Ethiopia - Demographic and Health Survey - 2006

Publication date: 2006

Ethiopia Demographic and Health Survey 2005 Central Statistical Agency Addis Ababa, Ethiopia ORC Macro Calverton, Maryland, USA September 2006 The 2005 Ethiopia Demographic and Health Survey (2005 EDHS) is part of the worldwide MEASURE DHS project which is funded by the United States Agency for International Development (USAID). The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. Additional information about the 2005 EDHS may be obtained from the Central Statistical Agency (CSA), P.O. Box 1143, Addis Ababa, Ethiopia; Telephone: (251) 111 55 30 11/111 15 78 41, Fax: (251) 111 55 03 34, E-mail: csa@ethionet.et. Additional information about the DHS project may be obtained from 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. Suggested citation: Central Statistical Agency [Ethiopia] and ORC Macro. 2006. Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro. Contents | iii CONTENTS TABLES AND FIGURES . ix FOREWORD .xvii ACKNOWLEDGMENTS . xix NATIONAL STEERING COMMITTEE MEMBERS . xxi SUMMARY OF FINDINGS .xxiii MILLENNIUM DEVELOPMENT GOAL INDICATORS, ETHIOPIA 2005 .xxix CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy .1 1.2 Population.3 1.3 Health Priorities and Programming .4 1.4 Objectives of the Survey .5 1.5 Organization of the Survey .6 1.6 Sample Design.7 1.7 Questionnaires .7 1.8 Haemoglobin and HIV Testing.8 1.8.1 Haemoglobin Testing .8 1.8.2 HIV/AIDS Testing .9 1.9 Listing, Pretest, Training and Fieldwork .10 1.9.1 Listing .10 1.9.2 Pretest.10 1.9.3 Training and Fieldwork .10 1.10 Data Processing .11 1.11 Response Rates.12 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population By Age And Sex.13 2.2 Household Composition .14 2.3 Household Education .17 2.3.1 Educational Attainment of Household Population .17 2.3.2 School Attendance Ratios.19 2.4 Household Characteristics .23 2.5 Household Possessions .27 2.6 Socioeconomic Status Index .28 iv Ň Contents CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents .31 3.2 Educational Attainment and Literacy.33 3.3 Access to Mass Media .37 3.4 Employment .39 3.4.1 Employment Status .39 3.4.2 Occupation.42 3.4.3 Earnings, Employers and Continuity of Employment .44 CHAPTER 4 FERTILITY 4.1 Current Fertility .47 4.2 Fertility Differentials.48 4.3 Fertility Trends.50 4.4 Children Ever Born and Surviving.51 4.5 Birth Intervals .52 4.6 Age at First Birth .53 4.7 Teenage Pregnancy and Motherhood .55 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods .57 5.2 Ever Use of Contraceptive Methods .59 5.3 Current Use of Contraceptive Methods.61 5.3.1 Trends in Contraceptive Use .64 5.3.2 Number of Children at First Use of Contraception.64 5.4 Use of Social Marketing Brands.65 5.5 Knowledge of Fertile Period.66 5.6 Source of Family Planning Methods .66 5.7 Informed Choice .67 5.8 Contraceptive Discontinuation.69 5.9 Future Use of Contraception.70 5.10 Reasons for Not Intending to Use A Contraceptive Method in the Future.71 5.11 Preferred Method of Contraception for Future Use .72 5.12 Exposure to Family Planning Messages.72 5.13 Contact of Nonusers with Family Planning Providers.73 5.14 Husband's Knowledge of Wife's Use of Contraception .75 5.15 Men's Attitude about Contraception .76 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status .79 6.2 Polygyny.80 6.3 Age at First Marriage .82 6.4 Age at First Sexual Intercourse .83 6.5 Recent Sexual Activity.85 Contents | v 6.6 Postpartum Amenorrhoea, Abstinence and Insusceptibility .88 6.7 Menopause .90 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children.91 7.2 Need for Family Planning Services .95 7.3 Ideal Family Size.97 7.4 Fertility Planning .99 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Assessment of Data Quality.102 8.2 Levels and Trends in Infant and Child Mortality .103 8.3 Socioeconomic Differentials in Childhood Mortality .104 8.4 Demographic Differentials in Mortality .105 8.5 Perinatal Mortality .107 8.6 High-Risk Fertility Behaviour.108 CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care.111 9.2 Delivery Care .116 9.3 Postnatal Care .119 9.4 Problems in Accessing Health Care .120 CHAPTER 10 CHILD HEALTH 10.1 Child’s Size at Birth.127 10.2 Vaccination Coverage .128 10.3 Acute Respiratory Infection.132 10.4 Fever .134 10.5 Prevalence of Diarrhoea .135 10.6 Diarrhoea Treatment .136 10.7 Feeding Practices.138 10.8 Knowledge of ORS Packets .139 10.9 Stool Disposal.140 CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN 11.1 Initiation of Breastfeeding .143 11.2 Breastfeeding Status by Age .144 11.3 Duration and Frequency of Breastfeeding .147 11.4 Types of Supplemental Food.148 11.5 Foods Consumed by Mothers .149 11.6 Micronutrient Intake.150 11.6.1 Iodine Intake.151 11.6.2 Micronutrient Intake Among Children .151 11.6.3 Micronutrient Intake among Mothers .154 vi Ň Contents 11.7 Prevalence of Anaemia .156 11.7.1 Prevalence of Anaemia in Children .156 11.7.2 Prevalence of Anaemia in Women .157 11.8 Nutritional Status .159 11.8.1 Nutritional Status of Children .159 11.8.2 Trends in Children’s Nutritional Status .162 11.8.3 Nutritional Status of Women.163 CHAPTER 12 MALARIA 12.1 Introduction.165 12.1.1 Malaria Vector Control.165 12.1.2 Malaria Diagnosis and Treatment .174 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 13.1 Knowledge of HIV/AIDS and of Transmission and Prevention Methods .179 13.1.1 Awareness of AIDS.179 13.1.2 Knowledge of Ways to Reduce HIV/AIDS Transmission .179 13.1.3 Knowledge about Transmission .181 13.1.4 Knowledge about Mother-to-Child Transmission .185 13.2 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS .187 13.3 Attitudes Towards Negotiating Safer Sex .189 13.4 Higher-Risk Sex .191 13.4.1 Multiple Sexual Partners and Higher-Risk Sex.191 13.4.2 Paid Sex.195 13.5 Testing for HIV .195 13.6 Reports of Recent Sexually Transmitted Infections .199 13.7 Male Circumcision.200 13.8 Injections .200 13.9 HIV/AIDS-Related Knowledge and Behaviour among Youth.202 13.9.1 Knowledge about HIV/AIDS and Source for Condoms.202 13.9.2 Age at First Sex and Condom Use at First Sexual Intercourse .205 13.9.3 Recent Sexual Activity .207 13.9.4 Higher-Risk Sex.209 13.9.5 Age-Mixing in Sexual Relationships .210 13.9.6 Drunkenness during Sexual Intercourse.210 13.9.7 HIV Testing .212 Contents | vii CHAPTER 14 HIV PREVALENCE AND ASSOCIATED FACTORS 14.1 Coverage of HIV Testing in the EDHS .213 14.2 HIV Prevalence.215 14.2.1 HIV Prevalence by Age.216 14.2.2 HIV Prevalence by Socio-economic Characteristics .217 14.2.3 HIV Prevalence by Other Sociodemographic Characteristics .218 14.2.4 HIV Prevalence by Sexual Risk Behaviour .220 14.2.5 HIV Prevalence by Other Characteristics Related to HIV Risk .222 14.3 HIV Prevalence and Male Circumcision .223 14.4 HIV Prevalence among Couples.223 14.5 EDHS and ANC Surveillance Results .225 14.6 Effect of Nonresponse on the EDHS HIV Prevalence Results .229 CHAPTER 15 ADULT AND MATERNAL MORTALITY 15.1 Data Quality Issues .231 15.2 Adult Mortality .232 15.3 Maternal Mortality .233 CHAPTER 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOME 16.1 Employment and Form of Earnings.235 16.2 Control Over and Relative Magnitude of Women’s Earnings .236 16.3 Woman’s Participation in Decisionmaking .238 16.4 Attitude Towards Refusing Sex with Husband .241 16.5 Attitudes Towards Wife Beating .244 16.6 Current Use of Contraception by Women’s Status .247 16.7 Ideal Family Size and Unmet Need by Women’s status.247 16.8 Reproductive Health Care by Women’s Status.248 16.9 Early Childhood Mortality Rates by Women’s Status .249 16.10 Property Dispossession .250 16.11 Harmful Traditional Practices.252 REFERENCES . 261 APPENDIX A SAMPLE IMPLEMENTATION .265 APPENDIX B ESTIMATES OF SAMPLING ERRORS.271 APPENDIX C DATA QUALITY TABLES .289 APPENDIX D PERSONS INVOLVED IN THE 2005 ETHIOPIA DEMOGRAPHIC AND HEALTH SURVEY.297 APPENDIX E QUESTIONNAIRES .301 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators.3 Table 1.2 Results of the household and individual interviews.12 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.13 Table 2.2 Household composition.14 Table 2.3 Children's living arrangements and orphanhood.15 Table 2.4 Succession planning.16 Table 2.5.1 Educational attainment of household population: female.18 Table 2.5.2 Educational attainment of household population: male.19 Table 2.6 School attendance ratios .20 Table 2.7 Grade repetition and dropout rates.22 Table 2.8 Household drinking water.24 Table 2.9 Household sanitation facilities.25 Table 2.10 Household characteristics .26 Table 2.11 Household possessions .27 Table 2.12 Wealth quintiles.28 Table 2.13 Birth registration of children under age five .29 Figure 2.1 Population pyramid .14 Figure 2.2 Age-Specific Attendance Rates .23 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .32 Table 3.2.1 Educational attainment by background characteristics: women .33 Table 3.2.2 Educational attainment by background characteristics: men.34 Table 3.3.1 Literacy: women.35 Table 3.3.2 Literacy: men.36 Table 3.4.1 Exposure to mass media: women.37 Table 3.4.2 Exposure to mass media: men.38 Table 3.5.1 Employment status: women .40 Table 3.5.2 Employment status: men.41 Table 3.6.1 Occupation: women.42 Table 3.6.2 Occupation: men .43 Table 3.7.1 Type of employment: women.44 Table 3.7.2 Type of employment: men.45 CHAPTER 4 FERTILITY Table 4.1 Current fertility .47 x | Tables and Figures Table 4.2 Fertility by background characteristics .49 Table 4.3 Trends in age-specific fertility rates.50 Table 4.4 Trends in age-specific and total fertility rates .50 Table 4.5 Children ever born and living.51 Table 4.6 Birth intervals.53 Table 4.7 Age at first birth .54 Table 4.8 Median age at first birth by background characteristics.55 Table 4.9 Teenage pregnancy and motherhood.56 Figure 4.1 Age-specific Fertility Rates by Urban-Rural Residence .48 Figure 4.2 Total Fertility Rates by Background Characteristics .49 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .58 Table 5.2 Couples' knowledge of contraceptive methods.59 Table 5.3.1 Ever use of contraception: women.60 Table 5.3.2 Ever use of contraception: men.61 Table 5.4 Current use of contraception .62 Table 5.5 Current use of contraception by background characteristics .63 Table 5.6 Trends in current use of contraception.64 Table 5.7 Number of living children at first use of contraception .65 Table 5.8.1 Pill brands.65 Table 5.8.2 Condom brands.65 Table 5.9 Knowledge of fertile period.66 Table 5.10 Source of modern contraceptive methods.67 Table 5.11 Informed choice .68 Table 5.12 First-year contraceptive discontinuation rates .69 Table 5.13 Reasons for discontinuation .70 Table 5.14 Future use of contraception .70 Table 5.15 Reason for not intending to use contraception in the future .71 Table 5.16 Preferred method of contraception for future use.72 Table 5.17 Exposure to family planning messages .73 Table 5.18 Contact of nonusers with family planning providers .74 Table 5.19 Husbands/partners knowledge of women's use of contraception .75 Table 5.20 Men's attitude about contraception.76 Figure 5.1 Trends in Current Use of Contraception, Ethiopia 1990-2005.64 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .80 Table 6.2 Number of co-wives and wives .81 Table 6.3 Age at first marriage .82 Table 6.4 Median age at first marriage.83 Table 6.5 Age at first sexual intercourse .84 Table 6.6 Median age at first intercourse .85 Table 6.7.1 Recent sexual activity: women.86 Table 6.7.2 Recent sexual activity: men.87 Table 6.8 Postpartum amenorrhoea, abstinence and insusceptibility.89 Tables and Figures | xi Table 6.9 Median duration of postpartum insusceptibility by background characteristics .90 Table 6.10 Menopause.90 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children .92 Table 7.2.1 Desire to limit childbearing: women .93 Table 7.2.2 Desire to limit childbearing: men.94 Table 7.3 Need for family planning .96 Table 7.4 Ideal number of children .97 Table 7.5 Mean ideal number of children.98 Table 7.6 Fertility planning status.99 Table 7.7 Wanted fertility rates. 100 Figure 7.1 Fertility Preferences of Currently Married Women Age 15-49 .92 Figure 7.2 Desire to Limit Childbearing Among Currently Married Women, by Number of Living Children, 2000 and 2005.94 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 103 Table 8.2 Early childhood mortality rates by socioeconomic characteristics. 105 Table 8.3 Early childhood mortality rates by demographic characteristics. 106 Table 8.4 Perinatal mortality. 108 Table 8.5 High-risk fertility behaviour . 109 Figure 8.1 Early Childhood Mortality Rates for the Period 0-4 Years Preceding the Survey, 2000 and 2005. 104 Figure 8.2 Under-Five Mortality by Selected Demographic Characteristics. 106 CHAPTER 9 MATERNAL HEALTH Table 9.1 Antenatal care. 112 Table 9.2 Number of antenatal care visits and timing of first visit . 113 Table 9.3 Components of antenatal care . 114 Table 9.4 Tetanus toxoid injections . 115 Table 9.5 Place of delivery . 117 Table 9.6 Assistance during delivery . 118 Table 9.7 Timing and type of provider of first postnatal checkup . 120 Table 9.8 Problems in accessing health care . 121 Table 9.9.1 Knowledge and attitude concerning tuberculosis among women. 123 Table 9.9.2 Knowledge and attitude concerning tuberculosis among men . 124 Table 9.10 Use of tobacco: men . 125 CHAPTER 10 CHILD HEALTH Table 10.1 Child's size at birth . 128 Table 10.2 Vaccinations by source of information. 129 Table 10.3 Vaccinations by background characteristics . 131 xii | Tables and Figures Table 10.4 Vaccinations in the first year of life. 132 Table 10.5 Prevalence and treatment of symptoms of ARI . 133 Table 10.6 Prevalence and treatment of fever. 135 Table 10.7 Prevalence of diarrhoea . 136 Table 10.8 Diarrhoea treatment . 137 Table 10.9 Feeding practices during diarrhoea . 139 Table 10.10 Knowledge of ORS packets or prepackaged liquids . 140 Table 10.11 Disposal of children's stools. 141 Figure 10.1 Percentage of Children Age 12-23 Months with Specific Vaccinations. 129 CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN Table 11.1 Initial breastfeeding. 144 Table 11.2 Breastfeeding status by age . 145 Table 11.3 Median duration and frequency of breastfeeding . 147 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview. 149 Table 11.5 Foods consumed by mothers in the day and night preceding the interview. 150 Table 11.6 Presence of iodized salt in household . 151 Table 11.7 Micronutrient intake among children . 153 Table 11.8 Micronutrient intake among mothers . 155 Table 11.9 Prevalence of anaemia in children . 157 Table 11.10 Prevalence of anaemia in women . 158 Table 11.11 Nutritional status of children . 160 Table 11.12 Nutritional status of women by background characteristics. 164 Figure 11.1 Breastfeeding Practices by Age . 146 Figure 11.2 Trends in Infant Feeding Practice for Children 0-5 Months and 6-9 Months, 2000 and 2005 . 146 Figure 11.3 Nutritional Status of Children Under Age Five . 162 CHAPTER 12 MALARIA Table 12.1 Household possession of mosquito nets . 166 Table 12.2 Use of mosquito nets by children. 168 Table 12.3 Use of mosquito nets by women. 169 Table 12.4 Use of mosquito nets by population age five and older . 171 Table 12.5 Coverage of spraying programs . 172 Table 12.6 Prophylactic use of antimalarial drugs and use of intermittent preventive treatment (IPT) by women during pregnancy. 174 Table 12.7 Prevalence and prompt treatment of children with fever . 175 Table 12.8 Type and timing of antimalarial drugs received by children with fever. 177 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 13.1 Knowledge of AIDS. 179 Table 13.2 Knowledge of methods of HIV prevention. 181 Table 13.3.1 Misconceptions and comprehensive knowledge about AIDS: women . 183 Tables and Figures | xiii Table 13.3.2 Misconceptions and comprehensive knowledge about AIDS: men. 184 Table 13.4 Knowledge of prevention of mother to child transmission of HIV . 186 Table 13.5.1 Accepting attitudes toward those living with HIV: women. 188 Table 13.5.2 Accepting attitudes toward those living with HIV: men . 189 Table 13.6 Attitudes toward negotiating safer sex with husband. 190 Table 13.7.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women . 192 Table 13.7.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men . 193 Table 13.8 Payment by men for sexual intercourse. 195 Table 13.9.1 Coverage of prior HIV testing: women . 196 Table 13.9.2 Coverage of prior HIV testing: men. 197 Table 13.10 Pregnant women counselled and tested for HIV. 198 Table 13.11 Self-reported prevalence of sexually-transmitted infections (STI) and STI symptoms . 199 Table 13.12 Prevalence of male circumcision . 200 Table 13.13 Prevalence of injections . 201 Table 13.14 Comprehensive knowledge about AIDS and a source for condoms among youth . 203 Table 13.15 Adult support for education about condom use to prevent AIDS. 204 Table 13.16 Age at first sex among youth . 205 Table 13.17 Condom use at first sexual intercourse among youth. 207 Table 13.18 Premarital sexual intercourse and condom use among youth . 208 Table 13.19 Higher-risk sexual intercourse among youth . 209 Table 13.20 Drunkenness during sexual intercourse among youth. 211 Table 13.21 Recent HIV tests among youth . 212 Figure 13.1 Percentage of Women and Men Age 15-49 with Comprehensive Knowledge about AIDS. 185 Figure 13.2 Multiple Sexual Partners and Higher-Risk Sexual Intercourse in the Past 12 Months among Men Age 15-49 . 194 CHAPTER 14 HIV PREVALENCE AND ASSOCIATED FACTORS Table 14.1 HIV testing coverage by residence and region . 214 Table 14.2 HIV testing coverage by background characteristics. 215 Table 14.3 HIV prevalence by age. 217 Table 14.4 HIV prevalence by socioeconomic characteristics. 218 Table 14.5 HIV prevalence by demographic characteristics . 219 Table 14.6 HIV prevalence by sexual behaviour . 221 Table 14.7 HIV prevalence by STI status and prior HIV testing status . 222 Table 14.8 HIV prevalence by male circumcision . 223 Table 14.9 HIV prevalence among couples. 224 Table 14.10 HIV prevalence results from the EDHS and the National Antenatal Care Surveillance System . 226 Table 14.11 Observed and adjusted HIV prevalence among women and men . 229 Table 14.12 Observed and adjusted HIV prevalence among women and men by background characteristics . 230 Figure 14.1 HIV Prevalence among Women and Men Age 15-49. 216 xiv | Tables and Figures Figure 14.2 HIV Prevalence among EDHS Respondents by Antenatal Care Status and HIV Rate from ANC Surveillance Data . 226 Figure 14.3 2005 Ethiopia Sample Cluster Locations and 2005 HIV Sentinel Surveillance Sites . 228 Figure 14.4 HIV Prevalence by Distance from 2005 ANC Sentinel Sites, EDHS Respondents Age 15-49 . 229 CHAPTER 15 ADULT AND MATERNAL MORTALITY Table 15.1 Adult mortality rates. 232 Table 15.2 Direct estimates of maternal mortality . 233 CHAPTER 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOME Table 16.1 Employment and cash earnings of currently married women. 235 Table 16.2 Control over women's earnings and relative magnitude of women's earnings . 237 Table 16.3 Women's control over her own earnings and over those of her husband/ partner. 238 Table 16.4 Women's participation in decisionmaking . 239 Table 16.5 Women's participation in decisionmaking by background characteristics. 240 Table 16.6.1 Attitude toward refusing sexual intercourse with husband: women . 242 Table 16.6.2 Attitude toward refusing sexual intercourse with husband: men . 243 Table 16.7.1 Attitude toward wife beating: women . 245 Table 16.7.2 Attitude toward wife beating: men. 246 Table 16.8 Current use of contraception by women's status. 247 Table 16.9 Ideal number of children and unmet need for family planning by women’s status . 248 Table 16.10 Reproductive health care by women's status . 249 Table 16.11 Early childhood mortality rates by women's status . 250 Table 16.12 Widows dispossessed of property. 251 Table 16.13 Knowledge, prevalence, and support of female circumcision . 253 Table 16.14 Daughter's circumcision experience and type of circumcision . 254 Table 16.15 Knowledge, prevalence, and support of uvulectomy or tonsillectomy. 255 Table 16.16 Daughter's uvulectomy/tonsillectomy . 256 Table 16.17 Knowledge, prevalence, and support of marriage by abduction. 257 Table 16.18 Daughter's marriage by abduction. 258 Table 16.19 Prevalence of obstetric fistula . 259 Figure 16.1 Number of Household Decisions in Which Currently Married Women Participate . 241 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: women . 265 Table A.2 Sample implementation: men. 266 Table A.3 Coverage of HIV testing among eligible respondents by social and demographic characteristics: women . 267 Tables and Figures | xv Table A.4 Coverage of HIV testing among eligible respondents by social and demographic characteristics: men. 268 Table A.5 Coverage of HIV testing by sexual behaviour characteristics: women . 269 Table A.6 Coverage of HIV testing by sexual behaviour characteristics: men . 270 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 274 Table B.2 Sampling errors for national sample . 275 Table B.3 Sampling errors for urban sample. 276 Table B.4 Sampling errors for rural sample. 277 Table B.5 Sampling errors for Tigray Region. 278 Table B.6 Sampling errors for Affar Region. 279 Table B.7 Sampling errors for Amhara Region . 280 Table B.8 Sampling errors for Oromiya Region . 281 Table B.9 Sampling errors for Somali Region. 282 Table B.10 Sampling errors for Benishangul-Gumuz Region. 283 Table B.11 Sampling errors for SNNP Region. 284 Table B.12 Sampling errors for Gambela Region . 285 Table B.13 Sampling errors for Harari Region . 286 Table B.14 Sampling errors for Addis Ababa Region. 287 Table B.15 Sampling errors for Dire Dawa Region . 288 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 289 Table C.2.1 Age distribution of eligible and interviewed women . 290 Table C.2.2 Age distribution of eligible and interviewed men. 290 Table C.3 Completeness of reporting . 291 Table C.4 Births by calendar years . 292 Table C.5 Reporting of age at death in days . 293 Table C.6 Reporting of age at death in months. 294 Foreword | xvii FOREWORD The 2005 Ethiopia Demographic and Health Survey (EDHS) was conducted under the auspices of the Ministry of Health and implemented by the then Population and Housing Census Commission Office (PHCCO), now merged with the Central Statistical Agency (CSA). The key findings of the survey were released in a preliminary report in November 2005. This final report details the findings of the survey. The first ever Demographic and Health Survey (DHS) in Ethiopia was conducted in 2000. The 2005 EDHS differed from the 2000 EDHS mainly because it included testing for the prevalence of anaemia and HIV. Major stakeholders from various Ministries were closely involved in the management and oversight of the survey and analysis of the survey results. The primary objective of the 2005 EDHS was to provide up-to-date information for policy makers, planners, researchers and programme managers, which would allow guidance in the planning, implementation, monitoring and evaluation of population and health programmes in the country. The information obtained from the EDHS, in conjunction with statistical information obtained from the Welfare Monitoring Survey (WMS) and Household Income, Consumption and Expenditure Survey (HICES), will provide critical information for the monitoring and evaluation of the country’s Plan for Accelerated and Sustained Development to End Poverty (PASDEP), the various sector development policies and programmes, and assist in the monitoring of the progress towards meeting the Millennium Development Goals (MDGs). The 2005 EDHS collected information on the population and health situation, covering topics on family planning, fertility levels and determinants, fertility preferences, infant, child, adult and maternal mortality, maternal and child health, nutrition, malaria, women’s empowerment, and knowledge of HIV/AIDS. In addition the EDHS includes population estimates of HIV and anaemia prevalence in the country. Key indicators relating to each of the above topics are provided for the nine regional states and two city administrations. In addition, data are also provided by urban and rural residence for the country. Findings from the survey indicate some improvements in major health and demographic variables in the past five years. The CSA would like to acknowledge a number of organizations and individuals who contributed to the successful completion of the 2005 EDHS. The Agency is grateful for the commitment of the Government of Ethiopia and the generous funding support primarily by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), the Dutch and Irish Governments, and the United Nations Population Fund (UNFPA). We also appreciate UNICEF for supplying weighing scales and salt test kits; and WHO/Ethiopia and the Japan International Cooperation Agency (JICA) for each lending a vehicle to support fieldwork. We would also like to thank ORC Macro in Maryland, U.S.A. for technical assistance in all aspects of the survey. The agency extends a special thanks to the Ministry of Health, to all the member institutions of the EDHS Steering Committee and to development partners and stakeholders, who contributed to the successful completion of the survey. Special thanks also goes to the Ethiopia Health and Nutrition Research Institute (EHNRI), which handled the testing of the blood samples for determining the HIV status of the surveyed population. We also wish to acknowledge the tireless effort of the CSA staff who made this survey a success. Finally, we highly appreciate the field staff and, more importantly, the survey respondents, who were critical to the successful completion of this survey. Samia Zekaria Director General Central Statistical Agency Acknowledgments | xix ACKNOWLEDGMENTS The following persons contributed to the preparation of this report Mrs. Samia Zekaria, Central Statistical Agency Mr. Gebeyehu Abelti, Central Statistical Agency Mr. Genene Bizuneh, Central Statistical Agency Mrs. Gezu Berhanu, Central Statistical Agency Mr. Behailu G/Medhin, Central Statistical Agency Mr. Mekonen Tesfaye, Central Statistical Agency Mr. Yehualashet Mekonen, Central Statistical Agency Mrs. Alemtsehay Biru, Central Statistical Agency Mrs. Genet Mengistu, National Office of Population Mr. Ambachew Medhin, Ministry of Health/ WHO Mrs. Hiwot Mengistu, Ministry of Health Dr. Yared Mekonen, Ethiopian Health and Nutrition Research Institute Mr. Woldemariam Girma, Ethiopian Health and Nutrition Research Institute Dr. Aseged Woldu, HIV/AIDS Prevention and Control Office Mr. Hailu Belachew, CORHA Dr. Pav Govindasamy, ORC Macro Dr. Ann Way, ORC Macro Mr. Albert Themme, ORC Macro Dr. Alfredo Aliaga, ORC Macro Dr. Sidney Moore, ORC Macro Ms. Kaye Mitchell, ORC Macro Ms. Anne Cross, ORC Macro Ms. Joy Fishel, ORC Macro National Steering Committee Members | xxi NATIONAL STEERING COMMITTEE MEMBERS Mrs. Samia Zekaria CSA Mr. Amare Isaias PHCCO Dr. Tesfanesh Belay MOH Mr. Misganaw Lijalen HAPCO Dr. Tsehaynesh Messele EHNRI Dr. Yared Mekonnen EHNRI Mr. Hiruy Mitiku NOP Mrs. Genet Mengistu NOP Dr. Yemane Teklay ESTA Mr. Hailu Belachew CORHA Mr. Genene Bizuneh CSA Mr. Kefene Asfaw CSA Mr. Behailu G/Medhin CSA Mrs. Gezu Berhanu CSA Mr. Gebeyehu Abelti CSA Dr. Monique Rakotomalala UNFPA Mr. Jude Edochie UNFPA Mrs. Mulugojjam Assaye UNFPA Mrs. Meron Tewfik UNFPA Dr. Alemach Teklehaimanot UNICEF Dr. Habtamu Argaw WHO Ms. Sue Anthony USAID Mrs. Mary Ann Abeyta-Behnke USAID Dr. Omer Ahmed Omer USAID Dr. Kidest Lulu USAID Dr. Pav Govindasamy ORC Macro Mr. Bernard Ghaleb ORC Macro Summary of Findings | xxiii SUMMARY OF FINDINGS The 2005 Ethiopia Demographic and Health Survey (EDHS) is a nationally representative survey of 14,070 women age 15-49 and 6,033 men age 15-59. The EDHS is the second comprehensive survey conducted in Ethiopia as part of the worldwide Demographic and Health Surveys (DHS) project. The primary purpose of the EDHS is to furnish policymakers and planners with detailed information on fertility, family planning, infant, child, adult and maternal mortality, maternal and child health, nutrition and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one of two households selected for the survey, women age 15-49 and children age 6-59 months were tested for anaemia, and women age 15-49 and men age 15-59 were tested for HIV. The 2005 EDHS is the first survey in Ethiopia to provide population- based prevalence estimates for anaemia and HIV. FERTILITY Survey results indicate that there has been a decline in fertility from 6.4 births per woman in 1990 to 5.4 births per woman in 2005, a one child drop in the last 15 years. The decline was more pronounced in the 10 years between 1990 and 2000 than in the five years between 2000 and 2005 and in urban than in rural areas. Rural women on average have two and a half children more than urban women. There is a substantial differential in fertility by region ranging from a low of 1.4 children per woman in Addis Ababa to a high of 6.2 children per woman in Oromiya. Education and wealth have a marked effect on fertility, with uneducated mothers having three times as many children as women with at least some secondary education and women in the lowest wealth quintile having twice as many children as women in the highest wealth quintile. Childbearing starts early. At current age- specific rates of childbearing, an Ethiopian woman will have had more than half of her lifetime births by age 30, and nearly three- fourths by age 35. Marriage patterns are an important determinant of fertility levels in a population. Although there was a marked decline in the percentage of women in union from 72 percent in 1990 to 64 percent in 2000, little change was observed in women currently in union in the last five years. Similar trends were observed in the median age at marriage and the median age at first sexual intercourse, with obvious increases in the ten-year period between 1990 and 2000 and little change in the five-year period between 2000 and 2005. Ethiopian women generally begin sexual intercourse at the time of their first marriage. This can be seen from the identical medians in age at first marriage and age at first sexual intercourse (16.1). Men, on the other hand, are sexually active before marriage, although the difference in age at first intercourse and age at first marriage has narrowed over the past five years. The median age at first sexual intercourse for men is 21.2 years while the median age at first marriage is 23.8. In general, Ethiopian men marry nearly eight years later than women. Data from the 2005 EDHS show that 12 percent of currently married women are married to men who are in a polygynous union. Older women, rural women, women residing in Gambela, uneducated women, and women in the poorest wealth quintile are more likely to be in a polygynous union than other women. About one in fifteen men is in a polygynous union. The extent of polygyny has declined over the past five years. The interval between births is relatively long in Ethiopia. The median number of months since the preceding birth is 33.8. Twenty-one percent of nonfirst births occur within two years of a previous birth, 35 percent occur between 24 and 35 months later and 44 percent occur at least three years after a previous birth. Postpartum insusceptibility is one of the major factors contributing to the long birth interval in Ethiopia. The median duration of amenorrhea is 15.8 months, postpartum abstinence is 2.4 months, and insusceptibility is 16.7 months. xxiv | Summary of Findings FAMILY PLANNING Overall, knowledge of contraception has remained consistently high in Ethiopia over the past five years with 88 percent of currently married women and 93 percent of currently married men having heard of at least one method of contraception. The pill, injectables, and condom are the most widely known modern methods among both women and men. Currently married men are more than twice as likely to recognize the condom as a method of family planning than currently married women (84 percent versus 41 percent). Twenty-four percent of currently married women and 19 percent of currently married men have used a family planning method at least once in their lifetime. Fifteen percent of currently married women are using a method of contraception. Modern methods are more widely used than traditional methods, with 14 percent of currently married women using a modern method and 1 percent using a traditional method. The most popular modern method is the injectable used by one in ten currently married women. About four in five currently married women obtain modern methods from the public sector, while 17 percent and 3 percent, respectively, obtain their method from the private medical sector or other private sources. Use of contraceptive methods tripled in the fifteen-year period between 1990 and 2005 from 5 percent to 15 percent. The increase is especially marked for modern methods which more than doubled in the five years between 2000 and 2005. This trend is mostly attributable to the recent rapid rise in the use of injectables from 3 percent in 2000 to 10 percent in 2005. More than half of currently married women who were not using any family planning method at the time of the survey say they intend to use a method in the future. The majority of prospective users prefer injectables while a sizeable proportion cite the pill as their preferred method. The desire for more children is frequently mentioned by currently married nonusers as a reason for not intending to use a method of contraception in the future. The proportion of women who cited this reason for not wanting to use a method has dropped markedly over the past five years from 42 percent in 2000 to 18 percent in 2005. Family planning information is largely received through the radio with limited exposure through the television and print media. Twenty- nine percent of women heard about family planning on the radio compared with 11 percent who heard about it from television and 8 percent who read about it in newspapers or magazines. The majority of Ethiopian women (78 percent) and men (76 percent) prefer to space or limit the number of children they have, and have a potential need for family planning. One in three currently married women has an unmet need for family planning (34 percent). The need for spacing (20 percent) is higher than the need for limiting (14 percent). If all currently married women who say they want to space or limit the number of children were to use family planning, the contraceptive prevalence rate in Ethiopia would increase from 15 percent to 49 percent. Currently, only 31 percent of the demand for family planning is being met. CHILD HEALTH At current mortality levels, one in every 13 Ethiopian children dies before reaching age one, while one in every eight does not survive to the fifth birthday. Data from the 2005 EDHS show that infant mortality has declined by 19 percent over the past 15 years from 95 deaths per 1,000 live births to 77. Under-five mortality has gone down by 25 percent from 166 deaths per 1,000 live births to 123. The corresponding declines in neonatal and postneonatal mortality over the 15-year period are 15 percent and 22 percent, respectively. Mortality is consistently lower in urban areas than in rural areas. The lowest level is in Addis Ababa, the most urbanized part of the country, while the highest levels are in Benishangul- Gumuz, Gambela, and Amhara. Maternal education is strongly correlated with child mortality. Under-five mortality among children born to mothers with no education is more than twice as high as that among children born to mothers with secondary education or higher. Survival of infants and children is strongly influenced by the gender of the child, mother’s Summary of Findings | xxv age at birth, birth order, and birth interval. Male children experience higher mortality than female children and the gender difference is especially pronounced for infant mortality. Childhood mortality is relatively higher among children born to mothers under age 20 and over age 40. First births and births of order seven and higher also suffer significantly higher rates of mortality than births of order two to six. Children born within two years of a preceding birth are more than three times as likely to die within the first year of life as children born three or more years after an older sibling. Twenty percent of children age 12-23 months had been fully vaccinated at the time of the survey. Three in five have received the BCG vaccination, and 35 percent have been vaccinated against measles. The coverage for the first dose of DPT is relatively high (58 percent). However, only 32 percent go on to receive the third dose of DPT. Polio coverage is much higher than DPT coverage because of the success of the national immunization day campaigns during which polio vaccines are administered. Nevertheless, the dropout between the first and subsequent doses of polio is marked – a 40 percent decline between the first and third dose. Vaccination coverage in Ethiopia has improved over the past five years. The percentage of children 12-23 months fully vaccinated at the time of the survey increased by 43 percent from 14 percent in 2000 to 20 percent in 2005. However, the percentage who received none of the six basic vaccinations also increased from 17 percent in 2000 to 24 percent in 2005. Thirteen percent of children under age five showed symptoms of acute respiratory infection (ARI) in the two weeks before the survey. Use of a health facility for the treatment of symptoms of ARI is low, with only 19 percent of children taken to a health facility or provider. Nineteen percent of children under five were reported to have had fever, a major manifestation of malaria, in the two weeks before the survey. Less than one in five children was taken to a health facility or provider for treatment. A very small percentage of children with fever received antimalarial drugs (3 percent) or antibiotics (6 percent). The 2005 EDHS gathered information on the use of mosquito nets, both treated and untreated. The data show that only 6 percent of households in Ethiopia own a mosquito net, with 3 percent of households owning an insecticide-treated net (ITN). Consistent with the degree of risk of malaria, ownership of mosquito nets varies inversely with altitude. For instance, 36 percent of households living in areas below 1,000 metres own some type of net, while the corresponding figure for households at altitudes above 2,000 metres or more is only 2 percent. Only 2 percent of children under five slept under a net the night prior to the interview, while less than 2 percent slept under an ever-treated net and under an ITN. Use of nets varies inversely with altitude with 19 percent of children living at altitudes less than 1,000 metres sleeping under a net compared with 4 percent or less among children living at altitudes above 1,000 metres. Eleven percent of households occupying a dwelling had their inner walls sprayed with insecticide to prevent malaria, 2 percent had been sprayed in the 6 months preceding the survey, and 3 percent had white insecticide powder visible on the inner walls. Nationally, 18 percent of children under age five had diarrhoea at some time in the two weeks before the survey, while 6 percent had diarrhoea with blood during the same period. Around one in five of these children were taken to a health provider. Thirty-seven percent of children with diarrhoea were treated with some kind of oral rehydration therapy (ORT): 20 percent were treated with ORS (solution prepared from ORS packets); 19 percent were given recommended home fluids (RHF) prepared at home; and 9 percent were given increased fluids. About half of children with diarrhoea did not receive any type of treatment at all. MATERNAL HEALTH Twenty-eight percent of mothers who had a live birth in the five years preceding the survey received antenatal care from health professionals; less than 1 percent of mothers received antenatal care from trained and untrained traditional birth attendants. More than seven in ten mothers did not receive antenatal care. There was little improvement in the percentage of mothers who received antenatal care from a health professional in the five years between the 2000 and 2005 surveys. About one in ten women make four or more antenatal care visits during their entire pregnancy. The median duration of xxvi | Summary of Findings pregnancy for the first antenatal visit is 5.6 months, indicating that Ethiopian women start antenatal care at a relatively late stage of their pregnancy. Among mothers who received antenatal care 31 percent reported that they were informed about pregnancy complications during their antenatal care visits. Weight and blood pressure measurements were taken for 72 percent and 62 percent of mothers, respectively. About one- quarter of mothers gave urine and blood samples. For last live births in the five years preceding the survey, only one in three women was protected against neonatal tetanus. Most of these women (28 percent) had received two or more tetanus injections while pregnant with the last birth. Despite the low coverage, there is evidence of improvement over time. The percentage of women who received two or more tetanus injections during pregnancy for the last birth increased from 17 percent in 2000 to 28 percent in 2005. An overwhelming majority of births in the five years before the survey were delivered at home (94 percent). Five percent of births were delivered in a public facility and 1 percent in a private facility. Six percent of births were delivered with the assistance of a trained health professional, that is, a doctor, nurse, or midwife, while 28 percent were delivered by a traditional birth attendant (TBA). The majority of births (61 percent) were attended by a relative or some other person. Five percent of births were delivered without any type of assistance at all. Postnatal care is extremely low in Ethiopia. Nine in 10 mothers who had a live birth in the five years preceding the survey received no postnatal care at all and only 5 percent of mothers received postnatal care within the critical first two days after delivery. BREASTFEEDING AND NUTRITION Breastfeeding is nearly universal in Ethiopia, and the median duration of any breastfeeding is long (25.8 months). Exclusive breastfeeding, on the other hand, is relatively short, with a median duration of 2.1 months. Contrary to WHO recommendations, only around one in three children age 4-5 months is exclusively breastfed. The data also show that complementary foods are not introduced in a timely fashion for many children. At 6-8 months, only one in two children is receiving complementary foods. The use of a bottle with a nipple is not widespread in Ethiopia. However, the proportion of children who are bottle-fed rises from 8 percent among children age less than 2 months to 19 percent among children age 6-8 months, after which it declines gradually. More than half of Ethiopian children age 6- 59 months are classified as anaemic, with 21 percent mildly anaemic, 28 percent moderately anaemic, and 4 percent severely anaemic. The prevalence of anaemia among women is less pronounced than among children. Twenty-seven percent of women age 15-49 are anaemic, with 17 percent mildly anaemic, 8 percent moderately anaemic, and just over 1 percent severely anaemic. The level of malnutrition is significant with nearly one in two (47 percent) Ethiopian children under five years of age stunted (short for their age), 11 percent wasted (thin for their height), and 38 percent underweight. In general, rural children and children of uneducated mothers are more likely to be stunted, wasted, or underweight than other children. Regional variation in nutritional status of children is substantial. Stunting levels are above the national average in Amhara and SNNP. Wasting is higher than the national average in Somali, Benishangul-Gumuz, Amhara, Tigray and Dire Dawa. The percentage of underweight children is above the national average in Somali, Amhara, Tigray and Benishangul-Gumuz. Survey results show that the level of chronic energy deficiency among women in Ethiopia is relatively high. Twenty-seven percent of women fall below the cutoff of 18.5 for the body mass index (BMI), which utilizes both height and weight to measure thinness. Four percent of women are overweight or obese. HIV/AIDS AND STIs Knowledge of AIDS is widespread in Ethiopia. Ninety percent of women age 15-49 and 97 percent of men age 15-49 have heard of AIDS. Women and men are most aware that the chances of getting the AIDS virus can be reduced Summary of Findings | xxvii by limiting sex to one uninfected partner who has no other partners (63 percent and 79 percent, respectively) or by abstaining from sexual intercourse (62 percent and 80 percent, respectively). Knowledge of condoms and the role they can play in preventing transmission of the AIDS virus is much less common, particularly among women. Only 51 percent of women and 69 percent of men know that a healthy-looking person can have the AIDS virus. Also, many women and men erroneously believe that AIDS can be transmitted by mosquito bites. Larger proportions of respondents are aware that the AIDS virus cannot be transmitted by supernatural means or by sharing food. The EDHS results also show that a minority of women (16 percent) and men (30 percent) have comprehensive knowledge of HIV/AIDS transmission, that is, they know that both condom use and limiting sex partners to one uninfected partner are HIV prevention methods; that a healthy-looking person can have HIV; and reject the two most common local misconceptions about HIV/AIDS —that AIDS can be transmitted through mosquito bites and by sharing food with an infected person. Around one-fifth of women and one-third of men age 15- 24 have comprehensive knowledge about HIV/AIDS. Sixty-nine percent of women and 75 percent of men know that HIV can be transmitted by breastfeeding. About one-fifth of women and one-fourth of men know that the risk of mother- to-child transmission (MTCT) can be reduced through the use of certain drugs during pregnancy. Information on higher-risk sex (sexual intercourse with a partner who is neither a spouse nor a cohabiting partner) shows that less than 1 percent of women and 4 percent of men have had two or more partners during the 12 months preceding the survey, and 3 percent of women and 9 percent of men have had higher-risk sexual intercourse. Among respondents who engaged in higher-risk sexual intercourse, 24 percent of women and 52 percent of men reported condom use the last time they had sexual intercourse. Among the adult population age 15-49, 4 percent of women and 6 percent of men reported that they had been tested for HIV at some time, and the majority of them had received the results of their test. Three percent of women reported that they had received information and counselling about HIV/AIDS during antenatal care for their most recent birth. Two percent each of sexually active women and men reported that they had had an STI and/or STI symptoms in the 12 months prior to the survey. Results from the 2005 EDHS indicate that 1.4 percent of Ethiopian adults age 15-49 are infected with HIV. HIV prevalence among women is nearly 2 percent, while for men 15-49, it is just under 1 percent. HIV prevalence levels rise with age, peaking among women in their late 30s and among men in their early 40s. The age pattern suggests that young women are particularly vulnerable to HIV infection compared with young men. Urban residents have a significantly higher risk of HIV infection (6 percent) than rural residents (0.7 percent). The risk of HIV infection among rural women and men is almost identical, while urban women are more than three times as likely as urban men to be infected. Prevalence levels are highest in Gambela (6 percent) and Addis Ababa (5 percent). Other regions in which HIV prevalence exceeds the national average include Harari, Dire Dawa, Affar, Tigray and Amhara. HIV infection levels increase directly with education among both women and men and are markedly higher among those with a secondary or higher education compared with those having less education. Employed women and men are also more likely to be HIV infected than the unemployed, as are women and men in the highest wealth quintile compared with those in the other wealth quintiles. WOMEN’S STATUS The DHS data shed some light on the status of women in Ethiopia. While the majority of Ethiopians have little or no education, women are generally less educated than men. However, the male-female gap in education is more obvious at higher than at lower levels of education, indicating the government’s recognition and successful intervention to address gender disparity in more recent years. xxviii | Summary of Findings Marked differences were observed in the levels of employment by gender. The majority of men (86 percent) were employed at the time of the survey, compared with 29 percent of women. Nearly one in three currently married women was employed during the 12 months before the survey. Three-tenths of employed women earn cash only or cash and in-kind earnings. Nearly three-fifths of currently married women are not paid at all. Almost two-fifths of currently married women who receive cash earnings report that they alone decide how their earnings are used, while more that half of currently married women say that they decide jointly with their husband or partner. Information on women’s decisionmaking autonomy shows that almost 53 percent of currently married women make independent decision about daily household purchases. While 15 percent of women make sole decisions on their own health care, one-third say that their husband or partner makes such decisions. Decisions on large household purchases are typically made by the husband or partner alone or jointly with their husband or partner. More than two-thirds of women say that decisions to visit family or relatives are made jointly with their husband or partner. The majority of women and men agree that a woman is justified in refusing to have sexual intercourse with her husband or partner for at least one of three specified reasons. Only one in ten women and men is of the opinion that a woman cannot refuse sexual intercourse for any reason. On the other hand, a sizable proportion of women (44 percent) and to a lesser extent men (23 percent), believe that a husband is justified in beating his wife if she refuses to have sex with him. Overall, eight in ten women and around half of men believe that there are at least some situations in which a husband is justified in beating his wife. EDHS data indicate a positive relationship between women’s status and contraceptive use. Contraceptive use is highest among women who participate in most household decisions, who agree that a woman can refuse sexual intercourse with her partner for all three specified reasons, and who believe that wife beating is not justified for all five specified reasons. The data show that mean ideal family size declines as women’s status increases. Also, there is a correlation between women’s status and utilization of health services. The more empowered a woman, the more likely she is to receive antenatal, postnatal, and delivery care from a health professional. The relationship between childhood mortality and women’s empowerment is mixed. The EDHS provides insight into several harmful traditional practices existent in Ethiopia. The practice of female circumcision is widespread in Ethiopia, with three in four women age 15-49 circumcised. Six percent of circumcised women reported that their vagina had been sewn closed (infibulation). More than two in five Ethiopian women themselves have had a uvulectomy or tonsillectomy. More than two-fifths of women with at least one daughter have a daughter who has had a uvulectomy or tonsillectomy. Eight percent of women reported that they had been married by abduction and about 1 percent with at least one daughter reported that a daughter was married by abduction. Around one in four women interviewed in the EDHS had heard of obstetric fistula and 1 percent of women who have ever given birth reported having experienced obstetric fistula. A small percentage of women (less than 1 percent) reported that they had been treated for obstetric fistula. According to information gathered from women who have heard of the condition, 4 percent of other women resident in the household also suffer from obstetric fistula. Maternal mortality is relatively high in Ethiopia with more than one in five deaths to women age 15-49 in the seven years preceding the survey attributed to pregnancy or pregnancy- related causes. The maternal mortality ratio, which measures the obstetric risk associated with each live birth, is 673 deaths per 100,000 live births for the period 1994-2000. Direct estimates of male and female mortality obtained from the sibling history gathered in the EDHS show that there were more female than male deaths in the seven years preceding the survey (925 compared with 903). The female mortality rate is 6.4 deaths per 1,000 population, which is 8 percent higher than the male mortality rate of 5.9 deaths per 1,000 population. Millennium Development Goal Indicators | xxix Millennium Development Goal Indicators, Ethiopia 2005 Goal Indicator Value 1. Eradicate extreme poverty and hunger Prevalence of underweight children under five years of age Male: 38.9% Female: 37.9% Total: 38.4% 2. Achieve universal primary education Net enrolment ratio in primary education1 Male: 42.2% Female: 42.4% Total: 42.3% Proportion of pupils starting grade 1 who reach grade 51 Male: 73.7% Female: 83.5% Total: 78.0% Literacy rate of 15-24-year olds2 Male: 67.2% Female: 41.6% Total: 54.4% 3. Promote gender equality and empower women Ratio of girls to boys in primary and secondary education Primary education: 0.91 Secondary education: 0.65 Ratio of literate women to men, 15-24 years old 0.62 Share of women in wage employment in the non-agricultural sector3 76.5% 4. Reduce child mortality Under-five mortality rate (per 1,000 live births) 123 per 1,000 Infant mortality rate (per 1,000 live births) 77 per 1,000 Proportion of 1-year-old children immunised against measles Male: 36.4% Female: 33.2% Total: 34.9% 5. Improve maternal health Maternal Mortality Ratio (per 100,000 live births) 673 per 100,000 Proportion of births attended by skilled health personnel 5.7% 6. Combat HIV/AIDS, malaria, and other diseases Condom use rate of the contraceptive prevalence rate (any modern method, currently married women 15-49) 1.32% Condom use at last high-risk sex (population age 15-24)4 Male: 46.8% Female: 28.4% Percentage of population age 15-24 years with comprehensive knowledge of HIV/AIDS5 Male: 33.3% Female: 20.5% Contraceptive prevalence rate (any modern method, currently married women 15-49) 13.9% Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 years 0.9 7. Ensure environmental sustainability Proportion of population using solid fuels6 Urban: 96.5% Rural: 99.9% Total: 99.5% Proportion of population with sustainable access to an improved water source, urban and rural7 Urban: 92.7% Rural: 55.5% Total: 60.0% Proportion of population with access to improved sanitation, urban and rural8 Urban: 22.6% Rural: 5.4% Total: 7.4% 1 Excludes children with parental status missing 2 Refers to respondents who attended secondary school or higher and women who can read a whole sentence 3 Wage employment includes respondents who receive wages in cash or in cash and kind. 4 High risk refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent; time frame is 12 months preceding the survey. 5 A person is considered to have a comprehensive knowledge about AIDS when they say that use of condoms for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, that a healthy-looking person can have the AIDS virus, and when they reject the two most common local misconceptions. The most common misconceptions in Ethiopia are that AIDS can be transmitted through mosquito bites and that a person can become infected with the AIDS virus by sharing food or utensils with someone who is infected. 6 Charcoal, firewood, straw, dung, or crop waste 7 Improved water sources are: household connection (piped), public standpipe, borehole, protected dug well, protected spring, or rainwater collection. 8 Improved sanitation technologies are: connection to a public sewer, connection to septic system, pour-flush latrine, simple pit latrine, or ventilated improved pit latrine. Introduction | 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY History Ethiopia is an ancient country with a rich diversity of peoples and cultures and a unique alphabet that has existed for more than 3,000 years. Palaeontological studies identify Ethiopia as one of the cradles of mankind. “Dinknesh” or “Lucy,” one of the earliest and most complete hominoids discovered through archaeological excavations, dates back to 3.5 million years. Ethiopia’s geo- graphical and historical factors have had a great influence on the distribution of its peoples and languages. The country is situated at the cross roads between the Middle East and Africa. Through its long history, Ethiopia has become a melting pot of diverse customs and varied cultures, some of which are extremely ancient. Ethiopia embraces a complex variety of nations, nationalities and peoples, and linguistic groups. Its peoples altogether speak over 80 different languages constituting 12 Semitic, 22 Cushitic, 18 Omotic and 18 Nilo-Saharan languages (MOI, 2004). The country has always maintained its independence, even during the colonial era in Africa. Ethiopia is one of the founding members of the United Nations. Ethiopia has been playing an active role in African affairs, specifically played a pioneering role in the formation of the Organization of African Unity (OAU). In fact, the capital city, Addis Ababa, has been a seat for the OAU since its establishment and continues serving as the seat for the African Union (AU) today. Ethiopia was ruled by successive emperors and kings with a feudal system of government until 1974. In 1974, the military took over the reign of rule by force and administered the country until May 1991. Currently, a federal system of government exists, and political leaders are elected every five years. The government is made up of two tiers of parliament, the House of Peoples’ Representatives and the House of the Federation. Major changes in the administrative boundaries within the country have been made three times since the mid-1970s, and at present Ethiopia is administratively structured into nine regional states, namely, Tigray, Affar, Amhara, Oromiya, Somali, Benishangul-Gumuz, Southern Nations, Nationalities and Peoples, Gambela and Harari regional states and two city administrations, that is, Addis Ababa and Dire Dawa Administration Council. Geography Ethiopia is situated in the Horn of Africa between 3 and 15 degrees north latitude and 33 and 48 degrees east longitude. It is a country with great geographical diversity; its topographic features range from the highest peak at Ras Dashen, which is 4,550 metres above sea level, down to the Affar Depression at 110 metres below sea level (CSA, 2000). The climatic condition of the country varies with the topography, with temperatures as high as 47 degrees Celsius in the Affar Depression and as low as 10 degrees Celsius in the highlands. The total area of the country is about 1.1 million square kilometres and Djibouti, Eritrea, Sudan, Kenya, and Somalia border it. A large part of the country is high plateaux and mountain ranges, with precipitous edges dissected by rushing streams of tributaries of famous rivers like the Abay (The Blue Nile), Tekeze, Awash, Omo, the Wabe Shebelie and the Baro-Akobo (MOI, 2004). As the country is located within the tropics, its physical conditions and variations in altitude have resulted in great diversity of terrain, climate, soil, flora, and fauna. Ethiopia’s major physical features are the result of extensive and spectacular faulting that cracked the old crystalline block of the African continent along the eastern side, producing the Great Rift Valley that stretches from the 2 | Introduction eastern end of the Mediterranean Basin down to Mozambique in the southeastern part of our continent (MOI, 2004). There are three principal climatic groups in Ethiopia, namely the tropical rainy, dry, and warm temperate climates. In Ethiopia the mean maximum and minimum temperatures vary spatially and temporally. Generally, the mean maximum temperature is higher from March to May and the mean minimum temperature is lower from November to December as compared to the other months (MOI, 2004). Ethiopia’s mean annual distribution of rainfall is influenced by the direction of both westerly and southeasterly winds. Thus, in Ethiopia the general pattern of annual rainfall distribution remains seasonal, varying in amount, space, and time, as the rain moves from the southwest to the northeast of the country (MOI, 2004). Economy Ethiopia is an agrarian country and agriculture accounts for 54 percent of the gross domestic product (GDP). Agriculture employs about 80 percent of the population and accounts for about 90 percent of the exports (CSA, 2000). The country is one of the least developed in the world, with a per capita gross national income (GNI) in 2004 of US$110 (World Bank, 2006). Coffee has remained the main export of the country; however, other agricultural products are currently being introduced on the international market. The Ethiopian currency is the Birr, and at present, 1 US dollar is equivalent to about 8.60 Birr. Between 1974 and 1991, the country operated a central command economy under the socialist banner of the Derg regime. However, since their overthrow, Ethiopia has moved toward a market-oriented economy. At present, the country has one commercial and two specialized government-owned banks and also six privately owned commercial banks; one government-owned insurance company and seven private insurance companies (NBE, 2000). There are also 15 microfinancing institutions established by private organizations. For the past three years the Ethiopian economy has shown mixed performance, with negative real GDP growth rate of 3.8 percent in 2002/03 as a result of drought, followed by strong positive performance of 11.3 percent and 8.9 percent during the past two years. Accordingly, during 2001/02- 2004/05 the annual real GDP growth averaged 5 percent. As usual, variability of growth was mostly a result of the variability in the output of the agricultural sector. Agricultural value-added declined by about 12 percent in 2002/03 and rebounded by 18 percent in the following year. Inflation stood at 15.1 percent in 2002/03, but declined to 9 percent in 2003/04 and 6.8 percent in 2004/05. Exports registered substantial growth in recent years, owing to both increases in volume and revival in the prices of major exports in the international market. In 2003/04 and 2004/05 the total value of exports grew by 25.0 and 36.0 percent, respectively (MoFED, 2005). Despite improvements in the past few years, sustaining long-term growth remains a challenge. Economic growth averaged about 5 percent per annum over the period 1999/2000 to 2004/05. Adjusting for population growth, the average per capita income rose by about 2.1 percent per annum. Major disruptions and shocks in the 1970s and 1980s resulted in economic decline, and the relatively good performance of the 1990s and early 2000s has only recently helped to reverse and raise incomes (MoFED, 2005). Ethiopia is one of the seven priority countries selected by the Millennium Project to prepare a scaled-up investment plan that would allow the country to meet the Millennium Development Goal (MDG) targets in 2005. Ethiopia is on the verge of embarking on the second poverty reduction strategy, which is referred to as the ”Plan for Accelerated and Sustained Development to End Poverty (PASDEP)” that supersedes the first strategy “Sustainable Development and Poverty Reduction Program (SDPRP). The PASDEP carries forward important strategic directions pursued under the SDPRP—related to human development, rural development, food security and capacity building—but also embodies some bold new directions (MoFED, 2005). The PASDEP, which is the government’s national development plan for the five years covering 2005/06- 2009/10, consists of eight strategic elements, namely: a massive push to accelerated growth, a geographically differentiated strategy, addressing the population challenge, unleashing the potential of Introduction | 3 Ethiopia’s women, strengthening the infrastructural backbone, managing risk and volatility, scaling- up to reach the MDG, and creating jobs. 1.2 POPULATION Despite its long history, there were no estimates of the total population of Ethiopia prior to the 1930s. However, population estimates for some towns like Axum, Lalibela and Debre Berhan are available from the 16th century onwards. Many of the estimates were made by travellers and were based on a general observation. The first ever population and housing census was conducted in 1984. The 1984 Census covered about 81 percent of the population of the country and official estimates were given for the remaining 19 percent that were not enumerated in the census. The second population and housing census was conducted in 1994. Unlike the first census, the second census covered the entire population. Table 1.1 provides a summary of the basic demographic indicators for Ethiopia from data collected in the two population and housing censuses. The population increased over the decade from 42.6 million in 1984 to 53.5 million in 1994. There was a slight decline in the population growth rate over the decade, from 3.1 percent in 1984 to 2.9 percent in 1994. Ethiopia is one of the least urbanized countries in the world, with less than 14 percent of the country urbanized in 1994. Female life expectancy is about two years higher than male life expectancy. Over the decade, life expectancy for both males and females did not improve. Table 1.1 Basic demographic indicators Indicator 1984 Census1 1994 Census2 Population (millions) 42.6 53.5 Intercensal grown rate (percent) 3.1 2.9 Density (pop./km2.) 34.0 48.6 Percent urban 11.4 13.7 Life expectancy Male 51.1 50.9 Female 53.4 53.5 1 Including Eritrea; CSA, 1991 2 CSA, 1998 The majority of the population lives in the highland areas of the country. The main occupation of the settled population is farming, while in the lowland areas, the mostly pastoral population moves from place to place with their livestock in search of grass and water. Among the nine regional states, Amhara, Oromiya and SNNP comprised about 80 percent of the total population of the country. Affar, Somali, Benishangul-Gumuz and Gambela regions are relatively underdeveloped. Christianity and Islam are the main religions; 51 percent of the population are Orthodox Christians, 33 percent are Muslims, and 10 percent are Protestants. The rest follow a diversity of other faiths. The country is home to about 80 ethnic groups that vary in population size from more than 18 million people to less than 100 (CSA, 1998). Efforts were made to generate reliable demographic data by conducting a number of demographic surveys. These include the 1981 Demographic Survey, the 1990 National Family and Fertility Survey, the 1995 Fertility Survey of Urban Addis Ababa, and the 2000 Ethiopia Demographic and Health Survey (EDHS). The 1990 National Family and Fertility Survey (NFFS) was the first nationally representative survey that incorporated wider information on fertility, family planning, contraceptive use and other related topics. In addition to the topics covered by the NFFS, the 2000 EDHS collected information on maternal and child health, nutrition and breastfeeding practices, HIV and other sexually transmitted diseases. 4 | Introduction Population Policy Population policies had been accorded a low priority in Ethiopia prior to the early 1990s. After the end of the Derg regime, the Transitional Government adopted a national population policy in 1993 (TGE, 1993b). The primary objective of the population policy was to harmonize the rate of population growth with socio-economic development to achieve a high level of welfare. The main long-term objective was to close the gap between high population growth and low economic productivity and to expedite socio-economic development through holistic integrated programs. Other objectives included preserving the environment and reducing rural-urban migration and reducing morbidity and mortality, particularly infant and child mortality. More specifically, the population policy was targeted to: i. Reduce the total fertility rate from 7.7 children per woman in 1990 to 4.0 children per woman in 2015; ii. Increase the prevalence of contraceptives from 4 percent in 1990 to 44 percent in 2015; iii. Reduce maternal, infant and child morbidity and mortality rates as well as promote the level of general welfare of the population; iv. Significantly increase female participation at all levels of the educational system; v. Remove all legal and customary practices that prevent women from the full enjoyment of economic and social rights, including the full enjoyment of property rights and access to gainful employment; vi. Ensure spatially balanced population distribution patterns with a view to maintaining environmental security and extending the scope of development activities; vii. Improve productivity in agriculture and introduce off-farm and non-agricultural activities for the purpose of employment diversification; viii.Mount an effective countrywide population information and education programme addressing issues pertaining to small family size and its relationship with human welfare and environmental security (TGE, 1993b). The policy indicated that population activities will be undertaken in Ethiopia under the framework that would be defined in the technical and programmatic guidelines to be developed by the Office of Population in consultation with the National Population Council. The policy also proposed the establishment of certain institutional structures for its implementation. In general, the national population policy covered all the major grounds that need to be covered in providing directives on the management of population dynamics in the interest of sustainable development. 1.3 HEALTH PRIORITIES AND PROGRAMMING The health system in Ethiopia is underdeveloped, and transportation problems are severe. The majority of the population resides in the rural areas and has little access to any type of modern health institution. It is estimated that about 75 percent of the population suffers from some type of communicable disease and malnutrition, which are potentially preventable (TGE, 1995). There was no health policy up through the 1950s; however, in the early 1960s, a health policy initiated by the World Health Organization (WHO) was adopted. In the mid-1970s, during the Derg regime, an elaborate health policy with emphasis on disease prevention and control was formulated. This policy gave priority to rural areas and advocated community involvement (TGE, 1993a). At present, the government health policy takes into account population dynamics, food availability, acceptable living conditions, and other requisites essential for health improvements (TGE, 1993a). The present health policy arises from the fundamental principle that health constitutes physical, mental, and social well- being for the enjoyment of life and for optimal productivity. To realize this objective, the government has established the Health Sector Development Programme (HSDP), which incorporates a 20-year health development strategy, through a series of five-year investment programmes (MOH, 1999). This programme calls for the democratisation and decentralization of health services; development of preventive health care; capacity building within the health service system; equitable access to health services; self-reliance; promotion of intersectoral activities and participation of the private sector, Introduction | 5 including non-governmental organizations (NGOs); and cooperation and collaboration with all countries in general and neighbouring countries in particular and between regional and international organizations (TGE, 1993a). The HSDP was implemented in two cycles, currently extending into the third programme (HSDP III). The focus of HSDP III will be on poverty-related health conditions, communicable diseases such as malaria and diarrhoea, and health problems that affect mothers and children. Efforts will be concentrated on rural areas and on extending services outwards from static facilities to reach villages and households. In addition, and more importantly, gender will be mainstreamed at all levels of the health system (MoFED, 2005). The main implementation modalities identified were: i. The Health Service Extension Programme (HSEP)—which involves the use of female workers to deliver 16 health care packages in four main areas, i.e., hygiene and environmental sanitation, disease prevention and control, family health services, and health education and communication on outreach basis. ii. The Accelerated Expansion of Primary Health Care Coverage—which has already been developed and endorsed by the government, with a view to achieving universal coverage of primary health care in the rural population by 2008. iii. A Health Care Financing Strategy—which aims at increasing resource flow to the health sector, improving efficiency of resource utilization, and ensuring sustainability of financing to improve the coverage and quality of health service; iv. The Health Sector Human Resource Development Plan—which aims at overcoming problems related to the absolute shortage, maldistribution and productivity of workforce. Despite the progress to date, coverage of the system remains inadequate, and the quality of services available, especially in rural areas, is variable. In line with the government’s current five-year national plan, the health sector will continue to emphasize primary health care and preventive services; with a big focus on extending these services to those who have not been reached, and improving the effectiveness of services, especially addressing difficulties in staffing and the flow of drugs. The major health outcome objectives envisaged in the five-year period include (MoFED, 2005): i. To cover all rural localities with the HSEP to achieve universal primary health care coverage by the year 2008; ii. To reduce the maternal mortality ratio from 871/100,000 to 600 per 100,000 live births; iii. To reduce under-five mortality from 140 to 85 per 1000 population, and the infant mortality rate from 97 to 45 per 1000 populations; iv. To reduce total fertility rate from 5.9 to 4.0 children per woman; v. To reduce the adult incidence of HIV from 0.68 to 0.65 and maintain the prevalence of HIV at 4.4 percent; vi. To reduce morbidity attributed to malaria from 22 percent to 10 percent; vii. To reduce the case fatality rate of malaria in age groups five years and above from 4.5 percent to 2 percent and the rate in children under five from 5 percent to 2 percent; and viii. To reduce mortality attributed to tuberculosis (TB) from 7 percent to 4 percent of all treated cases. 1.4 OBJECTIVES OF THE SURVEY The principal objective of the 2005 Ethiopia Demographic and Health Survey (DHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, the utilization of maternal and child health services, knowledge of HIV/AIDS and prevalence of HIV/AIDS and anaemia. The specific objectives are to: • collect data at the national level which will allow the calculation of key demographic rates;G 6 | Introduction • analyze the direct and indirect factors which determine the level and trends of fertility; • measure the level of contraceptive knowledge and practice of women and men by method, urban-rural residence, and region;G • collect high quality data on family health including immunization coverage among children, prevalence and treatment of diarrhoea and other diseases among children under five, and maternity care indicators including antenatal visits and assistance at delivery; • collect data on infant and child mortality and maternal and adult mortality; G • obtain data on child feeding practices including breastfeeding and collect anthropometric measures to use in assessing the nutritional status of women and children; • collect data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluate patterns of recent behaviour regarding condom use;G • conduct haemoglobin testing on women age 15-49 and children under age five years in a subsample of the households selected for the survey to provide information on the prevalence of anaemia among women in the reproductive ages and young children; • collect samples for anonymous HIV testing from women and men in the reproductive ages to provide information on the prevalence of HIV among the adult population. This information is essential for informed policy decisions, planning, monitoring, and evaluation of programs on health in general and reproductive health in particular at both the national and regional levels. A long-term objective of the survey is to strengthen the technical capacity of the Central Statistical Agency to plan, conduct, process, and analyse data from complex national population and health surveys. Moreover, the 2005 Ethiopia DHS provides national and regional estimates on population and health that are comparable to data collected in similar surveys in other developing countries. The first ever Demographic and Health Survey (DHS) in Ethiopia was conducted in the year 2000 as part of the worldwide DHS programme. Data from the 2005 Ethiopia DHS survey, the second such survey, add to the vast and growing international database on demographic and health variables. Wherever possible, the 2005 EDHS data is compared with data from the 2000 EDHS. In addition, where applicable, the 2005 EDHS is compared with the 1990 NFFS, which also sampled women age 15-49. Husbands of currently married women were also covered in this survey. However, for security and other reasons, the NFFS excluded from its coverage Eritrea, Tigray, Asseb, and Ogaden autonomous regions. In addition, fieldwork could not be carried out for Northern Gondar, Southern Gondar, Northern Wello, and Southern Wello due to security reasons. Thus, any comparison between the EDHS and the NFFS has to be interpreted with caution. 1.5 ORGANIZATION OF THE SURVEY The 2005 EDHS was carried out under the aegis of the Ministry of Health and was implemented by the then Population and Housing Census Commission Office (PHCCO), now merged with the Central Statistical Agency (CSA). The testing of the blood samples for HIV status was handled by the Ethiopia Health and Nutrition Research Institute (EHNRI). ORC Macro provided technical assistance through its MEASURE DHS project. The resources for the conduct of the survey were committed by the Government of Ethiopia, and various international donor organizations and governments, namely, the United States Agency for International Development (USAID), the President’s Emergency Plan for AIDS Relief (PEPFAR), the Dutch and Irish Governments, and the United Nations Population Fund (UNFPA). A steering committee composed of major stakeholders drawn from the government, international organizations and NGOs was formed. The steering committee was responsible for coordination, oversight, advice and decision-making on all major aspects of the survey undertaking. Introduction | 7 Members of the steering committee include the Ministry of Health (MOH), PHCCO, EHNRI, the HIV/AIDS Prevention and Control Office (HAPCO), the National Office of Population (NOP), the Ethiopian Science and Technology Agency, the Consortium of Reproductive Health Associations (CORHA), USAID, UNFPA, UNICEF, and WHO. A technical committee was also formed from among the steering committee institutions. 1.6 SAMPLE DESIGN The 2005 EDHS sample was designed to provide estimates for the health and demographic variables of interest for the following domains: Ethiopia as a whole; urban and rural areas of Ethiopia (each as a separate domain); and 11 geographic areas (9 regions and 2 city administrations), namely: Tigray; Affar; Amhara; Oromiya; Somali; Benishangul-Gumuz; Southern Nations, Nationalities and Peoples (SNNP); Gambela; Harari; Addis Ababa and Dire Dawa. In general, a DHS sample is stratified, clustered and selected in two stages. In the 2005 EDHS a representative sample of approximately 14,500 households from 540 clusters was selected. The sample was selected in two stages. In the first stage, 540 clusters (145 urban and 395 rural) were selected from the list of enumeration areas (EA) from the 1994 Population and Housing Census sample frame. In the census frame, each of the 11 administrative areas is subdivided into zones and each zone into weredas. In addition to these administrative units, each wereda was subdivided into convenient areas called census EAs. Each EA was either totally urban or rural and the EAs were grouped by administrative wereda. Demarcated cartographic maps as well as census household and population data were also available for each census EA. The 1994 Census provided an adequate frame for drawing the sample for the 2005 EDHS. As in the 2000 EDHS, the 2005 EDHS sampled three of seven zones in the Somali Region (namely, Jijiga, Shinile and Liben). In the Affar Region the incomplete frame used in 2000 was improved adding a list of villages not previously included, to improve the region’s representativeness in the survey. However, despite efforts to cover the settled population, there may be some bias in the representativeness of the regional estimates for both the Somali and Affar regions, primarily because the census frame excluded some areas in these regions that had a predominantly nomadic population. The 540 EAs selected for the EDHS are not distributed by region proportionally to the census population. Thus, the sample for the 2005 EDHS must be weighted to produce national estimates. As part of the second stage, a complete household listing was carried out in each selected cluster. The listing operation lasted for three months from November 2004 to January 2005. Between 24 and 32 households from each cluster were then systematically selected for participation in the survey. Because of the way the sample was designed, the number of cases in some regions appear small since they are weighted to make the regional distribution nationally representative. Throughout this report, numbers in the tables reflect weighted numbers. To ensure statistical reliability, percentages based on 25 to 49 unweighted cases are shown in parentheses and percentages based on fewer than 25 unweighted cases are suppressed. 1.7 QUESTIONNAIRES In order to adapt the standard DHS core questionnaires to the specific socio-cultural settings and needs in Ethiopia, its contents were revised through a technical committee composed of senior and experienced demographers of PHCCO. After the draft questionnaires were prepared in English, copies of the household, women’s and men’s questionnaires were distributed to relevant institutions and individual researchers for comments. A one-day workshop was organized on November 22, 2004 at the Ghion Hotel in Addis Ababa to discuss the contents of the questionnaire. Over 50 participants attended the national workshop and their comments and suggestions collected. Based on these comments, further revisions were made on the contents of the questionnaires. Some additional questions were included at the request of MOH, the Fistula Hospital, and USAID. The questionnaires were finalized in English and translated into the three main local languages: Amharic, Oromiffa and 8 | Introduction Tigrigna. In addition, the DHS core interviewer’s manual for the Women’s and Men’s Questionnaires, the supervisor’s and editor’s manual, and the HIV and anaemia field manual were modified and translated into Amharic. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor and roof of the house, ownership of various durable goods, and ownership and use of mosquito nets. In addition, this questionnaire was used to record height and weight measurements of women age 15-49 and children under the age of five, households eligible for collection of blood samples, and the respondents’ consent to voluntarily give blood samples. The Women’s Questionnaire was used to collect information from all women age 15-49 years and covered the following topics. • Household and respondent characteristics • Fertility levels and preferences • Knowledge and use of family planning • Childhood mortality • Maternity care • Childhood illness, treatment, and preventative actions • Anaemia levels among women and children • Breastfeeding practices • Nutritional status of women and young children • Malaria prevention and treatment • Marriage and sexual activity • Awareness and behaviour regarding AIDS and STIs • Harmful traditional practices • Maternal mortality The Men’s Questionnaire was administered to all men age 15-59 years living in every second household in the sample. The Men’s Questionnaire collected similar information contained in the Women’s Questionnaire, but was shorter because it did not contain questions on reproductive history, maternal and child health, nutrition and maternal mortality. 1.8 HAEMOGLOBIN AND HIV TESTING In one in two households selected for the 2005 EDHS, women age 15-49 and children age 6- 59 months were tested for anaemia. In addition, all eligible women and men in this subsample of households were tested for HIV. Anaemia and HIV testing were only carried out if consent was provided by the respondents and in the case of a minor, by the parent or guardian. Consent for HIV and anaemia was obtained separately. The protocol for haemoglobin and HIV testing was approved by the National Ethics Review Committee of the Ethiopia Science and Technology Commission in Addis Ababa, Ethiopia and the ORC Macro Institutional Review Board in Calverton, USA. 1.8.1 HAEMOGLOBIN TESTING Haemoglobin testing is the primary method of anaemia diagnosis. In the EDHS, testing was done using the HemoCue system. A consent statement was read to the eligible woman and to the parent or responsible adult of young children and women age 15-17. This statement explained the purpose of the test, informed prospective subjects tested and/or their caretakers that the results would Introduction | 9 be made available as soon as the test was completed, and requested permission for the test to be carried out, as well as consent to report their names to health personnel in the local health facility if their haemoglobin level was severe. Before the blood was taken, the finger was wiped with an alcohol prep swab and allowed to air-dry. Then the palm side of the end of a finger was punctured with a sterile, non-reusable, self- retractable lancet and a drop of blood collected on a HemoCue microcuvette and placed in a HemoCue photometer which displays the result. For children 6-11 months who were particularly undernourished and bony, a heel puncture was made to draw a drop of blood. The results were recorded in the Household Questionnaire, as well as on a brochure given to each woman, parent, or responsible adult, explaining what the results meant. For each person whose haemoglobin level was severe, and who agreed to have the condition reported, a referral was given to the respondent to be taken to a health facility. 1.8.2 HIV/AIDS TESTING Eligible women and men in the subsample of households selected for HIV testing who were interviewed were asked to voluntarily provide a few drops of blood for HIV testing. The protocol for the blood specimen collection and analysis was based on the anonymous linked protocol developed for DHS. The protocol allows for the merging of the HIV results to the socio-demographic data collected in the individual questionnaires, provided that information that could potentially identify an individual is destroyed before the linking takes place. This required that identification codes be deleted from the data file and that the back page of the Household Questionnaires that contain the bar code labels and names of respondents be destroyed prior to merging the HIV results with the individual data file. If, after explaining the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the subject, a respondent consented to the HIV testing, a minimum of three blood spots was obtained from a finger prick and collected on a filter paper to which was affixed a bar code label unique to the respondent, but with no other identifying information attached. Each respondent who consented to being tested for HIV was given an information brochure on AIDS, a list of fixed sites providing voluntary counselling and testing (VCT) services throughout the country, and a voucher to access free VCT services at any of these sites for the respondent and/or the partner. Each dried blood spot (DBS) sample was given a bar code label, with a duplicate label attached to the Household Questionnaire on the line showing consent for that respondent. A third copy of the same bar code label was affixed to a Blood Sample Transmittal Form to track the blood samples from the field to the laboratory. Filter papers were dried overnight in a plastic drying box, after which the biomarker interviewer packed them in individual Ziploc bags for that particular sample point. Blood samples were periodically collected in the field along with the completed questionnaires and transported to the PHCCO headquarters in Addis Ababa for logging in, after which they were taken to EHNRI for HIV testing. In preparation for carrying out the HIV testing, an assessment was conducted jointly by EHNRI staff and Macro consultants (from the Zambia Tropical Disease Research Centre) of the equipment and staff training required for the testing of the DBS samples. In addition, the consultants together with a biomarker specialist from ORC Macro worked with laboratory scientists at EHNRI to conduct a validation study and set up the dried blood spot methodology to test for HIV using two Enzyme-Linked Immunosorbent Assay (ELISA) tests from different manufacturers. Several meetings with ORC Macro staff, EHNRI staff, and staff of PHCCO, were held to discuss the monitoring of sample collection in the field, the collection of samples from the field, and the delivery of the samples to the laboratory, with built-in checks to verify the samples collected and delivered. It was emphasized at the meeting that the period between the collecting of blood samples in the field and the time of refrigeration should not exceed 14 days. The DBS filter paper samples with barcodes were 10 | Introduction received by EHNRI. Upon receipt, the samples were counted and checked against the transmittal sheet to verify the barcode identifications and kept frozen until testing was started in September. All specimens were tested with a screening test, Vironostika HIV Uni-Form Plus O manufactured by BioMerieux (ELISA I). All samples positive on the first screening test as well as 10 percent of the negatives were further tested with Enzygnost Anti HIV-1/2 Plus manufactured by Dade Behring (ELISA 2). According to the testing algorithm, samples positive on both ELISAs were regarded as positive and samples negative for both ELISAs were regarded as negative. Samples that had discordant results on ELISA I and ELISA II were subject to a retest with both ELISAs. The results were obtained and interpreted in the same manner as indicated above for the repeat ELISA testing. Discordant samples from the repeat ELISAs, were tested with a confirmatory test, Genetic Systems HIV-1 Western Blot manufactured by Bio-Rad. The result on immunoblotting (Western Blot) was regarded as the final result. 1.9 LISTING, PRETEST, TRAINING AND FIELDWORK 1.9.1 Listing After the selection of the 540 clusters throughout the 11 administrative areas, a listing operation in the selected clusters starting from the month of October 2004 was conducted. For this purpose, training was conducted for 46 listers who had been recruited from all the regions to do the listing of households and delineation of EAs. A manual that described the listing procedure was prepared as a guideline and the training was conducted using classroom demonstrations and field practices. Instructions were given on the use of Global Positioning System (GPS) units to obtain locational coordinates for selected EAs. The listing was performed by organizing the listers into teams, with two listers per team. Seven field coordinators were also assigned from the head office to perform quality checks and handle all the administrative and financial issues of the listing staff. Supervision was carried out by the cartographic division of PHCCO to assess the quality of the field operation and the level of the accuracy of the GPS readings. Though the listing operation was aimed to be completed in three months, it was extended up to five months in some parts of the country, primarily because of a shortage of vehicles. 1.9.2 Pretest Prior to the start of the fieldwork, the questionnaires were pretested in all the three local languages, to make sure that the questions were clear and could be understood by the respondents. In order to conduct the pilot survey, 12 interviewers were recruited from the Amhara, Oromiya and Tigray regions. In addition to the new recruits, 14 senior staff members of PHCCO were trained for a period of three weeks to conduct the pilot fieldwork and serve as trainers for the main fieldwork. The pilot training which was conducted from January 24 to February 11, 2005, included training in blood sample collection for the anaemia and HIV testing. The pilot survey was conducted from 11-25 February 2005 in four selected sites. The areas selected for the pretest were urban Addis Ababa and both urban and rural parts of Mekele, Ambo and Debre Birhan areas. Based on the findings of the pretest, the household, the women’s and men’s questionnaires were further refined in all the three local languages. 1.9.3 Training and Fieldwork The recruitment of interviewers, editors and supervisors was conducted in the 9 regions and 2 city administrations taking into account language skills of the specific areas. Accommodation was arranged for the trainees as well as the trainers at a training site in Addis Ababa. The training of interviewers, editors and supervisors was conducted from March 14 to April 20, 2005. The Amharic questionnaires were used during the training, while the Tigrigna and Oromiffa versions were simultaneously checked against the Amharic questionnaires to ensure accurate translation. In addition Introduction | 11 to classroom training, trainees did several days of field practice to gain more experience on interviewing in the three local languages and fieldwork logistics. A total of 271 trainees were trained in five classrooms. In each class the training was conducted by two senior staff members of PHCCO. The Family Guidance Association of Ethiopia conducted a session demonstrating and explaining the different family planning methods, while UNFPA and CDC conducted a session on HIV/AIDS. After the training on how to complete the household, women’s and men’s questionnaires was completed, an exam was given to all trainees. On the basis of the scores on the exam and overall performances in the classroom, 240 trainees were selected to participate in the main fieldwork. From the group 30 of the best male trainees were selected as supervisors and 30 of the best female interviewers were identified as field editors. The remaining 180 trainees were selected to be interviewers. The trainees not selected to participate in the fieldwork were kept as reserve. After completing the interviewers’ training, the field editors and supervisors were trained for an additional three days on how to supervise the fieldwork and edit questionnaires in the field to ensure data quality. Thirty male interviewers and 30 female interviewers were selected to attend the biomarker training. In addition, the 30 field editors also attended the training, as a backup to the biomarker interviewers. Thirteen regional laboratory technicians who were recruited from Private Laboratory Consortium Unit (PLCU) to serve as regional coordinators for the HIV testing were also trained, of whom 11 were eventually selected to supervise the blood collection. During the one-week biomarker training, six experienced experts from ORC Macro and EHNRI provided theoretical training followed by practical classroom demonstrations of the techniques for testing of haemoglobin and collection of dried blood spots from a finger prick for HIV testing. In addition to the classroom training, trainees did several days of field practice to gain more experience on blood collection. A total of 30 data collection teams, each composed of four female interviewers, two male interviewers, one female editor, and a male team supervisor, were organized for the main fieldwork. Furthermore, the 30 field teams were organized into 11 regional groups, each headed by an experienced senior staff of PHCCO and accompanied by a regional coordinator from PLCU. The survey was fielded from April 27 to August 30, 2005. The fieldwork was closely monitored for data quality through regular field visits by senior staff from PHCCO, ORC Macro, and other member organizations of the Steering Committee. Data quality was also monitored through field check tables generated from completed clusters simultaneously data entered and produced during the fieldwork. Five senior experts from PHCCO were permanently assigned to monitor the fieldwork throughout the survey period by moving from one region to another. Continuous communication was maintained between the field staff and the headquarters through cell phones. Fieldwork was successfully completed in 535 of the 540 clusters, with the 5 clusters not covered primarily due to reasons of inaccessibility. Two of these clusters were located in rural Oromiya, one in rural Somali, one in rural SNNP and one in urban Gambela. DBS samples were collected in 534 out of the 535 clusters and delivered to EHNRI for analysis. In one cluster in the Gambela Region, households refused to be finger-pricked for cultural and traditional reasons. 1.10 DATA PROCESSING The processing of the 2005 EDHS results began soon after the start of fieldwork. Completed questionnaires were returned periodically from the field to the data processing department at the PHCCO headquarters. A total of 17 new recruits had been trained for office editing/coding and data entry of the questionnaires. Guidelines for the editing/coding procedures had been issued and questions, which needed coding, were identified and a list of codes prepared. After the actual entry of the data began, additional data entry operators were recruited and entry was performed in two shifts. A total of 22 data entry operators and 4 office editors carried out data entry and primary office editing 12 | Introduction activities. Each of the questionnaires was keyed twice by two separate entry clerks. Consistency checks were made and entry errors were manually checked by going back to the questionnaires. A secondary editing program was then run on the data to indicate questions that showed inconsistency and these were also corrected by secondary editors. The data entry for the 535 clusters that started on 9 May 2005 was completed on 24 September 2005. 1.11 RESPONSE RATES Table 1.2 shows the household and individual interview response rates for the survey. A total of 14,645 households were selected, of which 13,928 were occupied. The total number of households interviewed was 13,721, yielding a household response rate of 99 percent. A total of 14,717 eligible women were identified in these households and interviews were completed for 14,070 women, yielding a response rate of 96 percent. One in two households were selected for the male survey and 6,778 eligible men were identified in this subsample of households, of whom 6,033 were successfully interviewed, yielding a response rate of 89 percent. The response rates are higher in rural areas than urban areas for both males and females. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Ethiopia 2005 Residence Result Urban Rural Total Household interviews Households selected 3,989 10,656 14,645 Households occupied 3,762 10,166 13,928 Households interviewed 3,666 10,055 13,721 Household response rate 97.4 98.9 98.5 Interviews with women Number of eligible women 4,686 10,031 14,717 Number of eligible women interviewed 4,423 9,647 14,070 Eligible woman response rate 94.4 96.2 95.6 Household interviews for men Households selected 1,947 5,213 7,160 Households occupied 1,828 4,959 6,787 Households interviewed 1,785 4,904 6,689 Household response rate 97.6 98.9 98.6 Interviews with men Number of eligible men 1,948 4,830 6,778 Number of eligible men interviewed 1,628 4,405 6,033 Eligible man response rate 83.6 91.2 89.0 Household Population and Housing Characteristics | 13 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter provides a summary of the socioeconomic characteristics of households and respondents surveyed, including age, sex, place of residence, educational status, household facilities, and household characteristics. Information collected on the characteristics of the households and respondents is important in understanding and interpreting the findings of the survey and also provides indicators of the representativeness of the survey. The information is also useful in understanding and identifying the major factors that determine or influence the basic demographic indicators of the population. The 2005 EDHS collected information from all usual residents of a selected household (the de jure population) and persons who had stayed in the selected household the night before the interview (the de facto population). Since the difference between these two populations is very small and to maintain comparability with other DHS reports, all tables in this report refer to the de facto population unless otherwise specified. A household was defined as a person or group of related and unrelated persons who live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for cooking and eating. 2.1 HOUSEHOLD POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also very important variables in the study of mortality, fertility, and nuptiality. In general, a cross-classification with sex is useful for the effective analysis of all forms of data obtained in surveys. The distribution of the household population in the 2005 EDHS is shown in Table 2.1 by five- year age groups, according to urban-rural residence and sex. The total population counted in the survey was 67,556, with females slightly outnumbering males. The results indicate an overall sex ratio of 99 males per 100 females. The sex ratio is higher in rural areas (101 males per 100 females) than in urban areas (85 males per 100 females). 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 residence, Ethiopia 2005 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 10.3 8.9 9.5 16.9 16.5 16.7 16.1 15.5 15.8 5-9 11.5 10.6 11.0 17.9 17.5 17.7 17.2 16.6 16.9 10-14 13.7 12.0 12.8 15.8 14.7 15.3 15.6 14.3 15.0 15-19 14.3 16.2 15.3 10.0 9.1 9.5 10.4 10.1 10.2 20-24 12.0 12.7 12.4 6.9 7.1 7.0 7.5 7.8 7.7 25-29 8.4 10.2 9.4 5.7 7.3 6.5 6.0 7.7 6.9 30-34 6.1 5.8 5.9 5.2 5.3 5.3 5.3 5.4 5.3 35-39 5.4 5.4 5.4 4.4 4.8 4.6 4.5 4.8 4.7 40-44 4.3 3.8 4.0 3.4 3.5 3.4 3.5 3.5 3.5 45-49 4.1 3.9 4.0 3.0 3.3 3.1 3.1 3.4 3.3 50-54 2.6 3.2 2.9 2.5 2.8 2.7 2.5 2.9 2.7 55-59 1.7 2.2 2.0 1.7 2.6 2.1 1.7 2.5 2.1 60-64 2.2 2.0 2.1 2.3 2.2 2.3 2.3 2.2 2.2 65-69 1.2 1.1 1.2 1.6 1.1 1.4 1.6 1.1 1.3 70-74 1.2 0.7 0.9 1.2 1.1 1.1 1.2 1.0 1.1 75-79 0.4 0.5 0.5 0.6 0.4 0.5 0.6 0.4 0.5 80 + 0.6 0.8 0.7 0.9 0.7 0.8 0.9 0.7 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,752 4,425 8,177 29,903 29,475 59,378 33,656 33,900 67,556 14 | Household Population and Housing Characteristics The age structure of the household population is typical of a society with a youthful population. The sex and age distribution of the population is shown in the population pyramid in Figure 2.1. Ethiopia has a pyramidal age structure due to the large number of children under 15 years of age. Children under 15 years of age account for 48 percent of the population, a feature of populations with high fertility levels. Forty-nine percent of the population is in the age group 15-64 and about 4 percent are over 65. 2.2 HOUSEHOLD COMPOSITION Table 2.2 shows the distribution of households in the survey by the sex of the head of the household and by the number of household members in urban and rural areas. Households in Ethiopia are predominantly male headed, a common feature of most African countries. More than one in five households are headed by women with the proportion of female-headed households much higher in urban than in rural areas. The average household size observed in the survey is 5 persons, which is slightly higher than the 2000 EDHS (4.8 persons). Rural households have 5.2 persons per household and are larger than urban households (4.2 persons). Single-person households are more common in urban areas (13 percent) than in rural areas (4 percent). Only 7 percent of households have nine or more members. Detailed information on children’s liv- ing arrangements and orphanhood is presented in Table 2.3. In Ethiopia, 73 percent of children under 18 live with both parents, 12 percent live with only their mother, 4 percent live with only their father, Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Ethiopia 2005 Residence Characteristic Urban Rural Total Household headship Male 61.4 79.9 77.2 Female 38.6 20.1 22.8 Total 100.0 100.0 100.0 Number of usual members 1 13.0 3.7 5.0 2 13.0 8.4 9.0 3 16.4 13.4 13.8 4 17.6 15.3 15.7 5 14.4 17.2 16.8 6 10.5 14.6 14.0 7 6.4 11.9 11.1 8 3.9 7.7 7.2 9+ 4.8 7.8 7.4 Total 100.0 100.0 100.0 Number of households 1,974 11,747 13,721 Mean size 4.2 5.2 5.0 Note: Table is based on de jure members, i.e., usual residents. 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 Household Population and Housing Characteristics | 15 and 10 percent live with neither parent. Seven percent of children live with their mother even though their father is alive, 2 percent of children live with their father even though their mother is alive, and 6 percent live with neither parent even though both of them are alive. Eight percent of children do not have a father alive and 4 percent do not have a mother alive. The percentage of children not living with their parents increases with age of the child. The proportion of children living with both parents varies little by sex. However, rural children are more likely to live with both parents than urban children. The highest proportion of children living with both parents is in Somali (79 percent), while the lowest proportion is in Addis Ababa (49 percent). Table 2.3 Children's living arrangements and orphanhood Percent distribution of de jure children under age 18 by children's living arrangements and survival status of parents, according to background characteristics, Ethiopia 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 Missing informa- tion on father or mother Total Percentage with one or both parents dead Number of children Age <2 88.6 8.7 1.2 0.3 0.2 0.7 0.1 0.0 0.0 0.2 100.0 1.6 4,287 2-4 84.6 6.5 2.4 1.2 0.9 3.3 0.3 0.3 0.2 0.2 100.0 4.2 6,545 5-9 74.9 5.9 5.0 2.6 1.9 6.4 0.8 1.0 1.0 0.5 100.0 9.8 11,579 10-14 65.2 6.5 7.8 2.9 3.2 8.5 1.3 2.2 1.9 0.5 100.0 16.5 10,284 15-17 52.0 7.1 9.9 3.2 4.2 11.7 2.2 3.9 3.5 2.3 100.0 23.7 4,308 Sex Male 73.6 6.2 5.7 2.5 2.3 5.7 0.8 1.4 1.3 0.6 100.0 11.5 18,950 Female 72.1 7.1 5.3 1.9 2.0 7.1 1.1 1.4 1.3 0.7 100.0 11.2 18,052 Residence Urban 52.6 12.7 8.6 3.4 1.7 12.1 1.9 2.5 3.5 0.9 100.0 18.4 3,455 Rural 74.9 6.0 5.1 2.1 2.2 5.8 0.9 1.3 1.1 0.6 100.0 10.6 33,547 Region Tigray 70.0 12.9 5.0 2.1 1.8 4.5 1.0 0.9 1.4 0.5 100.0 10.1 2,344 Affar 75.2 7.1 5.8 2.1 3.1 3.3 1.3 0.7 1.2 0.3 100.0 12.0 408 Amhara 71.5 6.9 5.4 2.9 2.0 6.6 1.4 1.6 1.2 0.6 100.0 11.7 8,835 Oromiya 73.8 5.8 5.4 2.0 2.6 6.8 0.7 1.1 1.4 0.5 100.0 11.2 13,918 Somali 79.4 5.9 4.7 1.0 2.6 3.4 0.4 0.5 1.5 0.8 100.0 9.7 1,643 Benishangul-Gumuz 72.5 8.7 7.2 1.5 2.1 4.0 1.1 1.3 1.1 0.4 100.0 13.0 327 SNNP 74.8 5.7 5.5 2.1 1.6 6.0 1.0 1.8 0.9 0.7 100.0 10.8 8,449 Gambela 63.9 10.3 8.1 2.5 0.9 8.5 0.9 2.3 1.1 1.5 100.0 13.2 101 Harari 67.1 7.5 5.2 1.4 1.3 10.3 1.4 1.8 1.7 2.2 100.0 11.6 74 Addis Ababa 48.5 10.1 8.7 3.6 1.7 15.5 2.0 4.2 4.2 1.6 100.0 21.0 773 Dire Dawa 62.0 10.1 7.8 2.3 1.7 10.0 0.6 2.1 2.5 0.7 100.0 14.8 130 Wealth quintile Lowest 73.5 7.5 6.6 2.3 1.7 4.7 0.8 1.0 1.3 0.6 100.0 11.6 7,758 Second 73.9 6.9 5.6 1.8 2.4 4.9 1.3 1.4 0.9 0.8 100.0 11.6 7,534 Middle 74.7 5.7 4.8 2.2 2.5 6.2 0.9 1.5 1.1 0.4 100.0 10.8 7,574 Fourth 76.6 4.5 4.5 2.1 2.2 6.5 0.6 1.3 1.1 0.6 100.0 9.8 7,605 Highest 64.4 8.8 5.8 2.9 1.8 10.2 1.3 1.9 2.2 0.7 100.0 13.1 6,531 Total age <18 72.8 6.6 5.5 2.2 2.1 6.4 1.0 1.4 1.3 0.6 100.0 11.3 37,002 Total age <15 75.6 6.6 4.9 2.1 1.9 5.7 0.8 1.1 1.0 0.4 100.0 9.7 32,694 16 | Household Population and Housing Characteristics The EDHS administered three questions on succession planning to women and men. Women and men were first asked if they were primary caregivers to children under the age of 18, and if they were, an additional question was administered to ascertain if they had made any arrangements for someone to care for these children in the event of their illness or inability to care for their young children themselves. Information on succession planning is shown in Table 2.4. Three-fifths of women and men are primary caregivers to their children. Among primary caregivers, just under half (46 percent) had made provisions for someone else to take care of their children in case of their illness or inability to care for their own children. As the data show, younger, male, urban, highly educated and wealthy respondents are more likely than other respondents to make arrangements in the case of an eventuality. Succession planning varies markedly by region, with respondents residing in Harari (68 percent) most likely and respondents residing in Dire Dawa (34 percent) least likely to make plans in the case of an eventuality. Table 2.4 Succession planning Percentage of de facto women and men age 15-49 who are the primary caregivers of children under age 18 years, and among the primary caregivers, the percentage who have made arrangements for someone else to care for the children in the event of their own inability to do so because of illness or death, by background characteristics, Ethiopia 2005 Background Characteristics Percentage of women and men who are primary caregivers Number of women and men age 15-49 Percentage of caregivers who have made succession arrangements Number of primary caregivers Age 15-19 17.0 4,601 52.8 783 20-29 60.3 6,869 48.0 4,143 30-39 83.2 4,815 45.3 4,006 40-49 81.3 3,249 43.0 2,642 Sex Women 66.1 14,070 42.5 9,306 Men 41.5 5,464 61.7 2,268 Residence Urban 45.1 3,353 50.8 1,513 Rural 62.2 16,181 45.5 10,061 Region Tigray 61.4 1,235 55.8 758 Affar 60.6 205 45.7 124 Amhara 63.8 4,828 39.3 3,082 Oromiya 52.8 7,051 37.4 3,725 Somali 68.8 666 59.4 459 Benishangul-Gumuz 63.7 174 35.7 111 SNNP 67.0 4,138 60.2 2,774 Gambela 64.1 63 58.7 41 Harari 59.2 54 67.7 32 Addis Ababa 40.7 1,023 53.5 416 Dire Dawa 54.9 97 33.5 53 Education No education 71.9 11,436 42.4 8,217 Primary 44.1 5,263 52.8 2,322 Secondary and higher 35.7 2,641 61.5 943 Wealth quintile Lowest 65.9 3,373 45.2 2,225 Second 64.1 3,670 42.9 2,354 Middle 61.6 3,767 43.9 2,321 Fourth 60.2 3,727 45.3 2,245 Highest 48.6 4,996 53.4 2,429 Total 59.3 19,534 46.2 11,574 Household Population and Housing Characteristics | 17 2.3 HOUSEHOLD EDUCATION Studies show that education is one of the major socioeconomic factors that influence a person’s behaviour and attitude. In general, the higher the level of education of a woman, the more knowledgeable she is about the use of health facilities, family planning methods, and the health of her children. Ethiopia’s education system has been stable for a long time; however, recently a major restructuring and expansion programme was undertaken by the government. Following the free market oriented economic policy the education sector was opened to private investment. The current system of formal education is based on a three-tier system: eight years of primary education, followed by four years of secondary school and tertiary education. Prior to the change in the education policy, the education system was based on six years of primary education, followed by two years of junior secondary and four years of senior secondary education and tertiary education. Currently, several pre- university collages and various institutions operated by the government and the private sector offer vocational, technical and professional training in different parts of the country. The number of government universities, and private universities and vocational and technical schools has increased tremendously in various parts of the country. 2.3.1 Educational Attainment of Household Population Tables 2.5.1 and 2.5.2 show the percent distribution of the de facto female and male household population age six and over by highest level of education attended or completed, according to background characteristics. Survey results show that the majority of Ethiopians have little or no education, with females much less educated than males. Fifty-two percent of males and 67 percent of females have never attended school, and 32 percent of males and 25 percent of females have only some primary education. Four percent of males and 2 percent of females have completed primary education only, and 8 percent of males and 5 percent of females have attended, but not completed secondary education.1 Only 3 percent of males and 2 percent of females have completed secondary school or higher. Nevertheless, improvements in the education sector were observed since the 2000 EDHS, with the proportions of males and females with no education declining by 9 and 10 percentage points, respectively. The improvement is observed across all education categories. The male-female gap in education is more obvious at lower levels of education primarily because the proportion of males and females attending higher levels of education is so small. An investigation of the changes in educational attainment by successive age groups indicates the long-term trend of the country’s educational achievement. Survey results show that there has been a marked improvement in the educational attainment of women. For example, the proportion of women with no education has declined significantly from 99 percent among women age 65 and over to 41 percent among women age 10-14. A similar trend is noticeable among men, with the proportion of men with no education declining from 94 percent among those age 65 and over to 37 percent among those age 10-14. As expected, educational attainment is much higher among the urban than the rural population. For example, 83 percent of males and 69 percent of females in urban areas have some education, compared with only 42 percent of males and 27 percent of females in rural areas. Regarding regional variation, the proportion of men and women with no education is highest in the Somali Region (82 percent and 89 percent, respectively), followed by the Affar Region (80 percent and 87 percent, respectively), and is lowest in the capital city, Addis Ababa (13 percent and 25 percent, respectively). It is noticeable that in the majority of the regions (Affar, Amhara, Oromiya, Somali, Benishangul-Gumuz, SNNP, and Gambela) about 2 percent or less of women and 3 percent or less of men have completed secondary and higher education. In the most urbanized regions, Harari, Addis Ababa, and Dire Dawa, much higher proportions of women and men have secondary education. 1 Secondary education refers to both junior secondary (grades 7-8) and senior secondary (grades 9-12). 18 | Household Population and Housing Characteristics Table 2.5.1 Educational attainment of household population: female Percent distribution of the de facto female household population age six and over by highest level of education attended or completed, according to background characteristics, Ethiopia 2005 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Age 6-9 73.3 26.1 0.0 0.0 0.0 0.0 0.5 100.0 4,704 10-14 41.1 54.9 2.0 1.7 0.0 0.0 0.3 100.0 4,861 15-19 40.4 37.0 6.6 15.1 0.5 0.2 0.1 100.0 3,409 20-24 60.4 19.6 2.6 11.5 4.0 1.8 0.1 100.0 2,652 25-29 67.6 18.2 1.7 6.5 4.0 1.9 0.0 100.0 2,609 30-34 73.7 14.6 1.6 5.0 3.1 1.8 0.2 100.0 1,825 35-39 79.8 11.5 1.4 3.2 2.7 1.4 0.0 100.0 1,642 40-44 87.0 5.7 1.1 2.6 1.4 1.6 0.6 100.0 1,190 45-49 92.9 3.5 0.7 1.4 0.5 0.7 0.2 100.0 1,156 50-54 95.3 2.9 0.1 0.7 0.2 0.2 0.7 100.0 975 55-59 96.1 2.1 0.3 0.6 0.4 0.1 0.4 100.0 859 60-64 98.2 0.9 0.0 0.2 0.1 0.1 0.5 100.0 735 65+ 98.9 0.7 0.1 0.2 0.0 0.0 0.0 100.0 1,075 Residence Urban 30.7 28.6 5.5 22.1 8.7 4.3 0.1 100.0 3,951 Rural 72.8 23.8 1.3 1.7 0.1 0.1 0.3 100.0 23,750 Region Tigray 63.0 24.6 2.6 7.1 1.4 0.8 0.3 100.0 1,795 Affar 87.0 8.0 0.9 3.2 0.4 0.0 0.4 100.0 286 Amhara 69.5 24.2 1.4 3.3 0.9 0.5 0.2 100.0 6,937 Oromiya 66.1 26.5 1.8 4.3 0.9 0.3 0.2 100.0 9,919 Somali 88.8 6.6 0.5 1.5 0.9 0.3 1.5 100.0 1,063 Benishangul-Gumuz 67.9 26.7 1.6 2.4 0.5 0.7 0.3 100.0 240 SNNP 69.6 24.8 1.8 2.9 0.4 0.2 0.3 100.0 6,051 Gambela 58.6 32.4 3.2 4.4 0.5 0.2 0.7 100.0 79 Harari 49.4 21.5 2.9 15.6 8.0 2.2 0.4 100.0 69 Addis Ababa 24.6 26.8 5.5 22.9 11.9 8.0 0.2 100.0 1,143 Dire Dawa 52.9 22.4 3.9 14.0 5.3 1.4 0.1 100.0 119 Wealth quintile Lowest 84.1 14.7 0.3 0.5 0.0 0.0 0.4 100.0 5,426 Second 78.5 19.8 0.5 0.7 0.0 0.0 0.4 100.0 5,412 Middle 71.9 25.0 1.4 1.4 0.0 0.0 0.3 100.0 5,440 Fourth 65.0 30.4 1.9 2.4 0.0 0.0 0.2 100.0 5,334 Highest 38.0 31.6 4.7 16.6 5.8 3.1 0.2 100.0 6,088 Total 66.8 24.5 1.9 4.6 1.3 0.7 0.3 100.0 27,701 Note: Total includes 5 women missing information on age and not shown separately. 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level The proportion of female and male household members who have never attended school decreases with wealth. Seventy-three percent of men in the lowest wealth quintile have no education compared with only 24 percent in the highest quintile. Similarly, 84 percent of women in the lowest quintile have no education compared with 38 percent in the highest quintile. Household Population and Housing Characteristics | 19 Table 2.5.2 Educational attainment of household population: male Percent distribution of the de facto male household population age six and over by highest level of education attended or completed, according to background characteristics, Ethiopia 2005 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Age 6-9 73.7 25.6 0.0 0.0 0.0 0.0 0.7 100.0 4,865 10-14 37.0 57.7 3.1 2.1 0.0 0.0 0.2 100.0 5,247 15-19 26.8 42.4 9.0 20.7 0.7 0.2 0.2 100.0 3,512 20-24 35.5 30.4 6.3 21.2 4.1 2.3 0.2 100.0 2,527 25-29 43.0 31.3 5.0 12.5 5.0 2.7 0.6 100.0 2,019 30-34 46.9 29.1 6.7 9.7 5.4 2.1 0.0 100.0 1,789 35-39 49.4 27.6 6.3 9.1 4.1 3.2 0.3 100.0 1,527 40-44 59.5 21.0 3.2 8.0 4.1 4.0 0.3 100.0 1,179 45-49 65.4 16.8 3.8 7.4 2.7 3.7 0.2 100.0 1,041 50-54 74.7 14.7 2.9 3.2 2.2 1.7 0.6 100.0 838 55-59 78.9 14.8 1.7 2.5 0.8 1.3 0.0 100.0 567 60-64 88.2 8.3 0.4 1.3 0.5 1.0 0.4 100.0 781 65+ 93.8 3.7 0.4 0.6 0.4 0.4 0.7 100.0 1,406 Residence Urban 16.3 27.1 6.7 29.2 11.9 8.4 0.4 100.0 3,289 Rural 57.3 33.1 3.5 5.0 0.4 0.2 0.4 100.0 24,019 Region Tigray 53.7 30.3 3.3 9.3 1.6 1.6 0.2 100.0 1,669 Affar 80.0 13.7 1.3 3.3 1.2 0.2 0.3 100.0 303 Amhara 62.2 27.5 2.5 5.6 1.1 0.7 0.4 100.0 7,004 Oromiya 48.0 37.2 4.5 8.0 1.3 0.7 0.3 100.0 9,921 Somali 82.4 10.1 1.0 3.6 1.1 0.4 1.5 100.0 1,165 Benishangul-Gumuz 52.6 36.2 3.6 4.9 0.8 0.9 1.0 100.0 230 SNNP 47.3 38.0 4.9 7.9 1.1 0.5 0.3 100.0 5,798 Gambela 40.1 33.0 7.2 15.5 2.0 1.0 1.2 100.0 85 Harari 31.1 28.4 5.5 20.4 9.6 4.6 0.4 100.0 63 Addis Ababa 13.1 21.6 7.3 27.2 16.6 14.0 0.2 100.0 955 Dire Dawa 33.6 25.5 7.3 21.2 9.3 3.0 0.2 100.0 116 Wealth quintile Lowest 73.3 22.8 1.5 2.0 0.0 0.0 0.4 100.0 5,261 Second 61.8 31.9 2.9 2.9 0.1 0.0 0.4 100.0 5,387 Middle 56.0 35.5 3.3 4.6 0.2 0.0 0.3 100.0 5,447 Fourth 48.2 38.6 5.2 6.9 0.5 0.1 0.5 100.0 5,612 Highest 24.2 32.7 6.5 22.6 8.0 5.8 0.2 100.0 5,601 Total 52.4 32.4 3.9 7.9 1.8 1.2 0.4 100.0 27,308 Note: Total includes 8 men with missing information on age and not shown separately. 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 2.3.2 School Attendance Ratios Data on net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by school level, sex, residence, region and wealth index are shown in Table 2.6. The NAR indicates participation in primary schooling for the population age 7-12 and secondary schooling for the population age 13-18. The GAR measures participation at each level of schooling among those of any age. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level.2 An NAR of 100 percent would indicate that all those in the official age range for the level are attending at that level. The GAR can exceed 100 percent if there is significant overage or underage participation at a given level of schooling. 2 Students who are overage for a given level of schooling may have started school overage, may have repeated one or more grades in school, or may have dropped out of school and later returned. 20 | Household Population and Housing Characteristics Table 2.6 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by level of schooling and sex, according to background characteristics, Ethiopia 2005 Net attendance ratio1 Gross attendance ratio2Background characteristic Male Female Total Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 77.8 79.6 78.8 117.2 122.4 120.0 1.04 Rural 39.1 38.5 38.8 77.7 68.0 73.0 0.88 Region Tigray 48.6 52.7 50.6 78.3 84.1 81.1 1.07 Affar 19.1 11.0 15.3 34.9 21.0 28.5 0.60 Amhara 46.3 54.5 50.4 85.9 82.3 84.1 0.96 Oromiya 43.9 41.4 42.7 88.2 75.7 82.1 0.86 Somali 15.5 11.6 13.8 24.4 17.2 21.2 0.71 Benishangul-Gumuz 49.7 47.1 48.4 90.5 69.6 79.6 0.77 SNNP 37.2 31.8 34.5 76.3 63.7 70.0 0.84 Gambela 39.2 45.9 42.2 81.4 84.7 82.9 1.04 Harari 54.0 54.6 54.3 85.2 80.8 83.1 0.95 Addis Ababa 83.0 78.8 80.6 124.9 137.0 131.8 1.10 Dire Dawa 60.6 48.7 54.8 93.6 74.8 84.4 0.80 Wealth quintile Lowest 26.0 24.9 25.4 52.2 41.4 46.9 0.79 Second 35.9 34.7 35.3 71.8 60.8 66.6 0.85 Middle 42.8 40.2 41.5 83.9 76.0 80.1 0.91 Fourth 46.2 47.0 46.6 92.8 82.8 87.9 0.89 Highest 66.9 69.4 68.2 112.7 111.1 111.9 0.99 Total 42.2 42.4 42.3 80.9 73.3 77.1 0.91 SECONDARY SCHOOL Residence Urban 55.3 42.3 48.2 79.9 57.2 67.6 0.72 Rural 11.9 7.3 9.7 20.3 10.3 15.6 0.51 Region Tigray 19.6 17.6 18.6 32.8 26.1 29.3 0.80 Affar 6.7 4.1 5.3 12.6 7.9 10.2 0.62 Amhara 15.6 15.2 15.4 23.1 17.3 20.4 0.75 Oromiya 18.0 10.5 14.5 29.9 15.4 23.0 0.51 Somali 9.4 4.1 7.0 12.2 6.3 9.6 0.51 Benishangul-Gumuz 17.9 12.6 15.3 28.1 17.8 23.1 0.63 SNNP 14.2 9.6 11.9 25.0 15.1 20.2 0.60 Gambela 30.0 15.9 24.0 52.2 24.4 40.3 0.47 Harari 39.6 33.1 36.1 56.0 40.7 47.8 0.73 Addis Ababa 58.8 38.9 46.7 81.4 53.8 64.7 0.66 Dire Dawa 45.4 31.4 38.2 66.9 38.0 52.1 0.57 Wealth quintile Lowest 5.8 2.3 4.1 10.4 3.1 7.0 0.30 Second 8.3 3.3 5.8 15.2 4.9 10.1 0.32 Middle 9.4 7.0 8.2 18.8 9.3 14.1 0.49 Fourth 15.0 11.4 13.4 24.8 14.7 20.4 0.59 Highest 42.6 33.5 38.0 62.1 47.0 54.5 0.76 Total 17.7 13.3 15.6 28.2 18.3 23.5 0.65 1 The NAR for primary school is the percentage of the primary-school-age (7-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13- 18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The gender parity index for primary school is the ratio of the primary school GAR for females to the GAR for males. The gender parity index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. Household Population and Housing Characteristics | 21 Forty-two percent of children who should be attending primary school are currently doing so. At the same time, only 16 percent of secondary-school-age youths are in school. Nevertheless, marked improvements in NAR are observed since the 2000 EDHS, with 12 and 4 percentage point improvements in the NARs for the primary and secondary levels, respectively. The NAR is higher among males than among females at the secondary level. Attendance ratios are much lower in rural areas than in urban areas and are the lowest in the Affar and Somali regions. The GAR is higher among males than females at both the primary and secondary levels, at 81 and 73 at the primary-school level, respectively, and 28 and 18 at the secondary-school level, respectively, indicating higher attendance among males than among females. Although the overall GAR at the primary-school level is 77, there are significant levels of overage and/or underage participation in the urban areas among both males (117) and females (122) and also in Addis Ababa (132), the highest among the regions. There is a strong relationship between household economic status and schooling that can be seen at both the primary and secondary levels and among males and females. For example, the NAR increases from 25 percent among students from poorer households (lowest wealth quintile) in primary school to 68 percent among students from richer households (highest wealth quintile). Similarly, the NAR rises from 4 percent among secondary attendees in the lowest wealth quintile to 38 percent among those in the highest wealth quintile. The Gender Parity Index (GPI) represents the ratio of the GAR for females to the GAR for males. It is presented at both the primary and secondary levels and offers a summary measure of gender differences in school attendance rates. A GPI less than one indicates that a smaller proportion of females than males attend school. In Ethiopia, the GPI is slightly less than one (0.9) for primary school attendance, but 0.7 for secondary school attendance, indicating that the gender gap is smaller at the primary than the secondary level. There are also marked differences in the GPI by place of residence and by region. The primary school GPI is markedly lower in Affar, Somali and Benishangul-Gumuz than in other regions, while a higher female to male index is observed in Tigray, Gambela and Addis Ababa. The Tigray Region has the highest secondary school GPI (0.8) and Gambela, Oromiya and Somali regions the lowest. Grade repetition and dropout rates for the de facto household population age 5-24 years who attended school in the previous school year is shown in Table 2.7. The repetition rate is defined as the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. Dropout rate refers to the percentage of students in a given grade in the previous school year who are not attending school in the current school year. School attendance ratios in combination with repetition and dropout rates fully describe the flow of students through the school system. In countries with an automatic promotion policy, where students are nearly always promoted to the next grade at the end of the school year, repetition rates may approach zero. However, in Ethiopia the school system does not support automatic promotion of students. Therefore, repetition and dropout rates measure and show current educational problems and impacts of education policies and programmes. Repetition rates are higher in lower grades, specifically highest in grade one (6 percent). Males have higher repetition rates up to grade three compared with female children. However, more female than male children repeat in grades 4 and 5. Dropout rates are higher for males than females in all grade categories. Rural children are more disadvantaged than their urban counterparts; in all grade levels dropout rates are much higher for rural than urban children. 22 | Household Population and Housing Characteristics Table 2.7 Grade repetition and dropout rates Repetition and dropout rates for the de facto household population age 5-24 years who attended school in the previous school year by school grade, according to background characteristics, Ethiopia 2005 School grade Background characteristic 1 2 3 4 5 6 REPETITION RATE Sex Male 6.5 2.1 1.8 1.1 1.3 2.2 Female 4.7 1.2 1.1 2.5 2.0 1.5 Residence Urban 4.3 1.1 1.3 2.5 0.7 2.4 Rural 5.8 1.8 1.5 1.5 1.9 1.8 Region Tigray 1.8 2.1 1.0 0.8 1.7 0.0 Affar 2.1 (0.0) * * * * Amhara 6.6 1.2 1.8 0.6 2.2 0.0 Oromiya 6.5 2.2 0.6 2.4 1.4 3.2 Somali 1.6 (0.0) (0.0) (8.0) * * Benishangul-Gumuz 13.2 1.6 2.0 0.0 (2.3) 0.0 SNNP 3.8 1.4 2.7 1.5 0.8 0.0 Gambela 7.5 0.7 1.8 5.4 3.6 5.3 Harari 6.1 4.6 2.5 3.1 2.8 1.4 Addis Ababa 9.5 0.7 2.1 2.6 2.3 3.3 Dire Dawa 0.0 0.0 0.0 0.0 2.7 2.3 Wealth quintile Lowest 7.8 2.7 1.2 0.5 3.6 0.1 Second 5.2 3.0 4.0 1.6 3.5 4.9 Middle 6.3 1.3 0.0 1.3 0.1 3.1 Fourth 4.5 1.4 1.5 2.3 2.4 1.4 Highest 5.1 1.0 1.1 2.0 0.7 1.5 Total 5.7 1.7 1.5 1.7 1.6 2.0 DROPOUT RATE Sex Male 5.5 5.7 7.7 9.3 9.7 6.2 Female 3.6 5.4 3.9 4.0 5.2 4.8 Residence Urban 1.1 3.1 2.8 3.6 4.7 2.4 Rural 5.0 6.1 6.6 7.9 8.9 6.9 Region Tigray 2.5 4.1 7.0 8.1 6.8 5.0 Affar 2.3 4.8 * * * * Amhara 2.4 2.1 3.0 4.0 6.0 1.8 Oromiya 6.7 9.3 7.2 10.0 8.9 5.1 Somali 2.9 (1.4) (0.0) (6.8) * * Benishangul-Gumuz 2.6 8.2 6.6 8.9 8.0 7.9 SNNP 5.0 4.1 7.1 5.5 9.8 11.3 Gambela 5.8 10.1 10.8 11.1 6.9 14.1 Harari 5.6 8.1 2.2 8.7 7.9 4.7 Addis Ababa 1.4 2.1 3.9 2.8 7.4 4.6 Dire Dawa 5.3 0.0 4.7 6.6 3.2 3.9 Wealth quintile Lowest 5.7 8.7 5.7 10.1 6.6 15.2 Second 4.2 7.1 7.6 6.1 15.1 9.6 Middle 5.1 3.8 2.8 11.1 7.8 6.7 Fourth 4.9 5.4 9.2 4.9 8.9 5.2 Highest 3.3 4.8 4.1 6.0 4.6 3.1 Total 4.6 5.6 6.0 7.1 7.9 5.6 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. Household Population and Housing Characteristics | 23 The age-specific attendance rates (ASARs) for the population age five and over by sex are shown in Figure 2.2. The ASAR indicates participation in schooling at any level, from primary to higher levels of education. Although the minimum age for schooling in Ethiopia is seven, there are some children enrolled prior to this age. Nevertheless, only 21 percent of children age seven are attending school, indicating that a large majority of children that age in Ethiopia have not entered the school system. However, a marked improvement in enrolment at age seven was observed since 2000 when 15 percent were attending school. There is little difference in the proportion of males and females attending school up to age 12; thereafter, a significantly higher proportion of males than females attends school. 2.4 HOUSEHOLD CHARACTERISTICS The physical characteristics and availability and accessibility of basic household facilities are important in assessing the general welfare and socioeconomic condition of the population. In the 2005 EDHS respondents to the household questionnaire were asked about household drinking water and household sanitation facilities that included questions on the source of drinking water, time taken to the nearest source, and the person that usually collects drinking water, water treatment prior to drinking and questions on sanitation facilities. Table 2.8 presents information on household drinking water. The majority (61 percent) of households in Ethiopia have access to an improved source of drinking water with access in urban areas much higher than in rural areas (94 percent and 56 percent, respectively). The most common source of improved drinking water in urban areas is piped water with 90 percent of households having access to this source. On the other hand, only 13 percent of rural households have access to piped water. The major source of improved drinking water in rural areas is a protected spring (39 percent). The proportion of households with access to piped water has increased from about 14 percent in 1994 (CSA, 1999) to 18 percent in 2000 and 24 percent in 2005. Figure 2.2 Age-Specific Attendance Rates 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 10 20 30 40 50 60 70 Percent Male Female EDHS 2005 24 | Household Population and Housing Characteristics Table 2.8 Household drinking water Percent distribution of households by source, time to collect, person who usually collects drinking water, and treatment of water, according to residence, and percent distribution of the de jure population by source, time to collect, person who usually collects drinking water, and treatment of drinking water, Ethiopia 2005 Households Characteristics of household drinking water Urban Rural Total De jure population Source of drinking water Improved source 93.7 56.0 61.4 60.0 Piped into dwelling 2.5 0.0 0.4 0.3 Piped into compound 45.0 0.2 6.6 5.7 Piped outside compound 42.6 12.3 16.7 15.8 Tube well or borehole 0.0 0.1 0.1 0.1 Protected dug well 1.2 4.5 4.0 4.1 Protected spring 2.3 38.7 33.5 33.7 Rainwater 0.0 0.2 0.2 0.2 Non-improved source 6.1 43.8 38.4 39.9 Unprotected dug well 0.8 6.0 5.3 5.4 Unprotected spring 4.1 7.5 7.0 7.3 Tanker truck 0.5 0.2 0.2 0.2 Surface water 0.8 30.1 25.9 26.9 Other 0.2 0.2 0.2 0.2 Total 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 48.4 1.6 8.4 7.4 Less than 30 minutes 36.4 45.6 44.3 44.1 30 minutes or longer 14.6 52.1 46.7 47.9 Missing 0.6 0.7 0.6 0.6 Total 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult male age 15+ 7.1 5.7 5.9 4.8 Adult female age 15+ 38.6 80.5 74.4 75.0 Male child under age 15 1.8 2.5 2.4 2.7 Female child under age 15 3.0 9.0 8.1 9.6 Water on premises 48.4 1.6 8.4 7.4 Other 1.0 0.6 0.6 0.4 Missing 0.1 0.2 0.2 0.1 Total 100.0 100.0 100.0 100.0 Water treatment prior to drinking Boiled 2.9 2.4 2.4 2.5 Bleach/chlorine added 0.6 0.2 0.2 0.2 Strained through cloth 0.6 5.2 4.6 4.9 Ceramic, sand or other filter 0.6 0.3 0.3 0.4 Let it stand and settle 0.1 0.2 0.2 0.1 Other 0.3 0.3 0.3 0.3 No treatment 94.7 91.4 91.9 91.6 Don't know/missing 0.5 0.9 0.9 0.9 Total 100.0 100.0 100.0 100.0 Number 1,974 11,747 13,721 68,981 Only 8 percent of households reported having water on their premises. Households not having access on their premises were asked for the time taken to fetch water. Forty-four percent of all households (36 percent urban and 46 percent rural) take less than 30 minutes to fetch drinking water. In the majority (74 percent) of households, an adult female usually collects drinking water. Female children under age 15 are over three times more likely than male children the same age to fetch drinking water. Household Population and Housing Characteristics | 25 In the survey all households were asked whether they treat water prior to drinking. An overwhelming majority of households (92 percent) do not treat drinking water. Rural households are somewhat more likely than urban households to treat drinking water and this is mostly done by straining water through cloth. Table 2.9 presents information on household sanitation facilities by type of toilet/latrine. Sixty-two percent of Ethiopian households do not have a toilet facility. Overall a small proportion (7 percent) of households use improved toilets that are not shared. Urban households are more than three times as likely as rural households to have access to improved toilet facilities. In urban areas, a pit latrine with a slab (12 percent) is the major type of improved toilet facility. There has been a decline recently in the proportion of households with no toilet facilities from 82 percent in 2000 to 62 percent in 2005. The decline was observed in both urban and rural areas (from 30 percent to 12 percent in urban areas and from 92 percent to 70 percent in rural areas). Table 2.9 Household sanitation facilities Percent distribution of households by type of toilet/latrine facilities, according to residence and the percent distribution of the de jure population by toilet/latrine facilities, Ethiopia 2005 Households Type of toilet/ latrine facility Urban Rural Total De jure population Improved, not shared 18.0 4.9 6.8 7.4 Flush/pour flush to piped sewer system 1.1 0.0 0.2 0.1 Flush/pour flush to septic tank 1.3 0.0 0.2 0.2 Flush/pour flush to pit latrine 1.9 0.8 1.0 1.2 Ventilated improved pit (VIP) latrine 1.1 0.3 0.4 0.5 Pit latrine with a slab 11.5 0.8 2.3 2.5 Composting toilet 1.0 3.0 2.7 3.0 Not improved 81.9 95.0 93.1 92.5 Any facility shared with other households 51.1 5.9 12.4 9.8 Flush/pour flush not to sewer/septic tank/pit latrine 0.2 0.1 0.1 0.1 Pit latrine without slab/ open pit 18.1 18.6 18.5 20.3 Bucket 0.1 0.0 0.0 0.0 Hanging toilet/hanging latrine 0.1 0.0 0.1 0.0 No facility/bush/field 12.2 70.3 61.9 62.2 Other/missing 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 Number 1,974 11,747 13,721 68,981 Information on household characteristics such as availability of electricity, type of flooring material, number of rooms for sleeping, type of fuel used for cooking, place for cooking and type of fire/stove among households using biomass are shown in Table 2.10. Fourteen percent of households have electricity, but this varies widely by place of residence. Two percent of households in rural areas have access to electricity, compared with 86 percent of urban households. The proportion of households with electricity rose from 76 percent to 86 percent in urban areas between 2000 and 2005 and from 0.4 percent to 1.9 percent in rural areas. Sixty-five percent of households have earth or sand floors and 25 percent have dung floors. Rural houses are more likely than urban houses to have earth, sand, or dung floors, while urban houses are more likely than rural houses to have floors made with cement/bricks. 26 | Household Population and Housing Characteristics Table 2.10 Household characteristics Percent distribution of households by household characteristics, according to residence, Ethiopia 2005 Households Household characteristic Urban Rural Total De jure population Electricity Yes 85.7 1.9 14.0 12.0 No 14.3 98.0 85.9 87.9 Missing 0.0 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 Flooring material Earth/sand 32.8 70.6 65.2 65.7 Dung 12.8 27.5 25.4 25.7 Wood planks 1.1 0.1 0.3 0.3 Reed/bamboo 1.9 0.4 0.7 0.7 Parquet or polished wood 4.7 0.0 0.7 0.6 Vinyl 17.7 0.1 2.7 2.4 Ceramic tiles 1.8 0.0 0.3 0.2 Cement/bricks 23.3 0.5 3.8 3.5 Carpet 3.6 0.6 1.0 0.8 Other/missing 0.2 0.1 0.1 0.2 Total 100.0 100.0 100.0 100.0 Rooms for sleeping No bedrooms or only one 67.4 78.4 76.8 71.5 Two 25.3 18.2 19.2 22.8 Three or more 7.1 2.7 3.4 5.0 Missing 0.1 0.7 0.6 0.7 Total 100.0 100.0 100.0 100.0 Cooking fuel Electricity 1.0 0.0 0.2 0.2 LPG 0.4 0.0 0.1 0.0 Natural gas 0.6 0.0 0.1 0.1 Biogas 0.3 0.0 0.0 0.0 Kerosene 25.9 0.2 3.9 3.0 Charcoal 18.1 0.2 2.8 2.2 Wood 48.5 89.9 83.9 85.7 Straw/shrubs/grass 0.2 1.2 1.1 1.1 Animal dung 2.1 8.3 7.4 7.5 Other/missing 3.0 0.2 0.6 0.2 Total 100.0 100.0 100.0 100.0 Place for cooking In the house 31.1 74.1 67.9 66.4 In a separate building 53.5 21.0 25.7 27.6 Outdoors 12.4 4.8 5.9 5.8 Other/missing 2.8 0.1 0.5 0.2 Total 100.0 100.0 100.0 100.0 Number of households 1,974 11,747 13,721 68,981 Type of fire/stove among households using biomass fuel1 Open fire or stove whithout a chimney/hood 91.5 97.5 96.6 96.8 Open fire or stove with chimney/hood 5.9 2.1 2.6 2.6 Closed stove with chimney 1.7 0.1 0.4 0.3 Other 0.8 0.1 0.2 0.2 Missing 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 Number of households using biomass fuel 1,871 11,722 13,593 68,605 1 Biomass fuel includes kerosene, coal/lignite, charcoal, wood/straw/shrubs, and animal dung. Household Population and Housing Characteristics | 27 Data were collected on the number of sleeping rooms per household. Slightly over three- fourths of households have no bedrooms or have only one room for sleeping. Nineteen percent of households have two rooms and only 3 percent have three or more rooms for sleeping. Urban households are more likely than rural households to have two or more rooms for sleeping. The overwhelming majority of households (84 percent) use wood for cooking. Wood is the most common form of cooking fuel in rural areas (90 percent). In urban areas nearly half of the households use wood for cooking (49 percent), followed by kerosene (26 percent) and charcoal (18 percent). Slightly over two-thirds of households (68 percent) cook their meals in the house, while over a quarter use a separate building for cooking (26 percent). Slightly over half the households in urban areas (54 percent) use a separate building for cooking. Almost all households (99 percent) use a biomass fuel for cooking, that is, kerosene, charcoal, dung and wood/straw/shrubs, which generate smoke that is unhealthy when inhaled. In these households, almost all cooking is done over an open fire or stove with no chimney or hood to channel the smoke outside the house. 2.5 HOUSEHOLD POSSESSIONS Information on ownership of durable goods and other possessions is presented in Table 2.11. In general, ownership of household effects, means of transportation and agricultural land and farm animals is indicative of a household’s social and economic well-being. The survey results show that one-third of all households have a radio, about 5 percent have a television, 4 percent have a non- mobile telephone, 2 percent have a mobile telephone and 2 percent have a refrigerator. In general, households in rural Ethiopia are much less likely to possess consumer items like televisions, telephones, or refrigerators. Ethiopians in general are not very likely to own a means of transport, although urban households are more likely than rural households to own a means of transportation. Bicycles owned by 1 percent of households are the most commonly owned means of transportation. Most rural households in contrast to urban households own agricultural land (92 percent versus 11 percent) or farm animals (90 percent versus 24 percent). Table 2.11 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and farm animals, by residence, Ethiopia 2005 Households Possessions Urban Rural Total De jure population Household effects Radio 75.6 26.6 33.7 35.6 Television 33.1 0.1 4.9 4.9 Mobile telephone 11.4 0.0 1.7 1.8 Non-mobile telephone 28.2 0.1 4.2 4.4 Refrigerator 11.9 0.2 1.9 1.9 Means of transport Bicycle 5.5 0.5 1.2 1.5 Animal drawn cart 0.8 0.5 0.6 0.8 Motorcycle/scooter 0.2 0.0 0.0 0.1 Car/truck 3.0 0.0 0.5 0.6 Boat with a motor 0.2 0.0 0.0 0.0 Ownership of agricultural land 11.3 92.0 80.4 84.3 Ownership of farm animals1 23.8 89.5 80.1 85.4 Number of households 1,974 11,747 13,721 68,981 1 Cattle, cows, bulls, horses, donkeys, goats, sheep or chicken. 28 | Household Population and Housing Characteristics 2.6 SOCIOECONOMIC STATUS INDEX One of the background characteristics used throughout this report is an index of socio- economic status. The economic index used here was recently developed and tested in a large number of countries in relation to inequalities in household income, use of health services and health outcomes (Rutstein et al., 2000). It is an indicator of the level of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The economic index was constructed using household asset data including ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities and type of material used for flooring. Each asset was assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores were standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed for the whole sample; separate indices were not prepared for the urban and rural population. Table 2.12 presents the wealth quintiles by residence and administrative regions. Ninety-three percent of the population in urban areas is in the highest wealth quintile in contrast to the rural areas where only 10 percent are in this category. The wealth quintile distribution among regions shows large variations, with a relatively high percentage of the population in the most urbanized regions in the highest wealth quintile—Addis Ababa (99 percent), Dire Dawa (66 percent), and Harari (65 percent). On the other hand, a significant proportion of the population in the more rural areas of the country such as in Somali (72 percent), Affar (67 percent) and Gambela (44 percent) are in the lowest wealth quintile. Table 2.12 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, according to residence and region, Ethiopia 2005 Wealth quintile Background characteristic Lowest Second Middle Fourth Highest Total De jure population Residence Urban 0.3 0.7 1.3 5.1 92.6 100.0 8,260 Rural 22.7 22.6 22.5 22.0 10.1 100.0 60,721 Region Tigray 31.6 23.5 17.5 10.2 17.2 100.0 4,410 Affar 67.3 8.2 7.8 3.3 13.5 100.0 738 Amhara 17.5 21.4 22.1 23.5 15.5 100.0 17,081 Oromiya 19.9 22.0 20.6 19.7 17.9 100.0 25,278 Somali 71.8 11.1 4.4 3.2 9.6 100.0 2,835 Benishangul-Gumuz 19.1 21.9 24.6 18.5 15.9 100.0 600 SNNP 10.7 19.5 24.2 26.9 18.6 100.0 15,110 Gambela 44.0 15.1 7.9 13.6 19.4 100.0 202 Harari 5.7 6.7 10.3 12.7 64.6 100.0 163 Addis Ababa 0.1 0.3 0.3 0.6 98.7 100.0 2,280 Dire Dawa 11.4 11.2 8.3 3.2 65.8 100.0 285 Total 20.0 20.0 20.0 20.0 20.0 100.0 68,981 Household Population and Housing Characteristics | 29 The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of the registration of the birth. Although Ethiopia does not have a legal and administrative structure that performs official registration of births according to standard procedures, there exists in the urban parts of the country a practice where certificates of birth are issued without the event being officially registered. Birth certificates may also be issued by hospitals where the birth occurred, but this event again may not be officially recorded in a civil registry. In addition, some regional capitals in the country may also issue birth certificates that are not officially recorded by a civil registry. Thus the information in Table 2.13 should be interpreted in the light of the situation in Ethiopia. Information on the registration of births was collected in the household interview where respondents were asked if their child under age five had a birth certificate. If they responded that the child did not have a birth certificate, an additional question was posed to ascertain if the child’s birth had ever been registered with the municipal or local authorities. Seven percent of Ethiopian children under age five have had their births registered. However, most of these children (5 percent) did not have a birth certificate. Table 2.13 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, by background characteristics, Ethiopia 2005 Percentage of children whose births are registered: Background characteristic Had a birth certificate Did not have a birth certificate Total registered Number of children Age < 2 1.5 5.6 7.2 4,287 2 - 4 1.1 5.2 6.3 6,545 Sex Male 1.4 5.0 6.4 5,486 Female 1.2 5.7 6.9 5,345 Residence Urban 10.1 18.9 28.9 783 Rural 0.6 4.3 4.9 10,048 Region Tigray 3.4 4.1 7.5 694 Affar 1.5 2.8 4.3 102 Amhara 0.6 3.6 4.2 2,479 Oromiya 1.0 3.9 4.9 4,285 Somali 0.9 2.7 3.6 460 Benishangul-Gumuz 0.6 3.2 3.8 104 SNNP 0.9 9.1 10.0 2,467 Gambela 0.9 5.2 6.1 30 Harari 10.6 6.6 17.3 23 Addis Ababa 16.6 28.9 45.5 150 Dire Dawa 7.5 16.3 23.8 38 Wealth quintile Lowest 0.3 2.2 2.6 2,366 Second 0.1 3.6 3.8 2,308 Middle 0.6 5.2 5.7 2,356 Fourth 0.9 5.7 6.6 2,184 Highest 5.9 12.2 18.1 1,617 Total 1.3 5.4 6.6 10,831   Characteristics of Respondents | 31 CHARACTERISTICS OF RESPONDENTS 3 This chapter provides a demographic and socioeconomic profile of respondents interviewed in the 2005 EDHS. Such background information is essential to the interpretation of findings and for understanding the results presented later in the report. Basic characteristics collected include age, level of education, marital status, religion, ethnicity, and wealth status. Exposure to mass media and literacy status was examined and detailed information was collected on employment status, occu- pation, and earnings. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS The background characteristics of the 14,070 women age 15-49 and the 6,033 men age 15-59 interviewed in the 2005 EDHS are shown in Table 3.1. This table is important in that it provides the background for interpreting findings presented later in the report. Three in five women (59 percent) and one in two men (52 percent) are under age 30. In general, the proportion of women and men in each age group declines as age increases, reflecting the comparatively young age structure of the population in Ethiopia as a result of past high fertility levels. The majority of surveyed respondents (65 percent of women and 57 percent of men) are married or living together. The proportion not currently married varies by gender. One in four women has never married compared with two in five men. On the other hand, women are much more likely to be divorced, separated, or widowed (11 percent) than men (3 percent). Place of residence is another characteristic that determines access to services and exposure to information pertaining to reproductive health and other aspects of life. As expected, the majority of respondents reside in rural areas, with only 18 percent of women and 15 percent of men residing in urban areas. More than 80 percent of the respondents live in three major regions, namely: Amhara, Oromiya, and SNNP. Respondents from Tigray, Addis Ababa, and Somali constitute about 7 percent, 5 percent, and 3 percent, respectively, of the sample. One percent or less of respondents reside in other regions. Education is an important factor influencing an individual’s attitude and outlook on various aspects of life. Generally, educational attainment in Ethiopia is very low among both men and women, with women much more disadvantaged than men. Two-thirds of women compared with two- fifths of men do not have any formal education. The corresponding figures in the 2000 EDHS were 75 percent and 52 percent, respectively, indicating that the proportion of persons with no education has declined over the past five years. Nearly twice as many men as women have primary (37 percent of men compared with 22 percent of women) or secondary education (20 percent of men compared with 12 percent of women). The distribution of respondents by religious affiliation shows that half are Orthodox Christians and nearly 30 percent are Muslims. Protestant women and men account for about 19 percent and 17 percent, respectively. The ethnic composition of respondents indicates that a third of respondents belong to the Oromo ethnic group and about three out of ten are Amharas. Tigraways constitute 7 percent of the population. While there are more than 80 ethnic groups in Ethiopia, most are small in number and, therefore, are not shown separately. They are grouped under the category “Other.” 32 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Ethiopia 2005 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 23.2 3,266 3,252 22.1 1,335 1,278 20-24 18.1 2,547 2,617 17.6 1,064 1,039 25-29 17.9 2,517 2,557 12.3 741 830 30-34 12.8 1,808 1,754 12.5 754 759 35-39 11.4 1,602 1,629 10.8 651 650 40-44 8.4 1,187 1,181 8.2 497 496 45-49 8.1 1,143 1,080 7.0 422 420 50-54 na na na 5.5 335 339 55-59 na na na 3.9 235 222 Marital status Never married 25.0 3,516 3,830 40.1 2,419 2,460 Married 63.4 8,914 8,438 56.2 3,393 3,295 Living together 1.1 152 206 0.5 31 37 Divorced/separated 6.6 932 989 2.5 153 182 Widowed 4.0 556 607 0.6 37 59 Residence Urban 17.8 2,499 4,423 15.2 916 1,628 Rural 82.2 11,571 9,647 84.8 5,117 4,405 Region Tigray 6.5 919 1,257 6.1 366 512 Affar 1.0 146 789 1.1 65 314 Amhara 24.7 3,482 1,943 25.2 1,521 897 Oromiya 35.6 5,010 2,230 36.8 2,222 1,041 Somali 3.5 486 669 3.4 202 281 Benishangul-Gumuz 0.9 124 846 0.9 54 382 SNNP 21.3 2,995 2,087 20.6 1,244 880 Gambela 0.3 44 729 0.3 21 339 Harari 0.3 39 844 0.3 16 359 Addis Ababa 5.4 756 1,869 4.8 292 698 Dire Dawa 0.5 69 807 0.5 30 330 Education No education 65.9 9,271 8,454 42.9 2,589 2,434 Primary 22.2 3,123 2,966 37.3 2,252 1,946 Secondary 10.5 1,481 2,292 17.3 1,045 1,394 Higher 1.4 194 358 2.4 147 259 Religion Orthodox 49.2 6,920 6,809 49.3 2,974 2,916 Catholic 1.2 173 143 1.0 61 56 Protestant 18.9 2,654 2,301 17.2 1,038 876 Muslim 28.5 4,009 4,522 29.6 1,788 2,030 Other 2.2 313 295 2.9 172 155 Ethnicity Affar 0.7 104 603 0.8 46 249 Amhara 31.5 4,434 4,165 30.8 1,861 1,707 Guragie 4.6 648 786 4.4 268 343 Oromo 32.4 4,556 3,387 33.2 2,005 1,499 Sidamo 4.0 561 345 4.5 270 168 Somali 3.0 421 690 3.1 188 299 Tigraway 6.9 971 1,398 6.5 394 588 Welaita 2.6 361 266 2.2 132 103 Other 14.3 2,015 2,430 14.4 869 1,077 Total 100.0 14,070 14,070 100.0 6,033 6,033 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents | 33 3.2 EDUCATIONAL ATTAINMENT AND LITERACY Tables 3.2.1 and 3.2.2 present detailed distribution of educational attainment, according to background characteristics. As can be seen from the table, most women with no education are older and reside primarily in rural areas. The urban-rural difference in level of education is pronounced at secondary or higher levels. For example, only 3 percent of women in rural areas have some secondary education, compared with nearly a third of their counterparts in urban areas. Regarding regional differentials in educational attainment, the highest proportions of women with no education are observed in the Somali and Affar regions (91 percent and 85 percent, respectively). The lowest proportion is observed in Addis Ababa, where only 18 percent of women have never attended formal education. Table 3.2.1 Educational attainment by background characteristics: women Percent distribution of women by highest level of schooling attained, and median number of years of schooling, according to background characteristics, Ethiopia 2005 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of women Median years of schooling Age 15-19 40.1 36.4 7.2 15.5 0.4 0.5 100.0 3,266 1.2 20-24 60.2 19.8 2.7 11.4 3.8 2.1 100.0 2,547 0.0 25-29 68.9 17.4 1.6 6.6 3.8 1.7 100.0 2,517 0.0 30-34 73.0 15.5 1.7 5.0 3.2 1.6 100.0 1,808 0.0 35-39 80.1 11.3 1.5 3.4 2.3 1.5 100.0 1,602 0.0 40-44 87.0 6.0 1.1 2.6 1.8 1.6 100.0 1,187 0.0 45-49 92.8 3.5 0.9 1.5 0.5 0.8 100.0 1,143 0.0 Residence Urban 24.7 17.8 6.7 31.5 12.5 6.9 100.0 2,499 6.2 Rural 74.8 19.5 2.2 3.2 0.1 0.2 100.0 11,571 0.0 Region Tigray 63.5 16.4 3.7 12.0 2.0 2.4 100.0 919 0.0 Affar 84.8 6.7 1.7 6.1 0.7 0.0 100.0 146 0.0 Amhara 75.6 13.7 2.1 5.7 1.7 1.1 100.0 3,482 0.0 Oromiya 64.4 22.4 3.3 8.0 1.5 0.5 100.0 5,010 0.0 Somali 90.6 3.3 1.0 2.4 2.2 0.6 100.0 486 0.0 Benishangul-Gumuz 73.2 17.6 2.8 4.2 0.8 1.4 100.0 124 0.0 SNNP 65.7 24.6 3.0 5.6 0.7 0.3 100.0 2,995 0.0 Gambela 59.5 27.4 4.7 6.9 1.4 0.1 100.0 44 0.0 Harari 39.9 14.4 3.0 25.1 13.0 4.6 100.0 39 3.8 Addis Ababa 17.6 18.6 5.7 29.8 16.7 11.6 100.0 756 7.3 Dire Dawa 46.7 15.0 4.5 22.3 9.1 2.4 100.0 69 2.1 Wealth quintile Lowest 88.2 10.2 0.4 1.2 0.0 0.0 100.0 2,428 0.0 Second 83.5 14.3 1.0 1.2 0.0 0.0 100.0 2,643 0.0 Middle 73.2 21.8 2.4 2.5 0.0 0.0 100.0 2,732 0.0 Fourth 66.2 25.6 3.5 4.5 0.1 0.1 100.0 2,647 0.0 Highest 32.4 22.1 6.2 25.1 8.9 5.3 100.0 3,621 4.2 Total 65.9 19.2 3.0 8.2 2.3 1.4 100.0 14,070 0.0 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 34 | Characteristics of Respondents Table 3.2.2 Educational attainment by background characteristics: men Percent distribution of men by highest level of schooling attained, and median number of years of schooling, according to background characteristics, Ethiopia 2005 Highest level of schooling attended or completed Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number of men Median years of schooling Age 15-19 21.2 43.3 11.4 22.9 0.6 0.7 100.0 1,335 3.5 20-24 32.7 30.4 7.7 22.0 4.4 2.8 100.0 1,064 3.1 25-29 42.2 31.4 5.2 12.5 5.2 3.5 100.0 741 1.4 30-34 44.6 32.1 7.4 9.5 4.8 1.6 100.0 754 1.3 35-39 49.1 28.1 6.3 8.8 5.0 2.7 100.0 651 0.2 40-44 57.0 22.2 3.6 8.6 3.2 5.3 100.0 497 0.0 45-49 66.9 16.8 3.1 6.6 2.5 4.1 100.0 422 0.0 50-54 73.0 16.8 2.7 3.3 2.1 2.1 100.0 335 0.0 55-59 77.0 19.7 0.3 1.7 0.7 0.6 100.0 235 0.0 Residence Urban 7.9 14.6 5.8 40.3 18.1 13.4 100.0 916 8.5 Rural 49.2 33.4 7.0 9.3 0.6 0.5 100.0 5,117 0.0 Region Tigray 46.9 24.0 6.1 14.2 4.2 4.7 100.0 366 0.7 Affar 71.4 14.2 2.9 6.4 4.0 1.2 100.0 65 0.0 Amhara 60.5 23.8 3.1 9.4 2.0 1.2 100.0 1,521 0.0 Oromiya 36.7 34.5 8.5 16.1 2.6 1.6 100.0 2,222 1.9 Somali 81.9 7.7 2.5 5.3 1.7 0.9 100.0 202 0.0 Benishangul-Gumuz 49.9 30.6 6.9 10.3 0.4 1.9 100.0 54 0.0 SNNP 32.6 42.7 9.4 12.5 1.6 1.2 100.0 1,244 2.3 Gambela 27.5 32.5 8.2 26.8 3.6 1.3 100.0 21 3.7 Harari 20.5 21.7 6.2 31.8 12.2 7.6 100.0 16 6.3 Addis Ababa 7.2 12.7 6.9 33.0 21.5 18.7 100.0 292 9.2 Dire Dawa 22.8 18.0 6.7 33.9 11.8 6.8 100.0 30 6.3 Wealth quintile Lowest 69.6 21.9 4.3 4.2 0.0 0.0 100.0 1,100 0.0 Second 55.4 34.2 4.8 5.4 0.2 0.1 100.0 1,184 0.0 Middle 47.4 35.9 7.2 9.4 0.1 0.1 100.0 1,081 0.3 Fourth 37.0 39.2 9.7 13.0 1.0 0.1 100.0 1,200 2.1 Highest 14.5 22.9 7.7 32.6 12.5 9.8 100.0 1,469 6.7 Total 42.9 30.5 6.8 14.0 3.3 2.4 100.0 6,033 1.3 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Not surprisingly, access to wealth equates with access to education. An analysis of the variation in the level of education by wealth quintile indicates that only those in the highest wealth quintile have the opportunity to complete secondary or higher levels of education. Likewise, only a third of the women in the highest quintile have never attended school, compared with 88 percent of women in the lowest quintile. The pattern of educational attainment among men is similar to that of women. However, men are more educated than women at every level. This gender disparity is more marked at higher than at lower levels, indicating the government’s recognition and successful intervention to address gender disparity in recent years. Characteristics of Respondents | 35 Literacy is widely acknowledged as benefiting the individual and the society and is associated with a number of positive outcomes for health and nutrition. In the 2005 EDHS, literacy status was determined based on the respondents’ ability to read all or part of a sentence. During data collection, interviewers carried a set of cards on which simple sentences were printed in five of the major languages for testing a respondent’s reading ability. Only those who had never been to school and those who had not completed primary level were asked to read the cards in the language they were most likely able to read; those who had attained middle school or above were assumed to be literate. Table 3.3.1 indicates that only 3 of 10 women in Ethiopia are literate and that literacy status varies greatly by place of residence. Three-fourths of women residing in urban areas are literate compared with only a fifth of their rural counterparts. The level of literacy by age exhibits a consistent decrease with increasing age, suggesting that the younger generation has had more opportunity for learning than the older generation. Half of the women age 15-19 are literate compared with only 8 percent of the women age 45-49. Table 3.3.1 Literacy: women Percent distribution of women by level of schooling attended and level of literacy, and percent literate, according to background characteristics, Ethiopia 2005 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Number of women Percent literate1 Age 15-19 16.4 22.4 10.7 47.5 2.7 0.0 0.2 100.0 3,266 49.5 20-24 17.3 7.8 6.4 66.1 2.3 0.0 0.1 100.0 2,547 31.5 25-29 12.1 7.1 6.9 73.2 0.5 0.1 0.1 100.0 2,517 26.1 30-34 9.8 6.1 8.9 74.2 1.0 0.1 0.0 100.0 1,808 24.8 35-39 7.2 5.2 7.3 78.8 1.6 0.0 0.0 100.0 1,602 19.6 40-44 5.9 2.7 5.7 84.0 1.6 0.0 0.0 100.0 1,187 14.4 45-49 2.8 1.2 4.0 90.9 1.1 0.0 0.0 100.0 1,143 8.0 Residence Urban 50.9 14.3 8.3 26.0 0.3 0.0 0.1 100.0 2,499 73.6 Rural 3.5 8.6 7.5 78.4 2.0 0.0 0.1 100.0 11,571 19.6 Region Tigray 16.5 10.0 7.2 66.3 0.0 0.0 0.0 100.0 919 33.7 Affar 6.8 4.6 4.1 84.3 0.1 0.0 0.0 100.0 146 15.6 Amhara 8.5 9.6 6.9 74.8 0.0 0.0 0.1 100.0 3,482 25.1 Oromiya 10.0 10.7 8.8 68.6 1.9 0.1 0.0 100.0 5,010 29.5 Somali 5.2 1.8 2.8 89.5 0.2 0.0 0.5 100.0 486 9.8 Benishangul-Gumuz 6.4 9.2 7.6 74.7 1.9 0.0 0.2 100.0 124 23.2 SNNP 6.7 8.4 7.3 73.0 4.5 0.1 0.0 100.0 2,995 22.4 Gambela 8.4 5.4 9.1 73.2 3.8 0.0 0.1 100.0 44 22.8 Harari 42.7 6.6 5.7 44.4 0.1 0.0 0.5 100.0 39 54.9 Addis Ababa 58.1 12.7 9.0 19.8 0.2 0.0 0.2 100.0 756 79.9 Dire Dawa 33.7 9.9 9.4 46.7 0.0 0.2 0.0 100.0 69 53.0 Wealth quintile Lowest 1.2 3.1 5.2 88.7 1.7 0.1 0.0 100.0 2,428 9.5 Second 1.2 5.7 5.2 85.3 2.5 0.0 0.0 100.0 2,643 12.1 Middle 2.6 9.3 8.8 77.8 1.5 0.1 0.0 100.0 2,732 20.6 Fourth 4.6 12.5 9.4 71.5 1.9 0.0 0.1 100.0 2,647 26.5 Highest 39.3 14.9 8.9 35.7 1.0 0.0 0.2 100.0 3,621 63.1 Total 11.9 9.6 7.6 69.1 1.7 0.0 0.1 100.0 14,070 29.2 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 36 | Characteristics of Respondents Regional differences in literacy are marked, with literacy being highest among women in predominantly urban Addis Ababa, (80 percent) and lowest in the predominantly rural Somali Region (10 percent). There is also a marked difference in literacy levels by women’s wealth status, ranging from a low of 10 percent among women in the lowest wealth quintile to a high of 63 percent among women in the highest wealth quintile. In general, men are more likely to be literate than women (Table 3.3.2). The urban-rural differential in literacy among men is smaller compared with women, suggesting that men in the rural areas have much greater opportunity for learning than women. Table 3.3.2 Literacy: men Percent distribution of men by level of schooling attended and level of literacy, and percent literate, according to background characteristics, Ethiopia 2005 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Number of men Percent literate1 Age 15-19 24.2 33.8 12.9 25.4 3.7 0.0 0.0 100.0 1,335 70.9 20-24 29.3 22.4 11.0 35.3 1.7 0.2 0.1 100.0 1,064 62.7 25-29 21.2 22.0 13.9 41.6 1.4 0.0 0.0 100.0 741 57.0 30-34 15.9 30.0 14.4 38.5 1.0 0.2 0.0 100.0 754 60.3 35-39 16.5 25.7 20.5 36.7 0.6 0.0 0.0 100.0 651 62.7 40-44 17.2 21.9 13.2 47.1 0.6 0.0 0.0 100.0 497 52.3 45-49 13.2 16.7 17.0 52.3 0.8 0.0 0.0 100.0 422 46.9 50-54 7.5 20.9 9.3 61.9 0.4 0.1 0.0 100.0 335 37.7 55-59 3.0 11.8 15.6 67.9 0.7 1.0 0.0 100.0 235 30.4 Residence Urban 71.8 15.7 6.2 6.0 0.2 0.0 0.1 100.0 916 93.7 Rural 10.4 27.0 15.3 45.3 1.9 0.1 0.0 100.0 5,117 52.7 Region Tigray 23.1 31.4 13.0 32.5 0.0 0.0 0.0 100.0 366 67.5 Affar 11.5 8.1 7.4 71.2 1.2 0.5 0.0 100.0 65 27.0 Amhara 12.6 30.0 11.5 45.6 0.2 0.1 0.0 100.0 1,521 54.0 Oromiya 20.3 22.7 18.6 37.8 0.6 0.1 0.0 100.0 2,222 61.5 Somali 7.9 7.8 6.3 77.1 0.9 0.0 0.0 100.0 202 22.0 Benishangul-Gumuz 12.6 25.6 9.2 51.5 0.8 0.0 0.3 100.0 54 47.4 SNNP 15.3 28.6 13.2 36.5 6.4 0.1 0.0 100.0 1,244 57.0 Gambela 31.7 15.9 9.8 41.3 1.2 0.0 0.0 100.0 21 57.5 Harari 51.6 22.5 4.3 20.6 0.6 0.0 0.3 100.0 16 78.4 Addis Ababa 73.2 16.5 3.9 6.1 0.0 0.0 0.3 100.0 292 93.6 Dire Dawa 52.5 13.4 10.6 22.7 0.4 0.4 0.0 100.0 30 76.6 Wealth quintile Lowest 4.2 16.2 13.5 64.9 0.9 0.3 0.0 100.0 1,100 33.9 Second 5.7 21.2 17.7 53.1 2.3 0.0 0.0 100.0 1,184 44.5 Middle 9.5 30.8 14.1 43.3 2.2 0.0 0.0 100.0 1,081 54.5 Fourth 14.1 37.1 15.1 31.5 2.0 0.2 0.0 100.0 1,200 66.3 Highest 54.9 21.5 9.9 12.5 1.0 0.0 0.1 100.0 1,469 86.4 Total 19.8 25.3 13.9 39.3 1.7 0.1 0.0 100.0 6,033 58.9 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence Characteristics of Respondents | 37 3.3 ACCESS TO MASS MEDIA Exposure to mass media provides the opportunity to be acquainted with new ideas and knowledge that is useful in various aspects of everyday life. In the 2005 EDHS, exposure to media was assessed by asking respondents how often they listened to a radio, watched television, or read newspapers or magazines. This information is useful in determining which media may be more effective for disseminating health information to targeted audiences. The results are presented in Tables 3.4.1 and 3.4.2 by background characteristics. Table 3.4.1 Exposure to mass media: women Percentage of women who are exposed to specific media on a weekly basis, according to background characteristics, Ethiopia 2005 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio 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 5.3 11.0 19.9 1.3 72.6 3,266 20-24 2.7 10.3 19.6 1.1 76.2 2,547 25-29 1.9 6.8 15.2 0.7 81.2 2,517 30-34 1.4 5.4 13.0 0.7 84.3 1,808 35-39 0.9 4.8 13.4 0.3 84.4 1,602 40-44 1.3 5.0 11.2 0.7 86.6 1,187 45-49 0.7 5.7 11.6 0.6 85.3 1,143 Residence Urban 8.8 39.5 40.4 4.6 41.9 2,499 Rural 1.2 0.9 10.7 0.0 88.1 11,571 Region Tigray 2.8 7.3 13.4 0.9 82.2 919 Affar 0.5 4.4 8.3 0.0 88.4 146 Amhara 1.2 3.5 14.6 0.4 83.8 3,482 Oromiya 2.3 6.5 16.6 0.6 79.4 5,010 Somali 0.6 6.5 5.0 0.3 90.9 486 Benishangul-Gumuz 1.6 1.4 13.2 0.3 86.1 124 SNNP 1.6 2.5 11.3 0.2 86.6 2,995 Gambela 1.7 3.6 7.6 0.0 89.1 44 Harari 6.1 42.2 39.1 4.0 46.3 39 Addis Ababa 14.1 55.8 45.9 7.4 29.2 756 Dire Dawa 4.1 37.2 38.3 3.0 53.1 69 Education No education 0.0 1.5 8.1 0.0 91.0 9,271 Primary 3.6 7.4 21.2 0.3 72.8 3,123 Secondary and higher 14.3 43.5 50.1 6.6 31.6 1,675 Wealth quintile Lowest 0.3 0.2 2.2 0.0 97.2 2,428 Second 0.5 0.3 5.1 0.1 94.4 2,643 Middle 1.5 0.4 10.1 0.0 88.6 2,732 Fourth 1.5 1.1 15.6 0.0 82.8 2,647 Highest 6.9 28.7 37.9 3.3 48.9 3,621 Total 2.5 7.8 16.0 0.9 79.9 14,070 38 | Characteristics of Respondents Table 3.4.2 Exposure to mass media: men Percentage of men who are exposed to specific media on a weekly basis, according to background characteristics, Ethiopia 2005 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 8.6 13.3 26.5 2.9 65.6 1,335 20-24 9.9 14.9 37.1 4.0 57.0 1,064 25-29 7.8 12.4 33.5 3.8 61.7 741 30-34 6.2 8.2 34.0 3.2 63.8 754 35-39 6.2 8.2 30.1 2.4 66.6 651 40-44 6.6 7.8 33.4 3.1 64.0 497 45-49 5.6 8.0 31.4 2.3 65.4 422 50-54 5.3 6.4 23.3 2.1 73.9 335 55-59 3.4 4.3 27.6 1.2 71.0 235 Residence Urban 27.3 49.9 62.8 17.6 21.9 916 Rural 3.9 3.7 25.7 0.5 71.6 5,117 Region Tigray 13.7 18.4 37.0 4.1 54.1 366 Affar 1.4 13.1 29.1 1.2 67.1 65 Amhara 4.6 5.7 24.9 1.4 71.4 1,521 Oromiya 6.5 10.2 35.6 2.9 61.0 2,222 Somali 2.0 3.4 22.0 1.2 77.0 202 Benishangul-Gumuz 1.9 6.8 35.0 0.3 61.9 54 SNNP 4.6 5.6 24.6 1.2 72.3 1,244 Gambela 5.4 8.4 33.4 1.6 62.6 21 Harari 22.2 41.8 70.9 15.0 22.1 16 Addis Ababa 37.5 54.7 55.7 20.7 21.4 292 Dire Dawa 17.5 34.2 51.9 9.7 38.9 30 Education No education 0.6 1.4 16.1 0.0 82.9 2,589 Primary 5.5 7.7 33.4 0.9 61.8 2,252 Secondary and higher 25.8 36.5 60.5 13.9 27.2 1,192 Wealth quintile Lowest 2.8 1.0 10.4 0.2 87.8 1,100 Second 1.7 2.9 18.6 0.4 79.5 1,184 Middle 6.3 3.6 25.0 0.3 70.3 1,081 Fourth 4.1 4.4 35.9 0.5 61.5 1,200 Highest 19.0 34.6 58.1 11.4 31.2 1,469 Total 7.4 10.7 31.3 3.1 64.0 6,033 The survey shows that exposure to media in Ethiopia is low, especially with regards to the print media. Respondents are more likely to be exposed to the radio than any other media. Men have greater access to mass media, particularly radio, than women. Specifically, men are twice as likely to listen to the radio as women (31 percent and 16 percent, respectively). Young women under 25 years of age are more likely to be exposed to mass media than older women, primarily because of their higher level of education. There is also a wide gap in exposure to mass media by place of residence. For example, the proportion of newspaper readers is highest among urban residents and those with some secondary or higher levels of education. When looking into the regional variation, women in Addis Ababa are more likely to read newspapers or magazines on a weekly basis than other women. Characteristics of Respondents | 39 There has been an increase in exposure to the media since 2000. The proportion of women who listen to the radio at least once a week has increased by 43 percent, from 11 percent in 2000 to 16 percent in 2005, while the proportion among men rose from 24 percent to 31 percent. There was also an increase in exposure to television, from 4 to 8 percent among women and from 8 to 11 percent among men. 3.4 EMPLOYMENT 3.4.1 Employment Status In the 2005 EDHS, respondents were asked a number of questions regarding their employment status, including whether they were working in the seven days preceding the survey and, if not, whether they had worked in the 12 months before the survey. The results for women and men are presented in Tables 3.5.1 and 3.5.2. At the time of the survey, about 3 of 10 women were currently employed and an additional 5 percent were not employed but had worked sometime during the preceding 12 months. Current employment generally increases with increasing age and women who are divorced, separated, or widowed are more likely to be employed than other women. Women who have four or less children are more likely to be employed than those with five or more children. There are notable variations in the proportion currently employed by place of residence and region. Urban women are more likely to be currently employed than rural women (40 percent compared with 27 percent).Women in Addis Ababa and Harari are most likely to be employed (44 percent and 41 percent, respectively), while Affar and Somali regions have the lowest proportions of employed women (11 percent each). Current employment increases with an increase in level of education; the proportion of employed women increases from 27 percent among uneducated women to 38 percent among those with some secondary education. There is also an increase in the percentage of employed persons by wealth quintile, with those in the highest quintile much more likely to be employed than those in the other four quintiles. A marked difference was observed in the level of employment by gender. The proportion currently employed is much higher among men than women. As can be seen from Table 3.5.2, the majority of men (86 percent) were employed at the time of survey. The majority of employed men are in rural areas and have little or no education. This is probably because the EDHS data collection took place during the peak agricultural season when most men in rural areas are likely to be engaged in farm work. Although the level of female employment is lower in 2005 than in 2000, the patterns for men are very similar. The marked difference in the percentage of women currently employed between 2000 (57 percent) and 2005 (29 percent) can be attributed to the difference in the way the data on current employment were collected for women in the two DHS surveys. There was no difference in the wording of the question on current employment for men between the two surveys. 40 | Characteristics of Respondents Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Ethiopia 2005 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing Total Number of women Age 15-19 24.0 4.2 65.8 6.0 100.0 3,266 20-24 29.6 5.9 60.5 3.9 100.0 2,547 25-29 28.8 6.1 60.5 4.6 100.0 2,517 30-34 30.2 5.7 60.6 3.5 100.0 1,808 35-39 31.2 4.6 59.2 4.9 100.0 1,602 40-44 33.0 6.6 56.0 4.4 100.0 1,187 45-49 31.6 5.1 60.6 2.8 100.0 1,143 Marital status Never married 31.2 3.4 60.2 5.2 100.0 3,516 Married or living together 25.5 6.0 63.9 4.6 100.0 9,066 Divorced/separated/widowed 44.3 6.0 47.2 2.5 100.0 1,488 Number of living children 0 30.4 4.7 60.0 4.9 100.0 4,554 1-2 29.5 6.4 60.1 4.0 100.0 3,226 3-4 29.7 5.7 60.2 4.4 100.0 2,981 5+ 25.5 5.0 64.8 4.6 100.0 3,309 Residence Urban 39.6 3.8 53.5 3.1 100.0 2,499 Rural 26.6 5.7 62.9 4.8 100.0 11,571 Region Tigray 27.6 16.8 51.5 4.1 100.0 919 Affar 11.3 0.6 82.5 5.6 100.0 146 Amhara 27.9 8.4 59.9 3.8 100.0 3,482 Oromiya 32.0 3.3 59.9 4.7 100.0 5,010 Somali 11.4 0.1 73.1 15.4 100.0 486 Benishangul-Gumuz 34.3 9.1 51.1 5.5 100.0 124 SNNP 24.5 3.0 68.3 4.2 100.0 2,995 Gambela 26.7 6.2 59.8 7.3 100.0 44 Harari 41.1 1.0 53.5 4.4 100.0 39 Addis Ababa 44.2 4.7 49.4 1.7 100.0 756 Dire Dawa 33.7 0.9 64.5 0.9 100.0 69 Education No education 27.2 5.6 62.5 4.6 100.0 9,271 Primary 29.1 4.9 60.9 5.1 100.0 3,123 Secondary and higher 38.0 4.6 54.5 2.9 100.0 1,675 Wealth quintile Lowest 23.5 5.7 64.4 6.4 100.0 2,428 Second 26.6 6.3 62.0 5.1 100.0 2,643 Middle 25.9 5.2 64.0 4.8 100.0 2,732 Fourth 29.6 5.3 61.9 3.2 100.0 2,647 Highest 35.9 4.6 55.9 3.7 100.0 3,621 Total 28.9 5.4 61.2 4.5 100.0 14,070 1 "Currently employed" is defined as having done work in the last seven days. Includes persons who did not work in the last seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents | 41 Table 3.5.2 Employment status: men Percent distribution of men by employment status, according to background characteristics, Ethiopia 2005 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing Total Number of men Age 15-19 63.0 2.0 34.3 0.6 100.0 1,335 20-24 79.8 3.4 16.5 0.4 100.0 1,064 25-29 91.9 2.8 5.3 0.0 100.0 741 30-34 97.6 0.7 1.5 0.2 100.0 754 35-39 97.3 0.6 2.1 0.0 100.0 651 40-44 96.3 1.6 2.0 0.0 100.0 497 45-49 95.5 0.9 3.5 0.0 100.0 422 50-54 96.6 0.8 2.5 0.0 100.0 335 55-59 93.4 0.8 5.8 0.0 100.0 235 Marital status Never married 69.0 3.1 27.4 0.5 100.0 2,419 Married or living together 97.0 0.9 2.1 0.0 100.0 3,424 Divorced/separated/widowed 92.0 1.0 7.1 0.0 100.0 190 Number of living children 0 72.5 2.9 24.2 0.4 100.0 2,766 1-2 95.8 1.1 2.9 0.1 100.0 993 3-4 97.6 0.4 1.9 0.0 100.0 967 5+ 96.7 1.1 2.1 0.0 100.0 1,307 Residence Urban 62.1 5.5 32.0 0.4 100.0 916 Rural 89.8 1.2 8.8 0.2 100.0 5,117 Region Tigray 80.5 6.2 13.2 0.2 100.0 366 Affar 92.0 2.1 5.9 0.0 100.0 65 Amhara 91.3 0.7 8.0 0.0 100.0 1,521 Oromiya 84.1 1.2 14.5 0.1 100.0 2,222 Somali 87.2 1.9 10.5 0.3 100.0 202 Benishangul-Gumuz 91.0 1.6 7.5 0.0 100.0 54 SNNP 86.4 1.5 11.5 0.7 100.0 1,244 Gambela 82.1 6.1 11.8 0.0 100.0 21 Harari 81.0 3.1 15.7 0.2 100.0 16 Addis Ababa 68.9 7.3 23.6 0.1 100.0 292 Dire Dawa 68.8 6.1 25.2 0.0 100.0 30 Education No education 97.4 1.0 1.6 0.0 100.0 2,589 Primary 83.9 1.4 14.5 0.2 100.0 2,252 Secondary and higher 63.2 4.4 31.8 0.6 100.0 1,192 Wealth quintile Lowest 92.8 1.4 5.6 0.1 100.0 1,100 Second 91.8 1.2 6.9 0.1 100.0 1,184 Middle 90.7 0.9 7.9 0.5 100.0 1,081 Fourth 86.4 1.6 11.9 0.1 100.0 1,200 Highest 70.8 3.5 25.4 0.3 100.0 1,469 Total 85.6 1.8 12.4 0.2 100.0 6,033 1 "Currently employed" is defined as having done work in the last seven days. Includes persons who did not work in the last seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 42 | Characteristics of Respondents 3.4.2 OCCUPATION Respondents who were currently employed or had worked in the 12 months preceding the survey were further asked to specify their occupation. Tables 3.6.1 and 3.6.2 show data on employed women and men, respectively, by occupation according to background characteristics. Most employed persons are engaged in the agricultural sector. Specifically, more than half of employed women and 84 percent of employed men are engaged in agricultural jobs. Sales and service is an important occupation category, especially for women, employing nearly a third of the women and about 7 percent of the men. Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Ethiopia 2005 Manual labour Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled Unskilled Agricul- ture Missing Total Number of women Age 15-19 0.3 0.3 35.6 4.9 5.0 52.2 1.6 100.0 922 20-24 3.9 2.0 35.4 4.6 6.4 45.6 2.1 100.0 905 25-29 6.1 1.1 33.6 5.7 6.1 47.0 0.5 100.0 879 30-34 5.8 1.8 28.3 6.3 4.8 51.8 1.3 100.0 648 35-39 4.6 1.1 28.2 7.6 3.8 54.1 0.6 100.0 574 40-44 3.4 1.2 24.7 8.1 2.4 58.4 1.6 100.0 470 45-49 2.1 0.4 24.7 7.2 3.6 61.0 1.0 100.0 419 Marital status Never married 5.1 2.7 43.6 5.5 6.9 35.0 1.3 100.0 1,217 Married or living together 3.6 0.6 24.8 5.0 3.1 61.8 1.2 100.0 2,854 Divorced/separated/widowed 2.2 1.0 36.3 10.8 8.8 39.5 1.5 100.0 748 Number of living children 0 4.4 2.1 40.6 5.9 6.2 39.3 1.5 100.0 1,596 1-2 5.8 1.4 29.1 5.6 6.2 50.6 1.2 100.0 1,157 3-4 3.2 0.3 25.5 6.5 3.8 59.8 0.9 100.0 1,056 5+ 1.0 0.3 25.2 6.2 2.6 63.4 1.3 100.0 1,010 Residence Urban 14.2 5.0 57.5 12.2 9.0 1.2 1.0 100.0 1,084 Rural 0.7 0.1 23.7 4.2 3.8 66.2 1.3 100.0 3,734 Region Tigray 5.5 1.6 15.3 4.5 20.1 52.1 0.9 100.0 408 Affar 8.1 3.5 37.0 10.3 19.7 20.8 0.5 100.0 17 Amhara 3.4 0.5 15.3 6.5 4.7 68.4 1.2 100.0 1,265 Oromiya 2.3 0.7 25.2 4.1 2.5 63.7 1.5 100.0 1,771 Somali 14.9 2.8 74.8 2.4 0.0 4.0 1.2 100.0 56 Benishangul-Gumuz 4.2 0.7 18.0 2.8 0.3 73.2 0.8 100.0 54 SNNP 1.0 0.4 58.8 9.5 2.0 27.5 0.8 100.0 824 Gambela 3.0 1.9 31.9 17.5 7.2 38.2 0.3 100.0 15 Harari 14.4 5.5 64.9 5.7 5.1 2.6 1.8 100.0 16 Addis Ababa 13.7 6.0 62.7 7.9 7.4 0.3 2.1 100.0 370 Dire Dawa 7.0 4.0 73.9 3.3 11.1 0.0 0.7 100.0 24 Education No education 0.1 0.0 25.8 5.6 4.4 62.8 1.3 100.0 3,042 Primary 0.0 0.4 37.8 6.4 6.0 48.1 1.4 100.0 1,063 Secondary and higher 25.0 7.3 45.1 7.3 5.7 8.5 1.2 100.0 714 Wealth quintile Lowest 0.0 0.0 19.0 3.0 5.3 70.3 2.3 100.0 709 Second 0.2 0.0 18.9 6.3 5.0 68.3 1.3 100.0 870 Middle 0.0 0.0 22.8 5.0 3.3 68.1 0.9 100.0 851 Fourth 0.0 0.2 28.8 3.7 3.7 62.4 1.2 100.0 924 Highest 12.2 3.7 51.2 9.3 6.5 16.0 1.1 100.0 1,465 Total 3.8 1.2 31.3 6.0 4.9 51.5 1.3 100.0 4,819 Characteristics of Respondents | 43 Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Ethiopia 2005 Manual labour Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled Unskilled Agricul- ture Missing Total Number of men Age 15-19 0.1 0.1 6.4 2.0 2.6 88.3 0.6 100.0 869 20-24 1.9 0.2 9.8 4.2 3.8 79.6 0.6 100.0 884 25-29 2.7 0.3 8.0 4.3 3.6 80.3 0.7 100.0 702 30-34 1.8 0.0 5.1 5.7 1.9 84.5 0.9 100.0 741 35-39 3.9 0.4 7.5 2.1 1.4 84.0 0.6 100.0 637 40-44 5.8 0.1 5.9 3.2 1.5 82.1 1.4 100.0 487 45-49 4.7 0.1 4.4 2.2 2.0 85.8 0.7 100.0 407 50-54 3.2 0.1 2.8 1.4 1.7 90.3 0.6 100.0 326 55-59 1.7 0.2 7.2 1.3 2.5 87.1 0.0 100.0 221 Marital status Never married 1.9 0.2 9.2 5.0 3.9 79.3 0.5 100.0 1,745 Married or living together 2.9 0.2 5.5 2.2 1.7 86.7 0.8 100.0 3,353 Divorced/separated/widowed 4.4 0.0 5.6 5.6 4.0 79.9 0.5 100.0 177 Number of living children 0 1.8 0.2 8.6 4.6 3.6 80.9 0.4 100.0 2,084 1-2 3.9 0.2 8.9 4.9 2.5 78.3 1.3 100.0 963 3-4 4.1 0.3 5.0 1.2 2.0 86.5 1.0 100.0 948 5+ 1.8 0.1 3.5 1.5 1.0 91.7 0.5 100.0 1,279 Residence Urban 15.8 1.4 37.0 24.4 14.5 6.3 0.7 100.0 620 Rural 0.8 0.0 2.7 0.5 0.9 94.4 0.7 100.0 4,655 Region Tigray 4.0 0.8 8.0 3.3 5.1 78.4 0.5 100.0 317 Affar 4.6 1.1 15.2 4.7 4.4 67.9 2.2 100.0 61 Amhara 1.1 0.0 3.5 2.0 1.1 91.7 0.6 100.0 1,400 Oromiya 2.2 0.1 5.3 1.9 2.5 87.2 0.7 100.0 1,896 Somali 3.8 0.0 6.7 0.4 2.0 86.9 0.2 100.0 180 Benishangul-Gumuz 2.0 0.0 3.3 1.8 0.8 91.3 0.7 100.0 50 SNNP 1.6 0.0 5.4 1.5 1.7 89.0 0.9 100.0 1,093 Gambela 5.3 0.4 10.5 2.0 6.8 74.4 0.5 100.0 18 Harari 11.5 0.4 23.7 9.7 10.3 42.2 2.2 100.0 14 Addis Ababa 14.9 1.5 39.0 32.5 10.1 1.2 0.9 100.0 222 Dire Dawa 9.4 1.3 29.3 13.2 11.6 34.7 0.5 100.0 22 Education No education 0.1 0.0 3.0 0.5 1.1 94.8 0.6 100.0 2,547 Primary 0.3 0.0 6.1 2.0 2.6 88.2 0.7 100.0 1,922 Secondary and higher 15.9 1.1 20.1 15.1 6.6 40.1 1.1 100.0 806 Wealth quintile Lowest 0.0 0.0 1.9 0.0 0.7 96.8 0.5 100.0 1,037 Second 0.3 0.0 2.0 0.4 0.5 96.3 0.5 100.0 1,101 Middle 0.0 0.0 1.9 0.4 0.2 96.4 0.9 100.0 991 Fourth 0.7 0.0 3.2 0.7 1.7 93.2 0.5 100.0 1,055 Highest 11.4 0.8 24.0 14.4 8.9 39.4 1.0 100.0 1,091 Total 2.6 0.2 6.8 3.3 2.5 84.0 0.7 100.0 5,274 44 | Characteristics of Respondents Six percent of employed women are skilled manual workers, while 5 percent are engaged as unskilled manual workers. Only 4 percent of employed women work in the professional, technical, and managerial fields. Women are less likely to be highly educated and less likely to have attended vocational or technical schools. Therefore, their employment in the professional, technical, and managerial sector is somewhat low compared with men. The analysis of occupation by background characteristics suggests that the proportion of women with jobs in sales and services decreases as age increases and that married women are more likely to be employed in agricultural work than other women. Never-married women, on the other hand, are more likely to be employed in sales and services and in clerical work. Residence has a significant effect on the type of occupation. As expected, two-thirds of employed women and 94 percent of employed men in rural areas are engaged in agricultural work. Most educated women are employed in sales and services and professional, technical, and managerial occupations, whereas women with little or no education tend to be employed in the agricultural sector. Agriculture is by far the most important occupation for working women in the lower wealth quintiles. Employment outside the agricultural sector is greatest among men with secondary or higher education and men in the highest wealth quintile. 3.4.3 Earnings, Employers and Continuity of Employment Table 3.7.1 shows the percent distribution of employed women by type of earnings and employment characteristics. The table takes into account whether women are involved in agricultural or nonagricultural oc- cupations, because all of the employ- ment variables in the table are strong- ly influenced by the sector in which a woman is employed. An overwhelming majority (81 percent) of women engaged in agricultural work are unpaid workers most likely employed by family members at the peak of the agri- cultural season. Women are more likely to be paid in cash if they are employed in the nonagricultural sector; about three-fourths of the women employed in this sector are paid in cash. Overall, more than half (52 percent) of employed women are not paid at all and only 40 percent earn cash for their work. Six out of 10 employed women work for a family member, and about 27 percent are self- employed. Only 14 percent of em- ployed women work for someone outside the family. Table 3.7.1 Type of employment: women Percent distribution of 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), Ethiopia 2005 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 2.5 73.8 36.4 Cash and in-kind 3.6 2.7 3.1 In-kind only 12.6 2.7 7.8 Not paid 81.1 20.6 52.3 Missing 0.1 0.2 0.4 Total 100.0 100.0 100.0 Type of employer Employed by family member 75.4 42.5 59.5 Employed by nonfamily member 3.1 25.0 13.6 Self-employed 21.5 32.4 26.7 Missing 0.0 0.1 0.2 Total 100.0 100.0 100.0 Continuity of employment All year 5.8 63.0 33.2 Seasonal 88.5 14.1 52.6 Occasional 5.5 22.9 13.9 Missing 0.2 0.0 0.3 Total 100.0 100.0 100.0 Number of women 2,484 2,273 4,819 Note: Total includes women with missing information on type of employment who are not shown separately. Characteristics of Respondents | 45 Three-quarters of women working in the agricultural sector are working for a family member compared with 43 percent working in the nonagricultural sector. In addition, the proportion of women employed by someone outside the family is higher among those working in the nonagricultural sector than those in the agricultural sector (25 percent versus 3 percent). Generally, a third of employed women work all year round while 53 percent work seasonally. Those who work occasionally account for 14 percent. As in the case of type of earning and employer, continuity of employment also varies by sector of employment. Around 9 in 10 women employed in the agricultural sector are seasonal workers compared with only 14 percent among those working in the nonagricultural sector. On the other hand, continuity of employment is more assured for women engaged in nonagricultural work than those in agricultural work. For example, 63 percent of women working in the nonagri- cultural sector work all year compared with only 6 percent of women engaged in agri- cultural work. Male respondents were only asked questions on type of earning. Table 3.7.2 shows that only 3 in 10 employed men are paid in cash. Eighty-four percent of men employed in nonagricultural work are paid in cash compared with 18 percent among those engaged in agricultural work. Table 3.7.2 Type of employment: men Percent distribution of men employed in the 12 months preceding the survey by type of earnings, according to type of employment (agricultural or nonagricultural), Ethiopia 2005 Type of earnings Agricultural work Nonagricultural work Total Cash only 7.7 82.4 19.3 Cash and in-kind 10.5 1.9 9.2 In-kind only 23.6 1.1 20.1 Not paid 58.2 14.4 51.4 Missing 0.0 0.2 0.0 Total 100.0 100.0 100.0 Number of men 4,432 806 5,274 Note: Total includes men with missing information on type of employment who are not shown separately.   Fertility | 47 FERTILITY 4 Fertility is one of the three principal components of population dynamics that determine the size and structure of the population of a country. This chapter presents the 2005 EDHS results on the levels, trends, and differentials in fertility. The analysis is based on birth history information collected from women age 15-49 interviewed during the survey. Each eligible woman was asked a series of questions on the number of sons and daughters who were living with her, the number living elsewhere, and the number who had died, in order to obtain the total number of live births she had had in her lifetime. For each live birth, information was also collected on the name, sex, age and survival status of the child. For dead children, age at death was recorded. Information from the birth history is then used to assess current and completed fertility and factors related to fertility such as age at first birth, birth intervals, and adolescent childbearing. 4.1 CURRENT FERTILITY Measures of current fertility are presented in Table 4.1 for the three-year period preceding the survey, corresponding to the calendar period 2003- 2005. A three-year period was chosen because it reflects the most current information, while also allowing the rates to be calculated on a sufficient number of cases so as not to compromise the statistical precision of the estimate. Several measures of current fertility are shown. Age-specific fertility rates (ASFRs), expressed as the number of births per thousand women in a specified age group, are calculated by dividing the number of live births to women in a specific age group by the number of woman-years lived in that age group The total fertility rate (TFR) is a common measure of current fertility and is defined as the total number of births a woman would have by the end of her childbearing period if she were to pass through those years bearing children at the currently observed age- specific fertility rates. The general fertility rate (GFR) is the number of live births occurring during a specified period per 1,000 women age 15-44. The crude birth rate (CBR) is the number of births per 1,000 population during a specified period. Table 4.1 shows current fertility levels for Ethiopia as a whole, and for urban and rural areas. The total fertility rate for Ethiopia is 5.4 births per woman. As expected, fertility is considerably higher in the rural areas than urban areas. The TFR in the rural areas is 6.0, two and half times higher than the TFR in the urban areas (2.4). As the ASFRs show, this pattern of higher rural fertility is prevalent in all age groups (Figure 4.1). The urban-rural difference in fertility is especially pronounced among women age 20-34. The overall age pattern of fertility as reflected in the ASFRs indicates that childbearing begins early. Fertility is low among adolescents and increases to a peak of 241 births per 1,000 among women age 25-29 and declines thereafter. Table 4.1 Current fertility Age-specific and total fertility rate, the general fertility rate and the crude birth rate for the three years preceding the survey, by residence, Ethiopia 2005 Residence Age group Urban Rural Total 15-19 35 122 104 20-24 105 260 228 25-29 133 261 241 30-34 101 253 231 35-39 58 178 160 40-44 28 94 84 45-49 14 38 34 TFR (15-49) 2.4 6.0 5.4 GFR 77 200 179 CBR 23.4 37.3 35.7 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 48 | Fertility 4.2 FERTILITY DIFFERENTIALS Table 4.2 and Figure 4.2 present differentials in the total fertility rates, the percentage of women who are currently pregnant and the mean number of children ever born (CEB) to women age 40-49, by residence, region, education and wealth quintile. There are substantial differentials in fertility among regions, ranging from a low of 1.4 children per woman in Addis Ababa to a high of 6.2 children per woman in Oromiya. With the exception of Oromiya, Somali and SNNP, fertility levels in the other 8 regions are less than the national average. The level of fertility is inversely related to women’s educational attainment, decreasing rapidly from 6.1 children among women with no education to 2.0 children among women who have at least some secondary education. Fertility is also associated with wealth quintile. Women in the lowest wealth quintile have a TFR of 6.6, twice as high as that of women in the highest quintile (3.2). Table 4.2 also presents a crude assessment of trends in the various subgroups by comparing current fertility with a measure of completed fertility: the mean number of children ever born to women age 40-49. The mean number of children ever born to older women who are nearing the end of their reproductive period is an indicator of average completed fertility of women who began childbearing during the three decades preceding the survey. If fertility remained constant over time and the reported data on both children ever born and births during the three years preceding the survey are reasonably accurate, the TFR and the mean number of children ever born for women 40-49 are expected to be similar. When fertility levels have been falling, the TFR will be substantially lower than the mean number of children ever born among women age 40-49. The comparison suggests that fertility has fallen by more than one child during the past few decades, from 6.9 children per woman to 5.4. Fertility has declined in both rural and urban areas, in all regions, at all educational levels, and for all wealth quintiles. The difference between the level of current and completed fertility is highest in Addis Ababa (3 children), in all urban areas (2.7 children), and among women in the highest wealth quintile (2.7 children). � � � � � � � 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Group 0 50 100 150 200 250 300 Births per 1,000 Women Urban Rural Total� EDHS 2005 Figure 4.1 Age-specific Fertility Rates by Urban-Rural Residence Fertility | 49 Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Ethiopia 2005 Background characteristic Total fertility rate Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 2.4 2.5 5.1 Rural 6.0 9.7 7.3 Region Tigray 5.1 8.6 6.8 Affar 4.9 8.9 5.8 Amhara 5.1 7.2 7.0 Oromiya 6.2 9.0 7.1 Somali 6.0 10.0 6.7 Benishangul-Gumuz 5.2 10.2 6.7 SNNP 5.6 10.2 7.5 Gambela 4.0 8.3 5.3 Harari 3.8 6.7 5.2 Addis Ababa 1.4 1.5 4.4 Dire Dawa 3.6 3.9 5.6 Education No education 6.1 10.1 7.1 Primary 5.1 6.7 5.8 Secondary and higher 2.0 2.2 4.2 Wealth quintile Lowest 6.6 10.2 6.9 Second 6.0 11.0 7.0 Middle 6.2 10.5 7.4 Fourth 5.7 8.3 7.6 Highest 3.2 3.8 5.9 Total 5.4 8.4 6.9 1 Women age 15-49 years 5.4 2.4 6.0 6.1 5.1 2.0 5.1 4.9 5.1 6.2 6.0 5.2 5.6 4.0 3.8 1.4 3.6 ETHIOPIA RESIDE

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