Georgia Reproductive Health Survey 2010-2011

Publication date: 2012

F I N A L R E P O R T Reproductive Health Survey Georgia 2010 Reproductive Health Survey Georgia 2010 F I N A L R E P O R T National Center for Disease Control and Public Health (NCDC) Ministry of Labor, Health, and Social Affairs (MoLHSA) National Statistics Office of Georgia TBILISI, GEORGIA Division of Reproductive Health, Centers for Disease Control and Prevention (DRH/CDC) ATLANTA, GEORGIA USA United Nations Population Fund (UNFPA) United States Agency for International Development (USAID) The United Nations Children’s Fund (UNICEF) 2012 FINAL REPORT i Authors and Contributors: National Center for Disease Control and Public Health: M. Butsashvili - RHS Scientific Committee Director G. Kandelaki L. Sturua M. Shakh-Nazarova N. Mebonia N. Avaliani Panel of Experts: Z. Bokhua T. Asatiani Z. Sinauridze G. Tsuladze K. Chkhatarashvili J. Kristesashvili G. Tsagareishvili Division of Reproductive Health, Centers for Disease Control and Prevention: Florina Serbanescu Vasili Egnatashvili Alicia Ruiz Danielle Suchdev Mary Goodwin Editor in Chief - John Ross Cover: Openwork Buckle: Sheuba, 2nd-3rd centuries AD, bronze. (Artwork preserved at the Treasury of the Georgian National Museum) © Georgian National Museum (GNM); www.museum.ge This report is funded by UNFPA and UNICEF Joint Project “Support to Georgian RH Survey, 2010” The Preliminary Report of the survey was funded by the United States Agency for International Development (USAID) agreement with the Division of Reproductive Health of the Centers for Disease Control and Prevention and USAID Contract No. HRN-C-00-97-0019-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of UNFPA, UNICEF and USAID. Additional information about this report may be obtained from the National Center for Disease Control and Public Health (NCDC): 9, M. Asatiani str., Tbilisi 0177, Georgia Tel. :(995 32) 239 89 46 Fax : (995 32) 231 14 85 e-mail: ncdc@ncdc.ge The report was printed by: Vesta, Ltd (Tbilisi, Georgia) REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 2ii This report presents the findings of the 2010 Georgia Reproductive Health Survey (GERHS10). The GERHS10 is the third nationally representative survey to collect comprehensive information on reproductive health status and utilization of reproductive health and maternal and child health care services in the country. The first two surveys took place in 1999 and 2005 and provided a baseline and follow-up for numerous and essential health indicators that can track changes in family planning, maternal and child health, and other reproductive health efforts. Results showing low usage of modern contraception and high rates of unintended pregnancies were instrumental in designing and implementing new health strategies and programs and promoting health care reforms. Since then, maternal and child health services were strengthened, family planning supply efforts have been intensified, the number of sites and physicians providing family planning services has been expanded and reproductive health information, education and communication activities were strengthened. The efforts to improve the health of women, infants and children are at the core of the health care reforms in Georgia. The National Healthcare Strategy 2011-2015 “Access to Quality Healthcare” targets enhancement of maternal and child health services. For these efforts to be successful, public health professionals have to identify the needs of women and children, to design and implement appropriate interventions, and to monitor and evaluate those interventions. The Ministry of Labor, Health and Social Affairs (MoLHSA) is directly responsible for implementing reproductive health reforms, including: compliancy with international standards and treaties in the health sector; provision and access of high quality healthcare for mothers and children; establishment of an international standard infrastructure for health care services; and maternal and child death reviews to help design the most appropriate evidenced-based preventive measures. The surveys provide the MoLHSA with a much needed ability to track progress in program outcomes, formulate targeted interventions, monitor the national development programs, and report on progress toward the Millennium Development Goals (MDGs). By making available appropriate national and region specific data on reproductive health status and service delivery and enhancing the ability of local organizations to collect, analyze and disseminate such information, these three surveys brought a tremendous contribution to fostering collaboration among governmental agencies (MoLHSA, National Reproductive Health Council, National Center for Disease Control and Public Health), international donors (USAID, UNFPA and UNICEF) and technical experts (Centers for Disease Control and Prevention), whose common goal was to inform policies and advance appropriately designed reproductive health sector reforms. It is my pleasure and privilege to express my gratitude to these organizations for their dedication and allocation of time and resources. To my staff and all of the individuals involved in bringing this work to successful completion, my deepest thanks for your invaluable contributions. Preface Zurab Tchiaberashvili Minister of Labor, Health and Social Affairs of Georgia FINAL REPORT iii REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 4iv The 2010 Georgian Reproductive Health Survey (GERHS10) was conducted by the Georgian Center for Disease Control and Public Health (NCDC) in collaboration with the Georgian Ministry of Labor, Health, and Social Affairs (MoLHSA) with the support of United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and United States Agency for International Development (USAID). The Division of Reproductive Health of the United States Centers for Disease Control and Prevention (CDC/DRH) provided technical assistance on the survey design, questionnaire development, training, data processing and summary report writing. The NCDC and CDC/DRH wish to express their appreciation to those involved in the implementation of the 2010 Georgian Reproductive Health Survey and the preparation of this report. Particular thanks go to the Ministry of Labor, Health and Social Affairs for its chairmanship of the steering committee and the National Reproductive Health Council, chaired by Ms. Sandra Elisabeth Roelofs, The First Lady of Georgia, for its leadership in reproductive health in the country. Special thanks are extended to Mr. John Ross, Editor-in-Chief of the final report of the survey, and the team of national experts who have contributed to the development of the report. Our special thanks go to the United States Agency for International Development (USAID) who provided generous financial resources for implementation of the study and developed over the years the NCDC’s capacity to conduct population-based health studies; the technical assistance of DRH/CDC and the preparation of the summary survey report were supported by USAID. We are particularly grateful to Tamara Sirbiladze, Senior Health and Infectious Diseases Advisor, Jeri Dible, Director, Health and Social Development Office, Jonathan Conley, Mission Director, and Nana Chkonia, Programme Assistant, USAID Caucasus, Georgia — for their continuous support of NCDC and DRH/CDC and the catalyst contribution to the study. We are very grateful for the contribution provided by the United Nations Population Fund (UNFPA) and United Nations Children’s Fund (UNICEF), whose generous funding and technical expertise were essential in survey planning, fieldwork activities, and dissemination of the results. Particularly, we would like to acknowledge the UNFPA staff in Georgia — Tamar Khomasuridze, UNFPA Georgia Assistant Representative, Lela Bakradze, Programme Analyst, and Marina Tsintsadze, Admin/ Finance Associate and the UNICEF staff — Roeland Monasch, UNICEF Representative in Georgia and Tinatin Baum, Social Policy Specialist — for their assistance in design, planning and financial management. Most of all, we would like to thank the households whose participation made it possible to obtain the reliable information collected in the survey and advanced our knowledge of women’s reproductive health in Georgia. We are grateful to our highly skilled interviewers, supervisors, and data entry personnel for their commitment, discipline, and dedication to the project. This report was prepared by the NCDC with the invaluable guidance and contributions of many individuals, both inside and outside NCDC. Acknowledgements FINAL REPORT v REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 6vi Georgia is a country with a strong cultural identity. Ethnic Georgians represent 84% of the total popu- lation, with Armenians and Azeri the largest ethnic minorities. Women’s health in Georgia is strongly in- fluenced by cultural, historical, and socioeconomic factors. The previous Communist regime, notori- ous for its lack of support for family planning, had a profound impact on women and their reproductive health. Due to a significant decline in socioeconomic conditions in the 1990s, the health of the population deteriorated seriously. In response to the collapse of the publicly-supported hospital-based health system, Georgia initiated an extensive health sector reform in the mid-1990s. The process was designed to address all aspects of the health-care sector and to emphasize quality of care, improved access, efficiency, and reha- bilitation of the primary health care system. Decen- tralization and, since 2007, privatization, have been major components of the reform process. The privati- zation of hospitals called for full transfer of ownership to the private sector. Primary health care services are also in various stages of privatization. Despite the pro- gress made during the last decade, health care expen- ditures comprise a decreasing portion of public ex- penditures, resulting in the underfunding of medical facilities, as well as family planning and reproductive health services. Over the past several years, the United States Agency for International Development (USAID), the United Nations Population Fund (UNFPA), and other multi- lateral and bilateral donors have invested resources to improve access to family planning and other re- productive health services in Georgia. Through funds provided by USAID and UNFPA, a series of nationwide Reproductive Health Surveys (RHS) was conducted in 1999, 2005 and 2010. These surveys were developed by the U.S. Centers for Disease Control and Preven- tion (CDC), in response to the need to obtain detailed reproductive, maternal and child health indicators, with international comparisons. They draw upon CDC’s expertise with survey methodologies in the U.S. combined with its international experience, regard- ing family planning, maternal and child health, and women’s health. In many counties, including Georgia, these surveys have been the main source of popula- tion-based data for reproductive health policies and planning. The demographic and reproductive health indicators provided by the surveys serve multiple pur- poses: to examine health trends, set targets for im- provement, allocate resources, monitor performance, measure program achievements, prioritize activities, guide research, and allow global comparisons in re- productive health. A major purpose of the surveys in Georgia was to pro- duce national and sub-national estimates of factors related to pregnancy and fertility, such as sexual activ- ity and contraceptive use; use of abortion and other medical services; maternal and infant health, and women’s health. The first RHS was conducted in Geor- gia in 1999; a new cycle was implemented in 2005, fol- lowed by the most recent cycle, implemented in 2010. As with the first two rounds, the Georgian Ministry of Labor, Health and Social Affairs (MoLHSA) conducted the survey in collaboration with the Georgian National Center for Disease Control (NCDC). The CDC provided technical assistance with the survey design, sampling, questionnaire development, training, data processing and analysis to all three surveys through funding from USAID. Local costs were primarily covered by UNFPA and UNICEF. All three surveys employed large, nationally repre- sentative, probability samples and collected informa- tion on a wide range of health related topics from women aged 15–44 who were interviewed in their homes. The samples were selected in such a man- ner as to allow separate urban and rural, as well as regional-level estimates. In the most recent Georgian RHS (GERHS10), 13,363 households were visited and 6,292 women were successfully interviewed, yield- ing a response rate of 99%. Virtually all respondents who were selected to participate and who could be reached agreed to be interviewed. Several findings of the GERHS10 are highlighted be- low. GERHS10 Overview • Set within the context of overall social and economic development in Georgia, the aim of the 2010 survey was to obtain national and regional esti- mates of basic demographic and reproductive health indicators and compare them to previous RHS results. • In response to the decentralization of health activities, the survey employed a sample design that produced estimates for 11 regions of the country and for rural vs. urban sectors, to enable key stakeholders to assess reproductive health indicators at the subna- tional level. • The survey employed a stratified multistage sampling design, similar to the design used in the 1999 and 2005 cycles. Characteristics of Households and Respondents • While the majority of households had tap wa- ter in their residence or yard (76%) there is a great dis- parity between urban and rural households (96% vs. 55%). Overall, 98% of urban and 88% of rural house- Executive Summary FINAL REPORT vii holds in Georgia use improved sources of drinking wa- ter (tap water and water from protected wells). • Overall, 96% of urban households and 71% of rural households using improved sanitation facilities. • The distribution of the Georgian popula- tion across the wealth quintiles varied greatly by residence; almost three in four (74%) of urban house- holds were classified in the two highest wealth quin- tiles while only 3% of rural households were in these wealth groups. • The majority of respondents were of Geor- gian ethnicity (87%), followed by Azeri (5%) Armenian (5%) and other ethnicities (3%). Respondents belong- ing to minority ethnic groups were more likely to live in rural areas than in urban areas. • Eighty two percent of women were Georgian Orthodox and 11% were Muslim. • Educational attainment is wide-spread in Georgia with 77% of women reporting at least com- pletion of secondary education. Thirty-nine percent of women had gone on to complete university or post- graduate education. Tbilisi residents reported much higher educational attainment than in other regions: 60% of respondents have undergone university train- ing while only 13% did not complete secondary educa- tion. • Boys and girls are equal in the percent enter- ing grade 1 and in the percent transitioning from pri- mary to secondary school. • Most women (79%) reported not working outside of the house, a situation that was even more pronounced in rural areas (87%) where job availability is very low. Marriage and Fertility • Nearly 60% of women in the sample (aged 15-44) were married or in consensual unions, 7% were divorced or separated, and 34% had never been mar- ried. • The TFR (total fertility rate) calculated from the 2010 survey, of 2.0 births per woman (95%CI=1.9– 2.1) for the period 2007–2010, is the highest survey- based TFR ever reported for Georgia. It is 25% higher than the TFR of 1.6 births per woman (95%CI=1.4–1.7) observed for 2002–2005. • Traditionally, Georgian women initiate and complete childbearing at an early age, as reflected in very high age-specific fertility rates for young women. The highest fertility levels were at ages 20-24 and 25- 29, accounting for 36% and 29%, respectively, of the TFR. Fertility among adolescent women (39 births per 1,000 women aged 15–19) contributed to only 10% of the TFR. Fertility among women aged 30–34 was the third-highest ASFR, contributing 15% of the TFR. • Compared to the 2005 survey, age-specific fertility rates increased in all but one age group (ado- lescent women) suggesting a gradual transition to fer- tility postponement in Georgia. • Generally, peak fertility occurred at ages 25– 29 among women with the highest educational attain- ment, whereas at lower educational levels it occurred at ages 20–24. This partially reflects differences in the age at marriage. Fertility rates of ethnic minorities, particularly among the Azeri group (2.4 children per woman) were higher than those of the Georgians, the major ethnic group (2.0 children per woman), due to much higher ASFRs among Azeri women aged 15–24. Pregnancy Intention Status • Most women who have been pregnant in the past 5 years reported the last pregnancy as planned and only 36% said they had an unplanned pregnan- cy—11% mistimed and 26% unwanted. This compares to the higher levels of 51% of women reporting their last pregnancy as unplanned in 2005 and 59% in 1999. Mistimed pregnancies represented a larger share of unplanned pregnancies in 2010 than in previous sur- veys, suggesting that more women than in the past want to postpone rather than end childbearing. • Nearly all women whose last pregnancy end- ed in induced abortion reported that their concep- tions were unplanned (96%). • Thirty-five percent of women currently mar- ried or in consensual union wanted more children, compared to 25% in 1999 (a 40% increase). This trend was consistent regardless of the number of living chil- dren. Particularly notable was the relatively high pro- portion of women with two or more children who said in 2010 that they wanted more children (21% com- pared to only 12% in 1999). • The desire to have more children was very high among young women (89% at ages 15-19 and 73% at ages 20–24), dropping to 47% at ages 25-29 and declining further among women aged 30 or older. • Between 1999 and 2010, there were nota- ble changes in the timing of wanting a(another) child, according to the current age. Among the youngest women, the proportion who wanted a child within two years declined by 29% (from 61% to 44%); the percent saying they wanted no more fell from 14% to 7%. Similar declines occurred in each older age group. • Among fecund married women who had had two or more children, the majority (68%) were ready to terminate childbearing. This pattern is similar to the one documented in the 1999 and 2005 surveys, but in 2010 fewer women with two or more children said they did not want to have a(another) child. Induced Abortion • The survey data allow for calculation of the total induced abortion rate (TIAR), which gives the REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 8viii number of abortions a woman would have in her life- time under the current age specific induced abortion rates (ASIARs). Previous RHS surveys showed a steep increase in the TIAR after 1990, when the USSR broke up, with a peak of 3.7 abortions per woman in 1997– 1999. The abortion rate declined gradually to 3.1 abortions per woman (95%CI= 2.9–3.4 abortions per woman) in 2002–2005. Between 2005 and 2010, the abortion rate dropped significantly to 1.6 abortions per woman (95%CI= 1.5–1.8 abortions per woman), a 48% decline from 3.1, or 57% from 3.7. • The estimated TIAR for the period 2007–2010 according to official sources was only 0.9 abortions per woman (44% lower than the rate documented in the survey but an improvement from over 80% under- reporting documented in 1999 and 2005). • More than one-half of Georgian women ob- taining abortions in 2007–2010 were aged 25–29 (102 abortions per 1,000 women) and 30–34 (83 abortions per 1,000 women). The third highest age specific abor- tion rate, contributing to 25% of the TIAR, occurred among women aged 35–39. The ASIARs were signifi- cantly higher than ASFRs only among women aged 30 or older, suggesting that most Georgian women con- tinue to achieve their desired family size before age 30 after which, in the event of having unplanned preg- nancies, they are more likely to end them in induced abortions. • The survey-based estimate of the abortion- to-live–birth ratio changed from to 2.1 induced abor- tions for each live birth (2.1:1) in 1999, to 1.5:1 in 2005, and to 0.8:1 in 1999. Thus, birth experience surpassed abortion experience for the first time since survey-based reports were collected. This was mainly achieved by a combination of increases in fertility and declines in abortion at ages 20–24, 25–29, and 30–34, which contribute the most to both total fertility and total abortion rates. • Higher abortion rates among rural women, less educated women, and women of Azeri descent suggest that access to services is unequal and that Georgia’s family planning program needs to expand its reach to disadvantaged subgroups. • The main reasons given for choosing abortion included: desire to stop childbearing (51%), desire to space the next birth (18%), and socioeconomic cir- cumstances that prevent the family from supporting another child (20%). • Of all abortions reported by survey respond- ents during the past 5 years, 71% were mini-abortions; this is sharply up from 40% in 1999 and 56% in 2005. • Most induced abortions occurring in 2005 or later were performed in gynecological wards (56%); 42% were performed in ambulatory clinics, such as women’s consultation clinics (WCCs); and 2% were performed outside medical facilities. Regarding fees, the average abortion payment did not vary by type of medical facility. At the time of the survey, mean charg- es for an abortion procedure were about US$29.00, which represents an increase of 65% compared to the average cost in 2005. • Few family planning services are received around the time of having an abortion. While one in three (33%) respondents with a history of abortion in 2005-2010 reported receiving contraceptive coun- seling before or/and after the abortion; only 6.6% of women (20% of women who received counseling) received a contraceptive method to prevent future unintended pregnancies; and an additional 7.4% of women received a prescription for contraceptive sup- plies (22% of all women counseled). • Receipt of contraceptive information in 2010 was however more than twice the level documented in the 1999 survey (33% vs. 15%). Actual receipt of a contraceptive method or prescription for a method almost tripled, from 5% to 14%, both rather low rates but improving. Maternal and Child Health Services • Use of prenatal care was almost universal: 98% of pregnant women received at least one prena- tal examination. Initiation of prenatal care in the first trimester was more common in urban areas than in rural areas (93% vs. 86%) and was most widespread in Tbilisi (94%). • Ninety percent of women received at least 4 prenatal care visits and this was more common among women in urban areas (95%) than in rural areas (86%). • One in two women received most of their prenatal care from women’s consultation clinics (49%) and 44% received their care from regional maternity hospitals. Only 7% of the women received care from primary care clinics or family medicine centers. • In both 1999 and 2005, about one in twelve births (8%) was delivered at home, the majority with- out skilled attendance; in 2010 only 2% of births were delivered at home. Home births were slightly higher among Azeri women (5%), but in clear decline com- pared to the level of 40% home deliveries among this ethnic group in 2005. • Eighty four percent of newborns received a well-baby checkup but only 23% of women reported receiving postpartum care in 2010. Use of postpartum care was also low in 2005 (23%), indicating that this service is still vastly underutilized in Georgia. • Virtually all (97%) babies born alive in 2005– 2010 were registered, according to the mother; how- ever, registered births ranged from a low of 92% in the region of Kakheti to a high of 99% in the region of Samtskhe-Javakheti. Home births were least likely to be registered (67%). FINAL REPORT ix Breastfeeding • The majority (87%) of infants born within the five years leading up to the 2010 survey had been breastfed, virtually unchanged compared to 1999 and 2005. Georgian women reported lower rates of breastfeeding than women of other ethnicities. • Since the 1999 survey, the proportion of ba- bies who were breastfed within the first hour after birth increased by 4 times (from 5% in 1999 to 10% in 2005 and 20% in 2010), while the proportion of those who received breast milk 1–23 hours after birth dou- bled, from 28% to 55%. • On average, the duration of any breastfeed- ing was 12.1 months, 2 months longer from the 10.1 months recorded in the 2005 survey. The duration of full breastfeeding (either exclusive breastfeeding or predominantly breastfeeding) was 4.1 months, longer than the 3.7 months documented in the 1999 and 2005 surveys. Perhaps the most important gain was in the duration of exclusive breastfeeding (only breast milk), which doubled from the level documented in the 1999 survey (from 1.5 to 3 months). Perinatal & Childhood Mortality • Of all births that occurred during the five years prior to the survey, 8 per 1,000 were stillbirths. The stillbirth rate was highest among women who did not receive any prenatal care (50 stillbirths per 1,000), women who suffered complications during their preg- nancies (34 stillbirths per 1,000), women who had prolonged labor (30 stillbirths per 1,000) and women who delivered after age 35 (11 stillbirths per 1,000). • The infant mortality rate, the rate at which babies less than one year of age die, has continued to decline steadily, from 41.6 per 1,000 live births in 1995–1999 to 21.1 per 1,000 live births in 2000–2004 and to 14.1 per 1,000 live births in 2005-2009. The ne- onatal mortality rate (deaths in the first month of life) went down from 25.4 per 1,000 live births in 1995– 1999 to 16.8 per 1,000 live births in 2000–2004 and even lower to 9.5 per 1,000 live births in 2005-2009. • A two-thirds reduction in mortality before age five between 1990 and 2015 is centrally formu- lated in the Millennium Development Goal 4 (MDG- 4). This “under-5 mortality rate” dropped from 45.3 per 1,000 births in 1995–1999 to 25.0 in 2000–2004 and 16.4 in 2005-2009—a nearly 64% decline. Thus, according to the survey estimates, Georgia essentially achieved MDG-4 by 2010. • Child survival in Georgia improved substan- tially over the past 15 years, mainly through signifi- cant reductions in neonatal and post-neonatal mortal- ity. Given that neonatal deaths continue to account for most of infant mortality and 58% of under-5 deaths in Georgia, further reductions in child mortality will de- pend heavily on continuing the improvements in sur- vival during the neonatal period. Contraception Awareness • Virtually all respondents (96%) had heard of at least one modern method—particularly the con- dom (94%), IUD (87%), and oral contraceptives (81%). However, only 39% of women had heard of tubal liga- tion and few (4%) had heard of vasectomy. • For each contraceptive method, there is a considerable gap between awareness of the method and knowledge of how that procedure or product is used. • Most women do not have correct knowledge about how effective the modern methods of contra- ception are; while 30% of women correctly stated that IUDs are very effective in preventing pregnancy, only 16% believed that contraceptive sterilization is very effective. The majority of women incorrectly thought that pills were not very effective. Contraceptive Use • Among all women aged 15–44, 32% were currently using a contraceptive method, including 21% who were using supplied methods (condoms, IUDs, oral contraceptives, tubal ligation, and spermi- cides). • Among married women aged 15-44 more than half (53%) were currently using contraception, in- cluding 35% using modern methods. The use of mod- ern contraceptive methods rose sharply, from 20% in 1999 to 35% in 2010. For the first time, the prevalence of modern methods exceeded the prevalence of tra- ditional methods, which declined. As a result the con- traceptive prevalence rate (CPR) for married women increased from 41% in 1999 to 45% in 2005 and 53% in 2010. • Among all current contraceptive users, 26% were using the condom (14% out of 53%), followed by 25% using the IUD (13% out of 53%), 21% using withdrawal (11% out of 53%), 13% using periodic ab- stinence (7% out of 53%), 7% using the pill (4% out of 53%), 5% using tubal ligation (2.9% out of 53%), and 3% using spermicides (1.5% out of 53%). • Between 1999 and 2010, condom use among couples increased 2.5 times (from 6% to 14%) and IUD use increased from 10% to 13%, becoming the first and second most used methods, respectively. With- drawal and the rhythm method, the leading methods in 1999, became the third and fourth most commonly used methods in 2010. Pill use, still very low, increased from 2% in 1999 to 4% in 2010, and tubal ligation in- creases from 2% to 3%. • Health facilities including primarily health care clinics/centers, women’s consultation clinics and city or regional hospitals with gynecology wards were the main sources of modern contraceptive methods, REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 10x supplying 50% of users. Commercial sales, specifically through pharmacies, were the second largest source of modern contraceptive supplies (45%). Nearly 5% of users obtained their method from “other” sources, such as their partners, friends and relatives, and the open market. Potential Demand for Contraception • Almost two-thirds (65%) of married women have a potential demand for contraception, including 52% who already use a method and 12% whose de- mand has yet to be satisfied (i.e. have an unmet need for some contraceptive method). The unmet need for contraception among married women in 2010 is half the level documented in 1999 (12% vs. 24%), mostly as a result of increased use of modern methods. Need rises with rural residence, low education, larger fami- lies, and poor wealth quintiles. Most need is for limit- ing rather than spacing, in a 2 to 1 ratio. • Among current users (52%), 18% use tradi- tional methods, which are subject to high failure rates and consequent abortions. When these are added to the unmet need group (12%) the total need for mod- ern methods is 30%, nearly a third of all married wom- en. • Among married women, besides the 52% who use a method; 13% are currently pregnant or postpartum, 9% are infecund, 6% are not sexually ac- tive, and 8% are seeking to become pregnant, totaling 88%. The other 12% have unmet need as noted, or 30% including traditional method users. (In addition, some who are postpartum will soon be exposed to an unwanted conception.) Contraceptive Counseling • Family planning counseling in Georgia is mostly available only through specialized facilities, is mostly offered as part of postpartum or post-abortion care, and seldom includes distribution of supplies or prescription for supplies. Thus, Georgia has a great need for new policies that will expand the scope of contraceptive counseling and allow its integration with other reproductive health services at the primary care level. • Most family planning services in Georgia are provided by Ob/Gyns and “reproductologists” (phy- sicians who have received extra training related to reproductive issues) who traditionally have little ex- pertise in providing family planning client-oriented counseling. An important component of the newly implemented reproductive health strategy in Georgia is to train health professionals to provide family plan- ning counseling at any point of contact with medical care, including primary health care services. • Most respondents were advised by a gynecol- ogist or reproductologist to use their current or most recent modern method (56%). Women who did not receive medical advice started using their last method at the partner’s suggestion (23%), at their own coun- sel (9%), at the suggestion of friend (5%), or at the suggestion of a relative (4%), bypassing any potential family planning counseling. In only 1% of cases was the choice of the method made at the suggestion of a pharmacist. • During provider-client interactions, 64% of women received general information about alterna- tive contraceptive methods in 2010, compared to only 32% in 1999; 59% were counseled about the effec- tiveness of the chosen method in 2010 compared to only 31% in 1999; and 82% reported that the provider explained possible side effects of the method chosen, compared to only 70% in 1999. Women’s Health • The majority of respondents (79%) reported having a usual place where they obtain most of their health care. Of those who had a usual place of care, most obtained the care in hospitals (38%) and ambu- latory clinics (i.e. policlinics and women’s consultation clinics) (26%). Only a minority obtained their usual care in primary health care (PHC) facilities (14%). • More than one in every three women (37%) reported visiting a health care facility in the last year. Among these one half (51%) were seen for acute care, 41% for preventive care including family planning ser- vices, and 20% for care of a chronic condition (sum- ming to over 100% due to multiple visits). • One quarter (25%) of respondents indicated they had to delay getting medical care in the last 12 months (preventive, acute, or chronic care). The over- whelming majority of these women (82%) reported that the cost of health care services was the most im- portant deterrent. • Only 22% of women had any health insur- ance at the time of the interview. Given the unequal geographical distribution of the population below the poverty level, insured women in rural areas were much more likely to have government-supported health insurance than urban women and less likely to have private insurance. • The prevalence of routine gynecological visits remains low in Georgia, since only 24% of women with sexual experience had accessed this preventative ser- vice. Since screenings for cervical and breast cancer are generally provided or prescribed during the rou- tine gynecologic visits, the low prevalence of routine gynecologic exams inevitably has an impact on early detection and treatment of the gynecologic cancers. It also has a substantial negative effect on family plan- ning counseling and on dissemination of other health messages. • Overall, 42% of sexually experienced women FINAL REPORT xi had ever performed BSE (breast self exam), which was higher than in 2005 (29%), but still leaves significant room for improvement. In terms of BSE frequency, 17% of sexually experienced women reported doing one every month, 12% every 2–5 months, 12% every 6–12 months or more, and 58% never. • BSE is not adequate on its own; consequently, women were also asked about the utilization of CBE (clinical breast exam) and mammography. Less than one in five (18%) of sexually experienced women had ever had a CBE (done by a health professional to de- tect abnormalities). • Only 10% of women aged 40-44 have ever had a mammography; the three most important rea- sons women gave for not having a mammogram were lack of a recommendation from their health provider, saw no need for it, and never heard of it • The prevalence of cervical cancer screen- ing was also low; only 12% of sexually experienced women reported ever having had a Pap smear test; however, this represents a 3-fold increase from the 4% reported in both 2005 and 1999. • For the first time, the 2010 survey explored the level of awareness and use of the HPV vaccine in Georgia. Only a fifth (21%) of all women aged 15-44 had ever heard of HPV; 18% had heard of the vaccine, and once told about the vaccine’s effectiveness in pre- venting cervical cancer, 29% expressed an interest in receiving it. • Almost all women surveyed (95%) were aware of tuberculosis (TB), and two-thirds (67%) cor- rectly indicated that it is transmitted through the air when coughing. A substantial proportion of women had been exposed to TB either from a family member who has had TB (9%) or from frequent contact with someone else who has had TB (12%). • Only three-quarters (75%) of women were aware that TB can be completely cured. When asked the most appropriate treatment for TB-infected peo- ple, the vast majority (82%) said they should be hos- pitalized, 14% said they should be hospitalized initially and then treated at home, and 2% said they should be treated entirely at home. • Across all age groups, reports of ever, current, and past smoking were low with only 8% of women having ever smoked, 6% being current smokers and 2% past smokers. These figures were higher in urban areas than in rural areas. For example, 9% of urban women reported being current smokers (13% of Tbilisi women), compared to only 2% of rural women. • Although the majority of women surveyed did not smoke, one in two reported high levels of cur- rent (in the past 30 days) secondhand smoke (SHS), both at home and at work. The level of SHS in the home was high, reported by 52% of all women aged 15–44 and by 50% of non-smokers. Among women working indoors, 44% were exposed to SHS, including 40% of non-smokers. • On average, 31% of women have ever drunk alcohol and 17% were current drinkers, but only 2% were current frequent drinkers. Eight percent of women reported binge drinking (5 or more drinks on one occasion) in the three months preceding the sur- vey. Young Adult Behaviors • Nearly a third of young women (aged 15–24 years) in Georgia reported sexual experience (32%); of those, the overwhelming majority (31%) reported sexual initiation after marriage. • One of the most noticeable differences in age at first intercourse is across education levels; over half of women who had secondary education or less had engaged in sexual activity prior to age 22, whereas only 39% of young women with university or techni- cum education had done so. Age at marriage helps explain this. • Among young women who had their first sex- ual intercourse before age of 18, more than half had partners who were 5 or more years older. • Contraceptive use at first sexual intercourse is uncommon in Georgia, regardless of marital status. The primary reasons given for not using a contracep- tive method at first intercourse were wanting to get pregnant (67%) and not thinking about using a meth- od (24%). Domestic Violence • There are new legal regulations and increased efforts to raise awareness on domestic violence. In 2010 women’s reports of violence by an intimate part- ner were quite low: few women reported experience of physical and sexual abuse, either during the last 12 months (2%) or during lifetime (7%). These per- centages remained relatively unchanged since 1999. Moreover, the patterns of formal reports of abuse to the authorities did not change significantly. • Physical abuse by an intimate partner oc- curred in all subgroups regardless of socioeconomic and educational backgrounds, and was the high- est (23%) among previously married women. Higher prevalence of recent physical violence was reported by young women aged 15 to 19 years compared to older women. • Domestic violence has consequences for chil- dren too. On average, 8% of all respondents reported having heard or seen abuse between their parents, and 8% reported that they had experienced parental physical abuse. Witnessing or experiencing domestic abuse as a child increases the likelihood of becoming a victim of intimate partner violence as an adult: among women who had experienced parental abuse, the REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 12xii prevalence of recent psychological abuse was three times as high and prevalence of physical abuse twice as high as among those who had not experienced pa- rental abuse. • Living in households with low gender equity was associated with a higher risk of any type of do- mestic violence. • Among women who had ever experienced physical abuse, about one in three (29%) had not disclosed their experience to anyone. Those who disclosed the abuse had primarily discussed it with a family member or friend; only 5% reported the abuse to the police; 3% sought medical help; and 2% sought legal counsel. • Overall, almost 20% of ever-married women agreed with at least one circumstance in which they consider wife-beating justifiable. This percentage was greater among women who reported lifetime physi- cal or sexual abuse compared to those who had never been abused, suggesting that lack of empowerment may leave women more vulnerable to physical or sex- ual intimate partner violence. FINAL REPORT xiii REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 14xiv PREFACE . iii ACKNOWLEDGEMENTS . v EXECUTIVE SUMMURY . vii CHAPTER 1. INTRODUCTION . 1 1.1 Background . 1 1.2 Objectives . 3 CHAPTER 2. METHODOLOGY . 5 2.1 Sampling Design . 6 2.2 Questiounaire Content . 7 2.3 Data Collection . 7 2.4 Response Rates . 8 2.5 Quality Control Measures . 8 2.6 Sampling Weight . 9 2.7 Comparision with Official Statistics . 9 CHAPTER 3. CHARACTERISTICS OF THE SAMPLE . 11 3.1 Household Characteristics . 12 3.2 Characteristics of the Respondents . 17 3.3 School Entries and Attendance Ratios . 19 CHAPTER 4. FERTILITY AND PREGNANCY EXPERIENCE . 37 4.1 Fertility Levels and Trends . 37 4.2 Fertility Differentials . 40 4.3 Nuptiality . 41 4.4 Age at First Intercourse, Union and Birth . 43 4.5 Recent Sexual Activity . 45 4.6 Planning Status of the Last Pregnancy . 45 4.7 Future Fertility Preferences . 47 4.8 Infertility Problems . 49 CHAPTER 5. INDUCED ABORTION . 61 5.1 Abortion Levels and Trends . 62 5.2 Induced Abortion Differentials. 66 TABLE OF CONTENT FINAL REPORT xv 5.3 Abortion Services . 67 5.4 Abortion Complications . 72 5.5 Reasons for Abortion . 73 CHAPTER 6. MATERNAL AND CHILD HEALTH . 87 6.1 Maternal Mortality Statistics . 87 6.2 Prenatal Care . 88 6.3 Intrapartum Care . 95 6.4 Postpartum Care . 97 6.5 Smoking and Drinking During Pregnancy . 99 6.6 Pregnancy and Postpartum Complications . 100 6.7 Poor Birth Outcomes . 100 6.8 Breastfeeding . 101 6.9 Infant and Child Mortality . 102 CHAPTER 7. CONTRACEPTIVE KNOWLEDGE . 125 7.1 Contraceptive Awareness and Knowledge of Use . 125 7.2 Most Important Source of Information about Contraception . 129 7.3 Knowledge about Contraceptive Effectiveness . 130 CHAPTER 8. CONTRACEPTIVE USE . 139 8.1 Ever Use of Contraceptives . 139 8.2 Current Use of Contraceptives . 141 8.3 Source of Contraception . 146 8.4 Desire to Use a Different Contraceptive Method . 148 8.5 Users of Traditional Methods . 148 8.6 Reasons for not Using Contarception . 150 8.7 Intention to Use Contraceptives Among Non-users . 150 CHAPTER 9. NEED FOR CONTRACEPTIVE SERVICES . 169 9.1 Potential Demand and Unmet Need for Contraception . 170 9.2 Potential Demand for Family Planning by Fertility Preferences . 170 CHAPTER 10. CONTRACEPTIVE COUNSELING . 177 10.1 Client-Provider Communications Regarding Family Planning . 177 10.2 Satisfaction with Counseling Services . 180 10.3 Postabortion and Postpartum Counseling . 181 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 16xvi FINAL REPORT xvii CHAPTER 11. OPINIONS ABOUT CONTRACEPTION . 187 11.1 Opinions on Method Effectiveness . 187 11.2 Opinions on Advantages and Disadvantages of the Bill and the IUD . 189 11.3 Opinions on the Risks of Contarceptive Use . 190 11.4 Desire for More Information on Contraceptive Methods . 191 CHAPTER 12. REPRODUCTIVE HEALTH KNOWLEDGE AND OPINIONS . 205 12.1 Ideal Family Size . 205 12.2 Knowledge of the Menstrual Cycle . 206 12.3 Knowledge of the Contraceptive Effect of Breastfeeding . 207 12.4 Opinions on the Acceptability of Abortion . 207 12.5 Attitudes and Opinions toward Family and Reproductive Roles . 209 CHAPTER 13. HEALTH BEHAVIOR . 219 13.1 Utilization of Health Care Services . 219 13.2 Prevalence of Routine Gynecologic Visits . 221 13.3 Breast Cancer Screening . 221 13.4 Cervical Cancer Screening and HPV Awareness . 223 13.5 Tuberculosis Awareness and Exposure . 225 13.6 Cigarette Smoking . 226 13.7 Alcohol Use . 227 13.8 Prevalence of Selected Health Problems . 227 CHAPTER 14. FAMILY LIFE EDUCATION . 247 14.1 Opinions about Family Life Education at Schools . 247 14.2 Discussions about Sex Education. Topics with Parents . 249 14.3 Family Life Education at Schools . 249 14.4 Sources of Information on Sexual Matters . 250 14.5 Impact on Knowledge about Fertility Issues from Exposure at School or with Parents . 251 CHAPTER 15. YOUNG ADULTS SEXUAL AND CONTRACEPTIVE EXPERIENCE . 259 15.1 Sexual Experience . 259 15.2 Partner at First Intercourse . 260 15.3 Contarceptive Use at First Intercourse, Current Sexual Activity and Contarceptive Use . 261 15.4 Opinions and Attitudes about Condoms and Condom Use . 262 CHAPTER 16. SEXUALLY TRANSMITTED INFECTIONS OTHER THAN HIV/AIDS . 273 16.1 STIs in Georgia and Former Soviet Countries . 273 16.2 Awareness of STIs . 274 16.3 Awareness of Symptoms Associated with STIs . 274 16.4 Self-Perceived Risk of Contracting an STI . 275 16.5 Self-Reported STI Testing . 275 16.6 Self-Reported STI Symptoms . 276 16.7 Primary Sources of Information on STIs . 278 CHAPTER 17. HIV/AIDS . 289 17.1 HIV/AIDS in Georgia . 289 17.2 Awareness and Correct Knowledge of HIV/AIDS . 289 17.3 HIV testing . 291 17.4 Sources of Information on HIV/AIDS . 293 17.5 Knowledge of HIV transmission . 293 17.6 Knowledge of HIV prevention . 294 17.7 Self-perceived of HIV/AIDS . 295 CHAPTER 18. DOMESTIC VIOLENCE . 309 18.1 History of Winessing or Experiencing Parental Physical Abuse . 311 18.2 Prevalence of Intimate Partner Violence . 312 18.3 Seeking Help for Intimate Partner Violence . 312 18.4 Aspects of Intimate Partner Relationships and Gender Norms . 313 ANNEX A: INSTITUTIONAL PARTICIPATION . 322 ANNEX B: FIELD AND DATA ENTRY PERSONNEL . 324 REFERENCES . 325 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 18xviii 1 INTRODUCTION 1.1 Background The status of women’s health in Georgia is strongly influenced by cultural, historical, and socioeconomic factors. The old health system placed emphasis on cu- rative rather than preventive services, relied on spe- cialized care and did not maintain adequate primary health care services. Subsequently, family planning services received little support as well. With the end of the centralized USSR administration and the following economic decline, the costly hospi- tal-based curative system became impossible to main- tain. Most hospitals lacked minimal equipment, drugs, and supplies, and could not afford maintenance costs. In response to the collapse of the publicly-supported hospital-based health system, Georgia’s health sec- tor went through several transformation stages. Since 2007 the Government has initiated bold health care reforms to develop an insurance-based health care fi- nancing system targeted at the poor population, while increasing the share of public resources allocated to public health interventions. The 2011-2015 national healthcare strategy “Access to Quality Healthcare” outlined a new plan for health- care development. The complete replacement of the obsolete hospital infrastructure by modern district healthcare centers that combine primary, pre-hospi- tal, and hospital care services will be fully complete by 2013. Significant improvements in family planning (FP) and reproductive health (RH) service provision have marked the last few years in Georgia. The Govern- ment with the support of international and local non- governmental communities is increasingly supporting staff retraining, education, and infrastructure develop- ment to increase access to quality FP and RH services. Public health interventions and government financed services currently include TB, HIV/AIDS, immunization, mother and child health including universal access to antenatal care, and breast and cervical cancer screen- ing services. However challenges still exist to integrate family planning and other reproductive health servic- es in the health insurance schemes. Family planning activities are currently supported by several donor initiatives, primarily from the United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA). USAID, UNFPA, and other bilateral and multilateral do- nors have supported the efforts of the Georgian gov- CHAPTER 1 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 2 ernment and local non-governmental organizations to increase access to reproductive health and fam- ily planning services. Since the early 1990s, most of the efforts have focused on designing client-centered family planning and reproductive health policies and programs, training physicians and other medical pro- fessionals, organizing public information campaigns, and developing a nationwide system for delivery of contraceptive supplies. USAID has funded several reproductive health ini- tiatives, including the Healthy Women in Georgia (HWG) project (concluded). The HWG project, im- plemented by the John Snow Research and Training Institute (JSI), primarily focused on evidence-based, women-friendly, and client-focused family planning and reproductive health services. More emphasis was placed on maternity and newborn care by introduc- ing effective perinatal care in 16 maternities. Family planning services were expanded to several hundred service delivery points. The program also supported breast and cervical cancer screening, quality of care in reproductive health, family life education courses, and other initiatives. In 2008-2009, MoLHSA in collabora- tion with CDC and HWG conducted the first mortality study among women of reproductive age (RAMOS) with USAID support. Since then, USAID has funded two additional RH pro- grams, also implemented by JSI: SURVIVE (breast and cervical cancer prevention), conducted in 2009–2010, and SUSTAIN, which is currently in progress. SUSTAIN continues to provide FP training for primary health care and family doctors, pediatricians, and OB/Gyns, and supports the implementation of EPC principles through EPC training for multidisciplinary teams. UNFPA has provided Georgia with reproductive health commodities and supplies since 1993, including sup- plies of modern FP methods, for all regions of Georgia. Building on the results achieved during the previous years, UNFPA’s second Country Program, for 2011- 15, supports implementation of the ICPD Program of Action and the Georgia National Health Strategy 2011-15, and includes large portfolios of RH activi- ties in three main areas: strengthening RH policies, enhancing the legislative environment, and improving quality of services according to internationally recog- nized standards. UNFPA also supports the National RH Council (NRHC), initiated and chaired by the First Lady of Georgia since 2006, and in partnership with MoL- HSA helps to develop and implement clinical practice guidelines for RH, including EmOC, FP, cervical and breast cancer screening, etc. UNFPA also supports the integration of RH services at the PHC level through training for PHC providers on relevant RH services, such as antenatal care, postpar- tum care, FP, and breast and cervical cancer screening, including practical training on Pap-test methodology. MOLHSA and the Reproductive Health Council also col- laborate with UNICEF and the Sheba Medical Centre of Israel, to strengthen the perinatal/neonatal system in the country. In addition, MOLHSA and the Ministry of Justice in collaboration with UNICEF collaborated to introduce a Parent-Baby Book (Personal Record for Child Health and Development) in 2011. The book provides parents of all newborns in the country with essential knowledge of child health and development in the first six years. The partnership of UNFPA/Georgia and Municipality of Tbilisi for reproductive tract cancer prevention and early diagnoses, initiated in 2006, was chosen for a “Pearl of Wisdom” award at the European Parliament Cervical Cancer Prevention Summit in 2009. From 2008 to 2012, in Tbilisi, more than 57,000 women benefited from breast cancer screening (clinical ex- amination or mammography) and more than 59,000 women benefited from cervical cancer screening ser- vices. The program was subsequently expanded by the MOLHSA/NCDC to all regions of Georgia. UNFPA has also supported youth reproductive health initiatives, including the introduction of youth-friendly reproductive health services, youth awareness rising on SRH&R through peer education. Through the government’s efforts and the support provided by international donor organizations, Geor- gia has increased women’s access to modern contra- ceptives and other reproductive health services. How- ever, many challenges remain, particularly to further improve access and quality of services. To help poli- cymakers and program managers assess and respond to current needs, nationwide surveys on reproductive health were conducted in Georgia in 1999, 2005 and 2010. Two major international agencies have primarily supported these surveys: USAID, which funded tech- nical assistance from the US Centers for Disease Con- trol and Prevention’s Division of Reproductive Health (CDC/DRH), and UNFPA, which covered costs related to field work, translation, and dissemination seminars. Technical assistance and funding for the 2010 survey was also contributed by the United Nations Children Fund (UNICEF). For all three surveys, CDC/DRH pro- vided technical assistance to the National Centers for Disease Control and Public Health (NCDC) the main implementing agency. The 1999 Georgia Reproductive Health Survey (GER- HS) was the first national representative household survey ever conducted in Georgia and it document- FINAL REPORT 3 ed low levels of contraceptive use and high levels of abortion. The second round of GERHS was carried out during the first part of 2005. Similarly, the 2010 GER- HS continues to document RH efforts, as well as the trends in the main RH indicators. The 2010 question- naire incorporated certain indicators from UNICEF’s Multiple Indicator Cluster Survey (MICS), specifically related to children’s education, water, sanitation, and hygiene issues. The 1999 survey included a supple- mental sample of internally displaced women living in nonresidential housing, which was not replicated in the later rounds. All three surveys used nationally representative sam- ples of women aged 15–44 and were similar in scope, design and content, with multistage probability sam- ples. The selection of primary sampling units in 2005 and 2010 was based on the 2002 Census and allowed for independent regional estimates for the most im- portant reproductive health indicators. However the sampling design in 1999, based on the sampling frame of MICS 1999, did not permit independent estimates for all regions. The availability of high-quality RHS data has revealed levels of contraceptive use and induced abortion in Georgia with more accuracy than was previously pos- sible. Survey estimates of contraceptive prevalence are more accurate than estimates based on service statistics, which count only women attending facilities that provide family planning services. Survey-based estimates of the number of abortions in Georgia are also higher than official values; however in recent years the official estimates are coming closer to the survey figures, indicating improved reporting. Two other surveys have augmented the information available for this report. One is the MICS (Multiple In- dicator Cluster Survey) of 2010-11, used to add infor- mation to Chapter 3. The other is the special survey on domestic violence of 2009 (Chitashvili et al., 2010), used especially in chapter 18. 1.2 Objectives Periodic household-based probability surveys are the best and most timely way to collect data on a wide assortment of health topics that are essential to de- termining the health needs of Georgian families and the types of services they should receive. Set within the context of overall social and economic develop- ment in Georgia, the aim of the 2010 survey was to obtain national and regional estimates of basic demo- graphic and reproductive health indicators, in order to set targets for improvements, allocate resources, and monitor performance of family planning and maternal and child health programs. The survey interviewed a sample of 6,292 women aged 15–44 years between October 2010 and February 2011. It was similar in de- sign and content to the 1999 and 2005 surveys as not- ed above, as well as with surveys conducted in other Eastern European and Central Asian countries. The GERHS10 was specifically designed to meet the following objectives: • to assess the current situation in Georgia con- cerning fertility, abortion, contraception and various other reproductive health issues; • to enable policy makers, program managers, and researchers to evaluate and improve existing pro- grams and to develop new strategies; • to document the socio-economic character- istics of households in Georgia and their patterns of access to and utilization of health care services; • to measure changes in fertility and contra- ceptive prevalence rates and study factors that affect these changes, such as geographic and socio-demo- graphic factors, breast-feeding patterns, use of in- duced abortion, and availability of family planning; • to provide data needed to estimate global de- velopment indicators related to education, maternal and child survival, gender equality, and reduction of HIV and other disease transmission; • to obtain data on knowledge, attitudes, and behavior of young adults 15–24 years of age and as- sess their exposure to sex education and health pro- motion programs; • to identify topics of special interest regarding reproductive health among high risk groups. By making available appropriate country- and region- specific data on reproductive health and related health services and enhancing the ability of national organizations to collect, analyze, and disseminate such information, the survey has fostered collabora- tion between the Georgian government, international donors, and other partners. Survey data will be used to monitor RH and maternal and child health programs within the context of Georgian health sector reforms and poverty reduction strategies. The survey will also help to identify linkages among health needs, health services, and health sector reforms. International bi- lateral and multilateral donors (e.g., USAID, UN agen- cies, World Bank, and EU) and various government partners, particularly MoLHSA, the Ministry of Eco- nomic Development, and Ministry of Finance, can use these data for developing new health strategies and health sector reforms under ‘Strategic “10-Point Plan” of the Government of Georgia for Modernization and Employment’ and ‘National health care strategy - Ac- cess to Quality Health Care’, as well as for monitoring and evaluating progress toward achieving the UN Mil- lennium Development Goals. REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 4 5 METHODOLOGY Worldwide, population-based surveys are widely used to complement the routine health information sys- tems. They have the advantage of providing informa- tion on a large number of health issues and can track progress of health programs and evaluate their im- pact for the population as a whole or for specific risk groups. The Reproductive Health Surveys (RHS) were developed by Centers for Disease Control and Preven- tion (CDC) in response to the need to collect detailed reproductive, maternal, and child health indicators in international settings (Morris, 2000). These surveys draw upon the CDC expertise in family planning and women’s health survey methodologies in the United States, combined with its international experience. Beginning in the mid-1990s, several RHS surveys were conducted in Eastern Europe with CDC technical as- sistance, including three surveys in Georgia. A major purpose of the RHS is to produce national and sub-national estimates of factors related to pregnancy and fertility, such as sexual activity and contraceptive use, use of abortion and other medical services, and maternal and infant health. The first RHS was conduct- ed in Georgia in 1999; a new cycle was implemented in March-July 2005, followed by the third Georgian RHS (GERHS10), implemented in 2010. As was the case with the first two rounds, the Georgian Minis- try of Labor, Health and Social Affairs (MoLHSA) con- ducted the survey in collaboration with the Georgian National Center for Disease Control. CDC provided technical assistance with the survey design, sampling, questionnaire development, training, data process- ing, and analysis to all rounds of the RHS in Georgia through funding from the United States Agency for International Development (USAID). All local costs of GERHS10, including the dissemination activities, were supported by the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF). All RHS in Georgia employed nationally representa- tive, probability samples and collected information on a wide range of health related topics from women of reproductive age. A major function of successive cycles of the survey is to produce comparable time trend data. Thus, the 2005 survey was modeled after the 1999 RHS and the 2010 drew from the experience of the previous rounds and added some new content. The content of all surveys was reviewed by Georgian national experts, government representatives, and re- searchers from inside and outside governmental or- ganizations, as well as donor agencies. The panel of experts who reviewed the questionnaire and the main findings of GERHS10 is attached. CHAPTER 2 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 6 Each survey collected information from a representa- tive sample of Georgian women aged 15–44 years, so the data can be used to estimate percentages, aver- ages, and other measures for the entire population of women of reproductive age residing in Georgian households at the time when the survey was imple- mented. 2.1 Sampling Design Similar to the 1999 and 2005 RHS surveys, the GER- HS10 is based on a large representative probability sample (13,363 households) and consists of face-to- face interviews with women of reproductive age at their homes. The population from which the respond- ents were selected included all females between the ages of 15 and 44 years, regardless of marital status, who were living in households in Georgia during the survey period (excluding the separatist regions of Ab- khazia and South Ossetia). This sample was selected in such a manner as to allow separate urban and rural, as well as regional-level es- timates for key population and health indicators, such as fertility, abortion, contraceptive prevalence, mater- nal and child health, and infant mortality for children under five. The number of households included in the sample was set to yield approximately 6,000 interviews with women aged 15-44. As in the 2005 RHS, the survey employed a stratified multistage sampling design that used the 2002 Georgia census as the sampling frame (State Department for Statistics, 2003). To better mon- itor the health issues at a sub-national level and assist key stakeholders in assessing decentralization efforts, the sample was designed to produce estimates for 11 regions of the country. Census sectors were grouped into 11 strata, corresponding to Georgia’s administra- tive regions; three small regions, Racha-Lechkhumi, Kvemo Svaneti, and Zemo Svaneti were included in one stratum, identified as the Racha-Svaneti stratum. Figure 2.1 compares the distribution of households in the 2002 census with the distribution of households that resulted in the sample. The first stage involved selection of a sample of pri- mary sampling units (PSUs), which were the same census sectors selected in the 2005 survey. The first stage selection was done with probability of selection proportional to the number of households in each of the 11 regional sectors. A systematic sampling process with a random starting point in each stratum was ap- plied. During the first stage, 310 census sectors were selected as primary sampling units (PSUs), as shown in Table 2.1. Therefore the overall sample consisted of 310 PSUs, and the target number of completed interviews was an average of 20 completed interviews per PSU. The minimum acceptable number of interviews per stra- tum was set at 400, so that the minimum number of PSUs per stratum was set at 20. With these criteria, 20 PSUs were allocated to each stratum, which accounted for 220 of the available PSUs. Another 80 PSUs were distributed in the largest regions in order to obtain a distribution of PSUs approximately proportional to the distribution of households in the 2002 census. An additional 10 PSUs were added to the smallest stra- tum, Racha-Svaneti, to compensate for the consider- able sparseness of women of reproductive age in this stratum. 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti 305,896 124,031 87,527 201,213 Sample (RHS) Census (2002) 3000 2500 2000 1500 1000 500 0 1056 2734 841 1053 51,381 643 39,743 115,982 20,395 109,632 1684 34,834 83,391 842 1005 1057 845 1603 320,000 280,000 240,000 200,000 160,000 120,000 80,000 40,000 0 Households in Sample Households in Census Number of Households in the 11 Strata of the GERHS10 Sample and the 2002 Census Figure 2.1 FINAL REPORT 7 Table 2.1 also compares the distribution of households in the sample with the distribution of households in the 2002 Census by the 11 strata. The sampling frac- tion ranges from 1 in 13 households in the Racha- Svaneti stratum (the least populated stratum) to 1 in 136 in Adjara. As shown in Table 2.1, if the ratio of households in the census to households in the sample is above 100.0, the region has been under-sampled, whereas if the ratio is less than 100.0, the region has been over-sampled. In the second stage of sampling, clusters of house- holds were randomly selected from each census sec- tor chosen in the first stage. A listing of each of the selected PSUs had been carried out in preparation for the 2005 survey. The 2010 survey selected house- holds from the updated household listing in each PSU. Determination of cluster size was based on the num- ber of households required to obtain an average of 20 completed interviews per cluster. The total number of households in each cluster took into account esti- mates of unoccupied households, the average num- ber of women aged 15–44 per household, the rule of interviewing only one respondent per household, and an estimated response rate of 98%. In the case of households with more than one woman between the ages of 15 and 44, one woman was selected at random to be interviewed. 2.2. Questionnaire Content Similar to the 1999 and 2005 RHS, GERHS10 used two questionnaires to collect information from the house- holds and from eligible respondents: the household questionnaire and the women’s questionnaire. Both questionnaires produced in both the Georgian and Russian languages. The household questionnaire included details on the household’s composition, questions about the edu- cation attainment of the household members and school readiness and attendance among children and youth, socio-economic characteristics of the house- hold, and questions about the availability and type of social assistance received by household members. These questions were adapted for Georgia’s needs us- ing the RHS model household questionnaire and the fourth round of the Multiple Indicator Cluster Surveys (MICS) developed by UNICEF. As in the previous surveys, the women’s question- naire for GERHS10 was designed to collect informa- tion on the following: • Demographic characteristics • Fertility and child mortality • Family planning and reproductive preferences • Use of reproductive and child health care ser- vices • Range and quality of maternity care services • Use of preventive and curative health care ser- vices • Reproductive health care expenditures • Perceptions of health service quality • Risky health behaviors (smoking and alcohol use) • Young adult health education and behaviors • Intimate partner violence • HIV/AIDS and other STDs Additionally, a series of questions was asked to as- sess the awareness and occurrence of tuberculosis and other chronic illnesses, the use of breast cancer screening, and awareness and use of the HPV vaccine. Finally, women were asked a number of questions aimed at assessing their access to preventive and cu- rative health services, their health insurance status, and affordability and costs of health services. Because a wealth of similar reproductive health sur- vey data from other countries in Eastern Europe are available, cross-country comparisons can be made, and successful regional approaches could be adapted to the country-specific context. 2.3 Data Collection The interviews were performed by 40 female in- terviewers trained in interview techniques, survey procedures, and questionnaire content. Interviewer training took place at the NCDC headquarters just be- fore data collection began. Interviewer training was conducted mostly in Georgian by a team of trainers. The training team consisted of three consultants from CDC and staff from NCDC. At the end of the training period, eight teams were selected, each consisting of five female interviewers, one supervisor, and two drivers. All interviewers were bilingual (Georgian and Russian). Fieldwork was managed by staff of NCDC, with technical assistance from CDC, and lasted from October 2010 through February 2011. Each team was assigned several primary sampling units and traveled by car throughout the country on planned itineraries. The majority of interviews were conducted in Geor- gian while approximately 20% were conducted in Rus- sian. Azeri-speaking health professionals facilitated interviews with monolingual Azeri respondents. Com- pleted questionnaires were first reviewed in the field by team supervisors and then taken by the fieldwork coordinators to the NCDC fordata processing. The field unit for GERHS10 consisted of two coordi- nators who divided the fieldwork assignments among the eight teams of interviewers and supervisors. The field work coordinators and supervisors prepared in- terviewer assignments and were responsible for mon- itoring the progress of each interviewer, performing REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 8 field observations, conducting in-person verifications of the interviewers’ work, and conducting refusal con- version efforts. Field supervisors were also responsi- ble for analyzing each interviewer’s weekly produc- tion and quality of work, reviewing errors, and serving as the point of contact for the data entry supervisors. 2.4 Response Rates Of the 13,363 households selected in the household sample, 6,356 included at least one eligible woman (aged 15–44 years). Of these identified respondents, 6,292 women were successfully interviewed, yield- ing a response rate of 99%. Virtually all respondents who were selected to participate and who could be reached agreed to be interviewed and were very co- operative. The refusal rates for the household ques- tionnaire and the women’s questionnaire were very low (0.2%). Response rates did not vary significantly by geographical location (Table 2.2). 2.5 Quality Control Measures A number of measures were taken to ensure that the data were of the highest possible quality. First, the questionnaire, already refined during the previ- ous RHS rounds in Georgia, was revised carefully and reviewed by a panel of Georgian experts. As a result, the content of the questionnaire was expanded sub- stantially and made more relevant for programmatic needs. The questionnaire was tested extensively, both before and during the pretest and prior to beginning the field work. Testing included practice field inter- views and simulated interviews conducted by both CDC and NCDC staff. The questionnaire was translated into Georgian and Russian and back-translated into English. The training team selected 40 interviewers and 8 su- pervisors after one week classroom training and an- other week in the field. The training was very com- petitive and allowed for selection of the most highly qualified staff from an original pool of 75 trainees. Supervisors were trained to review and edit the ques- tionnaires immediately after each interview; thus, if they noticed errors or omissions the interviewers or the respondents had made, the interviewers could make immediate corrections during short follow-up visits. These edits reduced the item nonresponse rate for most questions to less than 2%. Supervisors and field work coordinators spot-checked the quality of each interviewer’s work often and carefully. This pro- cess of verifying fieldwork was a critical component of the overall quality control system. The inclusion of life histories (marital history and pregnancy history) and the five-year month-by-month calendar of pregnancy, contraceptive use, and union status helped respondents accurately recall the dates of one event in relation to the dates of others they had already recorded. Consistency checks between life events were programmed into the data entry soft- ware, so that data entry supervisors would notice er- rors or inconsistencies and could send problematic interviews back to the field for follow-up visits. The CDC team followed the progress of fieldwork by receiving approximately every two weeks a standard set of quality control tables generated from the most recently collected data. In addition, the team spent four weeks in the field and accompanied all teams for visits in several PSUs. Along with the NCDC team members, the CDC staff observed fieldwork, reviewed progress, and checked the quality of fieldwork. 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Percentage Age Distribution of Women Aged 15–44, 2010 RHS and 2002 Census Figure 2.2 Age Group 15-19 20-24 25-29 30-34 35-39 40-44 25 20 15 10 5 0 Sample (2010) Census (2002) FINAL REPORT 9 2.6 Sampling Weights The purpose of the RHS is to produce statistical esti- mates that are nationally representative. National es- timates are produced by devising a “sampling weight” for each respondent that adjusts for her probability of selection in the sample. The weights for the RHS were calculated as follows: First, the weight was adjusted to reflect the selection of only one eligible woman from each household containing women of reproductive age. In cases where households included more than one eligible female respondent, the woman who was selected for interview received an additional weight. Second, the weight was adjusted to reflect that women residing in the regions with sparser populations were selected at higher rates (i.e., were over-sampled) rela- tive to those residing in regions with high population density, who were under-sampled. Because the over- all response rate (99%) was so high, no weighting was needed to adjust for the survey staff’s inability to lo- cate some eligible women or for nonresponse among those who were located. After the weighted survey population distribution was broken down by five-year age groups and by residence and was compared with the Census estimates, poststratification weights were not deemed to be necessary (see Section 2.7). Except for Table 2.2, all tables in this report present weighted results, but the unweighted number of cas- es, used for variance estimation, is shown in each ta- ble. Generally, tables where percent distributions are shown should add up to 100%, but due to rounding they may add up to either 99.9% or 100.1%. 2.7 Comparison with Official Statistics The weighted percentage distribution of women se- lected in the 2010 survey sample by 5-year age groups differs only slightly from the 2009 mid-year official estimates, based on the official census projections (Table 2.3). For the overall distribution by age, the dif- ferences were not statistically significant after confi- dence intervals are taken into account. Unfortunately, the urban/rural distribution of the sample cannot be compared with current official estimates because the official statistics do not project population figures separately for the urban and rural areas. Compared to 2002, both the total and the urban/rural distribution of the sample include fewer women aged 35–39 and 40–44 (Figure 2.2). However, the age composition had changed significantly since 2002 so comparisons need to be made with projected population figures. The of- ficial age projections for 2009 for the percentages of women in these age groups are similar to the figures documented by GERHS10 and there was no great vari- ation in age distribution among these women when stratified by urban or rural residence. These findings suggest that the sample distribution of women aged 35–39 and 39–44 by residence would be close to the official projections, if such projections were available. Table 2.1 Number of Households (HH) in the GERHS10 Sample and the 2002 Census and in the Sample, by Region, Reproductive Health Survey: Georgia, 2010 Strata (Regions) No. of HH in Census No. of PSUs in Sample No. of HH Sampled Ratio of HH-Census to the HH in Sample No. of Completed Women's Interviews Kakheti 109,632 25 1056 103.8 498 Tbilisi 305,896 65 2734 111.9 1,426 Shida Kartli 83,391 20 841 99.2 392 Kvemo Kartli 124,031 25 1053 117.8 546 Samtskhe-Javakheti 51,381 20 842 61.0 481 Adjara 87,527 20 643 136.1 419 Guria 39,743 20 1005 39.5 401 Samegrelo 115,982 25 1057 109.7 477 Imereti 201,213 40 1684 119.5 805 Mtskheta-Mtianeti 34,484 20 845 40.8 393 Racha-Svaneti† 20,395 30 1603 12.7 454 Total 1,173,675 310 13,363 87.8 6,292 *Source: SDS, 2002 Census Population HH = households; PSU = primary sampling unit the Ratio of the Number of Households in the Census to the Number of Households † Includes the regions of Racha-Lekhumi, Kvemo Svaneti, and Zemo Svaneti as one stratum. REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 10 Ta bl e 2. 2 R es ul ts o f H ou se ho ld V is its a nd In te rv ie w S ta tu s of E lig ib le W om en , b y R es id en ce R ep ro du ct iv e H ea lth S ur ve y: G eo rg ia 2 01 0 Tb ili si O th er U rb an R ur al K ak he ti Tb ili si Sh id a K ar tli K ve m o K ar tli Sa m ts kh e- Ja va kh et i A dj ar a G ur ia Sa m eg re lo Im er et i M ts kh et a- M tia ne ti R ac ha - Sv an et i Id en tif ie d el ig ib le w om an 47 .6 52 .7 49 .5 44 .9 47 .4 52 .7 47 .0 52 .0 57 .5 65 .6 40 .8 45 .5 48 .1 47 .7 28 .7 N o el ig ib le w om en 49 .0 43 .7 48 .0 51 .4 49 .5 43 .7 50 .2 44 .8 40 .1 30 .9 59 .0 53 .8 48 .9 49 .5 62 .2 R es id en t(s ) n ot a t h om e 0. 1 0. 5 0. 0 0. 1 0. 2 0. 5 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 H ou se ho ld re fu sa l 0. 2 0. 9 0. 1 0. 1 0. 0 0. 9 0. 0 0. 4 0. 2 0. 0 0. 0 0. 0 0. 0 0. 1 0. 1 U no cc up ie d ho us e 3. 0 1. 9 2. 4 3. 6 2. 8 1. 9 2. 9 2. 8 2. 0 3. 4 0. 2 0. 7 3. 0 2. 4 9. 0 O th er 0. 1 0. 3 0. 1 0. 0 0. 0 0. 3 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N o. o f H ou se ho ld s Vi si te d 13 ,3 63 2, 73 4 3, 15 2 7, 47 7 1, 05 6 2, 73 4 84 1 1, 05 3 84 2 64 3 1, 00 5 1, 05 7 1, 68 4 84 5 1, 60 3 El ig ib le W om en C om pl et ed in te rv ie w s 99 .0 98 .9 99 .4 98 .9 99 .4 98 .9 99 .2 99 .6 99 .4 99 .3 97 .8 99 .2 99 .4 97 .5 98 .7 S el ec te d re sp on de nt s no t a t h om e 0. 1 0. 3 0. 1 0. 1 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 7 0. 0 0. 0 0. 0 0. 0 S el ec te d re sp on de nt re fu se d 0. 2 0. 3 0. 1 0. 1 0. 6 0. 3 0. 0 0. 0 0. 0 0. 0 0. 2 0. 2 0. 0 0. 2 0. 0 S el ec te d re sp on de nt is n ot c om pe te nt 0. 7 0. 4 0. 5 0. 9 0. 0 0. 4 0. 8 0. 4 0. 6 0. 7 1. 2 0. 6 0. 6 2. 2 1. 3 In co m pl et e In te rv ie w 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N o. o f E lig ib le W om en Id en tif ie d 6, 35 6 1, 44 2 1, 55 9 3, 35 5 50 1 1, 44 2 39 5 54 8 48 4 42 2 41 0 48 1 81 0 40 3 46 0 R eg io n R es id en ce To ta l H ou se ho ld s Vi si ts N o. o f C om pl et ed in te rv ie w s 6, 29 2 1, 42 6 1, 54 9 3, 31 7 49 8 1, 42 6 39 2 54 6 48 1 41 9 40 1 47 7 80 5 39 3 45 4 Ta bl e 2. 3 W om en w ith C om pl et e In te rv ie w s C om pa re d w ith O ffi ci al E st im at es b y R es id en ce , by A ge G ro up . R ep ro du ct iv e H ea lth S ur ve y: G eo rg ia 2 01 0 20 09 O ffi cia l E st im at es (m id -y ea r)* To ta l To ta l Ur ba n Ru ra l 15 –1 9 17 .9 (1 .3) 17 .4 (1 .3) 18 .6 (1 .3) 17 .2 17 .6 16 .7 18 .8 20 –2 4 18 .9 (1 .4) 19 .7 (1 .4) 18 .0 (1 .3) 18 .1 16 .4 16 .2 16 .7 25 –2 9 16 .6 (1 .3) 16 .3 (1 .3) 17 .0 (1 .3) 17 .0 15 .8 15 .9 15 .8 30 –3 4 16 .3 (1 .3) 16 .7 (1 .3) 15 .9 (1 .3) 16 .1 15 .5 15 .6 15 .3 35 –3 9 15 .8 (1 .3) 15 .6 (1 .3) 16 .1 (1 .3) 15 .8 17 .0 17 .4 16 .6 40 –4 4 14 .4 (1 .4) 14 .3 (1 .3) 14 .5 (1 .4) 15 .8 17 .7 18 .3 16 .8 To ta l 10 00 10 00 10 00 10 00 10 00 10 00 10 00 Ag e G ro up 20 02 O ffi cia l E st im at es † To ta l U rb an Ru ra l GE RH S1 0 ( ±9 5% C on fid en ce In te rv al) To ta l 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 * S DS , 2 01 1: Mi d- ye ar po pu lat ion ac co rd ing to ag e a nd se x g ro up s, Ge or gia , 2 00 8 – 20 09 †  SD S, 20 03 . P op ula tio n o f G eo rg ia in 20 02 . 11 CHAPTER 3 CHARACTERISTICS OF THE SAMPLE The survey documents a wide array of key reproductive health outcomes and their determinants for women of reproductive age. To better understand these out- comes, Chapter 3 presents the main characteristics of the survey respondents that will be used throughout the report. Geographic key variables are area of resi- dence, meaning either urban and rural or else Tbilisi, other urban area, and rural area; as well as region of residence (11 regions). Key demographic variables are the age at the time of the interview, which is grouped by five years (or by ten years in some tables in other chapters), and current marital/union relationship sta- tus. The latter consists of 4 types: two formal union relationships (legal marriage and common-law union), one previous union relationship (widowed, divorced and separated women), and women who have never been married. Socioeconomic variables include education and the wealth status of the household . Education is catego- rized into secondary incomplete or less (roughly cor- responding to 0–10 years of education), secondary complete (11–12 years of education), postsecondary technical education (high vocational education), and postsecondary academic education. The wealth status is based on household assets, including durable goods (refrigerator, television, car, computer, etc.) and dwell- ing characteristics (type of source for drinking water, toilet facilities, fuel used for cooking and heating, main roof material, and the household’s crowdedness). To construct the index, each household asset was as- signed a weight or a factor score generated through principal component analysis. The resulting asset scores were standardized to have a standard normal distribution with a mean of zero and a standard de- viation of one (Gwatkin et al., 2000). Each household was assigned a standardized score reflecting its exist- ing set of assets and possessions; overall scores were generated by summing the standardized asset-specific scores. Next, the sample of households was divided into five equal-sized groups or quintiles based on a weighted frequency distribution of households by the resulting asset score. The households with the lowest 20% of the total asset scores are classified as quintile 1, the lowest wealth quintile, and the next 20% are classified as quintile 2 or the second wealth quintile, etc. Each respondent was ranked according to the wealth quintile of the household in which she resided. Thus, the wealth index measures the standard of liv- ing of a household relative to other households, in- dicating that respondents living in households with a higher wealth quintile have a better socioeconomic REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 12 status (SES) than those with a lower wealth quin- tile. Table 3.1.1 shows the distribution of the Geor- gian population by wealth quintiles, according to urban-rural residence and region. The distribution indicates the degree to which wealth is distributed in geographic areas. Almost three in four (74%) urban households were classified in the two highest wealth quintiles while only 3% of rural households were in those wealth groups. Looking at regional variation, Tbilisi has the largest proportion of households in the two highest wealth quintiles (91%). In Figure 3.1.1 Racha-Svaneti, Guria, and Samegrelo have the largest proportions of households in the two lowest wealth quintiles (85%, 75%, and 70%, respectively). It is also worth mentioning that previous RHS sur- veys in Georgia did not use the wealth index to char- acterize the SES of the households. Previous surveys used a socioeconomic index based on equal values assigned for possession of household amenities and goods. The resulting scores ranged from 0–9 or 0–10, where 0 represented the lower end (i.e. no score- related amenities or goods in the household) and 9 or 10 represented the higher end (all items present in the household). The score was further divided into terciles to create three levels of the SES of the house- hold. To facilitate comparisons of reproductive health indicators by the SES of the respondents interviewed in the 2010 survey with the results collected in pre- vious surveys, the wealth index created in GERHS10 is also used to create a distribution of households by terciles. The wealth terciles are based on the principal component analysis and classify the households in the sample as being in the lowest 33% of the total asset score, the middle 33%, and the highest 33%. Thus, the trend comparison of indicators by socioeconomic sta- tus should be interpreted with caution, since a slightly different methodology for assessing the SES was em- ployed in the analyses of the 2010 survey. 3.1 Household Characteristics Socio-economic well-being is an important determi- nant of reproductive health status. In order to assess the socio-economic conditions of respondents GER- HS10 collected information on the availability of basic services (such as electricity supply, source of drinking water, type of toilet facilities, energy used for cooking, type of heating system, and roof material) and various goods and amenities (e.g. T.V., telephone, refrigerator, working automobile, satellite dish, computer, VCR/ DVD, etc.) in respondents’ households. The source of drinking water for 76% of households is piped water either into the dwelling, compound, yard, or plot (Table 3.1.2). About 15% of households obtain their drinking water from wells and only for 3% of re- spondents the source of water is spring. Piped water is more common in urban areas (96%) than in rural areas (55%). The availability of piped water increases according to wealth index from 45% in lowest wealth quartile to almost 100% in highest wealth quartile (Ta- ble 3.1.3). Piped water is available in more than 80% of households in the Tbilisi, Adjara and Racha-Svaneti regions (Figure 3.1.2). Piped water is also the main source of drinking water in most other regions except Guria and Samegrelo regions, where most households obtain water from wells. Public taps are the second most important source of drinking water in Kakheti and Kvemo Kartli regions (Table 3.1.2). Overall 93 per- cent of households - 98 per cent of urban and 88 per cent of rural households in Georgia use an improved source of drinking water (water from unprotected wells or unprotected springs being considered as un- 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti 100 80 60 40 20 0 66 1 35 54 85 Households in Sample Percentage of Households in the Lowest Two Wealth Quintiles by Region Figure 3.1.1 59 44 50 75 70 43 FINAL REPORT 13 safe). The lowest percentage for improved sources of water is in Samegrelo (69%). (Table 3.1.4). Note: Tables 3.1.4 through 3.1.7 are tabulated us- ing data from the household questionnaires, which include MICS indicators, as do Tables 3.3.1 through 3.3.6. The MICS Indicator Number for each topic ap- pears below each table. (MICS: Multiple Indicator Cluster Survey, developed by UNICEF.) Table 3.1.5 shows that for 76% of households the drinking water source is on the premises. For 20% of households, it takes less than 30 minutes to get to the water source and bring water, while 4% of households spend 30 minutes or more. In 2010 almost all of the households were supplied with electricity for 24-hours per day and there were only slight differences among the regions (Table 3.1.2). There was a dramatic increase in the availabil- ity of uninterrupted electrical power supply between 2005 and 2010 surveys, from 37% to 96% in 2010. As shown in Table 3.1.2, 48% of households have flush toilets, while 50% have pit latrines. The presence of flush toilets at households differs dramatically be- tween urban (84%) and rural (9%) regions. The high- est prevalence of flush toilets was reported in Tbilisi (96%) and the lowest in Kakheti and Racha-Svaneti regions (8%) (Figure 3.1.3). In Table 3.1.6 the pit latrine is the main toilet facility at households in most of the regions except Tbilisi and Adjara. Overall, 84 percent of households use some type of improved sanitation facility (sum of 7 types in Table 3.1.6). By residence this is 96% of urban house- 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) <45 45-54 55-69 70-79 80+ * Abkhazia: Autonomous region not under goverment control Percentage of Households with Piped Water, by Region Figure 3.1.2 % Households with Water Faucet <45 45-54 55-69 70-79 80+ * 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) <45 45-54 55-69 70-79 80+ * Abkhazia: Autonomous region not under goverment control Percentage of Households with Flush Toilet, by Region Figure 3.1.3 % Households with Flush Toilet <20 20-29 30-44 45-54 55+ * REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 14 holds and 71% of rural households. Residents of Samtskhe-Javakheti are less likely than others to use improved sanitation facilities (53%). In rural areas the population is mostly using pit latrines with or without slabs (59% and 24% respectively, and pit latrines with- out slab are considered as unimproved), while in ur- ban areas the most common facilities are flush toilets with connection to a sewerage system (82%). Table 3.1.7 (last column) shows that 79% of the whole population use both improved water and sanitation facilities. A sharp gradient exists across the wealth quintiles, from 56% to 99% for this item. Table 3.1.2, discussed above, indicates that the main source of energy used for cooking in households is natural gas (45%) followed by coal or wood (40%). Electricity is used only in about 4% of households for cooking. Natural gas is the main source of energy for cooking in urban households (74%), while most of the rural households (70%) use coal or wood for cooking. The use of natural gas is highest in Tbilisi (90%) and the lowest in Racha-Svaneti region (2%). Nearly two thirds of households are heated with stoves (66%), followed by individual room heating (29%) with different kinds of space heaters. Central heating is used in only 1.4% of all households, report- ed mostly in Tbilisi. In 2% of households there was no heating available, more common in urban than in ru- ral households. Corrugated iron is the most common material used for roofing (36%), followed by sheet metal (33%) and tile or concrete (26%). Corrugated iron is mainly used in rural regions, while tile or concrete is more common in urban areas. The highest prevalence of households roofed with corrugated iron is in the Guria region (70%), while roofing with tile or concrete predomi- nates in Tbilisi (62%). In summary, urban households are more likely to have piped water, a flush toilet, central heating, and natural gas for cooking. There is no difference in 24- hour electric power supply between urban and rural residence, as it is available for almost all households in both urban and rural places (Figure 3.1.4). The only dwelling characteristic that is more favorable for rural households is the number of rooms per person. Rural dwellings have more rooms per person and are less crowded than urban dwellings. As shown in Table 3.1.8, television is the most com- mon amenity/good found in 97% of Georgian house- holds, with very little difference between urban and rural households. The availability of all other house- hold amenities and goods is higher in urban than in rural places (Figure 3.1.5). Refrigerators and cellular telephones (one at least) are present in more than two thirds of all households (79% and 75% respective- ly). Land-line telephones were reported by more than half of respondents (56%) It should be noted that the urban/rural gap is very large for having a land-line tel- ephone (73% vs. 38%), but it narrows significantly for ownership of cellular phones. While the percentage of urban households with cell telephones is 82%, a substantial proportion of rural households (67%) also have them. The proportion of households with at least one cell telephone ranges from a low 57% in Racha- Svaneti to a high 86% in Tbilisi (Figure 3.1.6). Overall, 25% of households have a functioning auto- mobile, and the ownership rates are highest in the Tbilisi and Samtskhe-Javakheti regions (31%) and the 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Availability of Basic Services in the Household by Residence Figure 3.1.4 Electricity (24 Hours) 100 80 60 40 20 0 Piped Water Flush Toilet Gas or Electric Cooking Central Heating Percentage Urban Rural FINAL REPORT 15 lowest in Racha-Svaneti (13%). Computers and inter- net are present in about 20% of all households, but this varies greatly by residence. Computers exist in 35% of urban but only 6% of rural households. Simi- larly, 34% of urban households and only 4% of rural households have internet supply (Table 3.1.3). Overall, one in five households has a satellite dish, but in this case it is more common in rural (29%) than in urban (14%) areas. Having a VCR/DVD was reported by 19% of all respondents, more in urban (26%) than in rural (11%) households. Air conditioners exist in only 4% of all households, mainly in urban areas. A vacation home (villa) is owned by 7% of respondents, with a great difference between urban and rural resi- dents (12% and 1.2% respectively). The availability of all household amenities and goods is generally higher in urban than in rural areas, except for TV sets, which are found in virtually all urban and rural households (Figure 3.1.5). Figure 3.1.7 shows changes over 11 years in selected basic services in the households. While the availabil- ity of flush toilets has remained basically unchanged, the availability of electricity 24 hours per day has increased more than 10 times, from 9% in 1999 to 96% in 2010. More households now have land-line telephone service (56% vs. 36%) and 10 times more households have central heating. Changes in the avail- ability of household goods are shown in Figure 3.1.8. The only substantial increase has been in ownership of cell telephones, from less than 10% in 1999 to al- most 75% in 2010. In contrast, during these 11 years, the percentage of households with a villa declined sig- 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Availability of Household Goods by Residence Figure 3.1.5 TV 100 80 60 40 20 0 Re fri ge ra to r Ce ll P ho ne La nd -li ne Ph on e Au to m ob ile Percentage Urban Rural Co m pu te r VC R 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) <45 45-54 55-69 70-79 80+ * Abkhazia: Autonomous region not under goverment control Percentage of Households with Cell phones, by Region Figure 3.1.6 % Households with Cell Phones <40 40-49 50-59 60+ * REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 16 nificantly, and ownership of a refrigerator or a func- tioning automobile decreased slightly. Table 3.1.3, discussed above, presents the proportion of households with selected characteristics (i.e. avail- ability of basic services, amenities and goods) within each of the five wealth quintiles. As expected, the proportion of households with each specific charac- teristic increases as wealth quintile increases, with the exception of having uncrowded living conditions and a satellite dish. The proportion of uncrowded living con- ditions is best in the lowest two wealth quintiles and worsens considerably in the highest quintiles. Pres- ence of a satellite dish is highest in the middle wealth quintile (31%) and lowest in the highest (16%) quintile. It should be noted that there is very little difference in the availability of 24-hour electricity supply and TV sets among the various wealth quintiles. On the other hand, a dramatic variation appears in the availability of flush toilets, ranging from 0% in the lowest wealth quintile to 100% in the highest wealth quintile. Very large differences also exist in the availability of several other household characteristics, such as energy used for cooking, type of heating system, computer and in- ternet across wealth quintiles. The proportion of respondents living in a privately owned flat or house increased between 2005 and 2010 RHS from 85% to 93%, with the highest rate in Kakheti region (99%) and the lowest in Tbilisi (84%). Living in a rental space and living with immediate fam- ily is more common in urban than in rural areas and the highest proportion is observed in Tbilisi (12% and 3% respectively). The proportion of respondents liv- 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Changes in Availability of Basic Services in the Household: GERHS 1999, 2005, and 2010 Figure 3.1.7 Electricity (24 Hours) 100 80 60 40 20 0 Land-line Phone Central Heating Percent 1999 2005 2010 Flush Toilet 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Changes in Ownership of Goods in the Household: GERHS 1999, 2005, and 2010 Figure 3.1.8 Vacation home 100 80 60 40 20 0 Refrigerator Automobile Percent TV 1999 2005 2010 VCR Cell Phone FINAL REPORT 17 ing with their immediate family decreased since 2005 and constitutes only about 2% of all respondents (see Table 3.1.9 for the 2010 data). A typical household in the 2010 survey has on average 3.8 rooms, excluding the kitchen and bathroom. Rural households have more rooms than urban households do (4.6 vs. 3.0). Respondents living in the Kakheti region report the highest average number of rooms (5.2), followed by Guria, Samegrelo and Imereti re- gions with averages of 4.5 each. The lowest average number of rooms is reported by respondents living in Tbilisi (2.5) (Table 3.1.10). On average there are 3.3 persons per household, more in rural (3.5%) than in urban (3.2%) areas. The aver- age household size is lowest in Racha-Svaneti region (2.8 persons) and highest in Adjara and Samtskhe- Javakheti regions (3.9 and 3.8 persons, respectively). Headship was owned by males in 67% of all house- holds. Household headship by males slightly predomi- nates in rural than in urban areas (71% vs. 64%). The highest prevalence of male headship in households is reported in Adjara and Guria regions (71%), and the lowest prevalence in Tbilisi (64%) (Table 3.1.11). Overcrowding in households can be approximately assessed by dividing the average number of persons (Table 3.1.11) by the average number of rooms (Table 3.1.10) in the household. Overall, there is an average 0.8 persons per room, with 1.1 in urban areas and 0.8 in rural areas. In Tbilisi there are on average 1.3 per- sons per room. According to self-reported data about the family’s material status as collected in the 2010 survey, 67% indicated that they “Can somehow satisfy our needs.” An additional 26% stated that they “Can hardly make ends meet.” Only about 7% declared that they “Can easily satisfy our needs;” most of these live in the Ad- jara region. The proportion of households which “Can hardly make ends meet” is highest in rural areas (35%) and in Guria Region (45%) (Table 3.1.12). 3.2 Characteristics of the Respondents As shown in Table 3.2.1, the respondent age distribu- tion is fairly uniform, both generally and across place of residence. Overall, 36% of the respondents were young adults (aged 15–24) at the time of interview, a percentage that does not vary significantly by resi- dence. Nearly 60% of the respondents were legally married or living in a consensual union; the vast majority were legally married (58%). The percentage of respondents who were married or living in a consensual union was much higher in rural areas (64%) than in Tbilisi (52%) or other urban areas (57%). Slightly more than one-third of the respondents have never been mar- ried or lived with a partner. In Tbilisi the proportion of women who have never been married is the highest (40%). Seven percent of the respondents stated that they had been previously married and were now ei- ther divorced or separated. Figure 3.2.1 provides additional details on marital sta- tus by age groups. The vast majority of women aged 15–19 years have never been married or lived with a partner. Among women 20–24 years of age, one in two (49%) is married or living in a consensual union; by the time women reach 25–29 years of age, 71% are married. The proportion of married respondents con- tinues to increase with age, and by the time women reach 40–44 years of age, 90% have been married. 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Current Marital Status by Age Group among Women Aged 15–44 Figure 3.2.1 25-29 100 80 60 40 20 0 20-24 30-34 Percent 15-19 Never married 35-39 40-44 Age Group Previously married Never married REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 18 The proportion of women who have previously been married increases from 0.8 % among women aged 15–19 years to 13% among women aged 40–44 years (Table 3.2.2). Overall, 41% of all respondents aged 15-44 had no living children at time of interview. Percentages were highest among Tbilisi respondents (47%), and lowest among rural respondents (38%). Almost one in five re- spondents reported having one living child, while 30% reported having two living children, and 10% reported having three or more (Table 3.2.1). As in the 2005 sur- vey, Tbilisi respondents reported having, on average, fewer living children (1.7) than respondents who live in other urban areas (1.8) and in rural areas (2.0) (Fig- ure 3.2.2). Georgian women are well-educated, as evidenced by the fact that only 23% have less than a complete secondary education. In general, respondents living in Tbilisi and other urban areas were better educat- ed than those living in rural areas (Figure 3.2.3). For example, as shown in Table 3.2.1, respondents living in Tbilisi were almost three times more likely than ru- ral respondents to have received university training. The regions with the least educated populations are Kvemo Kartli, Samtskhe-Javakheti, Kakheti, and Guria: only 37%–42% of respondents have 12 or more years of education (Figure 3.2.4). Not surprisingly, respondents living in these regions are the least likely to receive university training and, to a certain degree, technical training. Regarding higher education, the Tbilisi region stands out: 60% of respondents have undergone university training while only 13% have not completed secondary education 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Number of Living Children among Women Aged 15–44, by Residence Figure 3.2.2 2 50 40 30 20 10 0 1 3 Percent 0 Tbilisi Other Urban Rural 4+ Number of Living Children 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Educational Attainment among Women Aged 15–44, by Residence Figure 3.2.3 Other Urban 100 80 60 40 20 0 Tbilisi Rural Percent Total Secondary Complete Technicum University Less than Secondary Complete FINAL REPORT 19 (Table 3.2.1). No other region in the country is within 20 percentage points of achieving the same educa- tional attainment rates as Tbilisi. This disparity is likely due to better access to higher education facilities and faculty in Tbilisi. Slightly more than one-third of the respondents lived in households within the two lowest wealth quin- tiles, while 21% lived in middle-quintile households, and 44% lived in households within the two highest wealth quintiles. The percentage living in the lowest two quintiles was highest for rural respondents (66%) and lowest for Tbilisi respondents (1%). In contrast, only 5% of rural respondents were classified as living in two highest quintiles, while virtually all respond- ents living in Tbilisi were classified as living in those quintiles (Table 3.2.1). Only 21% of the respondents reported working out- side of the home at least 20 hours per week. Rural women were less likely to work outside of the home (13%) than women residing in Tbilisi and urban areas (31% and 26%). The vast majority of the respondents reported themselves to be Georgian (87%), while 5% each reported to be of Azeri and Armenian descent. Respondents belonging to minority ethnic groups were more likely to live in rural areas than in urban areas (19% vs. 8%). The dominant religion is Georgian Orthodox (82%); next is the Muslim religion (11%), with 5% belonging to other Orthodox denominations. As shown in Table 3.2.1, the majority of Muslims live in rural areas, where they constitute 18% of the popu- lation. Table 3.2.2 presents additional details on educa- tional attainment for women aged 15-44. Overall, fewer than one in four (23%) Georgian women have not completed secondary education while 39% are at the university or other postgraduate levels. With the exception of women aged 15–19 years, most of whom presumably are still in school, younger women are somewhat more likely than older women to have a university education. Women aged 40-44 are the most likely to report technical training as their highest education level. In Table 3.2.3 for females aged 6 and older, university and other postgraduate education is more common in urban (45%) than in rural (19%) areas. The highest prevalence of university and post- graduate education is reported in Tbilisi (53%), while the lowest is observed in Guria (15%) region. Educa- tional attainment changes across the wealth quintiles from only 13% of women having higher education in the lowest quintile to 57% of women having univer- sity/postgraduate education in the highest quintile. In Table 3.2.3, for women aged 6 and older, the me- dian years of education completed is 10.8. Table 3.2.4 summarizes the educational attainments of the male household population over age six. Over- all, 25% of men have less than complete secondary education (below 10 years) and 29% have received university or other postgraduate education. The me- dian years of education completed is 10.7, nearly the same as for women. Also, similar to women, the high- est percentage of university or other postgraduate ed- ucation for men is reported in Tbilisi and in the highest wealth quintile, while the lowest percentage is in the Guria region and in the lowest wealth quintile. 3.3. School Entries and Attendance Ratios The series of six tables, Nos. 3.3.1 to 3.3.6, present additional educational information on school entries 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) * Abkhazia: Autonomous region not under goverment control Percentage of Women with Post-secondary Education, by Region Figure 3.2.4 % Households with 12+ Yrs. of Education <45 45-54 55-59 60+ * REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 20 and attendance. These are all from the MICS survey in 2010-11, and the MICS Indicator number appears below each table. They are summarized as follows. Table 3.3.1 One indicator of interest concerns the movement from preschool to first grade. In Geor- gia 40% of children in the first grade attended pre- school in the previous year. Table 3.3.2 Among children at the entry age for grade one, 83% enter (84% for boys and 82% for girls, remarkably nearly the same.) Table 3.3.3 Among all children of primary school age, 96% are attending school (net attendance ratios). That leaves 4% who are out of school when they are expected to be attending. Slightly below the average were Kakheti and Kvemo Kartli, at 93%. Table 3.3.4 The overall secondary school attend- ance ratio is 86%, leaving 14% out of school com- pared to 4% for primary school children. It is probable that some of the 14% are actually attending primary school. Table 3.3.5 The transition rate from primary to secondary school is almost 100%, and it is nearly iden- tical for both girls and boys. Table 3.3.6 The very small difference between the sexes appears in the “gender parity” measure, for both primary and secondary school. Table 3.1.1 Percentage Distribution of Households by Wealth Quintiles by Residence and Region Reproductive Health Survey: Georgia, 2010 Lowest Second Middle Fourth Highest Total 20.0 20.0 20.2 19.8 20.0 100.0 12,904 Residence Urban 3.7 5.0 17.4 35.7 38.1 100.0 5,708 Rural 37.5 36.0 23.1 2.8 0.6 100.0 7,196 Residence Tbilisi 0.4 0.6 7.7 35.4 55.8 100.0 2,636 Other Urban 7.1 9.5 27.1 36.0 20.4 100.0 3,072 Rural 37.5 36.0 23.1 2.8 0.6 100.0 7,196 Region Kakheti 30.3 35.2 30.0 3.6 1.0 100.0 1,024 Tbilisi 0.4 0.6 7.7 35.4 55.8 100.0 2,636 Shida Kartli 25.9 32.9 27.2 9.8 4.2 100.0 817 Kvemo Kartli 23.3 20.5 23.7 18.4 14.0 100.0 1,020 Samtskhe–Javakheti 20.8 29.6 38.6 8.4 2.7 100.0 822 Adjara 14.0 20.6 25.9 26.6 12.9 100.0 621 Guria 50.4 24.9 17.4 6.0 1.2 100.0 1,003 Samegrelo 41.4 29.0 18.7 8.0 3.0 100.0 1,050 Imereti 19.0 23.9 22.2 22.7 12.2 100.0 1,633 Mtskheta–Mtianeti 24.4 29.1 26.6 14.1 5.8 100.0 821 Racha–Svaneti 57.1 27.8 13.6 1.4 0.1 100.0 1,457 Characteristic Wealth Quintile Total No. of Cases FINAL REPORT 21 Ta bl e 3. 1. 2 Ur ba n Ru ra l Ka kh et i Tb ili si Sh id a Ka rtl i Kv em o Ka rtl i Sa m ts kh e– Ja va kh et i Ad ja ra G ur ia Sa m eg re lo Im er et i M ts kh et a– M tia ne ti Ra ch a– Sv an et i El ec tri ci ty 2 4 ho ur s Ye s 96 .4 96 .6 96 .2 98 .3 97 .1 97 .7 91 .9 99 .3 91 .8 97 .9 97 .4 97 .6 90 .9 98 .1 N o 3. 6 3. 4 3. 8 1. 7 2. 9 2. 3 8. 1 0. 7 8. 2 2. 1 2. 6 2. 4 9. 1 1. 9 W at er Pi pe d w at er (p ip ed in to 53 .3 86 .8 17 .4 19 .4 96 .8 30 .7 44 .8 55 .8 63 .0 16 .7 19 .8 49 .1 38 .2 15 .9 Pi pe d w at er (i nt o 22 .7 9. 2 37 .2 42 .3 2. 7 33 .7 23 .9 34 .8 20 .8 23 .8 25 .7 26 .0 36 .3 68 .5 Pi pe d w at er /p ub lic 5. 8 0. 8 11 .2 19 .6 0. 3 11 .6 13 .7 7. 2 2. 9 5. 7 2. 0 2. 1 8. 0 7. 1 Tu be w el l, bo re ho le 1. 2 0. 3 2. 2 1. 6 0. 1 1. 2 0. 5 0. 0 1. 1 3. 0 3. 2 1. 5 3. 3 1. 3 Pr ot ec te d w el l 8. 4 1. 1 16 .2 11 .0 0. 0 5. 8 2. 8 0. 4 1. 1 46 .2 19 .8 16 .0 6. 8 1. 0 U np ro te ct ed w el l 5. 3 1. 5 9. 2 1. 6 0. 0 12 .2 5. 0 0. 0 0. 2 4. 2 29 .2 3. 2 1. 0 1. 2 Pr ot ec te d sp rin g 2. 0 0. 2 4. 1 2. 6 0. 0 2. 4 5. 0 1. 1 7. 9 0. 3 0. 2 1. 5 4. 8 1. 4 U np ro te ct ed s pr in g 0. 8 0. 0 1. 7 1. 1 0. 0 1. 5 3. 3 0. 7 0. 8 0. 2 0. 0 0. 6 0. 7 3. 6 O th er 0. 4 0. 0 0. 8 0. 8 0. 0 0. 9 0. 9 0. 0 2. 3 0. 0 0. 0 0. 1 0. 9 0. 1 To ile t F ac ili tie s Fl us h to ile t p ip ed to s ew er 45 .8 82 .9 6. 0 7. 3 95 .3 19 .8 38 .2 24 .8 54 .1 14 .2 13 .8 41 .7 25 .8 7. 0 Fl us h to ile t p ip ed to 2. 2 1. 3 3. 2 6. 8 1. 1 0. 7 2. 7 1. 9 5. 3 0. 7 0. 5 1. 4 5. 4 1. 4 Ve nt ila te d im pr ov ed p it 1. 9 0. 9 2. 9 2. 7 0. 5 1. 6 2. 6 2. 8 1. 3 1. 0 4. 9 1. 3 1. 7 3. 6 Pi t l at rin e w ith s la b 34 .5 11 .1 59 .6 64 .5 2. 0 54 .8 42 .3 26 .6 12 .7 69 .3 67 .8 36 .6 33 .9 58 .2 Pi t l at rin e w ith ou t s la b 14 .0 3. 4 25 .3 18 .4 1. 0 20 .9 13 .9 38 .7 11 .4 14 .7 13 .0 18 .7 32 .9 29 .6 H an gi ng la tri ne 1 4 0 0 2 9 0 3 0 0 0 0 0 1 4 5 15 1 0 2 0 0 0 2 0 2 0 1 Av ai la bi lit y of B as ic S er vi ce s in th e Ho us eh ol d by R es id en ce a nd R eg io n Re pr od uc tiv e He al th S ur ve y: G eo rg ia , 2 01 0 Ch ar ac te ris tic To ta l Re si de nc e Re gi on H an gi ng la tri ne 1. 4 0. 0 2. 9 0. 3 0. 0 0. 0 0. 1 4. 5 15 .1 0. 2 0. 0 0. 2 0. 2 0. 1 N o fa ci lit y/ Bu sh /F ie ld 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 5 0. 0 0. 0 0. 0 0. 0 0. 1 0. 1 O th er 0. 2 0. 4 0. 0 0. 0 0. 1 2. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 En er gy U se d fo r El ec tri ci ty 3. 7 6. 3 1. 1 0. 4 7. 5 1. 5 2. 9 0. 6 6. 0 1. 2 3. 3 2. 2 3. 8 0. 2 N at ur al g as 44 .8 73 .7 13 .8 26 .2 89 .8 29 .3 51 .8 9. 9 26 .9 8. 1 3. 7 43 .8 33 .0 1. 5 C oa l/W oo d 39 .8 11 .5 70 .1 57 .6 1. 1 55 .7 36 .1 64 .7 39 .3 81 .3 75 .5 40 .7 54 .8 96 .2 O th er 11 .6 8. 5 15 .0 15 .8 1. 6 13 .6 9. 2 24 .8 27 .9 9. 5 17 .4 13 .3 8. 4 2. 1 Ty pe o f H ea tin g Sy st em C en tra l h ea tin g 1. 4 2. 6 0. 1 0. 1 4. 1 0. 5 0. 3 0. 4 1. 6 0. 1 0. 1 0. 4 0. 6 0. 1 O w n bo ile r 0. 8 1. 4 0. 2 0. 2 1. 7 0. 5 1. 0 0. 2 1. 8 1. 2 0. 1 0. 2 0. 5 0. 1 In di vi du al ro om h ea tin g 28 .9 47 .5 9. 0 5. 7 57 .1 23 .9 24 .8 6. 1 27 .5 8. 7 23 .2 21 .6 17 .1 7. 5 St ov e he at in g 66 .5 45 .0 89 .6 93 .0 32 .7 74 .7 71 .5 93 .1 65 .4 89 .5 75 .5 75 .8 80 .3 92 .1 N o he at in g 2. 1 3. 3 0. 8 1. 0 4. 2 0. 5 2. 2 0. 2 1. 9 0. 5 1. 0 1. 7 1. 2 0. 2 O th er 0. 3 0. 2 0. 3 0. 1 0. 1 0. 0 0. 3 0. 0 1. 8 0. 0 0. 0 0. 4 0. 4 0. 0 M ai n Ro of M at er ia l Ti le o r c on cr et e 26 .5 45 .3 6. 5 3. 1 61 .8 8. 8 17 .2 4. 7 18 .7 7. 1 13 .5 22 .2 25 .3 3. 4 C or ru ga te d iro n 36 .0 19 .6 53 .6 42 .7 6. 8 47 .1 48 .7 58 .9 51 .7 69 .7 49 .2 38 .5 34 .0 23 .1 Sh ee t m et al 33 .2 28 .3 38 .3 52 .8 23 .7 42 .8 27 .4 35 .4 27 .5 22 .5 33 .7 36 .1 36 .1 68 .9 As ph al t s hi ng le s 2. 4 4. 5 0. 1 0. 1 5. 2 0. 1 5. 3 0. 0 0. 6 0. 3 0. 9 1. 6 1. 2 1. 0 N at ur al m at er ia ls 1. 3 1. 6 1. 1 0. 7 2. 0 0. 9 0. 6 0. 6 0. 6 0. 2 2. 6 1. 0 2. 2 2. 5 O th er 0. 5 0. 7 0. 4 0. 6 0. 5 0. 2 0. 9 0. 4 0. 8 0. 2 0. 1 0. 7 1. 2 1. 1 No . o f C as es 12 .9 04 5, 70 8 7, 19 6 1, 02 4 2, 63 6 81 7 1, 02 0 82 2 62 1 1, 00 3 1, 05 0 1, 63 3 82 1 1, 45 7 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 22 Ta bl e 3. 1. 4 Pe rc en t D is tr ib ut io n of H ou se ho ld P op ul at io n A cc or di ng to M ai n So ur ce o f D rin ki ng W at er a nd P er ce nt ag e of H ou se ho ld P op ul at io n U si ng Im pr ov ed D rin ki ng W at er S ou rc es , G eo rg ia , 2 01 0- 20 11 Pi pe d w at er (p ip ed in to d w el lin g) Pi pe d w at er (p ip ed in to co m po un d, ya rd o r p lo t) Pi pe d w at er (p ip ed to ne ig hb or ) Pi pe d w at er (p ub lic ta p/ st an dp ip e) Tu be w el l, bo re ho le Pr ot ec te d w el l Pr ot ec te d sp rin g B ot tle d w at er U np ro te ct ed w el l U np ro te c te d sp rin g Ta nk er tr uc ke r C ar ts w ith sm al l ta nk /d ru m Su rf ac e w at er (r iv er , s tr ea m , da m , l ak e, p on d, ca na l, irr ig at io n) O th er R eg io n K ak he ti 19 .4 41 .1 4. 8 15 .7 1. 7 11 .2 2. 8 .0 1. 4 1. 1 .1 .4 .0 .3 10 0. 0 96 .7 4, 07 9 Tb ili si 96 .9 2. 7 .2 .1 .1 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 10 0. 0 10 ,5 06 S hi da K ar tli 30 .9 32 .4 1. 7 9. 2 1. 7 6. 1 2. 4 .0 13 .5 1. 3 .0 .0 .0 .7 10 0. 0 84 .5 3, 05 2 K ve m o K ar tli 42 .9 23 .7 1. 3 13 .2 .7 3. 5 5. 2 .4 4. 7 3. 6 .1 .5 .1 .0 10 0. 0 90 .9 4, 69 2 S am ts kh e- Ja va kh et i 56 .1 33 .7 2. 4 5. 5 .0 .4 1. 2 .0 .0 .8 .0 .0 .0 .0 10 0. 0 99 .2 2, 14 8 A dj ar a 59 .4 22 .0 1. 1 2. 5 1. 6 .8 9. 1 .0 .1 .8 .0 .0 .0 2. 6 10 0. 0 96 .5 3, 78 2 G ur ia 16 .8 22 .9 .8 5. 0 3. 1 47 .0 .2 .0 3. 9 .2 .0 .0 .0 .0 10 0. 0 95 .9 1, 41 9 S am eg re lo 18 .8 24 .9 1. 7 .2 3. 5 19 .9 .3 .0 30 .6 .0 .0 .0 .0 .0 10 0. 0 69 .4 4, 34 5 Im er et i 49 .7 25 .1 .9 .9 1. 9 16 .2 1. 6 .0 3. 0 .6 .0 .0 .0 .0 10 0. 0 96 .4 7 , 00 5 M ts kh et a- M tia ne ti 39 .8 33 .8 2. 8 4. 5 3. 7 7. 7 4. 9 .1 1. 2 .9 .0 .5 .1 .0 10 0. 0 97 .3 1, 24 1 R ac ha -S va ne ti 17 .4 67 .4 2. 5 3. 6 .9 1. 1 1. 1 .0 1. 5 4. 3 .0 .1 .0 .0 10 0. 0 94 .1 58 4 R es id en ce U rb an 86 .9 8. 9 .4 .3 .3 1. 3 .2 .0 1. 7 .0 .0 .0 .0 .0 10 0. 0 98 .3 21 ,1 02 R ur al 19 .2 35 .5 2. 5 8. 8 2. 5 15 .3 4. 4 .1 9. 0 1. 8 .0 .2 .0 .6 10 0. 0 88 .4 21 ,7 51 Ed uc at io n of H ou se ho ld H ea d N on e 67 .8 15 .9 .9 3. 2 .9 5. 8 1. 6 .0 3. 0 .5 .0 .1 .0 .3 10 0. 0 96 .1 20 ,8 46 P rim ar y 31 .3 31 .6 2. 5 8. 5 1. 9 7. 9 6. 8 .0 5. 5 3. 7 .0 .2 .0 .0 10 0. 0 90 .6 1, 57 7 S ec on da ry + 38 .6 28 .4 1. 9 5. 8 1. 9 11 .1 2. 7 .1 7. 9 1. 0 .0 .1 .0 .4 10 0. 0 90 .5 20 ,4 24 M is si n g /D K 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 10 0. 0 5 W ea lth In de x Q ui nt ile s Lo w es t .1 43 .3 2. 8 8. 8 2. 0 20 .1 5. 5 .1 13 .1 3. 1 .0 .1 .0 .8 10 0. 0 82 .7 7 , 63 4 S ec on d 10 .7 43 .7 2. 2 9. 2 2. 8 15 .5 4. 7 .1 8. 9 1. 6 .1 .1 .1 .6 10 0. 0 88 .7 9, 17 5 M id dl e 54 .2 23 .1 1. 9 4. 6 2. 1 6. 8 1. 5 .1 5. 3 .0 .0 .3 .0 .2 10 0. 0 94 .2 9, 18 0 Fo ur th 96 .1 2. 1 .3 .7 .1 .5 .2 .0 .1 .0 .0 .0 .0 .0 10 0. 0 99 .9 7, 62 1 H ig he st 99 .9 .1 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 10 0. 0 9, 24 2 To ta l 52 .5 22 .4 1. 4 4. 6 1. 4 8. 4 2. 3 .0 5. 4 .9 .0 .1 .0 .3 10 0. 0 93 .2 42 ,8 53 U se o f I m pr ov ed W at er S ou rc es C ha ra ct er is tic [1 ] M IC S in di ca to r 4 .1 ; M D G in di ca to r 7 .8 Pe rc en ta ge us in g im pr ov ed so ur ce s of dr in ki ng w at er [1 ] M ai n so ur ce o f d rin ki ng w at er N um be r o f ho us eh ol d m em be rs Im pr ov ed s ou rc es U ni m pr ov ed s ou rc es To ta l Ur ba n Ru ra l Lo we st Se co nd M id dl e Fo ur th Hi gh es t El ec tri cit y 2 4 ho ur s 96 .4 96 .6 96 .2 94 .6 96 .4 97 .0 96 .0 97 .9 Pi pe d wa te r 76 .0 96 .0 54 .6 45 .3 57 .3 79 .1 98 .6 99 .9 Fl us h to ile t 48 .0 84 .2 9. 3 0. 0 2. 4 40 .6 97 .8 10 0. 0 Co ok ing w ith e lec tri cit y o r n at ur al ga s 48 .6 80 .0 14 .9 0. 2 11 .8 46 .7 87 .7 96 .9 Ce nt ra l o r i nd ivi du al ro om h ea tin g 31 .1 51 .5 9. 3 0. 2 8. 0 18 .8 47 .9 81 .1 Un cr ow de d liv ing co nd itio ns * 66 .5 57 .8 75 .8 76 .1 76 .3 73 .0 61 .4 45 .4 T. V. 96 .6 97 .9 95 .1 89 .3 98 .0 97 .8 98 .0 99 .8 Ce llu lar p ho ne 74 .5 81 .9 66 .5 43 .4 74 .0 79 .2 78 .1 97 .7 Re fri ge ra to r 78 .8 89 .1 67 .9 41 .7 78 .2 85 .2 90 .4 98 .9 Ho us eh old p ho ne 56 .0 72 .5 38 .3 15 .9 41 .3 59 .0 70 .3 93 .7 W or kin g au to m ob ile 25 .2 28 .1 22 .0 3. 2 25 .3 28 .9 20 .9 47 .3 Co m pu te r 21 .0 35 .2 5. 8 0. 0 1. 1 11 .7 18 .8 73 .7 In te rn et 19 .7 34 .0 4. 4 0. 0 0. 6 8. 8 17 .6 71 .7 VC R/ DV D 18 .6 26 .0 10 .6 0. 6 9. 3 17 .6 19 .5 45 .8 Sa te llit e dis h 21 .3 13 .9 29 .2 17 .6 29 .0 30 .7 13 .0 16 .1 Va ca tio n ho m e (v illa ) 6. 9 12 .2 1. 2 0. 2 1. 0 1. 8 4. 2 27 .3 Ai r c on dit ion er 3. 8 6. 9 0. 5 0. 0 0. 1 0. 4 1. 6 17 .2 No . o f C as es 12 ,9 04 5, 70 8 7, 19 6 3, 31 2 2, 81 5 2, 60 3 2, 12 1 2, 05 3 Ta bl e 3. 1. 3 A va ila bi lit y of B as ic S er vi ce s in th e Ho us eh ol d by R es id en ce a nd W ea lth Q ui nt ile . Re pr od uc tiv e He al th S ur ve y: G eo rg ia , 2 01 0 * T h t t l b f li i i th h h ld di id d b th t t l b f ( t i ld i ki th d b th ) l Ch ar ac te ris tic To ta l Re si de nc e W ea lth Q ui nt ile * T he to ta l n um be r o f p er so ns liv ing in th e ho us eh old d ivi de d by th e to ta l n um be r o f r oo m s ( no t in clu din g kit ch en a nd b at hr oo m ) w as o ne o r l es s. FINAL REPORT 23 Ta bl e 3. 1. 5 T im e to S ou rc e of D rin ki ng W at er Pe rc en t D is tri bu tio n of H ou se ho ld P op ul at io n Ac co rd in g to T im e to G o to S ou rc e of D rin ki ng W at er , G et W at er , a nd R et ur n, fo r U se rs o f I m pr ov ed a nd U ni m pr ov ed D rin ki ng W at er S ou rc es , G eo rg ia , 2 01 0- 20 11 C ha ra ct er is tic W at er o n pr em is es Le ss th an 3 0 m in ut es 30 m in ut es o r m or e Le ss th an 3 0 m in ut es 30 m in ut es o r m or e R e g io n Ka kh et i 65 .3 28 .0 3. 4 2. 0 1. 3 10 0. 0 4, 07 9 Tb ilis i 99 .8 .2 .0 .0 .0 10 0. 0 10 ,5 06 Sh id a Ka rtl i 65 .0 18 .5 1. 0 14 .8 .8 10 0. 0 3, 05 2 Kv em o Ka rtl i 68 .2 14 .2 8. 5 6. 2 2. 9 10 0. 0 4, 69 2 Sa m ts kh e- Ja va kh et i 92 .1 5. 8 1. 2 .8 .0 10 0. 0 2, 14 8 Ad ja ra 82 .5 6. 1 7. 8 1. 3 2. 3 10 0. 0 3, 78 2 G ur ia 40 .5 51 .8 3. 6 3. 8 .3 10 0. 0 1, 41 9 Sa m eg re lo 45 .4 23 .0 1. 0 30 .2 .4 10 0. 0 4, 34 5 Im er et i 75 .8 18 .4 2. 2 2. 5 1. 2 10 0. 0 7, 00 5 M ts kh et a- M tia ne ti 76 .5 17 .8 3. 0 2. 1 .6 10 0. 0 1, 24 1 R ac ha -S va ne ti 87 .3 5. 9 .8 5. 8 .1 10 0. 0 58 4 Re si de nc e U rb an 96 .1 1. 9 .2 1. 5 .2 10 0. 0 21 ,1 02 R ur al 57 .3 25 .8 5. 3 9. 9 1. 7 10 0. 0 21 ,7 51 Ed uc at io n of H ou se ho ld H ea d N on e 84 .6 9. 7 1. 8 3. 3 .6 10 0. 0 20 ,8 46 Pr im ar y 65 .5 18 .1 7. 0 7. 0 2. 4 10 0. 0 1, 57 7 Se co nd ar y + 68 .9 18 .1 3. 4 8. 3 1. 2 10 0. 0 20 ,4 24 M is si ng /D K 10 0. 0 .0 .0 .0 .0 10 0. 0 5 W ea lth In de x Q ui nt ile s Lo w es t 46 .3 30 .3 6. 1 14 .5 2. 8 10 0. 0 7, 63 4 Se co nd 56 .6 26 .8 5. 2 9. 9 1. 4 10 0. 0 9, 17 5 M id dl e 79 .2 12 .6 2. 4 5. 1 .7 10 0. 0 9, 18 0 Fo ur th 98 .5 1. 1 .3 .1 .0 10 0. 0 7, 62 1 H ig he st 99 .9 .1 .0 .0 .0 10 0. 0 9, 24 2 To ta l 76 .4 14 .1 2. 8 5. 8 1. 0 10 0. 0 42 ,8 53 Ti m e to s ou rc e of d rin ki ng w at er To ta l N o. of h ou se ho ld m em be rs Us er s of im pr ov ed d rin ki ng w at er s ou rc es Us er s of u ni m pr ov ed d rin ki ng w at er so ur ce s Ta bl e 3. 1. 6 T yp es o f S an ita tio n Fa ci lit ie s P er ce nt D is tri bu tio n of H ou se ho ld P op ul at io n Ac co rd in g to T yp e of T oi le t F ac ili ty U se d by th e Ho us eh ol d, G eo rg ia , 2 01 0- 20 11 Fl us h to ile t p ip ed to se we r s ys te m Fl us h to ile t p ip ed to s ep tic ta nk Fl us h to ile t p ip ed to p it (la tri ne ) Fl us h to ile t p ip ed un kn ow n pl ac e/ no t su re /d k wh er e Ve nt ila te d im pr ov ed p it la tri ne Pi t l at rin e wi th sl ab Co m po st in g to ile t Fl us h to ile t p ip ed to s om ew he re e ls e Pi t l at rin e wi th ou t sl ab Bu ck et Ha ng in g to ile t, ha ng in g la tri ne Ot he r No fa ci lit y/ bu sh /fi el d Re gi on Ka kh et i 5. 2 1. 4 3. 6 1. 9 2. 0 65 .5 .3 2. 1 18 .0 .0 .0 .0 .0 10 0. 0 4, 07 9 Tb ilis i 94 .8 .5 .7 .1 .5 2. 2 .0 .1 1. 0 .0 .0 .1 .0 10 0. 0 10 ,5 06 Sh id a Ka rtl i 18 .5 1. 1 .6 .1 1. 7 57 .0 .0 .1 19 .2 .0 .0 1. 5 .0 10 0. 0 3 , 05 2 Kv em o Ka rtl i 32 .9 2. 9 2. 3 .1 3. 1 44 .9 .1 .3 13 .4 .0 .0 .0 .0 10 0. 0 4 , 69 2 Sa m ts kh e- Ja va kh et i 20 .9 .4 1. 1 .0 3. 4 27 .6 .0 .9 40 .0 .0 5. 4 .1 .2 10 0. 0 2 , 14 8 Ad ja ra 47 .9 2. 0 1. 4 1. 9 1. 4 12 .9 2. 0 1. 6 12 .5 .0 16 .3 .0 .0 10 0. 0 3, 78 2 G ur ia 12 .4 1. 6 .4 .3 1. 0 68 .8 .2 .2 15 .0 .0 .0 .0 .0 10 0. 0 1 , 41 9 Sa m e g re lo 11 .3 1. 3 .3 .1 5. 2 68 .0 .0 .0 13 .8 .0 .0 .0 .0 10 0. 0 4, 34 5 Im er et i 38 .2 2. 9 .5 .1 1. 2 38 .2 .4 .9 17 .6 .0 .0 .0 .0 10 0. 0 7 , 00 5 M ts kh et a- M tia ne ti 24 .7 2. 0 4. 2 .0 1. 7 35 .1 .4 .7 31 .1 .0 .0 .0 .0 10 0. 0 1 , 24 1 Ra ch a- Sv an et i 6. 0 1. 3 1. 1 .1 3. 0 59 .6 .2 .2 28 .5 .0 .0 .0 .0 10 0. 0 58 4 Re si de nc e Ur ba n 81 .9 1. 0 .9 .1 .9 11 .5 .0 .2 3. 2 .0 .0 .3 .0 10 0. 0 21 ,1 02 Ru ra l 4. 3 2. 1 1. 6 .7 2. 9 58 .8 .6 1. 0 24 .4 .0 3. 4 .0 .0 10 0. 0 21 ,7 51 Ed uc at io n of H ou se ho ld H ea d No ne 59 .8 1. 9 1. 0 .3 1. 3 25 .2 .3 .4 9. 2 .0 .5 .1 .0 10 0. 0 20 ,8 46 Pr im ar y 13 .1 2. 4 2. 0 2. 6 1. 4 44 .4 1. 6 .5 21 .8 .0 9. 9 .2 .1 10 0. 0 1, 57 7 Se co nd ar y + 27 .2 1. 2 1. 4 .4 2. 6 45 .3 .2 .9 18 .2 .0 2. 3 .2 .0 10 0. 0 20 ,4 24 M iss in g/ DK 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 5 W ea lth In de x Qu in til es Lo we st .0 .0 .0 .0 2. 6 63 .8 .9 .0 30 .5 .0 1. 9 .1 .0 10 0. 0 7, 63 4 Se co nd .2 .2 .4 .9 2. 7 65 .1 .3 .3 24 .9 .0 4. 8 .2 .0 10 0. 0 9 , 17 5 M id dl e 23 .0 3. 8 3. 8 1. 0 3. 5 45 .9 .3 2. 1 14 .7 .0 1. 6 .3 .0 10 0. 0 9 , 18 0 Fo ur th 91 .2 3. 3 1. 6 .2 .6 2. 0 .0 .6 .3 .0 .0 .1 .0 10 0. 0 7 , 62 1 Hi gh es t 98 .9 .7 .4 .0 .0 .1 .0 .0 .0 .0 .0 .0 .0 10 0. 0 9, 24 2 To ta l 42 .5 1. 6 1. 3 .4 1. 9 35 .5 .3 .6 14 .0 .0 1. 7 .1 .0 10 0. 0 42 ,8 53 N um be r o f ho us eh ol d m em be rs Im pr ov ed s an ita tio n fa ci lit y Un im pr ov ed s an ita tio n fa ci lit y C ha ra ct er is tic Ty pe o f t oi le t f ac ili ty u se d by h ou se ho ld To ta l REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 24 Ta bl e 3. 1. 7 D rin ki ng W at er a nd S an ita tio n La dd er s P er ce nt ag e of H ou se ho ld P op ul at io n by D rin ki ng W at er a nd S an ita tio n La dd er s, G eo rg ia , 2 01 0- 20 11 Pi pe d in to d w el lin g, p lo t o r y ar d O th er im pr ov ed Un im pr ov ed fa ci lit ie s O pe n de fe ca tio n Re gi on Ka kh et i 60 .5 36 .2 3. 3 10 0. 0 79 .9 20 .1 .0 10 0. 0 79 .1 4, 07 9 Tb ilis i 99 .6 .4 .0 10 0. 0 98 .8 1. 2 .0 10 0. 0 98 .8 10 ,5 06 Sh id a Ka rtl i 63 .3 21 .2 15 .5 10 0. 0 79 .2 20 .8 .0 10 0. 0 68 .9 3, 05 2 Kv em o Ka rtl i 66 .6 24 .3 9. 1 10 0. 0 86 .2 13 .7 .0 10 0. 0 78 .2 4, 69 2 Sa m ts kh e- Ja va kh et i 89 .7 9. 4 .8 10 0. 0 53 .3 46 .5 .2 10 0. 0 52 .6 2, 14 8 Ad ja ra 81 .4 15 .0 3. 5 10 0. 0 69 .5 30 .5 .0 10 0. 0 68 .4 3, 78 2 G ur ia 39 .7 56 .3 4. 1 10 0. 0 84 .8 15 .2 .0 10 0. 0 81 .0 1, 41 9 Sa m e g re lo 43 .8 25 .6 30 .6 10 0. 0 86 .2 13 .8 .0 10 0. 0 61 .1 4, 34 5 Im er et i 74 .9 21 .5 3. 6 10 0. 0 81 .5 18 .5 .0 10 0. 0 79 .9 7, 00 5 M ts kh et a- M tia ne ti 73 .6 23 .7 2. 7 10 0. 0 68 .2 31 .8 .0 10 0. 0 66 .5 1, 24 1 Ra ch a- Sv an et i 84 .8 9. 2 5. 9 10 0. 0 71 .2 28 .7 .0 10 0. 0 68 .5 58 4 Re si de nc e Ur ba n 95 .7 2. 5 1. 7 10 0. 0 96 .3 3. 7 .0 10 0. 0 95 .0 21 ,1 02 Ru ra l 54 .8 33 .6 11 .6 10 0. 0 71 .1 28 .8 .0 10 0. 0 62 .9 21 ,7 51 Ed uc at io n of H ou se ho ld H ea d No ne 83 .6 12 .5 3. 9 10 0. 0 89 .8 10 .2 .0 10 0. 0 87 .1 20 ,8 46 Pr im ar y 63 .0 27 .6 9. 4 10 0. 0 67 .5 32 .4 .1 10 0. 0 61 .7 1, 57 7 Se co nd ar y + 67 .0 23 .5 9. 5 10 0. 0 78 .3 21 .7 .0 10 0. 0 71 .4 20 ,4 24 M iss in g/ DK 10 0. 0 .0 .0 10 0. 0 10 0. 0 .0 .0 10 0. 0 10 0. 0 5 W ea lth In de x Q ui nt ile s Lo we s t 43 .4 39 .3 17 .3 10 0. 0 67 .4 32 .6 .0 10 0. 0 56 .3 7, 63 4 Se co nd 54 .4 34 .3 11 .3 10 0. 0 69 .7 30 .2 .0 10 0. 0 61 .5 9, 17 5 M id dl e 77 .3 16 .9 5. 8 10 0. 0 81 .3 18 .7 .0 10 0. 0 76 .3 9, 18 0 Fo ur th 98 .2 1. 8 .1 10 0. 0 98 .9 1. 1 .0 10 0. 0 98 .8 7, 62 1 Hi gh es t 99 .9 .1 .0 10 0. 0 10 0. 0 .0 .0 10 0. 0 10 0. 0 9, 24 2 To ta l 74 .9 18 .3 6. 8 10 0. 0 83 .5 16 .5 .0 10 0. 0 78 .7 42 ,8 53 Un im pr ov ed s an ita tio n To ta l Im pr ov ed d rin ki ng w at er s ou rc es a nd im pr ov ed s an ita tio n [1 ] M IC S in di ca to r 4 .1 ; M DG in di ca to r 7 .8 [2 ] M IC S in di ca to r 4 .3 ; M DG in di ca to r 7 .9 Ch ar ac te ris tic Pe rc en ta ge o f h ou se ho ld p op ul at io n us in g: N um be r o f ho us eh ol ds Im pr ov ed d rin ki ng w at er [1 ] Un im pr ov ed dr in ki ng w at er To ta l Im pr ov ed sa ni ta tio n [2 ] Ta bl e 3 .1. 8 Av ail ab ilit y o f V ar io us H ou se ho ld A m en iti es an d Go od s i n th e H ou se ho ld b y R es id en ce an d Re gi on Re pr od uc tiv e H ea lth S ur ve y: G eo rg ia, 20 10 Ur ba n Ru ra l Ka kh et i Tb ilis i Sh id a Ka rtl i Kv em o Ka rtl i Sa m ts kh e- Ja va kh et i Ad jar a Gu ria Sa m eg re lo Im er et i Mt sk he ta - Mt ian et i Ra ch a- Sv an et i T. V. 96 .6 97 .9 95 .1 97 .0 97 .9 96 .1 94 .5 96 .2 96 .3 97 .5 95 .9 97 .7 91 .6 90 .7 Ce llu lar ph on e 74 .5 81 .9 66 .5 73 .8 85 .7 65 .4 70 .3 79 .2 73 .3 62 .4 64 .2 74 .0 71 .7 57 .4 Re frig er ato r 78 .8 89 .1 67 .9 76 .8 92 .3 72 .7 73 .4 73 .1 81 .0 58 .9 72 .2 77 .7 69 .5 57 .2 Ho us eh old ph on e 56 .0 72 .5 38 .3 44 .3 81 .9 42 .7 47 .7 47 .2 39 .0 49 .0 36 .7 62 .0 34 .1 35 .9 W or kin g a uto mo bil e 25 .2 28 .1 22 .0 28 .1 30 .7 17 .4 24 .2 31 .3 21 .4 16 .2 21 .0 25 .0 22 .4 12 .5 Co mp ute r 21 .0 35 .2 5.8 8.2 47 .0 7.8 15 .0 13 .0 19 .5 4.5 7.5 15 .6 10 .6 3.1 Int er ne t 19 .7 34 .0 4.4 7.1 46 .0 7.1 13 .4 10 .5 19 .2 3.9 6.2 13 .6 7.9 2.1 VC R/ DV D 18 .6 26 .0 10 .6 12 .1 31 .0 7.8 18 .3 30 .4 19 .2 6.4 9.2 14 .6 13 .8 5.2 Sa tel lite di sh 21 .3 13 .9 29 .2 29 .0 8.3 15 .8 33 .2 65 .0 39 .3 12 .7 18 .1 13 .2 30 .3 37 .7 Va ca tio n h om e ( vil la) 6.9 12 .2 1.2 0.8 17 .5 1.6 3.5 1.8 8.7 1.8 1.7 4.4 2.1 1.1 Ai r c on dit ion er 3.8 6.9 0.5 0.3 9.4 0.6 2.0 0.5 7.7 0.3 0.9 2.3 1.5 0.0 N f C 12 90 4 57 08 71 96 10 24 26 36 81 7 10 20 82 2 62 1 10 03 10 50 16 33 82 1 14 57 Ch ar ac te ris tic To ta l Re sid en ce Re gi on No . o f C as es 12 ,90 4 5,7 08 7,1 96 1,0 24 2,6 36 81 7 1,0 20 82 2 62 1 1,0 03 1,0 50 1,6 33 82 1 1,4 57 FINAL REPORT 25 Ta bl e 3. 1. 9 Ty pe o f L iv in g Ar ra ng em en ts b y Re si de nc e an d Re gi on Re pr od uc tiv e He al th S ur ve y: G eo rg ia , 2 01 0 Ur ba n Ru ra l Ka kh et i Tb ili si Sh id a Ka rtl i Kv em o Ka rtl i Sa m ts kh e- Ja va kh et i Ad ja ra Gu ria Sa m eg re lo Im er et i M ts kh et a- M tia ne ti Ra ch a- Sv an et i Liv es in p riv at ely o wn ed fla t o r h ou se 93 .3 88 .9 97 .9 98 .7 84 .1 93 .3 95 .8 97 .8 95 .2 98 .2 95 .5 97 .6 94 .4 98 .4 Liv es in re nt al sp ac e (ro om , f lat , o r h ou se ) 4. 4 8. 0 0. 5 1. 0 11 .9 0. 7 2. 6 0. 9 4. 2 0. 6 2. 1 1. 3 2. 1 0. 8 Liv es w ith im m ed iat e fa m ily 1. 5 2. 2 0. 8 0. 1 2. 8 4. 4 0. 8 0. 5 0. 0 0. 7 1. 7 0. 7 1. 0 0. 6 Liv es w ith o th er re lat ive s 0. 3 0. 3 0. 3 0. 2 0. 4 0. 0 0. 4 0. 5 0. 3 0. 2 0. 4 0. 2 1. 1 0. 1 Ot he r 0. 5 0. 6 0. 4 0. 0 0. 8 1. 6 0. 4 0. 4 0. 3 0. 3 0. 3 0. 2 1. 5 0. 1 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 No . o f C as es 12 ,9 04 5, 70 8 7, 19 6 1, 02 4 2, 63 6 81 7 1, 02 0 82 2 62 1 1, 00 3 1, 05 0 1, 63 3 82 1 1, 45 7 Ty pe o f L iv in g Ar ra ng em en ts To ta l Re si de nc e Re gi on Ta bl e 3. 1. 10 Nu m be r o f R oo m s in th e Ho us eh ol d by R es id en ce a nd R eg io n Re pr od uc tiv e He al th S ur ve y: G eo rg ia , 2 01 0 Ur ba n Ru ra l Ka kh et i Tb ili si Sh id a Ka rtl i Kv em o Ka rtl i Sa m ts kh e- Ja va kh et i Ad ja ra Gu ria Sa m eg re lo Im er et i M ts kh et a- M tia ne ti Ra ch a- Sv an et i 1 8. 5 14 .0 2. 6 1. 3 19 .5 7. 5 7. 7 3. 2 5. 6 2. 5 3. 3 4. 2 8. 9 2. 7 2 20 .1 28 .2 11 .4 7. 5 34 .2 17 .9 21 .1 14 .4 21 .9 13 .4 10 .7 14 .1 21 .7 13 .5 3 22 .5 27 .8 17 .0 12 .0 28 .8 20 .9 23 .9 27 .7 25 .0 14 .3 18 .5 20 .3 23 .4 21 .6 4 20 .4 15 .8 25 .3 23 .1 13 .2 24 .1 23 .0 26 .4 21 .4 27 .3 24 .0 19 .6 23 .8 29 .8 5 10 .4 6. 1 15 .0 14 .8 2. 7 11 .8 11 .2 13 .6 11 .4 14 .5 15 .5 12 .9 9. 0 17 .4 6 8. 5 4. 0 13 .4 18 .6 1. 3 6. 6 7. 4 8. 2 7. 2 15 .1 12 .0 13 .1 5. 8 10 .3 7 or m or e 9. 5 4. 1 15 .3 22 .7 0. 4 11 .3 5. 7 6. 6 7. 4 13 .1 16 .0 15 .8 7. 4 4. 8 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 Av er ag e No . o f R oo m s 3. 8 3. 0 4. 6 5. 2 2. 5 3. 9 3. 6 3. 9 3. 7 4. 5 4. 5 4. 5 3. 6 4. 0 N o. o f C as es 1 2, 90 4 5, 70 8 7, 19 6 1, 02 4 2, 63 6 81 7 1, 02 0 82 2 62 1 1, 00 3 1, 05 0 1, 63 3 82 1 1, 45 7 * N ot in clu din g kit ch en a nd b at hr oo m Nu m be r o f R oo m s* To ta l Re si de nc e Re gi on REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 26 Ta bl e 3. 1. 11 Nu m be r o f P er so ns L iv in g in th e Ho us eh ol d by R es id en ce a nd R eg io n Re pr od uc tiv e He al th S ur ve y: G eo rg ia , 2 01 0 Ur ba n Ru ra l Ka kh et i Tb ili si Sh id a Ka rtl i Kv em o Ka rtl i Sa m ts kh e- Ja va kh et i Ad ja ra Gu ria Sa m eg re lo Im er et i M ts kh et a- M tia ne ti Ra ch a- Sv an et i Ho us eh ol d He ad sh ip M ale 67 .2 64 .1 70 .6 69 .3 64 .0 67 .7 67 .6 69 .1 71 .8 71 .4 67 .8 66 .9 67 .6 67 .0 Fe m ale 32 .8 35 .9 29 .4 30 .7 36 .0 32 .3 32 .4 30 .9 28 .2 28 .6 32 .2 33 .1 32 .4 33 .0 Nu m be r o f P er so ns 1 17 .5 18 .7 16 .1 19 .7 18 .7 16 .4 17 .1 12 .8 10 .0 17 .1 15 .9 19 .2 18 .6 28 .0 2 21 .1 21 .1 21 .1 18 .3 19 .9 24 .1 21 .1 20 .3 14 .0 26 .4 22 .6 24 .1 20 .7 25 .9 3 18 .0 20 .3 15 .5 16 .1 22 .0 15 .5 13 .9 12 .5 17 .6 18 .0 19 .5 17 .0 17 .8 18 .0 4 18 .6 19 .6 17 .4 18 .3 19 .9 17 .0 20 .6 19 .2 20 .9 15 .6 16 .9 17 .5 16 .8 10 .8 5 12 .5 10 .9 14 .1 13 .5 10 .6 14 .7 12 .6 15 .6 16 .3 11 .5 14 .0 10 .7 13 .4 8. 9 6 7. 7 6. 0 9. 5 9. 5 5. 5 7. 7 9. 1 10 .6 14 .0 6. 9 5. 5 7. 2 8. 4 4. 5 7 or m or e 4. 8 3. 4 6. 2 4. 7 3. 3 4. 5 5. 6 9. 0 7. 2 4. 5 5. 6 4. 2 4. 3 3. 8 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 Av er ag e No . o f P er so ns 3. 3 3. 2 3. 5 3. 4 3. 2 3. 3 3. 4 3. 8 3. 9 3. 2 3. 3 3. 2 3. 3 2. 8 No . o f C as es 12 ,9 04 5, 70 8 7, 19 6 1, 02 4 2, 63 6 81 7 1, 02 0 82 2 62 1 1, 00 3 1, 05 0 1, 63 3 82 1 1, 45 7 To ta l Re si de nc e Re gi on Ta bl e 3 .1. 12 Se lf- Re po rte d Ev alu at io n of th e M at er ial S ta tu s o f t he F am ily b y R es id en ce an d Re gi on : Ho us eh ol ds W ith W om en A ge d 15 –4 4 Re pr od uc tiv e H ea lth S ur ve y: G eo rg ia, 20 10 Ur ba n Ru ra l Ka kh et i Tb ilis i Sh id a Ka rtl i Kv em o Ka rtl i Sa m ts kh e- Ja va kh et i Ad jar a Gu ria Sa m eg re lo Im er et i Mt sk he ta - Mt ian et i Ra ch a- Sv an et i Ca n ea sil y s at isf y o ur n ee ds 6. 7 9. 2 3. 8 2. 5 9. 7 4. 1 3. 3 2. 8 12 .8 1. 2 3. 2 8. 6 0. 8 4. 4 Ca n so m eh ow sa tis fy ou r n ee ds 67 .3 72 .9 60 .8 72 .5 75 .1 62 .7 60 .9 71 .0 54 .4 53 .4 69 .4 67 .7 58 .2 56 .8 Ca n ha rd ly m ak e en ds m ee t 25 .7 17 .4 35 .1 24 .5 14 .7 33 .1 35 .9 25 .9 32 .1 45 .0 27 .4 23 .5 41 .1 38 .7 Do es n ot kn ow 0. 3 0. 4 0. 2 0. 5 0. 5 0. 0 0. 0 0. 3 0. 7 0. 4 0. 0 0. 2 0. 0 0. 0 To ta l 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 No . o f C as es 6,2 92 2,9 75 3,3 17 49 8 1,4 26 39 2 54 6 48 1 41 9 40 1 47 7 80 5 39 3 45 4 Ma te ria l S ta tu s o f t he F am ily To ta l Re sid en ce Re gi on FINAL REPORT 27 Table 3.2.1 Characteristics of Eligible Women with Completed Interviews by Residence Tbilisi Other Urban Rural Age Group 15–19 17.9 17.2 17.7 18.6 20–24 18.9 20.3 18.9 18.0 25–29 16.6 16.3 16.3 17.0 30–34 16.3 17.2 16.2 15.9 35–39 15.8 14.9 16.3 16.1 40–44 14.4 14.1 14.5 14.5 Marital Status Legally married 57.9 50.2 57.2 62.8 Consensual union 1.2 1.4 1.3 1.2 Previously married 6.5 8.7 7.2 4.8 Never married 34.4 39.8 34.2 31.2 Number of Living Children 0 41.3 46.8 41.6 37.9 1 19.0 21.8 20.7 16.5 2 29.5 25.3 29.7 31.8 3 8.3 5.1 6.5 11.2 4 or more 1.9 1.1 1.5 2.6 Education Level Secondary incomplete or less 22.6 12.6 17.8 31.2 Characteristic Total Residence Reproductive Health Survey: Georgia, 2010 Secondary incomplete or less 22.6 12.6 17.8 31.2 Secondary complete 24.7 17.5 21.7 30.6 Technicum 13.2 10.0 14.1 14.6 University/Postgraduate 39.4 60.0 46.5 23.6 Wealth Quintile Lowest 14.6 0.5 3.5 28.9 Second 19.5 0.3 7.6 37.3 Middle 21.5 4.6 26.0 28.9 Fourth 18.5 27.9 34.9 4.0 Highest 25.9 66.7 27.9 0.9 Employment Working 21.3 30.9 25.7 13.3 Not working 78.7 69.1 74.3 86.7 Ethnicity Georgian 86.9 91.3 92.5 81.2 Azeri 5.2 0.9 2.3 9.3 Armenian 5.2 4.2 2.8 7.0 Other 2.8 3.6 2.4 2.5 Religion Georgian Orthodox 82.4 92.1 89.2 73.0 Other Orthodox 4.9 4.8 3.3 6.0 Muslim 10.5 1.0 6.2 18.4 Other 1.6 1.7 0.9 2.0 No Religion 0.5 0.4 0.5 0.6 Total 100.0 100.0 100.0 100.0 No. of Cases 6,292 1,426 1,549 3,317 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 28 Table 3.2.2 Percentage Distribution of Women Aged 15–44 by Age, Marital Status and Education Reproductive Health Survey: Georgia, 2010 Legally Married ConsensualUnion Previously Married Never Married 15–19 10.3 0.3 0.8 88.5 100.0 861 20–24 47.1 1.6 3.2 48.2 100.0 1,099 25–29 69.5 1.5 4.2 24.8 100.0 1,191 30–34 77.0 1.0 8.8 13.1 100.0 1,168 35–39 77.4 1.8 10.8 10.1 100.0 1,051 40–44 75.0 1.4 13.2 10.5 100.0 922 Total 57.9 1.2 6.5 34.4 100.0 6,292 Secondary Incomplete or Less Secondary Complete Technicum University/ Postgraduate 15–19 57.4 29.6 2.4 10.7 100.0 861 20 24 12 7 31 4 12 7 43 3 100 0 1 099 Age Group Education Total No. of Cases Age Group Marital Status Total No. of Cases 20–24 12.7 31.4 12.7 43.3 100.0 1,099 25–29 14.1 24.9 11.9 49.2 100.0 1,191 30–34 16.7 22.8 14.0 46.5 100.0 1,168 35–39 16.8 22.4 14.6 46.2 100.0 1,051 40–44 15.5 14.5 26.5 43.5 100.0 922 Total 22.6 24.7 13.2 39.4 100.0 6,292 FINAL REPORT 29 Table 3.2.3 Educational Attainment of the Female Household Population Percent Distribution of the De Facto Female Household Population Age Six and Over By Highest Level of Schooling Attended and Median Years of Schooling Completed, by Selected Characteristics Reproductive Health Survey: Georgia, 2010 No Education Preschool Primary(Grades 1–6) Lower Secondary (Grades 7–9) Upper Secondary (Grades 10–12) Vocational Higher Total 2.8 1.8 8.8 11.5 31.0 11.9 32.2 100.0 21,117 10.8 Age Group 3–9 23.5 24.8 51.6 0.1 0.0 0.0 0.0 100.0 1,466 1.0 10–14 0.6 0.0 45.7 52.0 1.7 0.0 0.0 100.0 1,263 5.5 15–19 0.9 0.0 0.8 14.9 63.3 3.6 16.6 100.0 1,415 10.1 20–24 1.2 0.0 1.0 5.3 30.4 10.8 51.4 100.0 1,444 12.1 25–29 0.8 0.0 1.5 7.3 28.0 10.2 52.1 100.0 1,380 13.1 30–34 1.1 0.1 0.6 8.2 27.2 12.0 50.7 100.0 1,331 12.5 35–39 0.7 0.0 0.6 6.3 29.0 12.0 51.4 100.0 1,303 12.7 40–44 0.5 0.0 0.4 4.8 24.0 19.7 50.6 100.0 1,278 12.4 45–49 0.9 0.0 0.3 4.2 35.3 20.9 38.3 100.0 1,783 11.5 50–54 1.3 0.1 1.4 6.1 35.3 18.5 37.4 100.0 1,686 11.4 55–59 1.3 0.0 1.5 7.6 36.0 19.3 34.2 100.0 1,407 11.2 60–64 1.5 0.0 3.6 9.2 37.0 15.5 33.1 100.0 1,267 11.0 65–69 1.4 0.0 4.0 14.2 39.7 13.0 27.7 100.0 920 10.5 70–74 1.6 0.0 6.7 18.1 42.8 12.3 18.5 100.0 1,416 9.9 75–79 3.2 0.3 9.8 20.7 39.0 10.0 17.0 100.0 803 9.7 80 or more 4.6 0.0 17.0 22.6 31.5 6.5 17.8 100.0 955 9.4 Residence Urban 1.7 2.4 7.3 7.2 24.1 12.0 45.4 100.0 9,279 11.7 Rural 4.1 1.2 10.3 16.0 38.2 11.7 18.6 100.0 11,838 10.0 Region Kakheti 7.7 1.7 10.3 17.2 32.5 12.6 18.1 100.0 1,694 10.0 Tbilisi 1.6 2.3 6.9 5.8 19.5 10.1 53.8 100.0 4,308 13.0 Shida Kartli 2.2 1.1 9.2 10.5 37.1 12.0 27.9 100.0 1,367 10.4 Kvemo Kartli 4.4 1.7 13.2 16.3 31.3 10.1 23.1 100.0 1,752 9.9 Samtskhe–Javakheti 3.2 1.2 10.2 11.9 40.4 9.6 23.5 100.0 1,555 9.8 Adjara 3.6 0.9 11.3 14.4 32.7 12.7 24.5 100.0 1,209 11.1 Guria 1.9 1.3 7.2 20.5 34.4 19.6 15.1 100.0 1,574 9.9 Samegrelo 2.1 1.3 6.4 11.2 43.4 10.1 25.5 100.0 1,728 10.4 Imereti 1.5 2.5 7.4 10.7 32.9 14.3 30.7 100.0 2,602 10.7 Mtskheta–Mtianeti 3.0 2.3 9.9 12.6 30.4 17.1 24.7 100.0 1,334 10.6 Racha–Svaneti 2.5 0.9 9.7 14.4 37.8 10.8 24.0 100.0 1,994 10.1 Wealth Quintile Lowest 5.2 0.7 11.0 20.3 39.9 9.9 13.1 100.0 4,748 9.6 Second 4.0 1.3 10.2 14.3 39.7 11.9 18.6 100.0 4,806 10.1 Middle 2.2 2.0 9.2 11.4 33.9 13.6 27.7 100.0 4,507 10.5 Fourth 1.9 2.4 6.8 7.2 26.0 14.3 41.3 100.0 3,341 11.5 Highest 1.3 2.5 6.9 5.3 17.0 9.6 57.4 100.0 3,715 14.0 * Excludes 2 women for whom the highest level of school attendance was unknown. Total No. of Cases* Median Years CompletedCharacteristic Highest Level of School Attended REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 30 Table 3.2.4 Educational Attainment of the Male Household Population Percent Distribution of the De Facto Male Household Population Age Six and Over By Highest Level of Schooling Attended and Median Years of Schooling Completed, by Selected Characteristics Reproductive Health Survey: Georgia, 2010 No Education Preschool Primary(Grades 1–6) Lower Secondary (Grades 7–9) Upper Secondary (Grades 10–12) Vocational University/Postgraduate Total 3.1 2.1 9.2 10.3 34.9 11.0 29.4 100.0 19,482 10.7 Age Group 3–9 25.0 24.0 50.9 0.1 0.0 0.0 0.0 100.0 1,606 1.0 10–14 1.1 0.2 49.4 48.5 0.7 0.1 0.0 100.0 1,338 5.2 15–19 1.1 0.0 0.8 15.3 66.0 2.5 14.4 100.0 1,582 10.0 20–24 1.2 0.0 1.1 6.1 41.4 7.6 42.7 100.0 1,548 11.6 25–29 0.5 0.0 1.1 6.8 36.4 8.7 46.5 100.0 1,507 11.8 30–34 1.1 0.1 0.7 6.4 36.0 11.3 44.5 100.0 1,410 11.7 35–39 1.0 0.0 0.8 4.5 39.6 13.4 40.6 100.0 1,292 11.5 40–44 0.9 0.1 0.4 4.3 36.5 17.5 40.2 100.0 1,302 11.5 45–49 0.6 0.0 0.5 3.2 37.8 19.6 38.2 100.0 1,481 11.4 50–54 1.0 0.0 1.3 3.8 39.9 19.5 34.5 100.0 1,450 11.3 55–59 1.2 0.0 0.7 4.8 37.0 20.3 36.0 100.0 1,209 11.4 60–64 0.6 0.0 1.6 7.7 39.9 17.4 32.8 100.0 982 11.0 65–69 0.8 0.0 2.2 13.8 43.4 13.3 26.6 100.0 701 10.7 70–74 1.3 0.0 3.6 17.1 40.9 13.3 23.7 100.0 944 10.1 75–79 2.9 0.2 11.1 20.8 39.0 8.8 17.1 100.0 543 9.6 80 or more 3.0 0.3 13.9 23.9 32.0 7.5 19.4 100.0 587 9.4 Residence Urban 2.2 2.9 8.6 6.6 26.5 10.5 42.7 100.0 7,936 11.6 Rural 4.0 1.4 9.8 13.6 42.4 11.4 17.4 100.0 11,546 10.0 Region Kakheti 7.6 1.4 10.3 13.7 40.1 11.4 15.6 100.0 1,647 10.0 Tbilisi 1.9 3.0 8.5 5.4 21.6 8.9 50.7 100.0 3,638 12.3 Shida Kartli 3.4 1.3 8.2 11.3 39.3 12.0 24.5 100.0 1,271 10.3 Kvemo Kartli 4.4 1.5 13.1 15.0 35.9 8.4 21.8 100.0 1,622 9.9 Samtskhe–Javakheti 4.3 1.2 10.1 8.4 45.7 10.1 20.1 100.0 1,410 9.9 Adjara 2.8 1.9 10.6 11.8 34.4 13.4 25.1 100.0 1,134 11.1 Guria 2.1 1.0 8.0 16.8 40.2 17.7 14.2 100.0 1,534 9.9 Samegrelo 2.8 1.4 7.4 9.2 48.0 8.5 22.6 100.0 1,661 10.3 Imereti 1.7 3.1 8.1 9.8 34.7 13.5 29.0 100.0 2,362 10.6 Mtskheta–Mtianeti 2.4 2.6 9.4 13.0 34.7 15.1 22.7 100.0 1,253 10.6 Racha–Svaneti 1.7 0.9 8.6 14.9 45.6 9.2 18.9 100.0 1,950 10.0 Wealth Quintile Lowest 4.9 0.9 10.2 16.8 44.9 10.4 12.0 100.0 4,376 9.7 Second 4.1 1.5 9.7 12.8 43.0 11.5 17.4 100.0 4,691 10.1 Middle 2.7 1.9 9.6 10.2 38.8 11.9 24.9 100.0 4,318 10.5 Fourth 2.1 2.4 8.3 7.2 28.5 13.1 38.4 100.0 2,798 11.4 Highest 1.8 3.7 8.4 4.7 18.9 8.3 54.2 100.0 3,299 13.3 * Excludes one man for whom the highest level of school attendance was unknown. Characteristic Median YearsCompletedTotal No. of Cases* Highest Level of School Attended FINAL REPORT 31 Table 3.3.1 School Readiness Percentage of Children Attending First Grade of Primary School Who Attended Pre-school the Previous Year, Georgia, 2010-2011 Characteristic Percentage of children attending first grade who attended preschool in previous year [1] Number of children attending first grade of primary school Sex Male 42.5 227 Female 38.3 224 Region Kakheti 21.6 37 Tbilisi 52.3 86 Shida Kartli 25.9 27 Kvemo Kartli 41.7 36 Samtskhe-Javakheti 16.7 36 Adjara 48.0 25 Guria 34.2 41 Samegrelo 37.1 35 Imereti 43.8 73 Mtskheta-Mtianeti 53.6 28 Racha-Svaneti 22.2 27 Residence Urban 49.9 196 Rural 30.5 255 Wealth Index Quintiles Lowest 26.2 102 Second 28.3 89 Middle 39.9 101 Fourth 53.5 68 Highest 51.4 91 Total 40.4 451 [1] MICS indicator 7.2 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 32 Table 3.3.2 Primary School Entry Percentage of Children of Primary School Entry Age Entering Grade 1 (Net Intake Rate), Georgia, 2010-2011 Characteristic Percentage of children of primary school entry age entering grade 1 [1] Number of children of primary school entry age Sex Male 84.1 476 Female 81.6 440 Region Kakheti 77.5 89 Tbilisi 86.9 183 Shida Kartli 82.4 51 Kvemo Kartli 78.7 89 Samtskhe-Javakheti 82.1 67 Adjara 84.8 46 Guria 83.3 72 Samegrelo 88.9 63 Imereti 80.0 135 Mtskheta-Mtianeti 84.5 58 Racha-Svaneti 85.7 63 Residence Urban 84.5 399 Rural 81.1 517 Wealth Index Quintiles Lowest 79.2 182 Second 81.7 208 Middle 76.8 210 Fourth 86.6 135 Highest 89.4 181 Total 82.8 916 [1] MICS indicator 7.3 FINAL REPORT 33 Ta bl e 3 .3. 3 Ne t a tte nd an ce ra tio (a dj us te d) [1 ] Nu m be r o f ch ild re n Ne t a tte nd an ce ra tio (a dj us te d) [1 ] Nu m be r o f ch ild re n Ne t a tte nd an ce ra tio (a dj us te d) [1 ] Nu m be r o f ch ild re n Re gi on Ka kh eti 95 .7 11 6 90 .8 10 9 93 .3 22 5 Tb ilis i 96 .6 26 5 97 .4 23 4 97 .0 49 9 Sh ida K ar tli 96 .6 89 10 0.0 85 98 .3 17 4 Kv em o K ar tli 92 .4 14 5 94 .7 11 3 93 .4 25 8 Sa mt sk he -Ja va kh eti 92 .7 10 9 96 .7 91 94 .5 20 0 Ad jar a 95 .9 73 96 .3 80 96 .1 15 3 Gu ria 99 .0 10 3 93 .4 91 96 .4 19 4 Sa me gr elo 94 .6 11 2 95 .5 89 95 .0 20 1 Im er eti 94 .7 17 0 97 .2 14 4 95 .9 31 4 Mt sk he ta- Mt ian eti 98 .8 84 96 .4 84 97 .6 16 8 Ra ch a- Sv an eti 99 .2 11 8 96 .3 10 7 97 .8 22 5 Re sid en ce Ur ba n 96 .3 58 9 97 .2 51 1 96 .7 11 00 Ru ra l 94 .5 79 5 95 .1 71 6 94 .7 15 11 Ag e a t b eg in ni ng o f s ch oo l y ea r 6 83 .5 21 9 85 .7 20 9 84 .6 42 8 7 97 .1 22 7 97 .5 20 1 97 .3 42 8 8 99 .0 23 8 98 .1 19 1 98 .6 42 9 9 99 .4 19 9 98 .4 19 6 98 .9 39 5 10 98 .0 27 8 98 .7 22 6 98 .3 50 4 11 95 .0 22 3 98 .8 20 4 96 .8 42 7 W ea lth In de x Q ui nt ile s Lo we st 93 .1 26 7 91 .7 25 9 92 .4 52 6 Se co nd 93 .2 32 6 97 .1 30 0 95 .0 62 6 Mi dd le 98 .0 34 2 96 .6 26 1 97 .4 60 3 Fo ur th 97 .6 19 1 96 .6 18 3 97 .1 37 4 Hi gh es t 94 .8 25 8 97 .8 22 4 96 .2 48 2 To ta l 95 .4 13 84 96 .1 12 27 95 .7 26 11 P rim ar y S ch oo l A tte nd an ce P er ce nt ag e o f C hi ld re n of P rim ar y S ch oo l A ge A tte nd in g Pr im ar y o r S ec on da ry S ch oo l ( Ne t A tte nd an ce R at io ), Ge or gi a, 20 10 -2 01 1 [1 ] M IC S in di ca to r 7 .4 ; M D G in di ca to r 2 .1 Ma le Fe m ale To ta l Ch ar ac te ris tic REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 34 Ta bl e 3 .3. 4 Ne t a tte nd an ce ra tio (a dj us te d) [1 ] Pe rc en t a tte nd in g pr im ar y s ch oo l Nu m be r o f ch ild re n Ne t a tte nd an ce ra tio (a dj us te d) [1 ] Pe rc en t a tte nd in g pr im ar y s ch oo l Nu m be r o f ch ild re n Ne t a tte nd an ce ra tio (a dj us te d) [1 ] Pe rc en t a tte nd in g pr im ar y s ch oo l N um be r o f ch ild re n Re gi on Ka kh eti 72 .7 11 .6 12 1 81 .8 6.4 11 0 77 .1 9.1 23 1 Tb ilis i 86 .9 7.6 23 7 87 .2 7.4 24 3 87 .1 7.5 48 0 Sh ida K ar tli 90 .8 5.1 98 91 .3 4.9 10 3 91 .0 5.0 20 1 Kv em o K ar tli 79 .9 11 .7 15 4 81 .0 10 .2 13 7 80 .4 11 .0 29 1 Sa mt sk he -Ja va kh eti 81 .2 11 .9 10 1 83 .9 11 .0 11 8 82 .7 11 .4 21 9 Ad jar a 89 .1 5.4 92 90 .9 6.8 88 90 .0 6.1 18 0 Gu ria 90 .0 7.0 10 0 93 .5 2.2 92 91 .7 4.7 19 2 Sa me gr elo 86 .6 6.7 11 9 90 .2 2.7 11 2 88 .3 4.8 23 1 Im er eti 90 .1 7.4 16 2 91 .1 7.0 15 8 90 .6 7.2 32 0 Mt sk he ta- Mt ian eti 88 .0 2.2 92 85 .5 5.8 69 87 .0 3.7 16 1 Ra ch a- Sv an eti 88 .8 7.5 16 1 87 .7 8.7 13 8 88 .3 8.0 29 9 Re sid en ce Ur ba n 87 .9 7.4 57 6 87 .7 6.9 57 2 87 .8 7.2 11 48 Ru ra l 83 .2 8.7 86 1 87 .3 6.9 79 6 85 .2 7.8 16 57 Ag e a t b eg in ni ng o f s ch oo l y ea r 12 61 .0 36 .4 27 9 64 .1 32 .0 26 8 62 .5 34 .2 54 7 13 92 .6 3.7 27 2 93 .7 2.1 29 0 93 .2 2.8 56 2 14 92 .0 1.0 28 6 96 .9 0.5 27 5 94 .4 0.7 56 1 15 92 .2 0.4 29 9 91 .2 0.0 28 5 91 .7 0.2 58 4 16 88 .8 0.0 30 1 91 .3 0.0 25 0 89 .9 0.0 55 1 W ea lth In de x Q ui nt ile s Lo we st 76 .1 8.7 29 1 89 .5 4.2 33 0 83 .3 6.3 62 1 Se co nd 85 .6 9.9 37 3 83 .6 8.7 29 2 84 .7 9.4 66 5 Mi dd le 88 .4 5.8 32 8 84 .9 10 .1 31 3 86 .7 7.9 64 1 Fo ur th 86 .5 7.4 20 0 89 .6 6.1 18 2 88 .0 6.8 38 2 Hi gh es t 88 .3 8.4 24 5 90 .1 5.1 25 1 89 .2 6.7 49 6 To ta l 85 .4 8.1 14 37 87 .5 6.9 13 68 86 .4 7.5 28 05 P er ce nt ag e o f C hi ld re n of S ec on da ry S ch oo l A ge S ec on da ry S ch oo l A tte nd an ce A tte nd in g Se co nd ar y S ch oo l o r H ig he r ( Ad ju st ed N et A tte nd an ce R at io ), an d Pe rc en ta ge o f C hi ld re n At te nd in g Pr im ar y S ch oo l, G eo rg ia, 20 10 -2 01 1 [1 ] M IC S in di ca to r 7 .5 Ma le Fe m ale To ta l Ch ar ac te ris tic FINAL REPORT 35 Ta bl e 3 .3. 5 Ch ar ac te ris tic Pr im ar y s ch oo l co m pl et io n ra te [1 ] N um be r o f c hi ld re n of pr im ar y s ch oo l c om pl et io n ag e Tr an sit io n ra te to se co nd ar y s ch oo l [ 2] Nu m be r o f c hi ld re n wh o we re in th e las t g ra de o f p rim ar y s ch oo l t he pr ev io us ye ar Se x Ma le 89 .3 27 9 10 0.0 24 4 Fe ma le 83 .8 26 8 99 .4 20 9 Re gi on Ka kh eti 85 .7 49 10 0.0 37 Tb ilis i 84 .7 11 1 98 .8 86 Sh ida K ar tli 85 .4 41 10 0.0 34 Kv em o K ar tli 89 .1 64 10 0.0 44 Sa mt sk he -Ja va kh eti 82 .9 41 10 0.0 35 Ad jar a 85 .7 28 10 0.0 28 Gu ria 84 .4 32 10 0.0 34 Sa me gr elo 92 .1 38 10 0.0 33 Im er eti 84 .2 57 10 0.0 47 Mt sk he ta- Mt ian eti 96 .9 32 10 0.0 29 Ra ch a- Sv an eti 10 0.0 54 10 0.0 46 Re sid en ce Ur ba n 83 .7 24 0 99 .4 19 0 Ru ra l 89 .5 30 7 10 0.0 26 3 W ea lth In de x Q ui nt ile s Lo we st 80 .4 10 8 10 0.0 93 Se co nd 89 .6 12 8 10 0.0 10 2 Mi dd le 91 .5 12 5 10 0.0 11 0 Fo ur th 92 .3 80 10 0.0 62 Hi gh es t 79 .7 10 6 98 .8 86 To ta l 86 .6 54 7 99 .7 45 3 P rim ar y S ch oo l C om pl et io n an d Tr an sit io n to S ec on da ry S ch oo l P rim ar y S ch oo l C om pl et io n Ra te s a nd T ra ns iti on R at e t o Se co nd ar y S ch oo l, G eo rg ia, 20 10 -2 01 1 [1 ] M IC S in di ca to r 7 .7 [2 ] M IC S in di ca to r 7 .8 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 36 Ta bl e 3 .3. 6 Ed uc at io n Ge nd er P ar ity Ra tio o f A dj us te d Ne t A tte nd an ce R at io s o f G irl s t o Bo ys , in P rim ar y a nd S ec on da ry S ch oo l, G eo rg ia, 20 10 - 20 11 Ch ar ac te ris tic Pr im ar y s ch oo l a dj us te d ne t a tte nd an ce ra tio (N AR ), gi rls Pr im ar y s ch oo l ad ju st ed n et at te nd an ce ra tio (N AR ), bo ys Ge nd er p ar ity in de x (G PI ) f or p rim ar y sc ho ol ad ju st ed N AR [1 ] Se co nd ar y s ch oo l ad ju st ed n et at te nd an ce ra tio (N AR ), gi rls Se co nd ar y s ch oo l ad ju st ed n et at te nd an ce ra tio (N AR ), bo ys Ge nd er p ar ity in de x (G PI ) f or s ec on da ry sc ho ol ad ju st ed N AR [2 ] Re gi on Ka kh eti 90 .8 95 .7 0.9 5 81 .8 72 .7 1.1 2 Tb ilis i 97 .4 96 .6 1.0 1 87 .2 86 .9 1.0 0 Sh ida K ar tli 10 0.0 96 .6 1.0 3 91 .3 90 .8 1.0 0 Kv em o K ar tli 94 .7 92 .4 1.0 2 81 .0 79 .9 1.0 1 Sa mt sk he -Ja va kh eti 96 .7 92 .7 1.0 4 83 .9 81 .2 1.0 3 Ad jar a 96 .3 95 .9 1.0 0 90 .9 89 .1 1.0 2 Gu ria 93 .4 99 .0 0.9 4 93 .5 90 .0 1.0 4 Sa me gr elo 95 .5 94 .6 1.0 1 90 .2 86 .6 1.0 4 Im er eti 97 .2 94 .7 1.0 3 91 .1 90 .1 1.0 1 Mt sk he ta- Mt ian eti 96 .4 98 .8 0.9 8 85 .5 88 .0 0.9 7 Ra ch a- Sv an eti 96 .3 99 .2 0.9 7 87 .7 88 .8 0.9 9 Re sid en ce Ur ba n 97 .2 96 .3 1.0 1 87 .7 87 .9 1.0 0 Ru ra l 95 .1 94 .5 1.0 1 87 .3 83 .2 1.0 5 W ea lth In de x Q ui nt ile s Lo we st 91 .7 93 .1 0.9 8 89 .5 76 .1 1.1 8 Se co nd 97 .1 93 .2 1.0 4 83 .6 85 .6 0.9 8 Mi dd le 96 .6 98 .0 0.9 9 84 .9 88 .4 0.9 6 Fo ur th 96 .6 97 .6 0.9 9 89 .6 86 .5 1.0 4 Hi gh es t 97 .8 94 .8 1.0 3 90 .1 88 .3 1.0 2 To ta l 96 .1 95 .4 1.0 1 87 .5 85 .4 1.0 2 [1 ] M IC S in di ca to r 7 .9 ; M D G in di ca to r 3 .1 [2 ] M IC S in di ca to r 7 .1 0; M D G in di ca to r 3 .1 37 CHAPTER 4 FERTILITY AND PREGNANCY EXPERIENCE One objective of the survey was to assess the current levels and trends of fertility and pregnancy experienc- es and to identify factors that might influence repro- ductive behaviors. To obtain information about repro- ductive patterns, the questionnaire included a series of questions about childbearing, the use of induced abortion, desired family size and fertility preferences, and planning status of all pregnancies in the last five years. All the survey based statistics regarding preg- nancy experiences are derived from a complete life- time pregnancy history, which consists of information about all births, abortions, and fetal losses, including date of pregnancy outcome, pregnancy duration and survival status. Each woman is asked to give a detailed history of all pregnancy outcomes, from the time of the first pregnancy up to the time of the interview. This information represents an important addition to vital statistics routinely compiled at the local and state level, because it allows examination of fertility and abortion differentials by background characteris- tics and health behaviors. It also allows for more accu- rate national and regional estimates of the pregnancy events, particularly since the earlier surveys showed that official statistics understate births and abortions (Serbanescu et. al, 2001). 4.1 Fertility Levels and Trends Demographically, Georgia has much in common with the other former Soviet-bloc countries, with whom it shares a common path of transition from communism and the inheritance of a centralized state-subsidized health care system. The total fertility rate (TFR)—the average number of children that would be born alive to a woman during her childbearing years if she were to experience the age-specific fertility rates of a given year—is used as an indicator for the study of fertility levels and trends; it is comparable across countries, since it is independent of differences in the size and structure of the population. According to the official statistics, fertility has been declining steadily over the last three decades in the former Soviet Union countries with the most promi- nent declines observed between 1985 and 1995; however fertility levels, trends and the pace of de- cline differed between the Central Asia republics and the European part of the former Soviet Union (WHO, 2011a and 2011b). The decline in the TFR started sooner in Central Asia and the pace of decline was faster, resulting in the present convergence of fertil- ity rates (Figure 4.1.1). In the mid-1980s, the disparity between regions with the highest (Central Asia) and the lowest fertility (European Soviet Union) was over REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 38 3 births per woman. By the mid-1990s, this difference had decreased to 2 births per woman. By 2005 it was less than one birth per woman, with Tajikistan (the only country with fertility of 3.5 births per woman) and Latvia representing the two ex- tremes. Recently, however, the downward trend reversed in several countries. In Georgia and nine other countries (Armenia, Azerbaijan, Belarus, Esto- nia, Kazakhstan, Lithuania, Moldova, Ukraine and Uz- bekistan), the 2007–2009 TFR is higher than it was in 2004-2006. A TFR of around 2.1 births per woman is considered to be the replacement level, that is, the average number of births per woman required to keep the long run population size constant in the absence of inward or outward migration. The TFR is still below the replacement level of 2.1 births per woman in all countries outside Central Asia, excepting Azerbaijan (2.3 births per woman). Among countries of the Eu- ropean former Soviet Union, Georgia has the second highest fertility rate, surpassed only by Azerbaijan. The information obtained from the birth histories col- lected in surveys is another source for computing to- tal fertility rates. As with analyses performed in the 1999 and 2005 surveys, the pregnancy histories were used to calculate two of the most widely used meas- ures of current fertility—the total fertility rate and its component age specific fertility rates. These measures are based on information from each woman’s preg- nancy history regarding the month and year of each live birth and the maternal age at the time of delivery. The (TFR) for a period is computed by accumulating the age-specific fertility rates (ASFRs) in each 5-year age group and multiplying the sum by five (the num- ber of years in each group). The TFR for a period is thus defined as the average number of live births a woman would have during her reproductive lifetime (ages 15–44) if she experienced the currently ob- served ASFRs for that period. ASFRs are expressed as the number of births to women in a given age group per 1,000 women per year. In this survey, as in the previous rounds, the ASFR for any five-year age group was calculated by dividing the number of births to women in that age group during the period 1 to 36 months preceding the survey, by the number of wom- an-years lived by women in that age group during the same period. Age-specific fertility rates are very useful in understanding the age pattern of fertility. The TFR calculated from GERHS10 of 2.0 births per woman (95%CI=1.9–2.1) for the period 2007–2010 is the highest survey-based TFR ever reported for Geor- gia (Figure 4.1.2). The most recent period fertility rate is 25% higher than the TFR of 1.6 (95%CI=1.4–1.7) observed during 2002–2005, also calculated from the GERHS05 pregnancy histories (Serbanescu et al., 2007). As in previous comparisons, the survey-based TFR for the most recent three years was higher than the cor- responding TFR based on vital registration figures. In the previous Georgian survey rounds, the underesti- mation of births in the vital registration system was attributed mainly to two factors: 1) undercounting of births in the numerator, mainly due to delays in birth registration and 2) denominator inflation due to the use of inaccurate population projections (Serbanescu et al., 2001; Aleshina and Redmond, 2005). As shown later in this report, early registration (within the first 2 weeks after birth) was almost universal among chil- dren born in the last 5 years in Georgia, so under- registration of births is unlikely to explain differences in the TFR. The persistence of inflated denominators Trends in Total Fertility Rates in the Countries of the Former Soviet Union, 1975-2009 Figure 4.1.1 FINAL REPORT 39 is still an issue, since the census projections are done without adjustment for out-migration and overesti- mate women of childbearing age. This may result in underestimation of the fertility rates and other official population-based statistics. The ASFRs and corresponding TFR for the period 2007–2010 are shown in Table 4.1.1 and Figure 4.1.3. Traditionally, Georgian women initiate and complete childbearing at an early age, as reflected in very high age-specific fertility rates for young women. The high- est fertility levels were at ages 20-24 and 25-29, ac- counting for 36% and 29%, respectively, of the TFR. Fertility among adolescent women contributed to only 10% of the TFR. Fertility among women aged 30–34 was the third-highest ASFR, contributing 15% of the TFR. Women aged 35–39 and 40–44 made mini- mal contributions; their ASFRs accounted for only 8% and 3%, respectively, of the TFR. Thus, 26% of the TFR was due to women aged 30 or older. Using data from all Georgia reproductive health sur- veys, period fertility rates can be compared across three 3-year periods (Table 4.1.1 and Figure 4.1.4). In the most recent survey, there is an increase of 25% in the 3-year (2007–2010) TFR, compared to the rate dur- ing 2002–2005. Compared to the period 1996–1999, the TFR increased by 18%. Age-specific fertility rates increased in all but one age group, adolescent women, suggesting a gradual transition to fertility postpone- ment in Georgia. In that group the ASFR dropped from 65 during 1996–1999, to 47 during 2002–2005, and to 39 during the most recent period (2007–2010). Al- together this was a 40% decline between 1996–1999 and 2007–2010. At the same time, the ASFRs of women aged 20-24 and 25–29 increased by 26% and 25%, respectively. As a result, their contribution to the TFR increased from 59% to 65% between 1996–1999 and 2007–2010. There was also a notable change in fertility among older women: the ASFRs of women aged 30–34, 35–39, and 40–44 increased by 29%, 43%, and 57%, respectively, though within low levels, as Figure 4.1.4 shows. Their contribution to the TFR increased from 22% to 26%. Table 4.1.2 shows the number of children ever born among all women and women currently married who were interviewed in the GERHS10. Information on all past fertility reflects the accumulation of births over a woman’s entire childbearing years and is useful in looking at how average family size varies across age groups. These data, however, have a limited relation- ship to current fertility levels. Overall, 41% of all women aged 15–44 years were childless at the time of the interview, 18% reported giving birth to only one child, 29% to two children and 12% to three or more children. Although only 5% of women aged 15–19 years reported giving birth, 69% of women aged 25–29 had done so. About one in sev- en (15%) women aged 40-44 remained childless. Among currently married women, 26% have so far had only one child, 45% have had two children, and 19% have had three or more children. One in ten currently married women has never had a child. Almost one in two of the few married adolescent women (aged 15- 19) have already had a first child; 79% at ages 20–24 have done so and 92% at ages 25–29 have done so. Five percent at ages 35–44 remained childless as of the survey, suggesting fertility impairment, because voluntary childlessness is rare in Georgia and most couples tend to have at least one child. 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Three-Year Period Total Fertility Rates: Survey Estimates and Official Sources: 1999, 2005, 2010 Figure 4.1.2 Births per Woman Official Source Survey Estimate 1999 2005 2010 1.3 1.7 1.4 1.6 1.7 2.0 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 40 4.2 Fertility Differentials In examining fertility determinants it is useful to com- pare various subgroups of women. Fertility varies with social, cultural, and economic factors, which influence decision making regarding the number of children a woman or couple decides to have. Fertility among women living in urban areas, includ- ing Tbilisi, was almost 10% lower according to the TFR than among rural-dwelling women in the three-year period preceding the interview (Table 4.2). Most of the difference between the rural and urban fertility rates was due to higher ASFRs among rural residents aged 15–19, 20–24 and 25–29. Oddly, fertility at ages 30-34 was higher in urban than in rural areas. By region, fertility was the lowest in Guria (1.7 TFR, and it was the highest in Mtskheta-Mtianeti and Ra- cha-Svaneti (2.3), followed by Adjara (2.2) and Samt- skhe-Javakheti and Kakheti (2.1) (Figure 4.2.1). The highest adolescent ASFR was reported by residents of Kakheti, Kvemo-Kartli, and Racha-Svaneti (Figure 4.2.2), probably because the average age of first mar- riage and first birth is lower in these regions than in the rest of the country. Fertility differences according to education were more pronounced among younger women. Generally, peak fertility occurred at ages 25– 29 among women with the highest educational attain- ment, whereas peak fertility among women at lower educational levels occurred at ages 20–24. Fertility of the Azeri minority (2.4 TFR) was higher than that of the Georgians (2.0 TFR), the major ethnic group, due to much higher ASFRs among Azeri women aged 15– 24 (Figure 4.2.3). 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) 15-19 160 140 120 100 80 60 40 20 0 39 Births per 1,000 Women Three-Year Period (2007–2010) Age-Specific Fertility Rates Figure 4.1.3 142 115 62 30 11 20-24 25-29 30-34 35-39 40-44 Age Group 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) 15-19 140 120 100 80 60 40 20 0 Births per 1,000 Women Three-Year Period Age-Specific Fertility Rates 1999, 2005, 2010 Figure 4.1.4 20-24 25-29 30-34 35-39 40-44 Age Group GERHS10 GERHS05 GERHS99 FINAL REPORT 41 4.3 Nuptiality Because in Georgia nearly all exposure to the risk of pregnancy occurs among women who are married or in a consensual union, reproductive health behav- iors are greatly influenced by marital status. A com- parative report of surveys taken in 11 countries since 1996, covering a wide range of women’s health topics, showed that the median age at first marriage among women of reproductive age in Eastern Europe and Central Asia is between 20 and 22 years of age (CDC and ORC/Macro, 2003). Most countries of the region exhibit the highest fertility rates among currently mar- ried young adults, for two reasons: the probability of having a child is much higher among married women and couples typically have a strong desire to initiate childbearing soon after marriage (first birth typically occurs within 2 years after the marriage). Thus, it is important to know the marital distribution by age group and the changes over time in age at first union and at first birth. The proportion of currently married women in Geor- gia (58%) was comparable to that of other countries of the region (ranging from 54% in Russia to 68% in Uzbekistan) (Figure 4.3.1). In addition, a small propor- tion of women (2%) were living in consensual unions, a rate that is similar to Central Asian countries, but much lower than in other countries of the region (10% of women in Russia, 6% in Romania, and 4% in Ukraine). At the time of GERHS2010, 6.5% of women were pre- viously married (e.g., widowed, divorced, or separat- ed from a spouse or from a partner in a consensual union; see Table 4.3). More than one in three women 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) * Abkhazia: Autonomous region not under goverment control Three-Year Period Total Fertility Rates by Region Figure 4.2.1 Total Fertility Rate (Births per Woman) <2.0 2.0-2.1 2.2+* 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) * Abkhazia: Autonomous region not under goverment control Three-Year Period Age-Specific Adolescent Fertility Rates (Ages 15–19) by Region Figure 4.2.2 Adolecent ASFR (per 1,000 Women) <25 25-39 40-59 60-69 70+ * REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 42 (34%) had never been married or lived with a part- ner. The proportion of the currently married women aged 15-44 is unchanged between the 2005 and 2010 surveys (58%), but the proportion of de facto (con- sensual) marriages decreased (from 2% in 2005 to 1% in 2010). The proportion of currently married women (either le- gal or consensual marriage) was higher in rural areas than in urban areas (64% vs. 54%) and in the regions of Guria and Adjara (64%) and in Kakheti (63%) and Kvemo Kartli (63%). The proportion of previously mar- ried women was slightly higher in urban areas than in rural areas (8% vs. 5%), as was the proportion of never-married women (37% vs. 31%). Rates of marriage increase rapidly with age from 10% among 15- to 19-year-olds to 47% among women aged 20-24, and to 69% among 25- to 29-year-olds; the rate reached a maximum of 75% for women aged 40-44. The proportion of never-married women decreased sharply with age from 88% among 15- to 19-year-olds to 48% among women aged 20-24, and to 25% among 25-29, and 13% among women aged 30-34. Among women aged 35 or older, about 10% had never been married. The proportion of women married or in union was lower among women who did not complete second- ary school 45% than among women with a complete secondary or technicum education (63% and 69%, re- spectively) and those with university or postgraduate education (58%). In studying the impact of education on marital levels, it should be kept in mind that the youngest women are less likely to marry because they are less likely to marry because they are still in school 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) Three-Year-Period (2007–2010) Age-Specific Fertility Rates by Ethnicity Figure 4.2.3 15-19 200 180 160 140 120 100 80 60 40 20 0 Births per 1,000 Women 20-24 25-29 30-34 35-39 40-44 Age Group Georgian Armenian Azeri 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) CZ MO RO RU UA AM AZ GE1999 GE2005 GE2010 KZ KG TM UZ 80 70 60 50 40 30 20 10 0 Percentage of Women Aged 15–44 Who Are Currently Married or in Consensual Unions* Figure 4.3.1 64 66 58 54 62 62 58 58 58 60 60 65 58 68 Eastern Europe Caucasus Central Asia * Source: CDC and ORC/Macro, 2003. Reproductive, Maternal and Child Health in Eastern Europe and Eurasia; A Comparative Report Note; CZ = Czech Rep; MD = Moldova; Ro = Romania; Ru = Russia; UA = Ukraine; AM = Armenia; AZ = Azerbaijan; GE = Georgia; KZ = Kazakhstan; KG = Kirgizia; TM = Turkmenistan; UZ = Uzbekistan FINAL REPORT 43 and the youngest age for official marital eligibility is 18 and with consent of parents – 16 years of age. Among the younger women aged 20-24 however the likelihood of being in a marital relationship, ei- ther consensual or formal, was highly correlated with education. For example in 2010, 56%-60% of young women with high school education or less (second- ary complete or incomplete) were in union, compared with 35%-49% of those with some post secondary education (Figure 4.3.2). This finding lends credence to the view that women tend to postpone marriage until after achieving their desired education goals. The trend between 1999 and 2010 shows that young women with less education are becoming less inclined to marry early. 4.4 Age at First Intercourse, Union, and Birth Age at first union and age at first sexual intercourse play an important role in determining fertility. Delays in these events decrease the number of reproductive years that a woman spends at risk of getting pregnant. They can also have a direct impact to reduce current fertility rates since births in any one year are fewer when they are deferred to some time in the future. Information on age at first sexual intercourse for all women is presented by age of the respondent at the time of interview in Table 4.4.1. The left side of the table shows the proportion of respondents within each 5-year age cohort who have ever had sexual in- tercourse (top panel), ever been in formal or consen- sual marriage (middle panel), and ever had a live birth (bottom panel), before reaching specific ages. For ex- ample, in the top panel, 30% of women now aged 25- 29 had sex before age 20. The overall median age (next to last column), for the age by which 50% of women aged 15-44 have experi- enced the event, and the median age within each age group, are also displayed for each event. By comparing the proportion of women in different age groups who experienced various events before age 20, it is pos- sible to detect whether the average age of occurrence of each event has changed over time. For example, the proportion of women who had sexual intercourse be- fore age 20 was 33% among women now aged 40-44, but otherwise it declined from a high 43% for women now aged 35-39 to 29% among 20-24-year-olds. There is very little gap between sexual exposure and entry into a union. Across age cohorts, the proportion of respondents who reported sexual experience be- fore marriage remained very low because the propor- tion of women married by age 20 is almost identical with the proportion of sexually experienced women (Figure 4.4.1). Similarly, the median age at first inter- course for each cohort was only slightly lower than the corresponding median age at first marriage. Thus, the 2010 survey confirms an earlier finding that in Geor- gia sexual abstinence before marriage is a common practice. Apparently, traditional norms are strong and have not been altered by recent changes that have influenced young adult reproductive behaviors in the industrialized world and in some of the Eastern Euro- pean former Soviet-bloc countries. The long term decline in the proportion of women who married before age 20 documents the trend away from early marriage. Since the number of women pur- suing higher education attainment has also risen, it is very likely that young Georgian women tend to delay the first union and first birth to a later age, after gain- ing qualifications and steady income. This trend is par- ticularly interesting and has potential implications for future fertility patterns and fertility control measures. Percentage Percent of Women Aged 20-24 Who Are Married, by Education Level: 1999, 2005, 2010 Figure 4.3.2 Secondary Incomplete Secondary Complete 100 80 60 40 20 0 Technicum University 1999 2005 2010 76 64 60 50 59 56 43 45 49 41 32 35 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 44 In 2010, the median ages at first union and first birth were 21.9 and 23.6 respectively (Figure 4.4.2). Geor- gian women continue to marry considerably earlier than in Western Europe, where the average age at the first marriage is about 27 years (UNECE, 2002). The median age at first intercourse is older in 2010 than in 2005 (21.8 vs. 21.3). The proportion of young adults who reported premarital sexual intercourse, although very low, almost doubled between 2005 and 2010 sur- veys (from 2.7% in 2005 to 5% in 2010) while the pro- portion with any sexual experience remained almost unchanged (66%). Urban women reported the initiation of sexual activ- ity, union, and childbearing 1.7 to 2 years later than rural women (Table 4.4.2). The highest median age for all these events was reported by women residing in Tbilisi, suggesting that the high cost of living, the pres- ence of educational opportunities, and a competitive career market in the capital may delay sexual debut, union and childbearing. Interestingly, women residing in Racha-Svaneti (mountainous area) reported simi- larly high median ages for the onset of sexual activ- ity, union and childbearing, but probably for entirely different reasons: judging from the scarcity of the population of reproductive age in the region (docu- mented in the census and in the 2010 RHS), a possi- ble explanation is that much of the male population is seeking higher education training and employment elsewhere. Differentials in median age of experienc- ing sexual activity, union, and childbearing are closely related to education. The median age of these events was 5 years older in women with university education compared to those who had not completed secondary education. 45 40 35 30 25 20 15 10 5 0 Percent Percentage of Women Aged 20-44 Who Had Sexual Debut, First Union and First Birth before Age 20 by Current Age Figure 4.4.1 20-24 25-29 30-34 35-39 40-44 Age Group First Sex First Union First Birth Median Age at First Sex, First Union and First Age Among Women Aged 15-44 Years: 1999, 2005, 2010 Figure 4.4.2 Median Age at First sex Median Age at First Union 24 23.5 23 22.5 22 21.5 21 20.5 20 Median Age at First Birth 1999 2005 2010 21.5 21.3 21.8 21.6 21.9 21.6 23.0 23.6 23.2 FINAL REPORT 45 4.5 Recent Sexual Activity Current sexual activity is an essential indicator for estimating the proportion of women who are at risk of having an unintended pregnancy and therefore in need of contraceptive services. It also has major im- plications for the selection of a contraceptive method that best suits the reproductive stage and fertility preferences of each individual. As shown in Table 4.5, about 34% of all women aged 15-44 reported that they had never had sexual intercourse. Sexual experi- ence includes the 5% of all women who were preg- nant, and the 3% reporting postpartum abstinence at the time of the interview. Nearly half, 48%, were currently active, with sexual experience in the last month, and another 10% irregularly. Among women who were married or living with a part- ner, 80% reported having had intercourse at least once within the past month, and 3% had had intercourse within the previous 3 months, plus the 13% who were pregnant or postpartum. Conversely, only 12% of pre- viously married women had had intercourse within the past 3 months. Most of them (70%) reported that their last sexual intercourse occurred over 12 months ago, perhaps while they were still married. Almost none (0.1%) of never-married women reported having had any sexual experience, yet another documenta- tion of the strong social prohibition against sex before marriage in Georgia. Almost one in three young adult women (i.e., those aged 15-24) (bottom panel) reported sexual inter- course, including the 10% who were pregnant or early postpartum. About 71% of women in the two groups aged 25 or older reported sexual experience. Of those, more than two-thirds had had intercourse within the past month. 4.6 Planning Status of the Last Pregnancy Unintended pregnancy is an important public health problem around the world, occurring in all cultures and affecting women of all ages and all socio-econom- ic and educational backgrounds. Accurate documenta- tion of reproductive intentions is important for under- standing a population’s fertility rates, fertility-related behaviors, and contraception needs. Unintended preg- nancies are more likely to be associated with elective termination of pregnancy, inadequate prenatal care, unfavorable maternal behaviors, and pregnancy or perinatal complications (Brown and Eisenberg, 1995). Unintended pregnancy has long been acknowledged as an important health, social and economic problem that creates hardships for women and their infants. Those consequences, in turn, have a broad societal impact such as the burden placed on the family, the increase in governmental health expenditures and the financial assistance for women living in poverty. Conventional measures of unintended pregnancy are designed to capture a woman’s intentions before she became pregnant (Henshaw, 1998). Thus, for each pregnancy ended since January 2005, all respondents were asked about the planning status of their preg- nancies at the time of conception. Each pregnancy was classified as either planned (i.e., wanted at the time it occurred), mistimed (i.e., occurred earlier than desired), unwanted (i.e., occurred when no children, or no more children, were desired), or unsure. Mis- Demographic Terminology for Pregnancy IntentionsFigure 4.6.1 Intended Wanted Mistimed Unintended Unwanted } } Planning Status of the Last Pregnancy Among All Women Aged 15–44 Years: 1999, 2005, 2010 Figure 4.6.2 Intended 41% Not Intended 59% Not Wanted 49% Mistimed 10% Intended 48% Not Intended 52% Not Wanted 40% Mistimed 12% Intended 63% Not Intended 36% Not Wanted 26% Mistimed 11% Georgia, 1999 Georgia, 2005 Georgia, 2010 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 46 timed and unwanted pregnancies together constitute unintended or “unplanned” pregnancies (Westoff, 1976) (Figure 4.6.1). Reliable information on pregnancy intention, howev- er, is difficult to collect. One common problem is the underreporting of pregnancies that ended in induced abortions. Because the majority of these pregnancies are mistimed or unwanted, unplanned pregnancies will be underreported to the extent that abortions are underreported. However, abortion underreporting does not appear to be a major concern in GERHS10 (see Chapter 5). Another problem may be due to ret- rospective rationalization and ambivalence about pregnancy intention when the outcome is a live birth. Compared to self-assessments of pregnancy intention at the time of conception, retrospectively reported intentions after the child is born tend to be more positive (Miller, 1994). Thus, the data presented here represent conservative estimates of the true levels of unintended pregnancy. In GERHS10, almost two thirds (63%) of women who have been pregnant in the past 5 years reported the last pregnancy as planned; 10% reported the last preg- nancy as mistimed and 26% as unwanted, resulting in a total of 36% unplanned, i.e. not intended (Table 4.6). This compares with a level of 52% of women report- ing their last pregnancy as unplanned (not intended) in 2005 and 59% in 1999 (Figure 4.6.2). As in previous surveys, the majority of unplanned pregnancies were unwanted, but mistimed pregnancies were a larger share of all unintended pregnancies (11% of 36%) or 31% than ever before (23% in 2005 and only 17% in 1999). This shows the continuing need for attention to contraceptive services for couples wishing to space, with good timing. As Table 4.6 shows, the majority of women whose last pregnancy resulted in a live births said the birth was planned (94%). Conversely, only 3% of women whose last pregnancy ended in induced abortion re- ported that the conception was planned. A relatively high proportion (19%) of women whose last preg- nancy ended in miscarriage or stillbirth reported the conception as unwanted. This is almost 10 times the proportion found among women with live births (2%), suggesting that either unintendedness had a negative influence on pregnancy development and outcome or that some of these outcomes may have been in fact induced abortions, misreported as other fetal losses. The high rate of unwanted conceptions for pregnan- cies ending in miscarriage or stillbirth was similar to that observed in the 1999 and 2005 (Serbanescu et al., 2001, 2007). Overall, the proportion of planned pregnancies sur- passed those unplanned in all age groups except for women aged 35–44 years and those with three or more children, where the proportion fell below 50%. The proportion of pregnancies that were unplanned increased dramatically at the higher ages and family sizes (Figure 4.6.3). However among young women, aged 15-19, only 16% of pregnancies were unplanned and most of their unplanned pregnancies were mis- timed rather than unwanted. The unwanted-to-mis- timed ratio for these women was about 0.6:1, that is 5.8/9.7, and it was the same at ages 20-24. However it then reversed, and ranged from 2.1:1 to 3.8:1 to 14.9:1 across the next higher age groups. The higher the age the more conceptions were regarded as un- wanted as opposed to merely mistimed. Thus, mistimed pregnancies are rapidly replaced by unwanted pregnancies with an increase in maternal 1056 2734 841 1053 842 643 1005 1057 1684 845 1603 109,632 305,896 83,391 124,031 51,381 87,527 39,743 115,982 201,213 34,484 20,395 0 40,000 80,000 120,000 160,000 200,000 240,000 280,000 320,000 0 500 1000 1500 2000 2500 3000 Kakheti Tbilisi Shida Kartli Kvemo Kartli Samtskhe- Javakheti Adjara Guria Samegrelo Imereti Mtskheta- Mtianeti Racha- Svaneti Households in CensusHouseholds in Sample Sample(RHS) Census(2002) 35-44 30-34 25-29 20-24 15-19 Unwanted Planning Status of the Most Recent Pregnancy by Maternal Age among Women Aged 15-44 Figure 4.6.3 Due to rounding, categories do not always add up to 100%. 0% 20% 40% 60% 80% 100% Mistimed Intended 54 39 24 8 6 4 10 12 14 10 42 51 63 78 85 FINAL REPORT 47 age, primarily because the desire for birth-spacing is replaced by the desire to terminate childbearing. As a result, virtually all unintended pregnancies were un- wanted at older ages. Women who had never given birth and women with only one child (presumably younger women) were less likely to report that their last pregnancy was unwanted than were women with two or more live births (Figure 4.6.4). Rates of unplanned pregnancy were higher among women with the lowest education level and those with the lowest wealth quintile. They were also higher among women with an Azeri or Armenian background than among Georgian women. 4.7 Future Fertility Preferences Knowledge about fertility expectations in a population is essential for helping couples to avoid unplanned pregnancies and attain their desired family size. Public health officials and health care providers need to be informed about fertility preferences so they can accu- rately help couples lower rates of unplanned pregnan- cies and induced abortion. In all surveys, the desire for more children was ex- plored by asking women if they intend to have (a/an- other) child in the future. Respondents who said that they would like to have more children were asked if they want to get pregnant right away, if they want to get pregnant within one year, within 1–2 years, or af- ter 2 years. The data presented in Table 4.7.1 and Figure 4.7.1 demonstrate that more than one in three women cur- rently married or in consensual union wanted more children; an additional 6% were unsure if they wanted to have more. Nine percent of women reported that either they or their partners were infecund. Those women were not asked about their future fertility preferences. Future fertility preferences are strongly influenced by the number of living children. For example, 70% of married women with no children wanted to have a child and almost all of them (66%/69.6%=95%) wanted to have a child within two years. Among women with one living child, 71% wanted to have an- other child in the future, including 37% who said at some time within the next two years (sum of “right away” through want in 1-2 years). This percentage decreased rapidly to 21% among women with two children, and 8% among women with three or more children. Conversely, the intention to have no more children increased rapidly with increasing number of living children (Figure 4.7.2). Among women who had had three or more children, the majority (81%) were ready to terminate childbearing. Conversely, among those with no living children, only 1% said they did not want children. The changes in fertility preferences across the three RHS surveys in Georgia are very relevant in interpret- ing the recent transition to higher fertility rates as doc- umented in 2010. As shown in Figure 4.7.3, the pro- portion of women who stated they want to have more children increased from 25% in 1999 to 35% in 2010, a 40% increase. This trend was consistent regardless of the number of living children. Particularly notable is the relatively high proportion of women with two or more children (21%) who said in 2010 they want more children, compared to only 12% in 1999. Percentage Planning Status of the Most Recent Pregnancy Children Among Married Women Aged 15–44 by Number of Living Figure 4.6.4 None One 100 80 60 40 20 0 Two Three or More Intended Mistimed Unwanted 87 3 6 81 13 6 55 11 34 48 7 45 Number of Living Children REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 48 The study of fertility patterns in Georgia has demon- strated a high concentration of childbearing at rela- tively young ages. Not surprisingly, the desire to have children was very high among young Georgian women (89% among 15–19 year-olds and 73% among 20–24 year-olds), declining to 47% at ages 25-29 and declin- ing further among women aged 30 or older (bottom panel of Table 4.7.1). About half of those wanting a(another) child wanted it within two years (Figure 4.7.4): for example 45% at ages 15-19 out of the 89% just mentioned who wanted a(another) child at some time in the future. On the other hand, among women aged 29 or younger who desired additional children, one in two wanted to wait at least two years (e.g. 34.8/72.8 at ages 20-24). Women aged 30 or older who wanted more children were more likely to want the child within the next two years and by age 40 nearly all did so. Between 1999 and 2010, there were notable changes in the timing of having a(another) child by the current age. Among the youngest women, the proportion who wanted a child within two years had declined sharply, by over a fourth, from 61% to 44% but no declines ap- peared in the proportions of women aged 30 or older wanted to have a (another) child within the next two years. These findings are consistent with the observed decline in adolescent age specific fertility rates and the increased fertility of women aged 30 years or older and may predict future increases of childbearing among older women. Future Fertility Preferences Among Married Women Aged 15–44 Figure 4.7.1 50% 9% 14% 7% 15% 6% Want No More Children Infecund Want Children Within 1 Year Want Children in 1-2 Years Want Children in 2 or More Years Undecided Percentage Intention to Have No More Children by Number of Living Children among Married Women Aged 15–44 Figure 4.7.2 Total One 100 80 60 40 20 0 Two Three or More Number of Living Children None 50 1 17 64 81 FINAL REPORT 49 A more accurate analysis concerning women who want no more children is obtained by restricting the view to only fecund women, i.e. those who can get pregnant and may be at risk of unintended pregnancy (Table 4.7.2). Further the exclusion of infecund wom- en permits a better examination of trends. (Between 1999 and 2010 there was a notable reduction in the infecund group, from 14% to 9%). The inverse rela- tionship between wanting no more children and par- ity is now more pronounced. Overall, 54% of Georgian women who could conceive reported that they did not want to have more children, but this proportion increased from 18% among those with one living child to 87% among those with three or more children (Fig- ure 4.7.5). Among women with one child, the desire to have no more children was higher for urban women than for rural women (21% vs. 15%) and it increased directly with the education level. At any parity, the intention to terminate childbearing was directly correlated with age. This pattern is similar to the one documented in the 1999 and 2005 surveys, but fewer women with two or more children in 2010 said they do not want to have a (another) child than in 1999 or 2005. The developing family planning program in Georgia needs to take account of the fertility preferences of Georgian couples, in order to provide the most ap- propriate contraceptive methods for each couple’s needs. Younger women, most of whom want to have one or more children, are more likely to need birth- spacing methods, whereas older women, the majority of whom want to stop childbearing, need longer-term or permanent methods. 4.8 Infertility Problems The 2010 survey included a module designed to as- sess current infertility levels and document existing reproductive health services for women with impaired fecundity. Infertility is often cited as a reproductive health concern in Eastern Europe given the dramat- ic declines in fertility, widespread use of abortion, Intention to Have More Children by Number of Living Children, for Married Women Aged 15–44: 1999, 2005, 2010 Figure 4.7.3 Percentage Total One 80 60 40 20 0 Two Three or More Number of Living Children None 25 27 35 63 65 70 66 64 71 12 13 21 3 4 8 1999 2005 2010 Intention to Have Children within Two Years by Age Group among Married Women Aged 15–44 1999, 2005, 2010 Figure 4.7.4 Percentage 15-19 25-29 80 60 40 20 0 30-34 40-4420-24 61 47 44 38 33 38 26 21 23 1999 2005 2010 17 15 21 7 15 2 4 77 35-39 REPRODUCTIVE HEALTH SURVEY IN GEORGIA 2010 50 increase in sexually transmitted infections and PID cases, and deficient health infrastructure. Although no clear documentation demonstrates that infertility rates in Georgia are increasing, anecdotic evidence leads to widespread beliefs that Georgian women seek treatment for infertility services more often than in the past, either because they may suffer from pelvic infections (as complications of abortion or childbirth) or because they experience a strong cultural pressure to conceive soon after marriage. Given that data on infertility and receipt of infertility services have impli- cations for projecting future demand for services and health care costs, the survey included a series of ques- tions about service attendance and diagnosed prob- lems. The term “impaired fecundity” in this chapter refers to a couple’s impaired ability to conceive or maintain pregnancy either because of a known medical condi- tion or because of absence of conception after at least two years of exposure to unprotected intercourse. As shown in Table 4.8.1, 10% of sexually experienced women or their partners had at some time received any infertility services and been diagnosed with im- paired fecundity. The proportion of women with the “ever” diagnosis was higher in Tbilisi than in other ur- ban or rural areas, probably because women in Tbilisi have better access to medical services that can diag- nose fecundity impairment. However among the five perc

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