [is/was] at any time level and grade nursery or other What is the during the (NAME) attending? during the did (NAME) program to prepare highest grade 2004-2005 previous attend? (him/her) for primary (NAME) school year? school year, school? completed at that (SEE CODES that is, in the (SEE CODES level? BELOW) 2003-2004 BELOW) school year? (SEE CODES (SEE CODES BELOW) BELOW) YES NO LEVEL GRADE YES NO LEVEL GRADE YES NO LEVEL GRADE 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 1 2 1 2 1 2 GO TO 026 GO TO 023 GO TO 026 CODES FOR Qs. 020, 022, AND 024 CODES FOR Q025 EDUCATION LEVEL: 1 = KINDERGARTEN AT PUBLIC SCHOOL 0 = NURSERY SCHOOL EDUCATION GRADE: 2 = KINDERGARTEN AT PRIVATE SCHOOL 1 = PRIMARY 3 = PRIVATE NURSERY 2 = PREPARATORY 0 = LESS THAN 1 YEAR COMPLETED 4 = OTHER 3 = SECONDARY (FOR Q. 020 ONLY. THIS CODE IS 5 = DIDN'T ATTEND PRESCHOOL PROGRAM 4 = UPPER INTERMEDIATE NOT ALLOWED FOR 8 = DON'T KNOW 5 = UNIVERSITY Qs. 022 AND 024.) 6 = MORE THAN 8 = DON'T KNOW UNIVERSITY IF AGE 6-24 YEARS 021 IF AGE 3-5 YEARSIF AGE 6 YEARS OR OLDER 020019 024022 023 025 EDUCATION 288 | Appendix E LINE NO. 01 02 03 04 05 06 07 08 09 10 CHILD LABOR Now I would like to ask you about any work that children in this household may do. IF AGE 5-14 YEARS 030 During the past week, Since last During the past year, During the Since last During the Since last did (NAME) do any (DAY OF THE did (NAME) do any past week, (DAY OF THE past week, (DAY OF THE kind of work for WEEK), kind of work for did WEEK), did (NAME) WEEK) someone who is not about someone who is not a (NAME) about do any about a member of this how many hours member of this help how many hours (other) how many hours household even if it did (NAME) household even if was with did (NAME) family work, did (NAME) was only for a short do this work only for a short period of household spend such as spend period of time? for someone time? chores, doing these helping on doing this who is not such as chores? the farm or work? IF YES: a member of IF YES: house in a family Was (NAME) paid this household? Was (NAME) cleaning, IF 95 HOURS business IF 95 HOURS in cash or in kind IF MORE paid for his/her work shopping, OR MORE, or selling OR MORE, for his/her work? THAN ONE JOB, during the past collecting RECORD 95. goods (in a RECORD 95. INCLUDE ALL 12 months? firewood, shop, on HOURS AT fetching the street,.) ALL JOBS. water, or even if it is for IF 95 HOURS caring for short period of OR MORE, children time? RECORD 95. even if it is for a short period of time? YES YES YES YES PAID UNPAID NO HOURS PAID UNPAID NO YES NO HOURS YES NO HOURS 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 NEXT GO TO 028 GO TO 029 GO TO 031 LINE NEXT LINE OR 033 1 2 3 1 2 3 1 2 1 2 GO GO TO 028 GO TO 029 GO TO 031 TO 033 NEXT LINE OR 033 033 CHECK 012 AND ENTER THE TOTAL NUMBER OF ELIGIBLE WOMEN 034 CHECK 013 AND ENTER THE TOTAL NUMBER OF ELIGIBLE CHILDREN 035 CHECK 014 AND ENTER THE TOTAL NUMBER OF ELIGIBLE ADOLESCENTS 036 TICK IF AN ADDITIONAL HOUSEHOLD QUESTIONNAIRE USED 026 032031029027 028 289Appendix E | IN THE SUBSAMPLE NOT IN THE SUBSAMPLE GO TO QUESTION 101 IF THERE IS NO ELIGIBLE WOMAN, RECORD '00' IN BOXES ASSIGNED FOR RECORDING LINE NUMBER OF ELIGIBLE WOMAN. THEN GO TO QUESTION 101. 037 LOOK AT THE LAST DIGIT OF THE QUESTIONNAIRE NUMBER ON THE COVER PAGE. PUT BOX AROUND THAT NUMBER ON THE LEFT IN THE TABLE BELOW TO IDENTIFY THE ROW YOU WILL USE IN SELECTING THE ELIGIBLE RESPONDENT. CHECK THE TOTAL NUMBER OF ELIGIBLE WOMEN ON Q033/THE COVER SHEET OF THE HOUSEHOLD QUESTIONNAIRE. PUT A BOX AROUND THAT NUMBER AT THE TOP OF THE TABLE TO IDENTIFY THE COLUMN YOU WILL USE IN SELECTING THE ELIGIBLE RESPONDENT. FIND POINT WHERE THE ROW AND THE COLUMN YOU HAVE MARKED MEET. CIRCLE THE NUMBER THAT APPEARS IN THE BOX. THIS NUMBER IS USED TO IDENTIFY WHETHER THE FIRST ('1'), SECOND ('2'), THIRD ('3'), ETC. ELIGIBLE WOMAN LISTED IN THE HOUSEHOLD SCHEDULE WILL BE ASKED THE DOMESTIC VIOLENCE QUESTIONS. EXAMPLE; IF THE QUESTIONNAIRE NUMBER IS ‘36716’, GO TO ROW ‘6’. IF THERE ARE THREE ELIGIBLE WOMEN IN THE HOUSEHOLD, GO TO COLUMN ‘3’. FIND THE BOX WHERE ROW '6' AND COLUMN '3' MEET. THE NUMBER IN THAT BOX ('2') INDICATES THAT THE SECOND ELIGIBLE WOMAN IN THE HOUSEHOLD LISTING SHOULD BE ASKED THE DOMESTIC VIOLENCE QUESTIONS. IF THE LINE NUMBERS OF THE THREE WOMEN ARE ‘02', ‘03', AND ‘07’, THEN THE SECOND ELIGIBLE WOMAN IS THE WOMEN WHOSE LINE NUMBER IS '03'. THIS WOMAN WILL BE ASKED THE DOMESTIC VIOLENCE QUESTIONS (SECTION 9 IN THE WOMAN QUESTIONNAIRE). LINE NUMBER OF WOMAN SELECTED FOR DOMESTIC VIOLENCE SECTION ADD A BOX ON THE LINE NUMBER FOR THIS WOMAN IN 012. 2 3 TOTAL NUMBER OF ELIGIBLE WOMEN IN THE HOUSEHOLD (COLUMN) 4 5 6 1 6 1 2 3 CHECK IF HOUSEHOLD IS IN THE ANEMIA SUBSAMPLE ON THE IDENTIFICATION SHEET TABLE FOR SELECTION OF THE ELIGIBLE WOMAN FOR THE DOMESTIC VIOLENCE QUESTIONS 6 2 6 LAST DIGIT OF THE QUESTIONNAIRE NUMBER (ROW) 1 1 1 2 5 4 3 1 4 4 3 5 3 67 7 3 2 8 4 24 4 5 7 1 1 5 3 1 3 8 0 2 3 4 1 2 5 6 7 1 1 1 1 3 1 9 1 2 2 1 2 1 1 1 1 1 2 3 4 2 2 2 53 4 1 2 1 4 1 1 2 1 8 2 7 5 1 6 5 2 3 1 290 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 What type of dwelling does your household live in? APARTMENT . . . . . . . . . . . . . . . . . . . . . 1 FREE STANDING HOUSE . . . . . . . . . . 2 OTHER ________________________ 6 (SPECIFY) 102 Is your dwelling owned or rented by your household? OWNED . . . . . . . . . . . . . . . . . . . . . . . . . 1 OWNED JOINTLY . . . . . . . . . . . . . . . . 2 IF OWNED: Is it owned solely by your household or RENTED . . . . . . . . . . . . . . . . . . . . . . . . . 3 jointly with someone else? OTHER ________________________ 6 (SPECIFY) 103 What is the main source of drinking water for members of your PIPED WATER household? PIPED INTO DWELLING . . . . . . . . 11 PIPED TO YARD/PLOT . . . . . . . . 12 PUBLIC TAP/STANDPIPE . . . . . . 13 TUBE WELL . . . . . . . . . . . . . . . . . . . 21 DUG WELL PROTECTED WELL . . . . . . . . . . 31 UNPROTECTED WELL . . . . . . . . 32 WATER FROM SPRING 105 PROTECTED SPRING . . . . . . . . 41 UNPROTECTED SPRING . . . . . . 42 TANKER TRUCK . . . . . . . . . . . . . . . . 61 CART WITH SMALL TANK . . . . . . . . 71 SURFACE WATER (RIVER/DAM/ LAKE/POND/STREAM/CANAL/ IRRIGATION CHANNEL) . . . . . . 81 BOTTLED WATER . . . . . . . . . . . . . . 91 OTHER ______________________ 96 108 (SPECIFY) 104 What is the main source of water used by your household for PIPED WATER other purposes such as cooking and handwashing? PIPED INTO DWELLING . . . . . . . . 11 PIPED TO YARD/PLOT . . . . . . . . 12 PUBLIC TAP/STANDPIPE . . . . . . 13 TUBE WELL. . . . . . . . . . . . . . . . . . . . . 21 DUG WELL PROTECTED WELL . . . . . . . . . . 31 UNPROTECTED WELL . . . . . . . . 32 WATER FROM SPRING PROTECTED SPRING . . . . . . . . 41 UNPROTECTED SPRING . . . . . . 42 TANKER TRUCK . . . . . . . . . . . . . . . . 61 CART WITH SMALL TANK . . . . . . . . 71 SURFACE WATER (RIVER/DAM/ LAKE/POND/STREAM/CANAL/ IRRIGATION CHANNEL) . . . . . . 81 OTHER ______________________ 96 (SPECIFY) 105 Where is (SOURCE IN 103 OR 104) located? IN OWN DWELLING . . . . . . . . . . . . . . 1 IN OWN YARD/PLOT . . . . . . . . . . . . . . 2 ELSEWHERE . . . . . . . . . . . . . . . . . . . . . 3 106 How long does it take to go there, get water, and come back? MINUTES . . . . . . . . . . . . . . 996 108 DON'T KNOW . . . . . . . . . . . . . . . . . . . 998 108 108 108 ON/NEXT TO PREMISES . . . . . . . . 291Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 107 Who usually goes to this source to fetch the water for your . . . . . . . . . . . . . . 1 household? ADULT MAN 15+ 2 FEMALE CHILD UNDER 15 YEARS OLD . . . . . . . . . . 3 MALE CHILD UNDER 15 YEARS OLD . . . . . . . . . . 4 OTHER ________________________ 6 (SPECIFY) 108 During the last two weeks, was there any time when water YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 was not available from (SOURCE IN 103 OR 104)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 109 Did this happen on a daily or almost daily basis, only a few DAILY/ALMOST DAILY . . . . . . . . . . . . . . 1 times per week, or less frequently? FEW TIMES PER WEEK . . . . . . . . . . . . 2 LESS FREQUENTLY . . . . . . . . . . . . . . 3 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 110 Do you treat your water in any way to make it safer to drink? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 111 What do you usually do to the water to make it safer to drink? BOIL . . . . . . . . . . . . . . . . . . . . . . . . . . . A ADD BLEACH/CHLORINE . . . . . . . . . . B Anything else? STRAIN THROUGH A CLOTH/COTTON C USE WATER FILTER (CERAMIC/ RECORD ALL MENTIONED. SAND/COMPOSITE/ETC.) . . . . . . . . D SOLAR DISINFECTION . . . . . . . . . . . . E LET IT STAND AND SETTLE . . . . . . . . F OTHER ______________________ X (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . Z 112 What kind of toilet facility do members of your household usually MODERN FLUSH TOILET . . . . . . . . 11 use? TRADITIONAL TANK FLUSH 12 TRADITIONAL BUCKET FLUSH 13 PIT TOILET/LATRINE TOILET . . . . . . 21 BUCKET TOILET . . . . . . . . . . . . . . . . 41 NO FACILITY/FIELD . . . . . . . . . . . . . . 61 117 OTHER ______________________ 96 (SPECIFY) 113 Into where does this toilet flush drain? 01 02 03 PIPED CONNECTED TO CANAL . . . . . . 04 PIPED CONNECTED TO GROUND WATER . . . . . . . . . . . . . . . . . . . . . . . 05 EMPTIED (NO CONNECTION) . 06 OTHER ______________________ 96 (SPECIFY) DON'T KNOW WHERE . . . . . . . . . . 98 114 Are you or your neighbors currently experiencing any problems YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 with this drainage system? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 116 115 What problems are you experiencing? POOLING AROUND OWN DWELLING . A POOLING AROUND NEIGHBOR'S DWELLING . . . . . . . . . . . . . . . . . . . . . B COST OF EVACUATION . . . . . . . . . . . . C MOSQUITOES/INSECTS . . . . . . . . . . . . D OTHER ________________________ X (SPECIFY) ADULT WOMAN 15+ . . . . . . . . . . . . . . . . . . . 110 . . . . . . . . . . . . . . . SEPTIC SYSTEM 112 VAULT (BAYARA) PIPED SEWER SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 116 Including your own household, how many households use this NO. OF HOUSEHOLDS toilet? IF LESS THAN 10 . . . . . . . . 10 OR MORE HOUSEHOLDS . . . 95 DON'T KNOW . . . . . . . . . . . . . . . . . . . 98 117 Does your household have: YES NO Electricity? ELECTRICITY . . . . . . . . . . . . . . 1 2 A radio with cassette recorder? RADIO . . . . . . . . . . . . . . . . . . . . . 1 2 A color television? COLOR TV . . . . . . . . . . . . . . . . 1 2 A black and white television? BLACK AND WHITE TV . . . . . . 1 2 A video or DVD player? VIDEO/DVD . . . . . . . . . . . . . . . . 1 2 A mobile? MOBILE TELEPHONE . . . . . . . . 1 2 A telephone? NON-MOBILE TELEPHONE . . . 1 2 A satellite dish? SATELLITE DISH . . . . . . . . . . . . 1 2 A personal home computer? COMPUTER . . . . . . . . . . . . . . 1 2 A sewing machine? SEWING MACHINE . . . . . . . . . . 1 2 An electric fan? ELECTRIC FAN . . . . . . . . . . . . 1 2 An air conditioner? AIR CONDITIONER . . . . . . . . . . 1 2 118 What type of fuel does your household mainly use for cooking? ELECTRICITY . . . . . . . . . . . . . . . . . . . 01 LPG . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 120 NATURAL GAS . . . . . . . . . . . . . . . . 03 BIOGAS . . . . . . . . . . . . . . . . . . . . . . . 04 KEROSENE . . . . . . . . . . . . . . . . . . . . . 05 COAL, LIGNITE . . . . . . . . . . . . . . . . 06 CHARCOAL . . . . . . . . . . . . . . . . . . . . . 07 WOOD . . . . . . . . . . . . . . . . . . . . . . . 08 STRAW/SHRUBS/GRASS . . . . . . . . 09 AGRICULTURAL CROP . . . . . . . . . . 10 ANIMAL DUNG . . . . . . . . . . . . . . . . 11 OTHER ______________________ 96 (SPECIFY) 119 In your household, is food cooked on a stove or an open fire? OPEN FIRE OR STOVE WITHOUT CHIMNEY/HOOD . . . . . . 1 PROBE FOR TYPE. OPEN FIRE OR STOVE WITH CHIMNEY/HOOD . . . . . . . . . . 2 CLOSED STOVE WITH CHIMNEY . . . 3 OTHER ________________________ 6 (SPECIFY) 120 Is the cooking usually done in the house, in a separate building, IN THE HOUSE . . . . . . . . . . . . . . . . . . . 1 or outdoors? IN A SEPARATE BUILDING . . . . . . . . 2 OUTDOORS . . . . . . . . . . . . . . . . . . . . . 3 122 OTHER ________________________ 6 (SPECIFY) 121 Do you have a separate room which is used as a kitchen? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 122 How does your household mainly dispose of kitchen waste COLLECTED and trash? FROM HOME . . . . . . . . . . . . . . . . . . . 11 FROM CONTAINER IN STREET . . . 12 RECORD MAIN METHOD OF DISPOSAL ONLY. DUMPED IF TWO OR MORE METHODS ARE USED EQUALLY, INTO STREET/EMPTY PLOT . . . . . . 21 RECORD THE METHOD HIGHEST ON THE LIST. INTO CANNAL/DRAINAGE . . . . . . . . 22 BURNED . . . . . . . . . . . . . . . . . . . . . . . . . 31 FED TO ANIMALS . . . . . . . . . . . . . . . . 41 OTHER ______________________ 96 (SPECIFY) 0 293Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 123 Does your household have: YES NO A refrigerator? REFRIGERATOR . . . . . . . . . . 1 2 A freezer? FREEZER . . . . . . . . . . . . . . . . 1 2 A water heater? WATER HEATER . . . . . . . . . . 1 2 A dishwasher? DISHWASHER . . . . . . . . . . . . . . 1 2 An automatic washing machine? AUTOMATIC WASHER . . . . . . 1 2 Any other washing machine? OTHER WASHER . . . . . . . . . . 1 2 A bed? BED . . . . . . . . . . . . . . . . . . . . . 1 2 A sofa? SOFA . . . . . . . . . . . . . . . . . . . . . 1 2 A hanging lamp (yellow with no cover)? HANGING LAMP 1 2 A table? TABLE . . . . . . . . . . . . . . . . . . . . . 1 2 A "Tablia" (very low round table)? TABLIA . . . . . . . . . . . . . . . . . . . 1 2 A chair? CHAIR . . . . . . . . . . . . . . . . . . . . . 1 2 Kolla/Zeer (a container for reserving water)? KOLLA/ZEER 1 2 124 How many rooms does your household use for living (excluding the bathrooms, kitchens and stairway areas)? ROOMS . . . . . . . . . . . . . . . . . . . 125 MAIN MATERIAL OF THE FLOOR. NATURAL FLOOR EARTH/SAND . . . . . . . . . . . . . . . . 11 RECORD OBSERVATION. RUDIMENTARY FLOOR WOOD PLANKS . . . . . . . . . . . . . . 21 FINISHED FLOOR PARQUET OR POLISHED WOOD . . . . . . . . . . . . . . . . . . . 31 CERAMIC/MARBLE TILES . . . . . . 32 CEMENT TILES . . . . . . . . . . . . . . 33 CEMENT . . . . . . . . . . . . . . . . . . . . . 34 WALL-TO-WALL CARPET . . . . . . 35 VINYL . . . . . . . . . . . . . . . . . . . . . . . 36 OTHER ______________________ 96 (SPECIFY) 126 TYPE OF WINDOWS. ALL WINDOWS WITH GLASS . . . . . . . . 1 RECORD OBSERVATION. SOME WITHOUT GLASS . . . . . . . . 2 . . . 3 NO WINDOW OPENINGS . . . . . . . . . . 4 127 Does any member of this household own: YES NO A watch? WATCH . . . . . . . . . . . . . . . . . . . 1 2 A bicycle? BICYCLE . . . . . . . . . . . . . . . . . . . 1 2 A motorcycle or motor scooter? MOTORCYCLE/SCOOTER . . . 1 2 An animal-drawn cart? ANIMAL-DRAWN CART . . . . . . 1 2 A car or truck? CAR/TRUCK . . . . . . . . . . . . . . 1 2 128 Does any member of this household own any land YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 that can be used for agriculture? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 130 129 How many feddans or kirates of agricultural land do members of this household own? LAND AREA IF MORE THAN 95 FEDDAN, ENTER '9995'. DON'T KNOW . . . . . . . . . . . . . . . . 130 Does your household own any livestock, herds, or farm animals YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 or any poultry or birds? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 132 9998 . FEDDAN KIRATE . . . . . . . . . . . . ALL WINDOWS WITHOUT GLASS SOME WINDOWS WITH GLASS AND . . . . . . . . . . . . . . 294 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 131 How many of the following does your household own? Cattle(buffalo, calf)? CATTLE . . . . . . . . . . . . . . . . . . . Milk cows or bulls? COWS/BULLS . . . . . . . . . . . . . . Horses, donkeys, or mules? HORSES/DONKEYS/MULES . Goats? GOATS . . . . . . . . . . . . . . . . . . . Sheep? SHEEP . . . . . . . . . . . . . . . . . . . Birds (Chickens, geese, ducks, and pigeons)? BIRDS(CHICKENS/GEESE/ETC) IF NONE, ENTER '00'. IF MORE THAN 95, ENTER '95'. IF UNKNOWN, ENTER '98'. 132 Does any member of your household have an account in a bank YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 or any saving institution? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 133 ASK RESPONDENT FOR A TEASPOONFUL OF COOKING 0 PPM (NO IODINE) . . . . . . . . . . . . . . . . 1 SALT. TEST SALT FOR IODINE. 7 PPM . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 15 PPM . . . . . . . . . . . . . . . . . . . . . . . . . 3 30 PPM . . . . . . . . . . . . . . . . . . . . . . . . . 4 RECORD PPM (PARTS PER MILLION) NO SALT IN HH . . . . . . . . . . . . . . . . . . . 5 SALT NOT TESTED ________________ 6 (SPECIFY REASON) 295Appendix E | WEIGHT, HEIGHT AND HEMOGLOBIN MEASUREMENT CHECK COLUMNS 012-014: RECORD THE LINE NUMBER, NAME AND AGE OF ALL EVER-MARRIED WOMEN AGE 15-49, ALL CHILDREN UNDER AGE 6, AND MALE AND NEVER-MARRIED FEMALE ADOLESCENTS AGE10-19. RESULT 1 MEASURED 2 NOT PRESENT 3 REFUSED 6 OTHER YEARS . . . . . . RESULT IF MOTHER INTERVIEWED, COPY 1 MEASURED MONTH AND YEAR FROM BIRTH 2 NOT PRESENT HISTORY AND ASK DAY. 3 REFUSED IF MOTHER NOT INTERVIEWED, 6 OTHER ASK DAY, MONTH, AND YEAR. DAY MONTH YEAR LYING STAND. . . 1 2 . . 1 2 . . 1 2 . . 1 2 . . 1 2 FROM FROM STANDING (201) (202) FROM 0 013 010 (203) (204) (208) UP 0 0 (207) OR (205) 0 MEASURED LYING DOWN OR STANDING EVER-MARRIED WOMEN 15-49 WEIGHT (KILOGRAMS) HEIGHT (CENTIMETERS) What is (NAME'S) date of birth?AGENAMELINE WEIGHT AND HEIGHT MEASUREMENT OF EVER-MARRIED WOMEN 15-49 WEIGHT HEIGHT UP MEASURED (206) (207) WEIGHT AND HEIGHT MEASUREMENT OF CHILDREN AGE 0-5 (208)(205) FROM 002 010 What is (NAME'S) date of birth? CHILDREN AGE 0-5 (204) NO. FROM (201) (202) (203) FROM 012 (CENTIMETERS) LYING DOWN (206) 0 (KILOGRAMS) LINE NAME AGE NO. 002 296 | Appendix E RESULT IF MOTHER INTERVIEWED, COPY 1 MEASURED MONTH AND YEAR FROM BIRTH 2 NOT PRESENT HISTORY AND ASK DAY. 3 REFUSED IF MOTHER NOT INTERVIEWED, 6 OTHER ASK DAY, MONTH, AND YEAR. YEARS DAY MONTH YEAR . . . . . . . . . . CHECK IN THE IDENTIFICATION SECTION ON THE COVER PAGE IF THE HOUSEHOLD IS INCLUDED IN THE ANEMIA SUBSAMPLE IN THE SUBSAMPLE NOT IN SUBSAMPLE GO TO 301 (208)(201) (202) (203) (204) AGE NO. MALE AND NEVER-MARRIED FEMALE ADOLESCENTS AGE 10-19 LINE NAME What is (NAME'S) date of birth? WEIGHT 014 FROM FROMFROM 002 010 HEIGHT MEASURED (CENTIMETERS) (205) (206) (207) UP OR STANDING WEIGHT AND HEIGHT MEASUREMENT OF ELIGIBLE ADOLESCENTS AGE 10-19 LYING DOWN(KILOGRAMS) 297Appendix E | READ CONSENT STATEMENT TO CURRENTLY RESULT WOMAN* PREGNANT 1 MEASURED CHECK COLUMN 2 NOT PRESENT CIRCLE CODE (AND SIGN) 3 REFUSED 6 OTHER GRANTED REFUSED YES NO/DK SIGN NEXT LINE . 1 2 SIGN NEXT LINE . 1 2 SIGN NEXT LINE . 1 2 HEMOGLOBIN MEASUREMENT OF CHILDREN AGE 0- 5 YEARS LINE NO. READ CONSENT STATEMENT TO RESULT OF PARENT/ PARENT/RESPONSIBLE ADULT* 1 MEASURED CHILD AGE 0-5 RESPONSIBLE 2 NOT PRESENT MONTHS, I.E, ADULT. 3 REFUSED BORN IN MONTH RECORD '00' IF 6 OTHER CHECK COLUMN OF INTERVIEW NOT LISTED IN CIRCLE CODE (AND SIGN) OR PREVIOUS HOUSEHOLD 5 MONTH? SCHEDULE. AGE 0-5 MONTHS OTHER GRANTED REFUSED 1 NEXT CHILD SIGN NEXT LINE . 1 1 NEXT CHILD SIGN NEXT LINE . 1 1 NEXT CHILD SIGN NEXT LINE . 1 1 NEXT CHILD SIGN NEXT LINE . 1 1 NEXT CHILD SIGN NEXT LINE . 201 2 2 210 2 2 2 2 2 CHECK COLUMN 2 2 1 HEMOGLOBIN 211 (214) LINE LINE 2 (210a) (202): 201 NO. FROM (G/DL) (214)211 (212) (213) 2 2 2 (212) (213) LEVEL 1 (209) (209) (202): NAME (G/DL) (204) 1 1 FROM 210(210a) NO. HEMOGLOBIN MEASUREMENT OF EVER-MARRIED WOMEN 15-49 NAME HEMOGLOBIN LEVEL 298 | Appendix E CHECK COLUMN LINE NO. READ CONSENT STATEMENT TO RESULT (203) OF PARENT/ ADOLESCENT/PARENT/RESPONSIBLE ADULT* 1 MEASURED CHECK COLUMN RESPONSIBLE 2 NOT PRESENT AGE ADULT. CIRCLE CODE (AND SIGN) 3 REFUSED RECORD '00' IF 6 OTHER NOT LISTED IN HOUSEHOLD SCHEDULE. AGE AGE PARENT/RESP ADOLESCENT 10-17 18-19 GRANTED AD. REFUSED REFUSED 1 2 2 GO TO 211 SIGN NEXT LINE . 1 2 2 GO TO 211 SIGN NEXT LINE . 1 2 2 GO TO 211 SIGN NEXT LINE . 1 2 2 GO TO 211 SIGN NEXT LINE . 1 2 2 GO TO 211 SIGN NEXT LINE . TICK HERE IF CONTINUATION SHEET USED 215 NAME OF MEASURER/TESTER NAME OF ASSISTANT * CONSENT STATEMENT As part of this survey, we are studying anemia among women, children and adolescents. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia. We request that you (and all children under age 6, and all male and never married female adolescents aged 10-19) to participate in the anemia testing part of this survey and give a few drops of blood from a finger. The test uses disposable sterile instruments that are clean and completely safe. The blood will be analyzed with new equipment and the results of the test will be given to you right after the blood is taken. The results will be kept confidential. May I now ask that you (and NAME OF CHILD[REN]/ADOLESCENT) participate in the anemia test. However, if you decide not to have the test done, it is your right and we will respect your decision. Now please tell me if you agree to have the test(s) done. (210a) 210 FROM 1 211 1 3 3 3 3 3 HEMOGLOBIN MEASUREMENT OF MALE AND NEVER-MARRIED FEMALE ADOLESCENTS AGE 10-19 HEMOGLOBIN LEVEL (214)(209) NAME (202): (213) (G/DL) (212) NO. LINE 201 1 1 1 299Appendix E | INTERVIEWER'S OBSERVATIONS COMMENTS ABOUT RESPONDENT: COMMENTS ON SPECIFIC QUESTIONS: ANY OTHER COMMENTS: SUPERVISOR'S OBSERVATIONS NAME OF SUPERVISOR: DATE: EDITOR'S OBSERVATIONS NAME OF EDITOR: DATE: 301 302 303 OBSERVATIONS TO BE FILLED IN AFTER COMPLETING INTERVIEW 300 | Appendix E ARAB REPUBLIC OF EGYPT MINISTRY OF HEALTH AND POPULATION NATIONAL POPULATION COUNCIL EL- ZANATY & ASSOCIATES DATA COLLECTED FROM THIS STUDY IS CONFIDENTIAL AND WILL BE USED FOR SCIENTIFIC PURPOSES ONLY. EGYPT DEMOGRAPHIC AND HEALTH SURVEY WOMAN QUESTIONNAIRE 2005 301Appendix E | WOMAN QUESTIONNAIRE IDENTIFICATION GOVERNORATE GOVERNORATE ___________________________ PSU/SEGMENT NO. ______________ KISM/MARKAZ ___________________________ BUILDING NO. ________________ PSU/SEGMENT NO. SHIAKHA/VILLAGE ________________________ HOUSING UNIT NO. ________________ HOUSEHOLD NUMBER ________________________________________________________ HOUSEHOLD NO. URBAN/RURAL URBAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 RURAL . . . . . . . . . . . . . . . . . . . . . . . 2 LARGE CITY . . . . . . 1 2 TOWN . . . . . . 3 VILLAGE . . . . . . 4 LOCALITY NAME OF HOUSEHOLD HEAD __________________________________________________ ADDRESS IN DETAIL __________________________________________________________ LINE NUMBER DV MODULE NAME OF WOMAN __________________________________________________________ LINE NUMBER OF WOMAN ____________________________________________________ WOMAN SELECTED FOR DOMESTIC VIOLENCE SECTION YES . . . 1 NO . . . 2 INTERVIEWER VISITS FINAL VISIT DAY MONTH YEAR DATE TEAM TEAM . . . . . . . . . . INTERVIEWER INT. NUMBER . . . SUPERVISOR SUP. NUMBER . . RESULT RESULT . . . . . . . . . . . . NEXT VISIT: DATE TOTAL NUMBER TIME OF VISITS RESULT CODES: 1 COMPLETED 4 REFUSED 2 NOT AT HOME 5 PARTLY COMPLETED 7 OTHER 3 POSTPONED 6 INCAPACITATED (SPECIFY) FIELD EDITOR OFFICE EDITOR CODER KEYER NAME DATE / / 2005 / / 2005 / / 2005 / / 2005 SIGNATURE SMALL CITY . . . 0 5 1 2 3 0 303Appendix E | SECTION 1. RESPONDENT'S BACKGROUND INFORMED CONSENT Hello. My name is _______________________________________ and I am working with the Ministry of Health and Population and the National Population Council. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important. At this time, do you want to ask me anything about the survey? May I begin the interview now? Signature of interviewer: Date: RESPONDENT AGREES TO BE INTERVIEWED . . . . . . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . 2 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME. HOUR . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . 102 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? YEARS . . . . . . . . . . . . . . . . . . . IF LESS THAN ONE YEAR, RECORD '00' YEARS. ALWAYS . . . . . . . . . . . . . . . . . . . . . . . 95 VISITOR/TEMPORARY STAYING . 96 104 103 Just before you moved here, did you live in Cairo, Giza, CAIRO/GIZA . . . . . . . . . . . . . . . . . . . . . 1 Alexandria, in another city or town, or in a village? ALEXANDRIA . . . . . . . . . . . . . . . . . . . . . 2 OTHER CITY/TOWN . . . . . . . . . . . . . . 3 VILLAGE . . . . . . . . . . . . . . . . . . . . . . . . . 4 ___________________________________________________ OUTSIDE EGYPT ________________ 5 (NAME OF LOCALITY AND GOVERNORATE) (SPECIFY) OFFICE: GOVERNORATE CODE 104 In what month and year were you born? MONTH . . . . . . . . . . . . . . . . . . . DON'T KNOW MONTH . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . DON'T KNOW YEAR . . . . . . . . . . . . 9998 105 How old were you at your last birthday? COMPARE AND CORRECT 104 AND/OR 105 IF AGE IN COMPLETED YEARS INCONSISTENT. 1301 304 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 106 What is your current marital status? MARRIED . . . . . . . . . . . . . . . . . . . . . . . 1 WIDOWED . . . . . . . . . . . . . . . . . . . . . . . 2 DIVORCED . . . . . . . . . . . . . . . . . . . . . . . 3 SEPARATED . . . . . . . . . . . . . . . . . . . . . 4 107 Now I would like to ask you some questions about your marriage(s). NUMBER OF TIMES How many times have you been married? MARRIED . . . . . . . . . . . . . . 108 CHECK 107: MARRIED MARRIED ONLY ONCE MORE THAN ONCE MONTH . . . . . . . . . . . . . . . . In what month and year Now I would like to ask about DON'T KNOW MONTH . . . . . . . . . . 98 did you enter into your first husband. a marriage contract with In what month and year your husband? did you enter into YEAR . . . . . . . . . . . . 110 a marriage contract with your first husband? DON'T KNOW YEAR . . . . . . . . . . . . 9998 109 How old were you when you entered into a marriage contract with your (first) husband? AGE IN COMPLETED YEARS . 110 CHECK 107: MARRIED MARRIED ONLY ONCE MORE THAN ONCE MONTH . . . . . . . . . . . . . . . . In what month and year Now I would like to ask about DON'T KNOW MONTH . . . . . . . . . . 98 did you start living together your first husband. with your husband? In what month and year did you start living together YEAR . . . . . . . . . . . . 112 with your first husband? DON'T KNOW YEAR . . . . . . . . . . . . 9998 111 How old were you when you started living together with your (first) husband? AGE IN COMPLETED YEARS . 112 DETERMINE ALL OF THE MONTHS SINCE JANUARY 2000 THAT THE RESPONDENT WAS MARRIED. ENTER 'X' IN COLUMN 1 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER '0' FOR EACH MONTH NOT MARRIED, SINCE JANUARY 2000. FOR WOMEN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS SINCE JANUARY 2000. 113 Have you ever attended school? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 117 114 What is the highest level of school you attended? PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . 1 PREPARATORY . . . . . . . . . . . . . . . . . . . 2 SECONDARY . . . . . . . . . . . . . . . . . . . . . 3 UPPER INTERMEDIATE . . . . . . . . . . 4 UNIVERSITY . . . . . . . . . . . . . . . . . . . . . 5 MORE THAN UNIVERSITY . . . . . . . . . . 6 115 What is the highest grade you successfully completed at that level? GRADE . . . . . . . . . . . . . . . . . . . . . . . 305Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 116 CHECK 114: PRIMARY PREPARATORY OR HIGHER 120 117 Now I would like you to read this sentence to me. CANNOT READ AT ALL . . . . . . . . . . . . 1 ABLE TO READ ONLY PART OF SHOW CARD TO RESPONDENT. SENTENCE . . . . . . . . . . . . . . . . . . . . . 2 ABLE TO READ WHOLE SENTENCE . . 3 IF RESPONDENT CANNOT READ WHOLE SENTENCE, BLIND/VISUALLY IMPAIRED . . . . . . . 4 PROBE: Can you read any part of the sentence to me? 118 Have you ever participated in a literacy program or any other program that involves learning to read or write (not including YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 primary school)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 119 CHECK 117: CODE '2' OR '3' CODE '1' OR '4' CIRCLED CIRCLED 121 120 Do you read a newspaper or magazine almost every day, at least ALMOST EVERY DAY . . . . . . . . . . . . . . 1 once a week, less than once a week or not at all? AT LEAST ONCE A WEEK . . . . . . . . . . 2 LESS THAN ONCE A WEEK . . . . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . . . . 4 121 Do you listen to the radio almost every day, at least once a week, ALMOST EVERY DAY . . . . . . . . . . . . . . 1 less than once a week or not at all? AT LEAST ONCE A WEEK . . . . . . . . . . 2 LESS THAN ONCE A WEEK . . . . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . . . . 4 122 Do you watch television almost every day, at least once a week, ALMOST EVERY DAY . . . . . . . . . . . . . . 1 less than once a week or not at all? AT LEAST ONCE A WEEK . . . . . . . . . . 2 LESS THAN ONCE A WEEK . . . . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . . . . 4 123 What is your religion? MUSLEM 1 CHRISTIAN 2 OTHER 6 (SPECIFY) _________________________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 | Appendix E SECTION 2. REPRODUCTION NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Now I would like to ask about all the births you have had during YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 your life. Have you ever given birth? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 202 Do you have any sons or daughters to whom you have given YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 birth who are now living with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 204 203 How many sons live with you? SONS AT HOME . . . . . . . . . . . . And how many daughters live with you? DAUGHTERS AT HOME . . . . . . IF NONE, RECORD '00'. 204 Do you have any sons or daughters to whom you have given YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 birth who are alive but do not live with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 205 How many sons are alive but do not live with you? SONS ELSEWHERE . . . . . . . . And how many daughters are alive but do not live with you? DAUGHTERS ELSEWHERE . IF NONE, RECORD '00'. 206 Have you ever given birth to a boy or girl who was born alive but later died? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 IF NO, PROBE: Any baby who cried or showed signs of life but NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 208 did not survive? 207 How many boys have died? BOYS DEAD . . . . . . . . . . . . . . And how many girls have died? GIRLS DEAD . . . . . . . . . . . . . . IF NONE, RECORD '00'. 208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'. TOTAL . . . . . . . . . . . . . . . . . . . . . 209 CHECK 208: Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct? YES NO PROBE AND CORRECT 201-209 AS NECESSARY. 210 CHECK 208: ONE OR MORE NO BIRTHS BIRTHS 226 307Appendix E | 211 Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES AND MARK WITH A BRACKET. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE). What name Were Is In what month Is IF ALIVE: IF ALIVE: IF ALIVE: IF DEAD: Were there was given to any of (NAME) and year was (NAME) How old was Is (NAME) RECORD How old was (NAME) any other your these a boy or (NAME) born? still (NAME) at living with HOUSE- when he/she died? live births (first/next) births a girl? alive? his/her last you? HOLD LINE between baby? twins? PROBE: birthday? NUMBER OF IF '1 YR', PROBE: (WHEN What is his/her RECORD CHILD How many months old YOU FIRST birthday? AGE IN (RECORD '00' was (NAME) when MARRIED/ COM- IF CHILD NOT he/she died? NAME OF In what season PLETED LISTED IN RECORD DAYS IF PREVIOUS was (NAME) born? YEARS. HOUSE- LESS THAN 1 BIRTH) and HOLD). MONTH; MONTHS IF (NAME), LESS THAN TWO including YEARS; OR YEARS. any children who died after birth? 01 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 02 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 03 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 04 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 05 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 06 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 07 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 220 221218 219214 215 216 217 AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS 212 213 AGE IN YEARS AGE IN YEARS (NAME) (NAME) (NAME) (NAME) (NAME) (NAME) (NAME) 308 | Appendix E What name Were Is In what month Is IF ALIVE: IF ALIVE: IF ALIVE: IF DEAD: Were there was given to any of (NAME) and year was (NAME) How old was Is (NAME) RECORD How old was (NAME) any other your these a boy or (NAME) born? still (NAME) at living with HOUSE- when he/she died? live births (first/next) births a girl? alive? his/her last you? HOLD LINE between baby? twins? PROBE: birthday? NUMBER OF IF '1 YR', PROBE: (WHEN What is his/her RECORD CHILD How many months old YOU FIRST birthday? AGE IN (RECORD '00' was (NAME) when MARRIED/ COM- IF CHILD NOT he/she died? NAME OF In what season PLETED LISTED IN RECORD DAYS IF PREVIOUS was (NAME) born? YEARS. HOUSE- LESS THAN 1 BIRTH) and HOLD). MONTH; MONTHS IF (NAME), LESS THAN TWO including YEARS; OR YEARS. any children who died after birth? 08 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 09 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 10 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 11 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) NEXT BIRTH 12 MONTH HH LINE NO. DAYS . . . 1 SING . . 1 BOY . . 1 YES . . . . 1 YES . . . 1 YES . . . . 1 MONTHS . 2 ADD BIRTH MULT . . 2 GIRL. . 2 YEAR NO . . . . . 2 NO . . . . 2 (GO TO 221) YEARS . . 3 NO . . . . . 2 (GO TO 220) GO TO 222 222 Have you had any live births since the birth of (NAME OF LAST YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ADD TO BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE. NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 TABLE 223 COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUMBERS NUMBERS ARE ARE SAME DIFFERENT (PROBE AND RECONCILE) CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. FOR EACH BIRTH SINCE JANUARY 2000: MONTH AND YEAR OF BIRTH RECORDED. FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. 224 CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 2000 OR LATER. IF NONE, RECORD '0' AND GO TO 225a. 215214213212 221220217216 218 219 AGE IN YEARS AGE IN YEARS YEARS AGE IN AGE IN AGE IN YEARS YEARS (NAME) (NAME) (NAME) (NAME) (NAME) 309Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 225 FOR EACH BIRTH SINCE JANUARY 2000, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 2 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. WRITE THE NAME OF THE CHILD TO THE RIGHT OF THE 'B' CODE. 225a ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 2000 IN THE BOXES AT THE BOTTOM OF THE CALENDAR. 226 Are you pregnant now? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . 8 230 227 How many months pregnant are you? MONTHS . . . . . . . . . . . . . . . . . . . RECORD NUMBER OF COMPLETED MONTHS. 228 ENTER 'P's IN COLUMN 2 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF MONTHS OF THE CURRENT PREGNANCY COMPLETED . 229 At the time you became pregnant did you want to become THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 pregnant then, did you want to wait until later, or did you not want LATER . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 to have any (more) children at all? NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . . 3 230 Unfortunately many women have pregnancies that do not end in a live birth. Sometimes a baby is still born, that is, the baby is born who does not breath or show any life. Other times women have a miscarriage or abortion early during a pregnancy. It is very important in our study to know about such pregnancies so health programs can be developed for women. USING THE INFORMATION IN THE CALENDAR, PROBE TO DETERMINE IF THE WOMAN HAD ANY STILL BIRTHS, MISCARRIAGES, OR ABORTIONS BACK TO JANUARY 2000. IF THE WOMAN REPORTS A PREGNANCY THAT DID NOT END IN A LIVE BIRTH, ASK ABOUT THE MONTH AND YEAR IN WHICH THE PREGNANCY ENDED. RECORD THE APPROPRIATE CODE FOR THE PREGNANCY OUTCOME ON THAT DATE IN COLUMN 2 IN THE CALENDAR ("S" FOR STILL BIRTH, "M" FOR MISCARRIAGE AND "A" FOR ABORTION). THEN ASK ABOUT THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD “P” IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. NOTE: SINCE THE OUTCOME OF THE PREGNANCY IS RECORDED IN THE MONTH THAT PREGNANCY ENDED, THE NUMBER OF P’s MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. ILLUSTRATIVE QUESTIONS TO IDENTIFY NON-LIVE BIRTH PREGNANCIES, ASK: • INTERVAL BETWEEN CURRENT PREGNANCY AND PRIOR BIRTH (LAST BIRTH) Did you have any pregnancy that ended in a still birth after the birth of (NAME OF LAST BIRTH) and before your current pregnancy? Or any pregnancy that ended in a miscarriage or abortion? • INTERVAL BETWEEN LAST AND PRIOR BIRTH Did you have any pregnancy that ended in a still birth between (NAME OF LAST BIRTH) and (NAME OF PRIOR BIRTH)? Or any pregnancy that ended in a miscarriage or abortion? • INTERVAL BETWEEN NEXT-TO-LAST BIRTH AND PRIOR BIRTH Did you have any pregnancy that ended in a still birth between (NAME OF NEXT-TO-LAST BIRTH) and (NAME OF PRIOR BIRTH)? Or any pregnancy that ended in a miscarriage or abortion? • WOMEN WITH NO LIVE BIRTHS BUT WITH CURRENT PREGNANCY Before your current pregnancy, did you ever have any other pregnancy that ended in a still birth? Or any other pregnancy that ended in a miscarriage or abortion? • WOMEN WITH NO LIVE BIRTHS AND NOT CURRENTLY PREGNANT Have you ever had a still birth? If YES: When did the last still birth occur? Have you ever had a miscarriage or abortion? If YES: When did the last miscarriage or abortion occur? FOR EACH PREGNANCY TERMINATION, ASK How many months pregnant were you when the pregnancy ended? 310 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 231 Did you have any (other) pregnancies that terminated before YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 January 2000 that did not result in a live birth? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 232 RECORD IN THE BOXES AT THE BOTTOM OF THE CALENDAR THE OUTCOME AND MONTH AND YEAR THAT THE PREGNANCY TERMINATED FOR THE LAST PREGNANCY THAT ENDED IN A STILL BIRTH, MISCARRIAGE, OR ABORTION PRIOR TO JANAURY 2000. IF NONE RECODE '0' IN OUTCOME. 233 When did your last menstrual period start? DAYS AGO . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . 2 MONTHS AGO . . . . . . . . 3 (DATE, IF GIVEN) YEARS AGO . . . . . . . . . . 4 IN MENOPAUSE/ HAS HAD HYSTERECTOMY . . . 994 BEFORE LAST BIRTH . . . . . . . . . . . . 995 NEVER MENSTRUATED . . . . . . . . . . 996 234 From one menstrual period to the next, are there certain days YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 when a woman is more likely to become pregnant if she has NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 sexual relations? DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 301 235 Is this time just before her period begins, during her period, right JUST BEFORE HER PERIOD after her period has ended, or halfway between two periods? BEGINS . . . . . . . . . . . . . . . . . . . . . . . 1 DURING HER PERIOD . . . . . . . . . . . . 2 RIGHT AFTER HER PERIOD HAS ENDED . . . . . . . . . . . . 3 HALFWAY BETWEEN TWO PERIODS . . . . . . . . . . . . . . . . 4 OTHER 6 (SPECIFY) DON'T KNOW . . . . . . . . . . . . . . . . . . . . . 8 _________________________ 311Appendix E | SECTION 3. CONTRACEPTION 301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 302, ASK 303. 302 Which ways or 303 Have you ever used methods have you heard (METHOD)? about? METHOD FOR METHODS NOT MENTIONED, ASK: Have you ever heard of (METHOD)? 01 FEMALE STERILIZATION Women can have an operation to avoid YES . . . . . . . . . . . . . 1 Have you ever had an operation to having any more children. NO . . . . . . . . . . . . . 2 avoid having any more children? YES . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 02 MALE STERILIZATION Men can have an operation to avoi