Ghana - Demographic and Health Survey - 1999

Publication date: 1999

World Summit for Children Indicators: Ghana 1998 _________________________________________________________________________________________________ BASIC INDICATORS Value _________________________________________________________________________________________________ Childhood mortality Infant mortality rate (adjusted rate) 57 per 1,000 Under-five mortality rate 108 per 1,000 Childhood undernutrition Percent stunted 26 Percent wasted 10 Percent underweight 25 Clean water supply Percent of households within 15 minutes of a safe water supply1 49 Sanitary excreta disposal Percent of households with flush toilets or VIP latrines 33 Iodised salt Percent of households using iodised salt 27 Basic education Percent of women 15-49 with completed primary education 57 Percent of men 15-49 with completed primary education 75 Percent of girls 6-12 attending school 76 Percent of boys 6-12 attending school 76 Percent of women 15-49 who are literate 56 Children in especially Percent of children who are orphans (both parents dead) 0.4 difficult situations Percent of children who do not live with their natural mother 22 Percent of children who live in single adult households 19 _________________________________________________________________________________________________ SUPPORTING INDICATORS _________________________________________________________________________________________________ Women's Health Birth spacing Percent of births within 24 months of a previous birth2 13 Safe motherhood Percent of births with medical prenatal care 88 Percent of births with prenatal care in first trimester 39 Percent of births with medical assistance at delivery 44 Percent of births in a medical facility 43 Percent of births at high risk 52 Family planning Contraceptive prevalence rate (any method, currently married women) 22 Percent of currently married women with an unmet demand for family planning 23 Percent of currently married women with an unmet need for family planning to avoid a high-risk birth 17 Nutrition Maternal nutrition Percent of mothers with low BMI 11 Low birth weight Percent of births at low birth weight (of those reporting numeric weight) 9 Breastfeeding Percent of children under 4 months who are exclusively breastfed 36 Child Health Vaccinations Percent of children whose mothers received tetanus toxoid vaccination during pregnancy 81 Percent of children 12-23 months with measles vaccination 73 Percent of children 12-23 months fully vaccinated 62 Diarrhoea control Percent of children with diarrhoea in preceding 2 weeks who received oral rehydration therapy (sugar-salt-water solution) 32 Acute respiratory infection Percent of children with acute respiratory infection in preceding 2 weeks who were taken to a health facility or provider 26 _________________________________________________________________________________________________ 1 Excludes surface water2 First births are excluded Ghana Demographic and Health Survey 1998 Ghana Statistical Service Accra, Ghana Macro International Inc. Calverton, Maryland, USA October 1999 The 1998 Ghana Demographic and Health Survey (GDHS) is part of the worldwide MEASURE DHS+ Project, designed to collect data on fertility, family planning, and maternal and child health. Additional information about the 1998 GDHS may be obtained from the Ghana Statistical Service, P.O. Box 1098, Accra, Ghana (Telephone: 663578 or 665441; Fax: 667069 or 664304). Additional information about the MEASURE DHS+ project may be obtained from Macro International Inc., 11785 Beltsville Drive, Calverton, MD (Telephone: 301-572-0200; Fax: 301-572-0999; E-mail: reports@macroint.com; Internet: http://www.macroint.com/dhs/). Recommended citation: Ghana Statistical Service (GSS) and Macro International Inc. (MI). 1999. Ghana Demographic and Health Survey 1998. Calverton, Maryland: GSS and MI. iii CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Map of Ghana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Geography, History and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Demographic Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Population and Reproductive Health Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.4 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.5 Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.6 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.7 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.8 Coverage of the Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . 7 2.1 Demographic Characteristics of Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3 Educational Level of Household Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.5 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.6 Educational Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.7 Access To Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.8 Women’s Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 CHAPTER 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.2 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3.3 Trends in Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.4 Pregnancy Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.5 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.6 Birth Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.7 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.8 Adolescent Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 iv Page CHAPTER 4 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.1 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4.2 Knowledge of Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.3 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.4 Current Use of Contraceptive Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.5 Trends in Contraceptive Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.6 Number of Children at First Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 4.7 Use of Social Marketing Brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.8 Sources of Supply of Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 4.9 Future Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.10 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.11 Preferred Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.12 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.13 Acceptability of Family Planning Messages on the Radio and Television . . . . . . . . . . 54 4.14 Exposure to Family Planning Messages Through the Print Media . . . . . . . . . . . . . . . . 55 4.15 Discussion of Family Planning Between Spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.16 Attitudes of Couples Toward Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 CHAPTER 5 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . 59 5.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.4 Age At First Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.5 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.6 Postpartum Amenorrhoea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . 68 5.7 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 CHAPTER 6 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 6.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 6.2 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6.3 Ideal Family Size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 6.4 Wanted and Unwanted Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 CHAPTER 7 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.1 Assessment of Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 7.2 Levels and Trends in Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 7.3 Socio-economic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.4 Demographic Differentials in Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7.5 Perinatal Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7.6 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 v Page CHAPTER 8 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 8.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 8.2 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 8.3 Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 8.4 Vaccination of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 8.5 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 8.6 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 8.7 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 CHAPTER 9 MATERNAL AND CHILD NUTRITION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 9.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 9.2 Nutritional Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 9.3 Nutritional Status of Mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 CHAPTER 10 KNOWLEDGE OF AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.1 AIDS Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.2 Knowledge of HIV/AIDS Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 10.3 Perception of HIV/AIDS Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 10.4 HIV/AIDS Prevention Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 10.5 Treatment of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 10.6 Knowledge and Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 10.7 Knowledge of other STDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 A.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 A.2 Sampling Frame and Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 A.3 Response Rates by Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 APPENDIX B ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 APPENDIX D SURVEY PERSONNEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 vii TABLES Page Table 1.1 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 2.1 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Table 2.2 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.4 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 2.5 Educational level of the female and male household population . . . . . . . . . . . . . . . . 12 Table 2.6 School attendance ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2.7 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 2.8 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.9 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table 2.10 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.11 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.12 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table 2.13 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.14 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.15 Decision on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2.16 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 3.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 3.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 3.3 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3.4 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 3.5 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 3.6 Pregnancy outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.7 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 3.8 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.9 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 3.10 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3.11 Adolescent pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 4.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 4.2 Couples’ knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 4.3 Knowledge of source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table 4.4 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 4.5 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 4.6 Current use of contraception by background characteristics: women . . . . . . . . . . . . 45 Table 4.7 Current use of contraception by background characteristics: men . . . . . . . . . . . . . . . 47 Table 4.8 Trends in current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.9 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.10 Pill and condom users by source of brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 4.11 Source of supply for modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 4.12 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 4.13 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table 4.14 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.15 Heard about family planning on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 4.16 Acceptability of media messages on family planning . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 4.17 Exposure to family planning messages in print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 4.18 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 viii Page Table 4.19 Wife's perception of husband's attitude toward family planning . . . . . . . . . . . . . . . . . 58 Table 5.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 5.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 5.3 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 5.4 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 5.5 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 5.6 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 5.7 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.8 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 5.9 Postpartum amenorrhoea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . 68 Table 5.10 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 5.11 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 6.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 6.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table 6.3 Desire for more children among monogamous couples . . . . . . . . . . . . . . . . . . . . . . . 74 Table 6.4 Desire to limit childbearing by background characteristics . . . . . . . . . . . . . . . . . . . . 75 Table 6.5 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 6.6 Ideal and actual number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 6.7 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . 79 Table 6.8 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 6.9 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 7.1 Rates of early childhood mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 7.2 Trends in infant mortality, 1975-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 7.3 Neonatal, postneonatal, infant, child, and under-five mortality by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table 7.4 Neonatal, postneonatal, infant, child, and under-five mortality by biodemographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 7.5 Perinatal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 7.6 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table 8.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 8.2 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . 93 Table 8.3 Antenatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 8.4 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 8.5 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table 8.6 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 8.7 Delivery characteristics: caesarean section, birth weight and size . . . . . . . . . . . . . . . 98 Table 8.8 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 8.9 Postnatal care providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 8.10 Postnatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Table 8.11 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table 8.12 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 8.13 Vaccinations in first year of life by current age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 8.14 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . 106 Table 8.15 Prevalence and treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table 8.16 Prevalence and treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table 8.17 Knowledge of diarrhoea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 ix Page Table 8.18 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table 8.19 Diarrhoea treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table 9.1 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 9.2 Breastfeeding status by child's age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 9.3 Median duration and frequency of breastfeeding by background variables . . . . . . . 117 Table 9.4 Types of food received by children in preceding 24 hours . . . . . . . . . . . . . . . . . . . . 118 Table 9.5 Nutritional status of children by demographic and background characteristics . . . . 120 Table 9.6 Maternal nutritional status by background characteristics . . . . . . . . . . . . . . . . . . . . 123 Table 10.1 Knowledge of AIDS and sources of AIDS information: women . . . . . . . . . . . . . . . 126 Table 10.2 Knowledge of AIDS and sources of AIDS information: men . . . . . . . . . . . . . . . . . 127 Table 10.3 Knowledge of ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Table 10.4 Knowledge of ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Table 10.5 Knowledge of AIDS-related issues: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Table 10.6 Knowledge of AIDS-related issues: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table 10.7 Perception of the risk of getting AIDS among couples . . . . . . . . . . . . . . . . . . . . . . . 133 Table 10.8 AIDS prevention behaviour: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 10.9 AIDS prevention behaviour: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Table 10.10 Treatment of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table 10.11 Knowledge and use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table 10.12 Knowledge and use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table 10.13 Knowledge of sexually transmitted diseases: women . . . . . . . . . . . . . . . . . . . . . . . 139 Table 10.14 Knowledge of sexually transmitted diseases: men . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Table A.1.1 Sample allocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Table A.1.2 Sample implementation: Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Table A.1.2 Sample implementation: Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Table B.1 List of selected variables for sampling errors, Ghana 1998 . . . . . . . . . . . . . . . . . . . 156 Table B.2 Sampling errors - National sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Table B.3 Sampling errors - Urban sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Table B.4 Sampling errors - Rural sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Table B.5 Sampling errors - Western sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Table B.6 Sampling errors - Central sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Table B.7 Sampling errors - Greater Accra sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . 162 Table B.8 Sampling errors - Volta sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Table B.9 Sampling errors - Eastern sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Table B.10 Sampling errors - Ashanti sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Table B.11 Sampling errors - Brong Ahafo sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . 166 Table B.12 Sampling errors - Northern sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Table B.13 Sampling errors - Upper West sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . 168 Table B.14 Sampling errors - Upper East sample, Ghana 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . 174 Table C.3 Age distribution of eligible and interviewed men . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Table C.4 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 Table C.5 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Table C.6 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Table C.7 Reporting of age at death in moths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 xi FIGURES Page Figure 2.1 Population Pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 2.2 Age-Specific Enrolment Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 3.1 Total Fertility Rates by Selected Background Characteristics . . . . . . . . . . . . . . . . . . 28 Figure 3.2 Age-Specific Fertility Rates, 1988-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Figure 3.3 Early Pregnancy Loss, 1988-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Figure 4.1 Current Use of Family Planning among Currently Married Women Age 15-49 . . . . 46 Figure 4.2 Current Use of Contraceptive Methods, 1988-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Figure 5.1 Marital Union by Age, 1993 and 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Figure 5.2 Recent Sexual Activity, Women and Men, Selected African Countries, 1996-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Figure 6.1 Fertility Preferences of Currently Married Women Age 15-49 . . . . . . . . . . . . . . . . . 72 Figure 6.2 Desire to Limit Childbearing among Currently Married Women and Men, by Number of Living Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Figure 7.1 Trends in Infant and Under-Five Mortality, Ghana 1975-1996 . . . . . . . . . . . . . . . . . 84 Figure 7.2 Under-Five Mortality by Selected Demographic Characteristics . . . . . . . . . . . . . . . . 86 Figure 8.1 Antenatal Care, Tetanus Vaccinations, Place of Delivery, and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Figure 8.2 Vaccination Coverage among children age 12-23 months . . . . . . . . . . . . . . . . . . . . 103 Figure 8.3 Prevalence of Diarrhoea and Bloody Diarrhoea in the Two Weeks Preceding the Survey, by Age of Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Figure 9.1 Level of Stunting among Children under Age 3 by Demographic Characteristics . . 121 Figure 9.2 Level of Stunting among Children under Age 3 by Background Characteristics . . 122 Figure 9.3 Percentage of Mothers with a Low Body Mass Index (BMI) by Background Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 xiii FOREWORD The 1998 Ghana Demographic and Health Survey (GDHS) is the third survey of its kind to be carried out in Ghana, following the 1988 GDHS and the 1993 GDHS. These surveys which are part of the worldwide Demographic and Health Surveys (DHS) programme have been conducted by the Ghana Statistical Service. In keeping with the expansion of programmes in population and health, the 1998 GDHS is more extensive in its treatment of some topics. The survey is designed to furnish policy makers, planners, researchers and programme managers with factual, reliable and up-to-date information on fertility, maternal and child health indicators, and demographic trends and differentials. The survey also provides information on the knowledge of HIV/AIDS and other sexually transmitted diseases. Information from the 1998 GDHS shows that Ghana is indeed undergoing a demographic transition, with a two-child decline in the total fertility rate over the last decade. This has been accompanied by a marked decline in infant and child mortality. Nevertheless, contraceptive use has not increased much in the most recent five years. Fear of side effects is a major reason for non-use. At the same time, the percentage of pregnancies terminated is noticeably high. It is expected that the findings in this report will raise important programmatic issues for policy makers involved in family planning and service delivery. The Statistical Service of Ghana acknowledges the invaluable assistance of a number of agencies, institutions, organisations and individuals both local and international towards the successful completion of the 1998 GDHS. The Service is particularly thankful to the United States Agency for International Development (USAID) for funding the survey through its mission in Ghana, and to Macro International Inc. for providing technical assistance. The Service is also grateful to the Ministry of Health for providing vehicles for the fieldwork and personnel for training of the interviewers. Various government and non- government organisations provided input in finalising the questionnaires used in the survey and translating the questionnaires into the five local languages. We are grateful for the invaluable support of the survey staff, and for their tireless effort in ensuring the timely completion of the survey and this report. Last but not least, we gratefully acknowledge the co-operation of all survey respondents in making the 1998 GDHS a success. Daasebre Dr. Oti Boateng Government Statistician and Project Director Ghana Statistical Service, Accra October 1999 xv ACKNOWLEDGMENTS The following persons contributed to the preparation of this report: Daasebre Dr. Oti Boateng, Ghana Statistical Service Dr. K.A. Twum-Baah, Ghana Statistical Service Mr. Stephen Adjei, Ghana Statistical Service Mr. K.B. Danso-Manu, Ghana Statistical Service Mr. Eric A. Okrah, Ghana Statistical Service Mr. Alex Ohene-Okai, Ghana Statistical Service Ms. Edith K. Ameka, Ghana Statistical Service Mr. Nana Akwasi Ango, Ghana Statistical Service Dr. Pavalavalli Govindasamy, Macro International Inc. Dr. Ann Way, Macro International Inc. Dr. Alfredo Aliaga, Macro International Inc. Mr. Albert Themme, Macro International Inc. Ms. Devin O’Neill, Macro International Inc. Ms. Kaye Mitchell, Macro International Inc. xvii SUMMARY OF FINDINGS The 1998 Ghana Demographic and Health Survey (GDHS) is a nationally representative survey of 4,843 women age 15-49 and 1,546 men age 15-59. This survey is the third in a series of Demographic and Health Surveys conducted in Ghana. The primary purpose of the 1998 GDHS is to furnish policy makers and planners with detailed information on fertility, family planning, infant and child mortality, maternal and child health, and nutrition. In addition, the survey collected information on knowledge of HIV/AIDS and other sexually transmitted diseases. Fertility Results from the 1998 GDHS indicate that fertility in Ghana has declined rapidly over the last decade, from over 6 births per woman in the mid-eighties to 4.6 births per woman during the last five years. Fertility has fallen recently in every age group, with fertility levels among women under age 35 declining by around 25 percent during the decade between the 1988 and 1998 surveys. Differences by place of residence are marked, with rural women having two and a half more children than urban women. Fertility is highest in the Northern Region (7.0 births per woman), and lowest in the Greater Accra Region (2.7 births per woman). Several factors could account for this dramatic decline in fertility in Ghana. There has been an 8 percent decline in the percent of women currently in union over the last five years, from 70 percent in 1993 to 65 percent in 1998. This decline in nuptiality is most obvious in the youngest (15-29) and oldest (44-49) age groups. There is a noticeable trend towards later marriage. The median age at marriage has risen steadily over the last two decades, from 18.7 years for women age 40-49 to 19.3 years for women age 20-24. At the same time, the proportion of women married by age 15 has declined from 11 percent among women age 40-44 to 4 percent among those currently age 15-19 years. Although the median age at first sexual intercourse has not changed much over the last 20 years (around 17.6), recent sexual activity is markedly lower in Ghana than in several other African countries. Only two in five women were sexually active in the four weeks prior to the survey, compared with for example, 57 percent in Niger, 58 percent in Cameroon, and 63 percent in Senegal. Age at first birth has risen in the most recent period, from 19.8 among women age 44-49 to 20.9 among women age 25-29. A more significant longer term decline is suggested by the fall in the percentage of first births occurring to women before age 18, from 30 percent in the cohort age 45-49 to 20 percent in the cohort age 20-24. The interval between births is long in Ghana. Half of all births in Ghana occur more than three years after a previous birth. The median birth interval increased slightly in the last five years from 36 months in 1993 to 38 months in 1998. Postpartum insusceptibility is one of the factors contributing to the long birth interval. The median duration of amenorrhoea is 11 months, that of abstinence is 9 months, and that of insusceptibility is 14 months. Over the last decade, Ghanaian women seem to have narrowed the gap between desired and achieved family size. The mean ideal number of children declined from 5.3 in 1988 to 4.4 in 1993 and 4.3 in 1998 (while the total fertility rate declined from 6.4 in 1988, to 5.5 in 1993 and 4.6 in 1998). Nevertheless, women in Ghana continue to revise downward the number of children they would like to have. Thirty-five percent xviii of women either want no more children or have been sterilised. If all unwanted births were prevented, the total fertility rate would fall to 3.7 births per woman. Unlike earlier demographic and health surveys conducted in Ghana, the 1998 GDHS gathered complete pregnancy histories from women and hence provides information on pregnancy outcomes. Twelve percent of all pregnancies that occurred in the ten years preceding the survey did not end in a live birth, and one in four pregnancies to women in the 15-19 age group was lost before term. Pregnancy losses are especially high among urban women age 15-19, with about two in five having experienced a pregnancy loss. Family Planning Knowledge of family planning is very high in Ghana, with 93 percent of currently married women having heard of at least one modern method of contraception. In addition, about eight in ten women know where to obtain a modern method of family planning. Mass media are important sources of information on family planning. Sixty-six percent of women have heard a family planning message on the radio and/or television, and 44 percent have read about it in the print media. The large majority of women and men also approve of family planning messages on the radio and television. Most women (77 percent) also exhibit a positive attitude towards the use of family planning, and more than one in two women believe that their husband also approves of the use of family planning. Nevertheless, the use of contraception is very low in Ghana, with a marked discrepancy between ever use and current use of contraceptives. Although one in two currently married women has used family planning at least once in her lifetime, only 22 percent are currently using a method. The use of modern methods is even lower, with 38 percent having ever used a modern method, and 13 percent currently using it. Thirty-two percent of men report current use of a method, and one in five reports the use of a modern method. Much of the male-female difference in current use is due to the higher reporting of condom use by men. Even though traditional methods are not actively promoted, their use is relatively high. Nine percent of women and 12 percent of men report that they are currently using periodic abstinence and withdrawal. The most widely used modern method is the pill (4 percent), followed closely by injectables and condoms (3 percent each). Both the public and private sectors are equally important sources of modern contraceptives. Within the public sector, government hospitals are the most important source, supplying 29 percent of contraceptives, while within the private sector, drug stores are an important source, supplying 32 percent of current users. The two most important reasons for non-use of contraception among currently married women are the desire for more children (19 percent), and the fear of side effects (18 percent). In fact, one in four women below age 30 cited the latter reason. Twenty-one percent of younger women also stated that they, or their partners, or someone else was opposed to the use of contraception. The substantial proportions of women not wanting to use contraceptives for these two reasons suggest that there is substantial scope for the family planning programme in Ghana to increase contraceptive use by providing information and counselling to dispel misconceptions about using contraception. There has been a very small increase in the contraceptive prevalence rate in Ghana in the most recent five-year period. Current use increased from 13 percent in 1988 to 20 percent in 1993 and 22 percent in 1998. The two-child decline in fertility between 1988 and 1998 far exceeds the increase in contraceptive prevalence over the same period and is inconsistent with international experience on the relationship between fertility and contraceptive prevalence. This contradiction warrants a closer examination of the impact of other proximate determinants on fertility. xix Even though contraceptive use has not increased significantly in the last five years, there has been a substantial decline (40 percent) in unmet need. Nevertheless, there continues to be considerable scope for increased use of family planning. Around one in four currently married women has an unmet need for family planning, 11 percent with an unmet need for spacing, and 12 percent with an unmet need for limiting. Childhood Mortality One in nine children born in Ghana dies before the fifth birthday. Approximately half of all deaths to children under five occur during the first year of life. Infant mortality is 57 deaths per 1,000 births. The risk of neonatal deaths is 30 per 1,000 births and the risk of postneonatal deaths is 27 per 1,000 births. There has been a 43 percent decline in infant and under-five mortality in the last two decades. Mortality is consistently lower in urban than rural areas, and infant mortality is lowest in the Greater Accra Region and highest in the Upper East Region. As expected, mother’s education displays a strong negative relationship with infant and child mortality, with children born to mothers with little or no education suffering the highest mortality. Maternity care also has significant impacts on infant and child survival, with mothers who receive neither antenatal nor delivery care experiencing the highest mortality rates. Maternity Care Antenatal care utilisation is high in Ghana, with mothers receiving care from a doctor, nurse or midwife for 87 percent of births. The median number of visits among women who received antenatal care is 4.6, and three in five women who received antenatal care have four or more visits. The quality of antenatal care is also reasonably good in Ghana. Mothers of about three in four births were weighed and measured, had their blood pressure taken, their urine tested, and given folic/folate acid tablets, during their pregnancy. For about half of births (52 percent), mothers received two or more tetanus toxoid injections. Institutional deliveries are not common in Ghana. Only two in five births were delivered in a medical facility. Forty-four percent of births were attended by a doctor, nurse or midwife. Non-institutional deliveries are more likely to be attended by someone other than a doctor, nurse or midwife. Trained traditional birth attendants assisted one in four births, and this is a substantial increase from the 15 percent of births in 1993. But there continues to be substantial scope for improving safe home delivery, since untrained traditional birth attendants delivered nearly one in five births. Postnatal care, an important component of maternity care, is crucial for monitoring and treating complications within the first two days following delivery. Only four percent of births that occurred outside a health facility received postnatal care within the first two days. Even more troubling is the fact that one in two non-institutional deliveries did not receive any postnatal care. The most important providers of postnatal care for non-institutional deliveries were nurses or midwives (39 percent). Child Health The proportion of children fully immunised by age one has increased in the last five years from 43 percent in 1993 to 51 percent in 1998. Around nine in ten children received the BCG, and first dose of DPT and polio vaccines before age one. However, the coverage for the third dose of DPT and polio fell to 67 percent. Sixty-one percent of children received the measles vaccine before age one and 39 percent have been vaccinated against yellow fever. One in four children also received Vitamin A in the six months prior to the survey. xx The prevalence of symptoms of acute respiratory infection (ARI) among children under five years of age, in the two weeks before the survey, was 14 percent. Use of a health facility for the treatment of symptoms of ARI is low, with only one in four children taken to a health facility. Advice or treatment for symptoms of ARI is most commonly sought from government health facilities. Twenty-seven percent of children under five were reported to have had fever, a major manifestation of malaria, in the two weeks before the survey. Antimalarial treatment is the most commonly prescribed treatment for fever, with three in five children receiving it, mostly from a government facility. Eighteen percent of children experienced diarrhoea at some time in the two weeks before the survey, and 4 percent had bloody diarrhoea, a symptom of dysentery. Twenty-one percent of children were treated at a government facility, and pharmacies/drugstores/chemists provided treatment or advice for 23 percent of children. Breastfeeding and Nutrition Breastfeeding is nearly universal in Ghana, and the median duration of breastfeeding is long (22 months). However, exclusive breastfeeding is relatively short and three in five children less than two months of age are given water, water-based liquids like juice, and other types of complementary food. The use of a bottle with a nipple is common, with 15 percent of children under 36 months using it, and bottle-feeding starting as early as 0-1 month. Undernutrition is significant in Ghana, with one in four Ghanaian children under five years of age stunted (short for their age), 10 percent wasted (thin for their age), and 25 percent underweight. In general, rural children, children residing in the three northern regions of Ghana (Northern, Upper West, and Upper East), and children of uneducated mothers are more likely to be stunted, wasted or underweight. The 1998 GDHS also collected information on mother’s nutritional status. Survey results show that the level of chronic energy deficiency in Ghana is relatively high. One in nine women falls below the 18.5 kilogram/metres squared cut-off for the body mass index, which utilises both the height and weight to measure thinness. However, only three percent of women had a mid-upper arm circumference, an index of nutritional status, of less than 23 centimetres, the recommended cut-off point. There has virtually been no difference in maternal nutritional status in the last five years. HIV/AIDS and STDs Most women (97 percent) and men (99 percent) have heard of AIDS. However, the depth of their knowledge of AIDS is somewhat more limited. Fourteen percent of women and 9 percent of men stated that they did not know if AIDS is avoidable, and one in five women and one in nine men, did not know of any way to avoid contracting AIDS. Information on AIDS is mostly obtained from the radio, the workplace and television. Three-quarters of women and four-fifths of men believe that a healthy person can have the AIDS virus. A very high percentage of respondents (more than 80 percent), also rightly believe that a woman with the AIDS virus can give birth to a child with the AIDS virus, and that AIDS can be passed to the child through breastfeeding. Fifty-four percent of women and 58 percent of men believe that they have no chance of contracting HIV/AIDS. Respondents who believe that they have no risk or have a small risk of contracting HIV/AIDS are less likely to change their behaviour than those who believe that they have a moderate or great risk of contracting the disease. About two in five women and men believe that the government should provide free medical treatment for persons with HIV/AIDS. Condoms play an important role in preventing the xxi transmission of HIV/AIDS. Men are more than twice as likely (15 percent) to have used condoms at last sex than women (6 percent), and twice as likely (7 percent) as women (3 percent) to have used condoms for the prevention of HIV/AIDS, than as a method of family planning. Apart from HIV/AIDS, gonorrhoea is the most commonly heard of sexually transmitted disease (STD), with 61 percent of women and 73 percent of men having heard of it. Thirteen percent of women and 21 percent of men have heard of syphilis. Nearly all women and men who have heard of other STDs know a source of treatment. Women’s Status The 1998 GDHS also sheds some light on the status of women in Ghana. Twenty-three percent of currently married women are in a polygynous union, with older women more likely to be one of several wives to a man than younger women. However, polygyny among married women appears to be on the decline over the last five years, declining from 28 percent in 1993. Women in Ghana are generally less educated than men, with a median number of years of schooling at 2.3 years compared to 4.9 years among males. Much of the female-male difference in educational attainment is at the secondary school level or higher. However, this gap in gender has narrowed in recent years. The net attendance ratio, which indicates participation in primary schooling among those age 6-11 years, and secondary schooling among those age 12-18 years, is nearly identical for females and males. Female employment is high in Ghana with three in four women employed at the time of the survey. However, only two in three women work fulltime, 9 percent work seasonally, and 2 percent work occasionally. Surprisingly, the more educated a woman, the less likely she is to be currently employed. Nine out of ten women currently employed earn cash for their work. Self-employment, which is more common among less educated women is very high, with three in four women in this category. One in two women is engaged in sales and services. Most Ghanaian women enjoy a high degree of autonomy with regards to spending their cash earnings. Just over half (54 percent) of working mothers have a child under six years. Forty-eight percent of these mothers look after their own children while they are working, 22 percent have relatives other than their husband/partner to look after the child, and 14 percent have the child in school or other institutional care. Less than 3 percent of women have husbands/partners to look after the child while they are at work. 1 CHAPTER 1 INTRODUCTION 1.1 Geography, History and Economy Geography Ghana is centrally located in the West African sub-region and has a total land area of 238,539 square kilometres. The topography of Ghana shows that it is generally a low-lying country. The only range of hills lies on the eastern border with the Republic of Togo and the west of the Volta River along the Akwapim- Kwahu area. Along the coast is savannah grassland that is criss-crossed by several rivers and streams that are navigable by canoe. In the west and central parts of the country is heavily forested terrain that is sub- divided by hills, rivers and streams. To the north of the country lies the undulating savannah drained by the Black and White Volta Rivers. The climate of Ghana is tropical, but rainfall and temperatures vary by distance from the coast, and elevation. The rainy season in the northern parts of Ghana begins in March and lasts until September, while two rainy seasons are recorded in the southern half of the country—April to July, and September to October. The average annual temperature is about 26o Celsius (79oFahrenheit). History Until 1957, the country was called the Gold Coast; a name given to it by the early Europeans, because of the abundant gold traded on the coast. Due to the belief of ties between the people of this country and the ancient empire of Ghana which was situated in the Sahelian region of Senegal, Mauritania and Mali, the country was given the name Ghana when it gained independence from the British on 6th March 1957. It became a republic in the British Commonwealth of Nations on 1st July 1960. Ghana has had its share of political turbulence with the military taking over the reigns of power on four occasions over the four decades of independence. Today, Ghana is one of the most politically stable and peaceful countries in Africa, having successfully gone through a transition from military rule to multi-party democracy in 1993. Ghana operates a parliamentary system of government based on multi-parties; and has an elected President. The country has a three tier local government. There are 10 administrative regions, representing the first level of administration, and these are subdivided into districts, totalling 110. In line with the country’s decentralised policy, the district represents the basic unit of planning and political administration. Below the districts are the unit committees. Economy The structure of the economy has not changed significantly in recent years. The primary sector continues to dominate in terms of its contribution to output, employment, revenue, and foreign exchange earnings. Agriculture is the main economic activity, and currently accounts for about 51 percent of the Gross Domestic Product (GDP), and employs about 60 percent of the labour force (Ghana, 1994). Tourism is however, fast becoming a very important foreign exchange earner. 2 The economy recorded its worst performance during the decade prior to 1984, but has made a dramatic recovery with the institution of the Economic Recovery Programme (ERP) in 1983. Since 1984, the real national income has grown at an average annual rate of 5.3 percent, compared to a decline of 1.3 percent during the 1976-1983 period (Ghana, 1994). 1.2 Demographic Profile When Ghana gained independence in March 1957, its population was barely 6 million. The first post- independence population census conducted in 1960 recorded the number of people in the country at 6.7 million, giving an inter-censal growth rate of 4.2 percent between 1948 and 1960 (Ghana, 1994). By 1970 the population of Ghana had increased to 8.6 million with an annual rate of increase of 2.4 percent. The last census in 1984 put the country’s population at 12.3 million with an inter-censal growth rate of 2.6 percent. The mid-year population of Ghana for 1999 is estimated at 18.3 million thus indicating a tripling of the population between 1957 and 1999, or a doubling of the 1970 population in just 26 years. With a substantial proportion of its population below fifteen years of age, Ghana’s population is relatively young. The 1984 Census showed that 45 percent of the population was under the age of 15 with 51 percent aged 15-64. A more recent study, the 1997 Core Welfare Indicators Questionnaires (CWIQ) Survey, showed a slight drop in the proportion of the population under 15 years to 42 percent while those age 65 and over increased to 5 percent (GSS, 1998) Although fertility has been declining, current levels have been a source of worry for policy makers and planners. The total fertility rate ranged between 6 and 7 for the period between 1960 and 1988. It dropped to 5.5 in 1993, but this is considered rather high (GSS, 1994). There is evidence to indicate that the death rate in Ghana has been steadily declining over the years as a result of a combination of several factors such as improvement in public health, sanitation, medical facilities, increasing education, and modernisation in general. The infant mortality rate (IMR), dropped from 133 per 1,000 in 1957 (MOH, 1996) to 77 per 1,000 in 1988 (GSS and IRD, 1989), and 66 per 1,000 in 1993 (GSS and MI, 1994). Life expectancy at birth has increased from about 45 years in 1960 to 57 years in 1998 (MOH, 1996). However, there still exist wide variations between regions, between urban and rural populations, and between different cultural and religious groups. The pattern of morbidity has virtually remained unchanged over the years, and the general populace seems to be afflicted largely with the same diseases such as malaria, upper respiratory infections and water- borne diseases. An underlying cause of the persistence of these diseases is the widespread prevalence of poor nutrition, poverty, inadequate housing, and lack of access to potable water in many communities. Ghana’s population is predominantly rural. In 1960 only 23 percent of the population lived in urban areas, increasing to 29 percent in 1970, 32 percent in 1984, and 34 percent currently. Thus, 66 percent of the country’s population reside in rural communities and are mainly employed in primary production (Ghana, 1994 and GSS and MI, 1998). 1.3 Population and Reproductive Health Programmes Ghana adopted a population policy in 1969. One of the major long-term objectives of this policy was to reduce the population growth rate from nearly 3.0 percent in 1969 to 1.7 percent by the year 2000 (Ghana, 1994). By 1993, seven years to the target date, the 1969 policy had made only modest gains, for instance, the growth rate was estimated at between 2.8 and 3.0 percent and this was considered to be quite high (GSS and MI, 1994). Besides, there were new issues and concerns, which needed to be taken into 3 account. The 1969 population policy was therefore revised in 1994 to take into account emerging issues like HIV/AIDS, population and the environment, and concerns about the elderly and children, and also to develop new strategies that would ensure the achievement of the policy objectives. The revised edition reviewed all policy goals and set new targets within the framework of a national development strategy. One of the major targets in the new policy is the reduction of total fertility rate (TFR) to 5.0 by the year 2000, to 4.0 by 2010 and to 3.0 by 2020. This is to be achieved by attaining a contraceptive prevalence rate (CPR) of 15 percent by the year 2000, 28 percent by 2010 and 50 percent by 2020. The new target for population growth rate is 1.5 percent by 2020. The attainment of these policy goals is recognised as integral components of the national strategy to accelerate the pace of economic development, eradicate poverty and enhance the quality of life of all citizens, as outlined in the Vision 2020 Plan of Action. It is expected that these goals would propel Ghana into a middle income earning country by the year 2020 (Ghana, 1995). The National Population Council (NPC) and its secretariat were established in 1992 as the highest statutory body to advise the government on population-related issues, and to facilitate, monitor, co-ordinate, and evaluate the implementation of population programmes. In December 1994, Parliament accorded the NPC statutory recognition by enacting an act to regulate its affairs. Ghana collaborates with the United Nations Fund for Population Activities (UNFPA), the United States Agency for International Development (USAID), and other donor agencies to implement a number of population-related activities. Both UNFPA and USAID support the Government of Ghana's efforts to address the high population growth rate, low contraceptive prevalence rate, reproductive/sexual health, HIV/AIDS and other sexually transmitted diseases (STDs), and maternal and child health. Strategies focus on policy coordination and implementation, service delivery, and demand generation. In its policies and programmes for the redirection and intensification of population activities, Ghana has incorporated the ideals and recommendations of the International Conference on Population and Development (ICPD) held in Cairo in September 1994, the World Summit on Poverty and Social Development held in Copenhagen in April 1995, and the Fourth World Conference on Women held in Beijing. The Ministry of Health is vigorously pursuing policies aimed at ensuring good health for all citizens by the year 2000. Emphasis has been on making primary health care delivery systems available and accessible to all communities by the target date. 1.4 Objectives and Organisation of the Survey The 1998 Ghana Demographic and Health Survey (GDHS) is the latest in a series of national-level population and health surveys conducted in Ghana. The primary objective of the 1998 GDHS is to provide current and reliable data on fertility and family planning behaviour, child mortality, children’s nutritional status, and the utilisation of maternal and child health services in Ghana. Additional data on knowledge of HIV/AIDS are also provided. This information is essential for informed policy decisions, planning and monitoring and evaluation of programmes at both the national and local government levels. The long-term objectives of the survey include strengthening the technical capacity of the Ghana Statistical Service (GSS) to plan, conduct, process, and analyse the results of complex national sample surveys. Moreover, the 1998 GDHS provides comparable data for long-term trend analyses within Ghana, since it is the third in a series of demographic and health surveys implemented by the same organisation, using similar data collection procedures. The GDHS also contributes to the ever-growing international database on demographic and health-related variables. 4 The 1998 GDHS was conducted under the aegis of the GSS. Macro International Inc. provided technical support for the survey through the MEASURE DHS+ project. Funding for the survey came from the United States Agency for International Development (USAID), through its mission in Ghana. The Ghanaian Government covered the salaries of survey personnel, office accommodation and vehicles and provided other logistical support. 1.5 Sample Design The major focus of the 1998 GDHS was to provide updated estimates of important population and health indicators including fertility and mortality rates for the country as a whole and for urban and rural areas separately. In addition, the sample was designed to provide estimates of key variables for the ten regions in the country. Details of the sample design and implementation are given in Appendix A. The list of Enumeration Areas (EAs) with population and household information from the 1984 Population Census was used as the sampling frame for the survey. The 1998 GDHS is based on a two-stage stratified nationally representative sample of households. At the first stage of sampling, 400 EAs were selected using systematic sampling with probability proportional to size (PPS-Method). The selected EAs comprised 138 in the urban areas and 262 in the rural areas. A complete household listing operation was then carried out in all the selected EAs to provide a sampling frame for the second stage selection of households. At the second stage of sampling, a systematic sample of 15 households per EA was selected in all regions, except in the Northern, Upper West and Upper East Regions. In order to obtain adequate numbers of households to provide reliable estimates of key demographic and health variables in these three regions, the number of households in each selected EA in the Northern, Upper West and Upper East regions was increased to 20. The sample was weighted to adjust for over sampling in the three northern regions (Northern, Upper East and Upper West), in relation to the other regions. Sample weights were used to compensate for the unequal probability of selection between geographically defined strata, and weighted data are used throughout the remainder of this report. The survey was designed to obtain completed interviews of 4,500 women age 15-49. In addition, all males age 15-59 in every third selected household were interviewed, to obtain a target of 1,500 men. In order to take cognisance of non-response, a total of 6,375 households nation-wide were selected. 1.6 Questionnaires Three types of questionnaires were used in the GDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were based on model survey instruments developed for the international MEASURE DHS+ programme and were designed to provide information needed by health and family planning programme managers and policy makers. The questionnaires were adapted to the situation in Ghana and a number of questions pertaining to on-going health and family planning programmes were added. These questionnaires were developed in English and translated into five major local languages (Akan, Ga, Ewe, Hausa, and Dagbani). The Household Questionnaire was used to enumerate all usual members and visitors in a selected household and to collect information on the socio-economic status of the household. The first part of the Household Questionnaire collected information on the relationship to the household head, residence, sex, age, marital status, and education of each usual resident or visitor. This information was used to identify women and men who were eligible for the individual interview. For this purpose, all women age 15-49, and all men age 15-59 in every third household, whether usual residents of a selected household or visitors who slept in a selected household the night before the interview, were deemed eligible and interviewed. The Household Questionnaire also provides basic demographic data for Ghanaian households. The second part of the 5 Household Questionnaire contained questions on the dwelling unit, such as the number of rooms, the flooring material, the source of water and the type of toilet facilities, and on the ownership of a variety of consumer goods. The Women’s Questionnaire was used to collect information on the following topics: respondent’s background characteristics, reproductive history, contraceptive knowledge and use, antenatal, delivery and postnatal care, infant feeding practices, child immunisation and health, marriage, fertility preferences and attitudes about family planning, husband’s background characteristics, women’s work, knowledge of HIV/AIDS and STDs, as well as anthropometric measurements of children and mothers. The Men’s Questionnaire collected information on respondent’s background characteristics, reproduction, contraceptive knowledge and use, marriage, fertility preferences and attitudes about family planning, as well as knowledge of HIV/AIDS and STDs. 1.7 Training and Fieldwork Prior to the main survey, 10 listing teams, each consisting of 1 supervisor, 1 geographical assistant, 3 listers and a driver were recruited and trained for about 10 days in July 1998. Household listing began in August and lasted for about two months. Spot checks were conducted while the listers were in the field to ensure that the work was being done correctly and completely. In some cases, listers were sent back to relist areas where households had been missed or wrongly listed. A pretest of the Household, Women’s and Men’s Questionnaires was conducted in September 1998 in all five main local languages and in both urban and rural areas. The pretest was conducted by staff of the GSS following three weeks of training. The questionnaires were finalised based on the outcome of the pretest. The English version of the questionnaires is included in Appendix E. The GDHS data were collected by 14 teams, each consisted of a team supervisor (13 of the 14 supervisors were male), one male or female field editor, three interviewers, either male or female, and a driver, who was male. The field staff were trained during a three-week period in October/November 1998. This included two days of training in anthropometric measurement. The main fieldwork began in mid- November 1998 and lasted until mid-February 1999. All call backs and reinterviews were completed by the end of February 1999. The completed questionnaires were returned to the Ghana Statistical Service head office in Accra for data processing. The office editing staff first checked that questionnaires for all selected households and eligible respondents had been received from the field. In addition, the few questions which had not been precoded (e.g., occupation, contraceptive brand) were coded at this time. The data were then entered and edited using microcomputers and the Integrated System for Survey Analysis (ISSA) programme developed for DHS surveys. Office editing and data processing activities were initiated immediately after the beginning of fieldwork and were completed in mid-March 1999. 1.8 Coverage of the Sample Table 1.1 presents information on the results of the household and individual interviews. A total of 6,375 households were selected for the GDHS sample. Of these, 6,055 were occupied. Interviews were completed for 6,003 households, which represent 99 percent of the occupied households. A total of 4,970 eligible women from these households and 1,596 eligible men from every third household were identified 6 Table 1.1 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Ghana 1998 ____________________________________________________ Residence _______________ Result Urban Rural Total ____________________________________________________ Household interviews Households sampled Households occupied Households interviewed Household response rate Individual interviews: women Number of eligible women Number of eligible women interviewed Eligible woman response rate Individual interviews: men Number of eligible men Number of eligible men interviewed Eligible man response rate 2,140 4,235 6,375 2,010 4,045 6,055 1,981 4,022 6,003 98.6 99.4 99.1 1,635 3,335 4,970 1,585 3,258 4,843 96.9 97.7 97.4 517 1,079 1,596 492 1,054 1,546 95.2 97.7 96.9 for the individual interviews. Interviews were successfully completed for 4,843 women or 97 percent and 1,546 men or 97 percent. The principal reason for nonresponse among individual women and men was the failure of interviewers to find them at home despite repeated callbacks. 7 Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Ghana 1998 ____________________________________________________________________________________________________ Urban Rural Total1 _______________________ _______________________ _______________________ Age group Male Female Total Male Female Total Male Female Total ____________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Total Number 12.4 11.0 11.7 16.4 15.7 16.1 15.2 14.2 14.7 13.6 11.8 12.6 17.8 15.7 16.7 16.5 14.4 15.4 14.0 13.5 13.7 14.9 13.3 14.1 14.6 13.3 14.0 10.9 9.8 10.3 10.1 7.9 9.0 10.4 8.5 9.4 9.6 9.9 9.8 6.4 7.6 7.0 7.4 8.3 7.9 9.1 9.5 9.3 5.7 7.5 6.6 6.8 8.1 7.5 6.6 7.2 6.9 5.3 5.6 5.4 5.7 6.1 5.9 4.9 6.1 5.5 4.2 5.5 4.9 4.4 5.7 5.1 4.7 4.5 4.6 3.9 4.3 4.1 4.2 4.4 4.3 3.7 3.9 3.8 3.6 3.7 3.6 3.6 3.7 3.7 2.9 3.8 3.4 2.6 3.4 3.0 2.7 3.5 3.1 2.4 2.2 2.3 2.1 2.5 2.3 2.2 2.4 2.3 2.0 2.0 2.0 1.8 2.4 2.1 1.9 2.3 2.1 1.1 1.7 1.4 1.6 1.6 1.6 1.4 1.6 1.5 1.0 1.5 1.3 1.3 1.4 1.4 1.2 1.4 1.3 0.5 0.8 0.7 0.9 0.8 0.8 0.8 0.8 0.8 0.4 1.1 0.7 1.4 1.1 1.3 1.0 1.1 1.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 3,158 3,433 6,592 6,907 7,417 14,324 10,065 10,850 20,915 _____________________________________________________________________________________________________ 1 Total includes 7 persons with age missing CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS This chapter provides a descriptive summary of the demographic and socio-economic characteristics of the household population and the individual respondents in the 1998 Ghana Demographic and Health Survey (GDHS). This information is useful for interpreting the survey findings and serves as an approximate indicator of the representativeness of the survey. It also provides valuable input for social and economic development planning. The 1998 GDHS collected information from all usual residents of a selected household (the de jure population) and persons who had slept in the selected household the night before the interview (the de facto population). The difference between these two populations is very small and since past surveys have looked at the de facto population, for comparison purposes, all tables in this report refer to the de facto population, unless otherwise specified. A household was defined as a person or group of related and unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult member as head of the household, and who share the same housekeeping arrangements. 2.1 Demographic Characteristics of Households Information on the age and sex of each household member was obtained from the household head or some other responsible adult member of the household. Table 2.1 and Figure 2.1 show the age distribution of the population by five-year age groups according to urban-rural residence and sex. The 1998 GDHS enumerated a total of 20,915 persons of whom 52 percent were female. The structure of the population of Ghana is typical of developing countries. Forty-four per cent of the population is below age 15, 1 The dependency ratio is defined as the sum of all persons age under 15 years or over 64 years divided by the number of persons age 15-64, multiplied by 100. 8 indicating high levels of fertility. In the rural areas, this percentage rises to 47 per cent while the corre- sponding figure for urban areas is 38 per cent. The number of children under age five is less than the number age 5-9, a finding that is consistent with recent fertility decline (discussed in greater detail in Chapter 3). As seen in Table 2.1, there is a smaller proportion of children under age five in urban areas, suggesting that recent declines in fertility are more evident in urban than rural areas and that the transition to lower fertility is occurring more rapidly with the urban population. An examination of the quality of the data in relation to age reporting indicates that there are no serious biases in reporting. For additional tables examining data quality refer to Appendix C. The results further indicate that 51 per cent of the population of Ghana is in the 15-64 age group, and the population age 65 years and above account for 5 percent of the total population. A distinct feature that is observed in the age distribution of the population is that the dependent population, that is, those age less than 15 or more than 64, is higher in the rural areas (52 percent) than in the urban areas (42 percent). This may be attributed to rural-urban migration of the economically active population and especially the youth, in search of jobs. The GDHS results show that females outnumber males in the country. The survey results give the overall sex ratio as 93 males to every 100 females. The sex ratio varies by age and residence. It is slightly higher in the rural than urban areas (93 versus 92 males per 100 females). The ratio is as high as 111 among those age below 15, and drops sharply to 90 among those age 65 and over. Table 2.2 shows the change in the age structure of Ghana’s population by comparing the proportion of persons in broad age groups from the 1988 GDHS, the 1993 GDHS, and the 1998 GDHS. The proportion of the population under 15 years of age did not change between 1988 and 1993 but fell from 48 percent in 1993 to 44 percent in 1998. As a result of this shift, the dependency ratio 1 in Ghana dropped from 109 in 1988 to 95 in 1998. Figure 2.1 Population Pyramid, Ghana, 1998 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 GDHS 1998 Age Male Female Percent 9 Table 2.2 Population by age from selected sources Percent distribution of the de facto household population by age group at different dates, Ghana 1998 ___________________________________________________ 19881 19932 1998 Age group GDHS GDHS GDHS ____________________________________________________ < 15 48.4 48.2 44.1 15-64 47.8 48.2 51.2 64+ 3.8 3.6 4.7 Median age 15.7 16.0 18.1 ____________________________________________________ 1 GSS and IRD, 1989 2 GSS and MI, 1984 Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children, according to urban-rural residence and region, Ghana 1998 ________________________________________________________________________________________________________________ Residence Region ___________ ______________________________________________________________________ Greater Brong Upper Upper Characteristic Urban Rural Western Central Accra Volta Eastern Ashanti Ahafo Northern West East Total ________________________________________________________________________________________________________________ Household headship Male Female Number of usual members 0 1 2 3 4 5 6 7 8 9+ Total Mean size Percent with foster children 1 61.2 64.6 66.5 49.9 69.2 59.6 65.2 53.8 62.3 81.0 89.4 80.2 63.4 38.8 35.4 33.5 50.1 30.8 40.4 34.8 46.2 37.7 19.0 10.6 19.8 36.6 0.1 0.1 0.3 0.0 0.0 0.0 0.0 0.2 0.6 0.0 0.0 0.0 0.1 30.2 23.9 21.5 25.4 26.8 16.0 30.3 34.0 32.2 26.3 10.3 10.2 26.1 16.0 14.0 12.2 13.8 13.2 13.6 15.6 18.7 16.7 11.2 7.8 14.5 14.7 14.2 13.4 15.8 12.0 15.3 14.0 14.4 12.1 11.3 13.7 13.9 15.1 13.7 13.0 13.4 14.2 14.5 12.9 15.1 13.7 10.6 12.7 11.5 14.6 16.3 13.3 9.6 12.2 12.5 13.6 10.7 14.6 10.8 8.8 10.1 10.2 11.8 11.5 11.3 7.4 8.7 8.2 8.8 8.2 11.0 5.8 7.1 6.6 9.9 15.4 10.7 8.2 4.8 5.9 6.2 5.7 6.1 5.4 4.8 4.4 5.5 3.4 10.3 8.2 5.5 2.0 3.6 3.5 2.9 3.1 4.4 1.9 1.8 2.5 3.9 7.1 5.3 3.0 2.7 4.9 5.5 3.1 3.5 5.9 2.8 2.2 1.8 9.9 8.8 8.2 4.1 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 3.3 3.8 3.9 3.6 3.6 4.2 3.2 3.0 3.2 4.1 5.0 4.6 3.6 14.9 16.1 21.0 19.3 11.2 22.9 15.5 12.5 15.6 11.1 9.1 12.7 15.7 __________________________________________________________________________________________________________ Note: Table is based on de jure members; i.e., usual residents.1 Foster children are children under age 15 living in households with neither their mother nor their father present. 2.2 Household Composition A combination of factors determines the composition of households in Ghana. While the desire for large families persists in some traditional homes, especially in the rural areas, the extended family system sometimes compels the more privileged members of the society in the urban centres to take care of their less fortunate relatives. Also, many parents have had to foster their grandchildren as a result of the high incidence of teenage pregnancy in the country. Table 2.3 shows that 37 percent of households are female headed, with a slightly larger proportion of females heading urban households (39 percent) than rural households (35 percent). 10 Table 2.4 Fosterhood and orphanhood Percent distribution of de jure children under age 15 by survival of parents and child's living arrangements, according to child's age, sex, residence, and region, Ghana 1998 ______________________________________________________________________________________________________ Living Living with mother with father but not father but not mother Not living with either parent Missing Living ____________ _____________ __________________________ infor- with Father Mother mation Number Background both Father Father Mother Mother Both only only Both on father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children ______________________________________________________________________________________________________ Age <2 3-5 6-9 10-14 Sex Male Female Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Total 59.1 36.2 0.8 0.7 0.1 2.2 0.3 0.1 0.0 0.6 100.0 1,839 53.4 28.9 1.7 3.3 0.4 10.6 0.6 0.7 0.1 0.4 100.0 1,883 48.0 22.9 2.8 5.2 1.7 16.0 1.0 1.4 0.4 0.6 100.0 2,676 41.4 21.6 3.4 7.1 1.4 19.2 1.5 2.0 0.9 1.6 100.0 2,981 49.7 26.6 2.6 5.3 1.1 11.3 1.0 1.1 0.5 0.9 100.0 4,740 48.5 26.0 2.2 3.7 1.0 15.2 0.9 1.2 0.3 0.9 100.0 4,639 43.5 31.0 2.3 3.9 0.5 15.8 0.9 0.8 0.4 0.9 100.0 2,576 51.2 24.5 2.4 4.8 1.2 12.3 1.0 1.3 0.4 0.9 100.0 6,803 44.8 25.3 1.1 5.9 0.8 18.1 0.9 1.9 0.6 0.6 100.0 1,167 36.7 36.1 2.7 3.2 1.2 16.0 1.0 1.1 0.3 1.7 100.0 1,106 51.6 25.3 1.9 5.4 1.2 12.6 0.5 0.5 0.3 0.6 100.0 1,125 42.4 25.9 2.9 6.8 0.8 18.0 1.5 0.7 0.3 0.6 100.0 1,106 52.5 22.3 2.0 5.3 0.6 13.4 1.7 1.1 0.6 0.5 100.0 1,191 39.2 41.1 1.6 3.2 0.7 11.0 0.9 0.8 0.5 1.0 100.0 1,413 44.6 30.8 2.8 4.1 0.7 13.4 0.3 2.5 0.1 0.6 100.0 811 75.0 6.9 1.6 3.0 0.8 8.3 1.0 1.8 0.4 1.2 100.0 595 78.2 7.6 2.6 4.9 1.0 3.5 0.5 0.9 0.1 0.6 100.0 280 72.3 7.3 7.1 2.0 3.7 4.8 0.2 0.4 0.7 1.5 100.0 584 49.1 26.3 2.4 4.5 1.0 13.2 0.9 1.2 0.4 0.9 100.0 9,379 ___________________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. The average size of a household has decreased slightly from 3.8 in 1993 (GSS and MI, 1994) to 3.6 in 1998. Rural households (3.8) are slightly larger than urban households (3.3). One person households constitute over a quarter of all households, 30 percent in urban areas and 24 percent in rural areas. Only 4 percent of households have nine or more members. Sixteen percent of households include children who are fostered, that is, children less than 15 years old living with neither biological parent. There is little urban-rural difference in the percent distribution of fostered children, but households with fostered children are more common in the Volta and Western Regions (23 percent and 21 percent, respectively). Table 2.4 provides information on fosterhood and orphanhood among children under age 15. Less than half of children under 15 years of age live with both parents, 29 percent live with their mothers alone, 6 percent live with their fathers alone, and 16 percent live with neither parent. Two percent of children less than 15 years have lost their father, one percent have lost their mother, and less than half a percent have lost both parents. 2 Youth who are overage for a given level of schooling may have started school overage, or may have repeated one or more grades in school, or may have dropped out of school and later returned. 11 2.3 Educational Level of Household Members The high correlation between levels of education and positive health and other social indicators makes education a very important variable in any study of households. Higher education, especially of women, is usually associated with greater knowledge and use of sound health practices and family planning methods. Successive governments since independence have therefore pursued various policies aimed at reducing illiteracy among the population to the barest minimum. The current programme, Free Compulsory Universal Basic Education (FCUBE), guarantees free education to all children of school going age. The educational reforms of 1989 introduced the 6-3-3-4 system. Basic education (6 years primary and 3 years junior secondary) starts at age 6. Secondary education continues for three more years after which tertiary education follows for four years. In addition to university education, there are a host of post- secondary institutions offering technical, vocational, and professional training that may be tertiary or non- tertiary. In spite of the progress made on the educational front, the GDHS data in Table 2.5 show that quite a substantial proportion of the Ghanaian population has no education. One in three females and one in five males has no education. In general females have less education than males, with a median number of years of schooling of 2.3 years compared with 4.9 years for males. Much of the female-male differential in educational attainment is at secondary school level or higher. For example, only half as many women (6 percent) as men (12 percent) have attended secondary school. Differences in educational attainment by age groups give an indication of the long-term trend. It is encouraging to note that the proportion of women with no education has fallen steadily from 89 percent for those age 65 and above to 14 percent for those age 10-14. A similar trend is observed among males, with the corresponding levels being 66 percent and 13 percent, respectively. As expected, educational attainment is higher in the urban than rural areas, and highest in the Greater Accra Region. Another way to assess the recent trends in educational attainment is to compare the 1993 and 1998 GDHS data. During the last five years, the percentage with no education has declined from 38 percent for females and 26 percent for males in 1993 (GSS and MI, 1994) to 34 percent for females and 21 percent for males. School Attendance Table 2.6 presents data on net attendance ratio (NAR) and gross attendance ratio (GAR), by school level, sex, residence and region. The NAR indicates participation in primary schooling among those age 6-11, and secondary schooling among those age 12-18, the official age group for that level in Ghana. The GAR measures participation at each level of schooling among youth of any age, from 6-24. The GAR is nearly always higher than the NAR for the same level, because the GAR includes participation by youth who may be older, or younger, than the official age range for that level.2 A NAR of 100 percent would indicate that all of the children in the official age range for the level are attending at that level. The GAR can exceed 100 percent, if there is significant overage or underage participation at a given level of schooling. 12 Table 2.5 Educational level of the female and male household population Percent distribution of the de facto female and male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Ghana 1998 ___________________________________________________________________________________________________________ Level of education Number Median _________________________________________________ of number Background No Middle/ Second- Don’t know/ women/ of years of characteristic education Primary JSS ary + missing Total men schooling ____________________________________________________________________________________________________________ FEMALE ___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Total 23.5 74.2 0.2 0.0 2.2 100.0 1,252 0.0 14.2 67.1 18.2 0.2 0.2 100.0 1,447 3.3 14.8 18.8 57.1 9.2 0.2 100.0 927 6.8 25.0 17.2 42.0 15.8 0.1 100.0 903 7.0 30.7 18.1 41.0 9.8 0.4 100.0 883 6.0 34.4 17.4 38.1 9.8 0.3 100.0 659 5.3 32.5 18.3 39.9 8.9 0.4 100.0 614 5.7 38.9 16.2 36.8 7.6 0.6 100.0 473 4.4 48.8 14.8 25.0 11.0 0.4 100.0 406 0.9 64.8 12.9 18.0 4.1 0.2 100.0 378 0.0 76.2 10.2 8.5 4.1 1.0 100.0 258 0.0 77.6 8.2 10.3 2.3 1.6 100.0 250 0.0 89.0 3.8 6.1 0.9 0.3 100.0 540 0.0 22.4 29.6 34.7 12.9 0.3 100.0 2,994 5.4 39.8 33.0 23.6 2.8 0.7 100.0 5,999 1.0 29.6 37.9 27.2 5.3 0.1 100.0 1,074 2.3 32.7 34.3 28.4 4.4 0.2 100.0 1,044 2.4 19.6 30.1 33.2 16.7 0.4 100.0 1,336 5.9 31.4 35.6 27.9 4.2 0.9 100.0 1,092 2.4 22.8 37.7 33.4 5.6 0.4 100.0 1,166 3.8 30.0 30.3 34.7 4.8 0.2 100.0 1,357 3.7 32.6 37.2 27.6 1.7 1.0 100.0 698 1.6 79.7 13.2 4.4 1.9 0.8 100.0 473 0.0 68.4 21.7 7.4 1.4 1.0 100.0 245 0.0 69.4 17.3 5.4 5.2 2.7 100.0 508 0.0 34.0 31.9 27.3 6.2 0.6 100.0 8,993 2.3 ____________________________________________________________________________________________________________ MALE ___________________________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Total 23.1 74.0 0.0 0.0 2.8 100.0 1,374 0.1 13.2 68.3 18.4 0.0 0.2 100.0 1,472 3.3 9.1 20.5 59.2 11.0 0.2 100.0 1,043 7.4 13.1 11.2 46.3 29.4 0.0 100.0 744 8.5 13.3 12.8 48.2 25.4 0.2 100.0 684 9.1 16.7 11.9 51.8 19.1 0.5 100.0 572 9.3 18.7 10.9 50.3 19.5 0.6 100.0 445 9.3 19.7 9.4 49.1 21.7 0.1 100.0 419 9.3 28.7 11.6 38.8 20.1 0.9 100.0 365 9.1 24.8 10.4 38.2 25.7 1.0 100.0 271 9.3 38.8 9.4 36.6 15.0 0.2 100.0 222 6.0 45.3 10.0 28.8 14.7 1.2 100.0 190 3.3 65.8 9.8 18.1 5.0 1.3 100.0 450 0.0 10.4 28.4 37.8 22.8 0.7 100.0 2,689 7.6 25.5 35.1 31.2 7.3 0.9 100.0 5,564 3.5 11.8 35.1 39.5 13.3 0.2 100.0 1,029 6.2 13.4 41.3 34.1 10.7 0.4 100.0 855 4.9 9.4 28.3 35.0 26.8 0.4 100.0 1,273 8.4 19.3 35.0 36.4 8.5 0.7 100.0 1,013 4.8 12.1 35.2 41.2 11.1 0.4 100.0 1,032 6.2 13.2 35.1 39.8 10.4 1.5 100.0 1,180 6.1 20.4 34.5 35.8 7.5 1.7 100.0 660 4.3 63.8 22.0 7.9 5.8 0.5 100.0 478 0.0 59.0 26.0 8.1 6.0 0.9 100.0 251 0.0 57.4 22.8 10.1 7.3 2.3 100.0 482 0.0 20.6 32.9 33.3 12.4 0.8 100.0 8,254 4.9 _____________________________________________________________________________________________________ 1 Includes 4 women and 2 men for whom age data are missing 13 Table 2.6 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by level of schooling, sex and residence, Ghana 1998 _______________________________________________________________________ NAR1 GAR2 Residence _________________________ _________________________ and region Male Female Total Male Female Total _______________________________________________________________________ PRIMARY SCHOOL _______________________________________________________________________ Residence Urban 86.0 84.8 85.4 118.3 111.4 114.8 Rural 70.8 70.5 70.7 98.2 95.0 96.7 Region Western 88.4 84.0 86.2 115.8 107.0 111.4 Central 82.9 84.7 83.7 110.2 114.1 112.0 Greater Accra 87.1 82.0 84.7 126.7 117.4 122.2 Volta 73.6 79.7 76.4 104.3 113.5 108.5 Eastern 85.8 86.8 86.3 115.6 111.8 113.6 Ashanti 80.8 77.2 79.1 104.2 98.4 101.5 Brong Ahafo 67.2 75.3 71.5 103.7 102.6 103.1 Northern 37.6 30.7 34.2 56.1 38.1 47.3 Upper West 44.3 44.9 44.6 71.6 67.6 69.7 Upper East 40.8 37.3 39.2 61.7 49.9 56.2 Total 75.0 74.0 75.0 104.0 100.0 102.0 _______________________________________________________________________ SECONDARY SCHOOL _______________________________________________________________________ Residence Urban 41.2 39.5 40.3 55.9 46.4 51.0 Rural 31.2 28.0 29.7 36.4 30.6 33.7 Region Western 36.5 34.5 35.5 41.7 36.9 39.4 Central 39.6 32.1 36.0 44.4 35.2 39.9 Greater Accra 35.7 36.1 35.9 54.6 44.1 49.2 Volta 34.8 26.7 31.0 41.2 29.1 35.5 Eastern 41.7 33.4 37.9 47.1 37.3 42.6 Ashanti 40.0 38.3 39.1 48.4 44.3 46.3 Brong Ahafo 27.6 34.6 31.1 29.1 35.3 32.2 Northern 16.1 11.9 14.4 28.4 13.9 22.6 Upper West 15.6 16.5 16.0 20.5 18.1 19.5 Upper East 22.8 22.8 22.8 34.0 28.0 31.3 Total 34.0 32.0 33.0 42.0 36.0 39.0 _______________________________________________________________________ 1 The NAR for primary school is the percentage of the population of primary school age (6-11 years) that is attending primary school. The NAR for secondary school is the percentage of the population of secondary school age (12-18 years) that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of students attending primary school—regardless of age—expressed as a percentage of the official primary school-age population. The GAR for secondary school is the total number of students attending secondary school—regardless of age—expressed as a percentage of the official secondary school-age population. If there are significant numbers of over-age or under-age students at a given level of schooling, the GAR can exceed 100 percent. 14 The NAR is nearly identical for females and males at both the primary and secondary school levels. Three in four children age 6-11, who should be attending primary school are currently doing so at that level. On the other hand, only one in three children age 12-18, who should be attending secondary school is, in fact, in school at that level. Attendance ratios are as expected, lower in rural areas and in the three northern regions (Northern, Upper West, and Upper East Regions). The GAR at both the primary and secondary school level is slightly higher for males than females. This reflects a relatively higher overage attendance among males than females. The ratio of male to female GAR at the primary level is 104 to 100, and at the secondary level is 42 to 36. Differences in the urban-rural and regional residence are similar to those for the NAR. Figure 2.2 shows the age-specific attendance ratios (ASAR) for the population age 6-24 by sex. The ASAR indicates participation in schooling at any level, from primary through higher education. The closer the ASAR is to 100 percent, the higher is the proportion of people of the given age that is attending school. While the official starting age in Ghana for Grade 1 is 6 years, only 57 percent of 6-year old children attend school, compared with about 73 percent of 7-year old children. This suggests that many children start school overage. Roughly the same proportion of males and females attends school through the age of 15, and thereafter, a much higher proportion of males than females attends school. This gender imbalance suggests that from the mid-teenage years onward, the various costs of schooling (both monetary and non- monetary) are higher, and/or the perceived benefits of schooling are lower, for females than for males. 2.4 Housing Characteristics Table 2.7 provides information on selected housing characteristics by residence. This information is helpful in assessing the general socio-economic conditions of the population. More than two in five households have electricity; a 40 percent increase over the last five years (GSS and MI, 1994). There is Figure 2.2 Age-Specific Enrolment Rates GDHS 1998 57 76 78 82 83 76 80 79 76 64 49 34 18 16 5 6 5 3 1 57 69 79 81 84 83 81 81 76 69 63 45 29 27 20 16 14 11 9 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 0 10 20 30 40 50 60 70 80 90 Female Male Note: De facto household population age 6-24 enroled in school at the time of the survey. Percent enroled Age 15 Table 2.7 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Ghana 1998 _____________________________________________________ Residence ______________ Characteristic Urban Rural Total _____________________________________________________ Electricity Yes No Total Source of drinking water Piped water Piped into residence Public tap/neighbour's house Well water Well in residence Public well Borehole Spring River/stream Pond/lake Dam Dugout Rainwater Tanker truck Total Time to water source (in minutes) <15 minutes Sanitation facility Flush toilet Own Shared Pit toilet Traditional Ventilated improved Bucket/pan No facility/bush Total Main floor material Earth/sand/mud Mud mixed with dung Linoleum Ceramic tiles/terrazzo Cement Carpet Total Persons per sleeping room 1-2 3-4 5-6 7+ Missing/Don’t know Total Mean persons per room Using iodised salt Total 82.4 20.9 42.6 17.5 79.0 57.3 100.0 100.0 100.0 41.4 3.5 16.9 42.6 12.2 22.9 0.8 1.9 1.5 5.2 14.8 11.4 3.2 29.6 20.3 0.4 1.4 1.0 3.4 25.5 17.7 0.1 2.5 1.6 0.9 4.4 3.2 0.3 2.8 1.9 0.5 0.9 0.8 1.2 0.5 0.7 100.0 100.0 100.0 79.7 44.0 56.6 10.5 1.2 4.5 7.8 0.9 3.3 21.7 50.8 40.5 36.9 18.2 24.8 13.7 2.3 6.3 9.4 26.6 20.5 100.0 100.0 100.0 0.6 14.5 9.6 0.3 5.5 3.7 19.5 5.3 10.3 2.7 0.0 1.0 62.2 70.7 67.7 14.3 3.8 7.5 100.0 100.0 100.0 64.2 61.5 62.5 25.2 26.2 25.8 7.5 9.3 8.6 2.6 2.9 2.8 0.5 0.2 0.3 100.0 100.0 100.0 2.4 2.5 2.5 29.9 25.6 27.1 2,118 3,885 6,003 a considerable difference in access to electricity between urban and rural households. While more than four-fifths (82 percent) of households in urban areas have electricity, only 21 percent of rural households have electricity. Information on the source of drinking water and accessibility to the source was also gathered in the 1998 GDHS. Safe drinking water is important for health and sanitation. Table 2.7 shows that 17 percent of households have water piped into their residence while an additional 23 percent collect water from a public tap or neighbour’s house. In total, 84 percent of urban households have access to piped water, compared to only 16 percent of rural house- holds. The proportion of households with access to piped water has changed little over the last five years, from 35 percent in 1993 (GSS and MI, 1994) to 40 percent in 1998. One-third of households have access to well water, either in their residence, or from a public well or from a borehole. The use of well water is much more common in rural households than urban house- holds. Rivers and streams provide water to 18 percent of all households, and especially in rural areas. Those households, which did not have drinking water within their own premises, were also asked about the time required to fetch water. Overall, nearly three in five households have access to water within 15 minutes. As expected quicker access to water is available to more households in urban (80 percent) than rural (44 percent) areas. Fetching water is predominantly a female job with twice as many women as men fetching water (data not shown). The majority of households use a tradi- tional pit toilet (41 percent), while one in four households have access to a ventilated pit toilet. Flush toilets are relatively rare in Ghana, with 18 percent of urban households having access to their own or shared flush toilets, compared to just 2 percent of rural households. One in five households has no sanitation facility at all, and this is more common in rural (27 percent) than in urban households (9 percent). 16 Table 2.8 Household durable goods Percentage of households possessing selected durable consumer goods, by urban-rural residence, Ghana 1998 ____________________________________________________ Residence ______________ Durable goods Urban Rural Total ____________________________________________________ Radio Television Telephone Refrigerator Bicycle Motorcycle Private car None of the above Number of households 64.0 42.7 50.2 40.6 9.7 20.6 9.7 1.2 4.2 5.3 0.2 2.0 11.0 20.9 17.4 1.6 0.9 1.1 6.0 1.4 3.0 31.1 48.6 42.4 2,118 3,885 6,003 A large percentage (68 percent) of houses have cement floors. Cement floors are slightly more common in rural households (71 percent) than urban households (62 percent). Ten percent of households (predominantly urban) have linoleum floors, and another 10 percent of households (predominantly rural) have a mixture of earth, sand and mud flooring. Eight percent of households have carpeted floors and, as expected, most of these are urban households. The number of rooms in a household used for sleeping provides an estimate of the extent of crowding. The majority (63 percent) of households have only 1-2 persons per sleeping room, suggesting that crowding is not a common problem in Ghana. One in four households has 3-4 persons per sleeping room. There is little difference in the extent of crowding between urban and rural households. The overall mean number of persons per sleeping room is 2.5. Insufficient iodine in the diet can lead to serious nutritional deficiencies such as goitre, nutritional stunting, mental retardation, and cretinism. The Government of Ghana has emphasised the addition of iodine to salt to prevent and control the occurrence of these health problems. Interviewers in the 1998 GDHS tested the iodine content of salt used in households, employing test kits supplied by UNICEF. These results are also presented in Table 2.7. The test involved placing a drop of a special solution onto a small amount of salt supplied by the household respondent. This test indicates the presence of iodine in the salt, but not its quality, which is subject to degrada- tion. Results show that the consumption of iodised salt is very low in Ghana, with only one in four households (27 percent) using iodised salt. Information on the possession of vari- ous durable goods was also collected at the household level. Table 2.8 shows that overall, one in two households has a radio, one-fifth have a television, and 17 percent have a bicycle. Fewer than one in twenty households have a telephone, refrigerator, motorcycle, or car. In general urban households are more likely to own these items, with the exception of bicycles which are more commonly found in rural areas. 2.5 Background Characteristics of Respondents Table 2.9 presents data on the background characteristics of the 4,843 female and 1,546 male respondents interviewed in the 1998 GDHS. The proportion of the respondents in each age group declines with increasing age for both sexes. Thirty-seven percent of the respondents are in the 15-24 age group, 44 percent of females and 38 percent of males are age 25-39, and the rest are in the age group 40-49 (women) and 40-59 (men). Around two in three respondents are rural residents. Greater Accra has the largest proportion of respondents (17 percent) and Upper West the smallest proportion (3 percent). The table further shows that around one in four women and two in five men have never been married. Nearly two-thirds of women are in union (married or living together), compared with around one in two men. Twice as many women are widowed, divorced or not living together with their partners (12 percent) as men (6 percent). 17 Table 2.9 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Ghana 1998 ______________________________________________________________________________________ Number of women Number of men __________________ __________________ Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted ______________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Marital status Never married Married Living together Widowed Divorced Not living together Education No education Primary Middle/JSS Secondary+ Currently attending school Yes No Missing Religion Catholic Protestant/other Christian Muslim Traditional No religion Other religion Ethnic group Akan Ga/Adangbe Ewe Guan Mole-Dagbani Grussi Gruma Hausa Dagarti Other Total 18.8 910 889 21.3 330 327 18.6 900 887 15.8 245 234 17.9 867 857 14.0 217 206 13.5 653 661 13.7 212 209 12.9 625 627 10.0 155 162 9.8 473 484 8.0 124 130 8.6 415 438 6.4 99 107 NA NA NA 5.6 87 91 NA NA NA 4.9 76 80 35.9 1,739 1,585 35.4 547 492 64.1 3,104 3,258 64.6 999 1,054 12.3 593 519 14.3 222 197 11.4 552 447 8.9 137 110 16.7 808 692 17.4 270 223 11.0 535 439 12.3 190 156 13.0 628 550 12.6 195 170 15.0 728 629 13.3 205 178 7.4 358 309 7.9 122 105 4.8 234 355 5.2 80 127 2.5 120 350 2.5 39 113 5.9 288 553 5.6 87 167 23.7 1,147 1,092 40.9 633 615 51.9 2,516 2,683 43.0 665 702 12.7 615 546 9.8 151 136 1.8 88 99 0.6 10 10 4.6 221 196 2.2 34 35 5.3 255 227 3.4 53 48 29.1 1,410 1,737 16.4 254 357 18.0 874 813 12.3 190 190 42.5 2,056 1,823 51.3 793 707 10.4 502 470 20.0 309 292 7.8 378 362 12.4 192 186 91.4 4,426 4,443 87.1 1,346 1,351 0.8 39 38 0.5 8 9 14.6 705 775 16.5 255 270 63.7 3,081 2,724 56.9 877 771 11.0 532 642 12.2 188 228 4.4 213 362 4.7 73 124 6.2 300 315 9.6 148 148 0.3 14 25 0.3 4 5 53.6 2,600 2,240 48.2 746 641 8.3 400 344 8.2 127 107 15.8 766 646 18.1 280 233 1.5 72 71 1.8 27 26 6.8 331 510 10.2 157 232 2.5 119 202 3.0 47 83 5.4 263 374 3.5 55 68 1.4 66 66 1.7 26 24 2.5 121 288 3.6 56 108 2.1 103 102 1.7 26 24 100.0 4,843 4,843 100.0 1,546 1,546 ______________________________________________________________________________________ NA = Not applicable 18 Table 2.10 Level of education Percent distribution of women and men by the highest level of education attended, according to selected background characteristics, Ghana 1998 ________________________________________________________________________________________________________________ Highest level of education: women Highest level of education: men ________________________________________ Number ________________________________________ Background No edu- Middle/ of No edu- Middle/ Number characteristic cation Primary JSS Secondary+ Total women cation Primary JSS Secondary+ Total of men _________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Total 13.9 18.6 58.8 8.7 100.0 910 7.2 18.6 60.0 14.2 100.0 330 23.9 16.9 44.0 15.2 100.0 900 9.9 13.9 48.4 27.8 100.0 245 29.8 19.9 40.7 9.6 100.0 867 12.1 10.4 48.5 29.0 100.0 217 33.8 18.1 37.9 10.2 100.0 653 17.8 8.9 56.2 17.1 100.0 212 32.2 18.2 40.7 8.9 100.0 625 20.4 12.5 48.8 18.3 100.0 155 37.9 18.6 36.3 7.2 100.0 473 24.1 8.5 54.3 13.1 100.0 124 50.2 14.6 23.8 11.3 100.0 415 29.6 8.2 46.2 16.0 100.0 99 NA NA NA NA NA NA 28.3 6.7 40.5 24.4 100.0 87 NA NA NA NA NA NA 33.9 12.1 36.6 17.4 100.0 76 16.5 14.8 48.5 20.2 100.0 1,739 5.9 6.6 53.9 33.6 100.0 547 36.2 19.9 39.1 4.9 100.0 3,104 22.2 15.4 49.9 12.6 100.0 999 28.3 20.8 42.8 8.1 100.0 593 8.1 12.7 59.9 19.3 100.0 222 25.3 21.7 46.1 6.9 100.0 552 8.3 13.4 59.3 19.0 100.0 137 14.8 15.6 43.5 26.1 100.0 808 5.8 8.5 47.1 38.6 100.0 270 24.0 21.4 46.6 8.1 100.0 535 9.3 15.2 59.4 16.2 100.0 190 15.9 21.4 53.3 9.4 100.0 628 11.0 10.3 60.1 18.6 100.0 195 21.2 18.0 53.1 7.7 100.0 728 9.0 13.4 60.0 17.7 100.0 205 30.0 19.4 47.7 2.9 100.0 358 20.0 16.2 57.2 6.7 100.0 122 82.8 5.9 7.8 3.5 100.0 234 63.8 13.3 13.0 9.9 100.0 80 72.5 11.4 13.0 3.1 100.0 120 61.5 13.3 9.6 15.6 100.0 39 73.9 9.8 7.8 8.5 100.0 288 59.8 10.2 17.4 12.6 100.0 87 29.1 18.0 42.5 10.4 100.0 4,843 16.4 12.3 51.3 20.0 100.0 1,546 ________________________________________________________________________________________________________________ NA = Not applicable There are marked differentials in the educational attainment of female and male respondents. Women are nearly twice as likely as men (29 percent versus 16 percent) to have no education. However, men are twice as likely as women to have some secondary education. Eighteen percent of women have primary education, and two in five have middle/JSS, while 12 percent of men have primary education and one in two has middle/JSS. A higher percent of men (12 percent) than women (8 percent) are currently attending school. Table 2.9 also shows that the majority of both male and female respondents are Christians, with around 15 percent of women and 17 percent of men being Catholics. Around 12 percent of female and male respondents are Muslim and six percent of females and 10 percent of males claim no religion. Akans, that is, the Asante, Akwapim, Fanti and other Akans, are the dominant ethnic group, with 54 percent of females and 48 percent of males belonging to this group. Ewe women and men account for 16 percent and 18 percent of the total. Eight percent of females and males are Ga/Adangbe while Mole- Dagbani account for 7 percent of female and 10 percent of male respondents. 2.6 Educational level of survey respondents Table 2.10 shows the percent distribution of female and male respondents by the highest level of education attended according to age, urban-rural and regional residence. Younger respondents have a higher level of educational attainment than older respondents. There is a marked urban-rural difference 19 in the educational attainment of female and male respondents. More than twice as many rural women as urban women, and almost four times as many rural men as urban men, have no education. Among those who have attended school, urban residents are more likely than rural residents to have completed primary school. The difference is even more marked when secondary education is considered—four times as many urban women as rural women, and three times as many urban men as rural men have secondary education. As expected, the Greater Accra Region has the highest level of educational attainment among both women and men. For example, 26 percent of women and 39 percent of men in Greater Accra have secondary level education or higher, compared with 3 percent of women and 7 percent of men in the Brong Ahafo Region. 2.7 Access To Mass Media Table 2.11 shows the percentage of female and male respondents exposed to different types of mass media by selected background characteristics. This information is useful for family planning and health programme dissemination. As expected, men are much more likely than women to be exposed to each of the different types of media. Twice as many women (30 percent) as men (15 percent) have no exposure to mass media. Men are twice as likely as women to read the newspapers (41 percent compared with 19 percent). Exposure to the electronic media (radio and television) is more common among all respondents than exposure to the print media. Fifty-nine percent of women and 79 percent of men listen to the radio daily while 49 percent of women and 57 percent of men watch television at least once a week. Only 14 percent of women and 30 percent of men report exposure to all three media. Exposure to mass media varies considerably by background characteristics. Generally, exposure varies inversely with age although this is more evident among female respondents than male. Urban respondents are three to four times as likely as rural respondents to be exposed to mass media. Residents of the Greater Accra Region are most likely to be exposed to the media and residents of the Upper West Region least likely. Education clearly impacts exposure to mass media. Almost all women and men with at least secondary education are exposed to the media compared with about 45 percent of women and 60 percent of men with no education. 2.8 Women’s Status The remaining discussion in this section refers to female respondents alone since information on employment and earnings status, decision on use of earnings, occupation, and child care while working, is useful for understanding the context in which reproductive and health decision-making take place. This information, together with women’s educational status, discussed earlier, are also important indicators of women’s overall status and their empowerment vis-à-vis men. Employment Status The 1998 GDHS collected information from women regarding their current employment situation. Table 2.12 shows that around three in four women were employed during the 12 months before the survey, while three percent of women were not working at the time of the survey but had been employed at some time during the last 12 months. Among those currently employed, more than eight in ten (63 percent) work full-time. There is substantial variation in employment status by women’s background characteristics. Older women (30 years and above) are more likely than younger women to be currently employed. Urban women are somewhat less likely than rural women to be currently working, but if they do they are more likely to work fulltime. Women residing in the Upper West Region are most likely to be currently employed, but most of their work is seasonal. Surprisingly, the more educated a woman the less likely 20 Table 2.11 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to radio daily, by selected background characteristics, Ghana 1998 _________________________________________________________________________________ Access to mass media No ____________________________________ access Read Watch Listen to All Number Background to mass newspaper television radio three of characteristic media weekly weekly daily media women _________________________________________________________________________________ FEMALE _________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Education No education Primary incomplete Primary complete Secondary+ Total 22.9 25.2 62.8 55.8 17.1 910 26.8 19.1 53.7 61.8 14.8 900 30.7 16.7 48.8 60.7 12.7 867 29.2 18.1 47.1 61.8 13.5 653 35.6 16.6 41.8 56.7 12.6 625 36.2 17.9 39.7 55.9 12.5 473 40.3 17.6 34.0 53.2 12.3 415 12.4 35.1 75.1 74.5 29.0 1,739 40.4 10.2 34.4 49.5 5.6 3,104 32.6 15.0 46.2 53.8 9.1 593 33.1 12.1 45.4 51.9 8.5 552 8.7 48.8 81.2 80.8 42.2 808 51.1 14.9 23.2 40.7 6.3 535 18.3 19.7 61.6 69.6 14.6 628 26.0 13.2 52.5 60.4 8.4 728 25.2 9.1 49.7 63.2 6.5 358 48.6 4.6 24.0 45.8 2.7 234 69.4 4.5 15.8 23.3 2.5 120 54.4 9.6 16.7 41.8 5.5 288 55.1 0.0 23.3 38.0 0.0 1,410 30.6 3.0 45.4 58.3 1.8 874 19.5 24.8 60.5 65.9 16.5 2,056 4.5 77.5 80.8 85.9 63.7 502 30.3 19.1 49.0 58.5 14.0 4,843 __________________________________________________________________________________ MALE ___________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Education No education Primary incomplete Primary complete Secondary+ Total 19.4 32.3 61.6 66.0 21.7 330 12.8 40.3 63.2 82.5 32.7 245 9.9 44.9 67.1 86.5 39.7 217 12.4 43.3 52.6 83.0 26.4 212 13.4 44.0 52.3 82.1 32.3 155 16.8 42.9 52.1 80.8 30.5 124 14.9 41.7 48.0 80.2 25.5 99 22.6 51.1 50.1 76.1 35.4 87 17.7 41.7 45.0 79.2 25.9 76 5.3 62.2 82.9 88.1 53.1 547 20.4 29.4 43.3 73.6 16.7 999 12.7 37.0 52.7 82.3 25.4 222 11.6 32.9 64.9 74.9 22.2 137 4.5 74.5 89.7 91.0 68.6 270 24.5 39.9 28.9 66.7 14.0 190 6.7 46.4 68.4 90.2 34.6 195 11.7 32.3 63.9 81.0 22.2 205 9.5 30.5 57.2 83.8 23.8 122 24.1 15.2 38.3 72.0 11.3 80 51.8 15.4 18.1 41.3 6.8 39 48.5 20.4 13.8 49.1 6.6 87 40.3 0.5 22.3 56.6 0.0 254 27.1 7.3 43.3 66.7 3.2 190 9.0 44.9 63.5 83.4 31.5 793 2.4 85.0 78.9 92.4 65.3 309 15.1 41.0 57.3 78.8 29.6 1,546 21 Table 2.12 Employment Percent distribution of women by employment status and continuity of employment, according to selected background characteristics, Ghana 1998 __________________________________________________________________________________________ Not currently employed _________________ Did not work Worked Currently employed in last in _________________________ Number Background 12 last 12 Season- Occasion- of characteristic months months All year ally ally Missing Total women __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Mother's education No education Primary Middle/JSS Secondary+ Total 67.5 2.6 23.0 4.9 1.8 0.2 100.0 910 26.6 3.7 57.1 10.2 2.4 0.0 100.0 900 13.5 4.2 70.4 9.8 2.0 0.0 100.0 867 9.3 1.8 78.3 9.1 1.4 0.0 100.0 653 7.7 1.7 78.0 11.2 1.4 0.0 100.0 625 6.7 1.5 79.7 9.8 2.0 0.2 100.0 473 7.5 2.1 76.4 12.0 1.4 0.6 100.0 415 26.5 2.9 63.9 4.9 1.7 0.1 100.0 1,739 22.0 2.6 61.7 11.7 1.9 0.1 100.0 3,104 26.4 2.5 65.5 4.8 0.8 0.0 100.0 593 19.5 3.4 68.5 5.6 3.1 0.0 100.0 552 26.3 3.9 64.3 3.6 1.9 0.0 100.0 808 25.3 2.7 63.7 6.7 1.2 0.5 100.0 535 20.4 2.5 69.6 5.1 2.4 0.0 100.0 628 22.2 1.7 70.1 4.9 1.1 0.0 100.0 728 24.3 1.0 63.4 8.1 2.6 0.6 100.0 358 31.6 5.1 35.5 25.2 2.2 0.3 100.0 234 13.1 2.3 44.2 35.3 5.1 0.0 100.0 120 22.2 2.2 31.5 43.4 0.7 0.0 100.0 288 14.7 3.0 62.0 18.5 1.6 0.2 100.0 1,410 20.1 1.9 70.1 5.7 2.3 0.0 100.0 874 29.1 3.1 60.1 5.7 1.8 0.1 100.0 2,056 32.1 1.8 60.6 3.6 1.8 0.0 100.0 502 23.6 2.7 62.5 9.2 1.8 0.1 100.0 4,843 she is to be currently employed. Eighty-two percent of women with no education are currently employed compared to 66 percent of women with secondary education or higher. Most of the difference between the two groups is owed to the greater level of seasonal employment among women with no education. Employer and Form of Earnings Nine out of ten working women earn cash (Table 2.13). Three quarters of all working women are self-employed and most of them earn cash. Fourteen percent of women work for someone other than a relative, eight in ten of whom are paid in cash. Ten percent of women work for a relative, and in contrast to the rest of working women, the majority of women working for a relative do not receive cash for their work. Generally urban women are more likely than rural women to earn cash for their work, though the difference is not great (93 percent versus 87 percent). Urban women who are not self-employed are also more likely to be employed by someone else, other than relatives. In contrast, non self-employed rural women are more likely to be employed by their relatives. Self-employment is most common among 22 Table 2.13 Employer and form of earnings Percent distribution of currently employed women by employer and form of earnings, according to selected background characteristics, Ghana 1998 __________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative _______________ ________________ _________________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Total women __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Mother's education No education Primary Middle/JSS Secondary+ Total 46.6 0.6 15.0 11.7 7.3 18.8 100.0 270 65.9 2.1 13.7 6.7 3.9 7.7 100.0 627 77.4 2.6 9.4 2.1 3.8 4.9 100.0 713 81.8 2.4 8.9 0.1 3.0 3.8 100.0 580 76.4 2.7 13.9 0.0 3.4 3.5 100.0 567 82.1 2.3 8.0 0.3 2.0 5.2 100.0 433 75.4 2.4 11.3 0.2 5.7 5.0 100.0 374 72.0 1.1 18.6 4.0 2.0 2.4 100.0 1,227 75.0 2.9 7.4 1.8 4.9 8.0 100.0 2,338 77.0 1.9 9.2 1.9 4.9 5.1 100.0 422 77.4 2.9 11.9 1.7 3.5 2.6 100.0 426 66.5 0.8 23.4 2.5 2.5 4.4 100.0 564 78.0 1.9 10.4 2.6 1.2 5.9 100.0 384 84.1 2.4 9.2 1.6 0.9 1.9 100.0 483 76.4 4.3 7.0 5.9 4.1 2.3 100.0 554 76.4 1.7 13.5 2.2 3.5 2.6 100.0 265 64.9 2.3 3.4 2.2 7.6 19.5 100.0 148 49.9 3.1 1.3 0.7 17.3 27.8 100.0 102 59.3 1.2 6.5 0.7 8.6 23.7 100.0 218 70.6 2.8 6.1 0.8 7.3 12.4 100.0 1,158 80.1 2.7 7.1 2.0 3.1 5.1 100.0 683 79.6 2.0 9.6 4.4 2.0 2.3 100.0 1,392 49.1 0.8 44.6 1.8 1.4 2.2 100.0 332 74.0 2.3 11.2 2.5 3.9 6.1 100.0 3,564 women residing in the Eastern Region, whereas, women residing in the three northern regions are more likely to be employed by a relative. Self employment is relatively more common among less educated women. For example, 83 percent of women with primary education are self-employed compared to 50 percent of women with secondary or higher education. In contrast, educated women are more likely to work for someone else other than a relative and are more likely to earn cash for their work. Occupation Table 2.14 shows that women are twice as likely to be employed in the non-agricultural sector (67 percent) than in the agricultural sector (33 percent). Nearly one in two women (46 percent) are engaged in sales and the provision of services. In fact, this is the predominant occupation for women of all ages and educational background, and in all regions, except the Upper West and Upper East Regions, where agricultural work on family land is most common (44 percent). Agricultural work is also important, especially in the three northern regions. Around half of women in agriculture work on family land (18 percent), with about five percent of women each working on their own land, rented land or land belonging 23 Table 2.14 Occupation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of nonagricultural employment, according to selected background characteristics, Ghana 1998 ____________________________________________________________________________________________ Agricultural Nonagricultural ____________________________ _____________________ Prof./ Number Background Own Family Rented Other's tech./ Sales/ Skilled of characteristic land land land land manag. services manual Total women __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Mother's education No education Primary Middle/JSS Secondary+ Total 0.7 22.0 1.7 2.8 0.8 50.8 21.2 100.0 270 1.6 16.9 1.9 3.8 2.7 51.8 21.3 100.0 627 3.8 15.5 4.6 6.7 3.2 43.8 22.5 100.0 713 2.6 18.1 4.9 5.8 4.8 47.0 16.9 100.0 580 6.6 17.2 6.1 4.5 6.6 49.4 9.5 100.0 567 9.9 18.1 4.9 8.5 5.8 40.2 12.8 100.0 433 14.5 17.9 4.1 6.6 7.2 38.6 11.2 100.0 374 0.9 2.7 0.8 1.1 8.4 64.3 21.8 100.0 1,227 7.5 25.3 6.0 8.0 2.4 36.6 14.3 100.0 2,338 8.4 16.0 4.9 8.1 5.1 42.5 14.9 100.0 422 4.4 17.7 6.7 4.6 3.8 47.5 15.4 100.0 426 0.2 1.9 1.5 1.0 9.9 64.8 20.7 100.0 564 2.2 21.2 3.8 5.3 4.6 45.5 17.4 100.0 384 4.5 10.7 6.2 7.4 3.4 51.1 16.8 100.0 483 7.4 15.9 4.7 6.5 2.3 44.7 18.4 100.0 554 13.5 17.4 7.0 14.3 3.1 34.2 10.6 100.0 265 7.3 35.4 0.9 3.2 1.3 40.5 11.5 100.0 148 1.7 43.8 0.3 4.1 1.6 9.0 39.5 100.0 102 6.2 48.7 0.5 0.5 2.9 31.6 9.6 100.0 218 8.0 30.7 5.3 10.0 0.0 33.1 13.0 100.0 1,158 4.9 17.7 5.9 6.3 0.0 48.0 17.2 100.0 683 4.2 10.4 3.3 2.9 2.9 56.4 19.9 100.0 1,392 0.7 0.9 0.4 0.4 35.7 45.1 16.9 100.0 332 5.3 17.5 4.2 5.6 4.5 46.2 16.8 100.0 3,564 __________________________________________________________________________________________ Note: Professional/technical/managerial includes professional, technical, managerial, and clerical occupations. to other people. Seventeen percent of currently employed women are skilled manual workers in the non- agricultural sector. Five percent of women are in professional, technical or managerial positions. As expected, work in sales and services is more common among urban women, while agricultural work is more common in the rural areas. Older women are more likely to work in agriculture and on their own land. Work in agriculture is inversely related to education. More than one in two women (54 percent) with no education work in agriculture compared with two percent of women with secondary or higher levels of education. Highly educated women are most likely to be in sales and service (45 percent) or in professional, technical or managerial jobs (36 percent). 24 Table 2.15 Decision on use of earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to selected background characteristics, Ghana 1998 _____________________________________________________________________________________________________ Person who decides how earnings are used ____________________________________________________ Jointly Jointly with with Number Background Self Husband/ husband/ Someone someone of characteristic only partner partner else else Missing Total women ______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Mother's education No education Primary Middle/JSS Secondary+ Marital status Currently married Not married Total 72.0 1.8 3.5 14.0 8.0 0.6 100.0 187 77.5 6.9 10.3 2.3 2.7 0.3 100.0 524 80.2 5.3 12.6 1.1 0.6 0.2 100.0 645 79.9 5.1 14.4 0.1 0.5 0.0 100.0 543 79.8 6.9 12.8 0.0 0.2 0.3 100.0 531 82.9 5.0 11.8 0.0 0.0 0.3 100.0 399 85.9 4.3 9.6 0.0 0.0 0.2 100.0 346 86.4 3.5 7.7 1.6 0.7 0.2 100.0 1,136 76.6 6.5 13.8 1.4 1.4 0.3 100.0 2,040 72.3 10.7 14.6 0.3 2.1 0.0 100.0 384 83.7 4.1 10.6 0.9 0.3 0.3 100.0 395 90.6 2.7 4.0 2.2 0.2 0.2 100.0 521 85.3 4.3 6.6 0.7 3.1 0.0 100.0 344 79.9 4.4 13.1 1.6 0.8 0.2 100.0 455 74.9 3.6 18.9 1.4 1.2 0.0 100.0 484 75.8 7.0 14.0 2.3 0.5 0.5 100.0 247 87.2 5.8 0.6 2.8 2.9 0.6 100.0 112 64.3 22.8 7.4 4.0 1.5 0.0 100.0 70 69.5 5.8 21.8 1.0 0.6 1.3 100.0 162 75.8 8.1 14.0 0.7 0.9 0.4 100.0 973 79.8 4.7 11.5 2.4 1.6 0.0 100.0 616 82.2 4.6 10.1 1.7 1.2 0.2 100.0 1,270 85.7 1.6 10.2 1.0 1.1 0.3 100.0 316 76.5 7.1 15.3 0.4 0.4 0.3 100.0 2,406 91.4 0.1 0.0 4.8 3.5 0.1 100.0 769 80.1 5.4 11.6 1.5 1.2 0.2 100.0 3,175 Decision on Use of Earnings Table 2.15 shows the percent distribution of women by the person who decides on how women’s cash earnings are used. Four out of five women state that they alone decide how their earnings are used, 12 percent decide jointly with their husbands, and five percent state that their partner decides how to use her earnings. Older women, urban women, women who reside in the Greater Accra Region, and women with secondary education or higher, are most likely to decide for themselves on the use of their earnings. Male partners in the Upper West Region have a relatively greater say in the use of their partner’s earnings than in the other regions. Unmarried women are also more likely than married women to decide for themselves on the use of their earnings. 25 Child Care Table 2.16 shows the percent distribution of working mothers who have a child under six years, by the caretaker of the child when the mother is working. Just over half of working mothers have a child under six years (54 percent). Forty-eight percent of employed mothers with a child under six, look after their own children, 22 percent have relatives other than the husband/partner to look after the child, and 14 percent have the child in school or other institutional care. Six percent of mothers of children under six have another female child to look after the child. Rural women are slightly more likely to look after their own child, whereas urban mothers are more likely to have their child in school or in institutional care. A higher proportion of mothers residing in the Western Region look after their young children. Education varies inversely with child care by respondent. For example, one in two women with no education looks after their own children under six years compared with two in five women with secondary or higher levels of education. Women who work in the agricultural sector are more likely to care for a child themselves than women in non- agricultural occupations. Full time working mothers are more likely to look after their own children than other mothers are, presumably because full time work is more common among self-employed mothers, who do most of their work at home. 26 Ta bl e 2. 16 C hi ld ca re w hi le w or ki ng Pe rc en t d ist rib ut io n of cu rre nt ly em pl oy ed w om en b y w he th er th ey h av e a c hi ld u nd er si x ye ar s o f a ge at h om e, an d th e p er ce nt d ist rib ut io n of em pl oy ed m ot he rs w ho h av e a ch ild u nd er si x by p er so n w ho c ar es fo r c hi ld w hi le m ot he r is at w or k, a cc or di ng to se le ct ed b ac kg ro un d ch ar ac te ris tic s, G ha na 1 99 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ch ild 's ca re ta ke r w hi le m o th er is a t w or k O ne o r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ N o ch ild m o re N ot N u m be r u n de r ch ild re n R e- N ei gh - Ch ild O th er O th er w o rk ed o f B ac kg ro un d six u n de r s ix sp on d- H us ba nd / O th er bo ur / H ire d is in fe m al e m al e sin ce em pl oy ed ch ar ac te ris tic at h om e at h om e en t pa rtn er re la tiv e Fr ie nd he lp sc ho ol ch ild ch ild bi rth 1 O th er M iss in g To ta l w o m en _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ R es id en ce U rb an R ur al R eg io n W es te rn Ce nt ra l G re at er A cc ra V ol ta Ea st er n A sh an ti B ro ng A ha fo N or th er n U pp er W es t U pp er E as t M ot he r' s ed u ca tio n N o ed u ca tio n Pr im ar y M id dl e/ JS S Se co n da ry + W or k st at us Fo r f am ily m em be r Fo r s om eo ne e lse Se lf- em pl oy ed O cc u pa tio n A gr ic ul tu ra l N on ag ric ul tu ra l Em pl o ym en t s ta tu s A ll ye ar , f ul l w ee k A ll ye ar , p ar t w ee k Se as o n al O cc as io na l To ta l 58 .3 41 .7 42 .7 2. 4 21 .5 1. 7 0. 5 23 .8 3. 3 0. 8 2. 6 0. 1 0. 7 10 0. 0 1, 22 7 38 .9 61 .1 49 .4 2. 9 22 .3 2. 4 0. 9 10 .5 7. 2 2. 3 1. 7 0. 2 0. 2 10 0. 0 2, 33 8 44 .2 55 .8 63 .6 1. 9 14 .6 0. 5 0. 5 15 .0 2. 9 0. 5 0. 0 0. 5 0. 0 10 0. 0 42 2 47 .5 52 .5 59 .7 1. 7 18 .8 0. 0 0. 6 14 .4 3. 3 1. 1 0. 6 0. 0 0. 0 10 0. 0 42 6 60 .8 39 .2 39 .7 2. 6 18 .5 2. 1 1. 1 24 .3 5. 8 1. 1 3. 7 0. 0 1. 1 10 0. 0 56 4 42 .9 57 .1 46 .1 3. 5 20 .1 5. 1 0. 0 11 .7 6. 5 1. 1 6. 0 0. 0 0. 0 10 0. 0 38 4 44 .8 55 .2 44 .1 4. 8 23 .2 1. 3 0. 0 18 .3 4. 8 0. 9 1. 7 0. 5 0. 4 10 0. 0 48 3 42 .1 57 .9 40 .5 2. 5 31 .5 0. 7 1. 1 13 .8 4. 6 2. 8 1. 8 0. 0 0. 7 10 0. 0 55 4 38 .9 61 .1 50 .0 2. 1 19 .3 2. 1 0. 0 16 .5 6. 4 0. 7 2. 8 0. 0 0. 0 10 0. 0 26 5 35 .0 65 .0 39 .2 2. 0 34 .4 2. 8 4. 9 1. 3 9. 1 5. 5 0. 0 0. 0 0. 7 10 0. 0 14 8 37 .1 62 .9 46 .8 2. 1 20 .5 2. 2 0. 5 2. 7 17 .8 7. 0 0. 5 0. 0 0. 0 10 0. 0 10 2 39 .3 60 .7 42 .5 3. 5 20 .9 9. 0 2. 0 2. 0 15 .3 4. 3 0. 0 0. 4 0. 0 10 0. 0 21 8 37 .7 62 .3 51 .0 2. 3 21 .2 3. 4 1. 0 7. 1 9. 5 2. 4 1. 6 0. 3 0. 1 10 0. 0 1, 15 8 42 .9 57 .1 50 .4 3. 5 21 .8 0. 8 0. 0 11 .0 7. 1 2. 6 1. 8 0. 0 0. 8 10 0. 0 68 3 49 .2 50 .8 44 .1 2. 9 24 .2 2. 1 0. 8 20 .1 3. 0 1. 1 1. 7 0. 0 0. 2 10 0. 0 1, 39 2 63 .4 36 .6 39 .1 2. 9 16 .6 0. 0 2. 2 29 .1 1. 9 0. 9 5. 8 0. 4 1. 0 10 0. 0 33 2 45 .5 54 .5 56 .8 1. 4 22 .5 0. 9 0. 7 3. 5 9. 6 3. 0 1. 2 0. 0 0. 3 10 0. 0 35 5 63 .5 36 .5 38 .5 1. 6 25 .5 2. 7 0. 6 20 .1 3. 7 1. 2 5. 4 0. 0 0. 6 10 0. 0 49 1 42 .3 57 .7 47 .5 3. 1 21 .7 2. 3 0. 8 14 .6 6. 0 1. 8 1. 6 0. 2 0. 3 10 0. 0 2, 71 8 35 .7 64 .3 52 .3 0. 4 20 .5 3. 1 1. 0 10 .3 7. 8 2. 3 1. 9 0. 2 0. 4 10 0. 0 1, 16 0 50 .3 49 .7 44 .7 4. 3 23 .1 1. 6 0. 7 16 .4 5. 2 1. 6 2. 0 0. 1 0. 3 10 0. 0 2, 40 5 48 .7 51 .3 50 .2 2. 4 21 .2 1. 3 0. 4 15 .7 4. 5 1. 2 2. 5 0. 2 0. 4 10 0. 0 2, 42 3 36 .9 63 .1 40 .2 5. 2 24 .7 1. 8 1. 0 14 .8 8. 7 2. 3 1. 2 0. 0 0. 0 10 0. 0 60 4 38 .8 61 .2 46 .3 1. 3 22 .2 6. 8 2. 6 6. 1 9. 6 4. 0 0. 9 0. 0 0. 2 10 0. 0 44 7 53 .2 46 .8 48 .4 2. 8 25 .4 0. 0 0. 0 9. 2 10 .4 3. 8 0. 0 0. 0 0. 0 10 0. 0 89 45 .6 54 .4 47 .6 2. 8 22 .1 2. 2 0. 8 14 .0 6. 2 1. 9 1. 9 0. 1 0. 3 10 0. 0 3, 56 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ N ot e: T ot al in cl ud es o ne w om an fo r w ho m in fo rm at io n on w or k sta tu s i s m iss in g. 1 R es po nd en t i s c ur re nt ly e m pl oy ed b ut ha s n ot w or ke d sin ce la st bi rth . 1 Numerators of the ASFRs are calculated by summing the number of live births that occurred in the period 1-59 months preceding the survey (determined by the date of interview and the date of birth of the child), and classifying them by age (in five-year groups) of the mother at the time of birth (determined by the mother’s birth date). The denominators of the rates are the number of woman-years lived in each of the specified five-year age groups during the 1-59 months preceding the survey. 27 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the five years preceding the survey, by urban-rural residence, Ghana 1998 ____________________________________________________ Residence ______________ Age group Urban Rural Total ____________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women 15-49 TFR women 15-44 General fertility rate Crude birth rate 58 110 90 123 233 192 149 239 206 141 205 183 82 173 143 36 101 79 2 22 16 2.96 5.41 4.55 2.95 5.30 4.46 103 183 154 25.4 36.0 32.7 ____________________________________________________ Note: Rates are for the period 1-59 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Total fertility rate expressed per woman. General fertility rate (births divided by number of women 15-49), expressed per 1,000 women. Crude birth rate expressed per 1,000 population. CHAPTER 3 FERTILITY Information on fertility is very crucial for governments, which seek to formulate explicit policies that will help to bridge the gap between high population growth and economic development. In this regard, women age 15-49 were asked about their pregnancy histories. The pregnancy history is designed to improve the completeness and accuracy of information on fertility. Each woman was asked to provide information on the number of sons and daughters living with her, the number living elsewhere, and the number who had died, and the number of pregnancies she had that did not result in a live birth. The woman was then asked to provide a comprehensive pregnancy history, including information about the date of occurrence of all live and non-live births, sex, and survival status of children born alive. This chapter examines current fertility levels, trends and differentials in fertility, cumulative fertility, birth intervals, age at first birth, and adolescent fertility. 3.1 Current Fertility Table 3.1 presents information on age- specific fertility rates (ASFR)1, the total fertility rate (TFR) for women age 15-49 and 15-44, the general fertility rate (GFR), and the crude birth rate (CBR) by residence. These rates were calculated over the five years preceding the survey. The TFR is the sum of the ASFRs and can be interpreted as the number of children a woman would have by the end of her childbearing years if she experienced the prevailing ASFRs. The GFR is defined as the total annual number of births per 1,000 women age 15-44 and the CBR is defined as the total number of live births in a year per 1,000 persons. The total fertility rate in Ghana for women age 15-49 is 4.6 births per woman. This means that a Ghanaian woman would have on the average 4.6 children in her lifetime if the current age specific fertility rates were to continue to prevail. The TFR for rural areas (5.4) is about two and a half children more than for urban areas (3.0). This pattern of higher rural fertility is evident at every age. At current fertility levels, a Ghanaian woman would have given birth to more than 2 children by age 30, and more than 3 children (about three-fourths of her lifetime births) by age 35. 28 Table 3.2 Fertility by background characteristics Total fertility rate for the five years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49, by selected background characteristics, Ghana 1998 ___________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant age 40-49 ___________________________________________________ Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Education No education Primary Middle/JSS Secondary+ Total 2.96 5.6 4.63 5.41 9.4 6.15 4.70 6.2 5.84 4.78 6.3 5.84 2.66 6.4 4.20 4.44 7.3 5.71 4.41 10.0 5.33 4.76 6.8 5.85 5.40 9.7 6.71 6.98 15.3 6.65 6.14 8.6 6.81 4.98 12.1 5.63 5.83 10.2 6.45 4.94 7.4 6.22 3.78 7.8 4.93 2.80 3.9 3.29 4.55 8.0 5.66 ___________________________________________________ 1 Women age 15-49 years 3.2 Fertility Differentials Table 3.2 and Figure 3.1 show differentials in fertility by urban-rural residence, region, and education. There are wide variations in fertility by region, with TFR being lowest in the Greater Accra Region (2.7) and highest in the Northern Region (7.0). Education is inversely related to fertility. Women with no education have more than twice the number of children (5.8) as women with some secondary education (2.8). The mean number of children ever born to women age 40-49, which is a measure of com- pleted fertility, is also shown in Table 3.2. This measure can be used to assess differentials in fertility trends over time for population subgroups. There has been a marked decline in fertility in urban areas, in most regions, and among most education subgroups. An overall comparison of past and present fertility suggests a recent decline of about one child per woman, from 5.7 to 4.6 children per woman. Eight percent of women reported that they were pregnant at the time of the survey (Table 3.2). This is an underestimate of the actual percentage of women who were pregnant, since women may not be aware of a pregnancy especially at the very early stages. Moreover, early disclosure of a pregnancy may be discouraged in some cultures. Nevertheless, differentials by current pregnancy status mirror differentials in current fertility. Figure 3.1 Total Fertility Rates by Selected Background Characteristics 3.0 5.4 4.7 4.8 2.7 4.4 4.4 4.8 5.4 7.0 6.1 5.0 5.8 4.9 3.8 2.8 RESIDENCE Urban Rural REGION Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East EDUCATION No education Primary Middle/JSS Secondary+ 0.0 2.0 4.0 6.0 8.0 Number of Children GDHS 1998 29 Table 3.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates for selected surveys, Ghana 1988-1998_______________________________________________ GDHS GDHS GDHS Age group 1988a 1993b 1998_______________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women age 15-49 124 119 90 258 231 192 278 244 206 248 215 183 195 163 143 117 99 79 60 29 16 6.41 5.50 4.55 _______________________________________________ Note: Rates refer to the five-year period preceding the survey. Rates for the age group 45-49 may be slightly biased due to truncation. a GSS and IRD, 1989b GSS and MI, 1994 3.3 Trends in Fertility Data from previous demographic surveys, fielded in Ghana over the last decade, can be used to examine the trends in current fertility. Table 3.3 shows the demographic transition experienced in Ghana. The TFR has declined dramatically from 6.4 children per woman in 1988 (GSS and IRD, 1989), to 5.5 children per woman in 1993 (GSS and MI, 1994), and to 4.6 children in 1998, a nearly 2 child drop in fertility over the decade. Figure 3.2 shows that fertil- ity has fallen in every age group, with fertility levels among women under age 35 declining by around 25 percent during the decade between the 1988 and 1998 surveys. Table 3.4, which shows the ASFRs for five- year periods preceding the survey, provides further evidence of a continuing decline in fertility in Ghana. A substantial and sustained decline in ASFRs is observed from 10-14 years before the survey, which roughly coincides with calendar years 1983-1988, to 0-4 years before the survey, that is, calendar years 1993-1998. Figure 3.2 Age-Specific Fertility Rates, 1988-1998 # # # # # # # & & & & & & & ) ) ) ) ) ) ) 15-19 20-24 25-29 30-34 35-39 40-44 45-49 0 50 100 150 200 250 300 1988 1993 1998) & # Births per 1,000 Women Age Group 2 Stillbirths are defined as children born dead after a gestation of 28 weeks or more. Early pregnancy losses are pregnancies of less than 28 weeks gestation, that are terminated through spontaneous or induced abortions. 30 Table 3.4 Age-specific fertility rates Age-specific fertility rates for 5-year periods preceding the survey, Ghana 1998 _______________________________________________ Number of years preceding the survey Age _________________________________ group 0-4 5-9 10-14 15-19 _______________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 90 104 117 123 192 213 242 265 206 247 257 255 183 216 241 [267] 143 162 [182] - 79 [97] - - [16] - - - _______________________________________________ Note: Age-specific fertility rates per 1,000 women. Esti- mates enclosed in brackets are truncated. Table 3.5 Fertility by marital duration Fertility rates for ever-married women by number of years since first marriage, for 5-year periods preceding the survey, Ghana 1998 _______________________________________________ Years Number of years preceding the survey since first _________________________________ marriage 0-4 5-9 10-14 15-19 _______________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 264 284 314 327 224 268 279 288 192 223 246 265 141 187 213 276 114 127 171 [187] 35 75 [239] - _______________________________________________ Note: Fertility rates per 1,000 women. Estimates enclosed in brackets are truncated. Fertility rates for ever-married women by duration since first marriage, for five-year periods preceding the survey, are shown in Table 3.5. This table is analogous to Table 3.4, but is restricted to ever- married women, and replaces age with marital duration. The data confirm a sharp decline in fertility, and indicate that fertility decline is evident at all marital durations. 3.4 Pregnancy Outcome Unlike earlier demographic and health surveys conducted in Ghana, the 1998 GDHS collected complete pregnancy histories from women. This has yielded information on pregnancy outcomes other than live births. Collecting retrospective information on pregnancies is comparatively more difficult than collecting retrospective birth information. This is particularly so for pregnancies that last only for a few months. Stillbirths and live births are probably more completely reported than early pregnancy losses.2 Since the total number of pregnancies is likely to be underestimated, caution should be exercised while interpreting these data. Table 3.6 presents the pregnancy outcomes of women 0-9 years before the survey by age of the mother at the time of the outcome and urban-rural residence. Overall, 12 percent of all pregnancies that occurred in the ten years before the survey did not end in a live birth. There is substantial variation in pregnancy outcomes across age groups (Figure 3.3). Nearly one in four pregnancies to women age 15-19 was lost early, and three percent ended in a stillbirth. In general, younger women (below 25 years) and older women (above 44 years) are more likely to have a pregnancy resulting in a non-live birth. A similar pattern by age is observed in urban and rural areas; however, urban women are much more likely than rural women to report early pregnancy losses. Early pregnancy losses are especially high among urban women age 15-19, with about two in five pregnancies to women in this age group ending in an early pregnancy loss. 31 Table 3.6 Pregnancy outcome Percent distribution of all pregnancies 0-9 years preceding the survey by pregnancy outcome, according to age and residence, Ghana 1998 _________________________________________________________________________ Pregnancy outcome ______________________________ Age at Early Number pregnancy pregnancy Still- Live of outcome loss birth birth Total pregnancies _________________________________________________________________________ URBAN _________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total (38.9) (2.4) (58.7) 100.0 41 17.3 1.5 81.3 100.0 288 13.1 3.0 83.9 100.0 469 10.0 1.0 89.0 100.0 458 13.7 1.1 85.2 100.0 360 8.3 0.0 91.7 100.0 165 11.3 8.7 80.0 100.0 82 13.2 1.9 84.9 100.0 1,864 _________________________________________________________________________ RURAL _________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 17.0 3.0 80.0 100.0 114 10.2 3.5 86.4 100.0 754 8.1 1.3 90.6 100.0 1,282 7.6 1.7 90.7 100.0 1,069 7.1 1.3 91.6 100.0 1,007 7.1 2.7 90.3 100.0 680 13.3 2.5 84.2 100.0 355 8.5 2.0 89.5 100.0 5,261 _________________________________________________________________________ TOTAL _________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 22.9 2.9 74.3 100.0 155 12.1 2.9 85.0 100.0 1,042 9.5 1.8 88.8 100.0 1,751 8.3 1.5 90.2 100.0 1,528 8.9 1.2 89.9 100.0 1,368 7.3 2.1 90.6 100.0 845 12.9 3.7 83.4 100.0 437 9.7 2.0 88.3 100.0 7,125 _______________________________________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases. 32 3.5 Children Ever Born and Living Table 3.7 gives the distribution of women by the mean number of children ever born (CEB) and the mean number of children living, by five-year age groups, for all women and currently married women. Information on the mean number of children ever born is useful in examining the variation among different age groups. The effect of age on mean CEB is apparent, with older women reporting higher mean CEB than younger women. On average, women in their late twenties have given birth to 2 children, and this rises to 4.5 children among women in their late thirties, and 6 children among women at the end of their childbearing years. The mean number of children ever born to currently married women is 3.5, which is 32 percent higher than the average for all women. Indeed, about 55 percent of women age 15-19 who are currently married have had at least one birth. This relatively low age at the initiation of childbearing means a very long exposure to the risk of pregnancy and further childbearing. The data indicate that childlessness declines rapidly with age. About ninety percent of women in the age group 15-19 have never had a child. This reduces to about 40 percent for the 20–24 age group and thereafter declines steeply to 3 percent for women age 45-49 years. A similar pattern is observed for currently married women. The proportion of all women that have never had a child is much higher (29 percent) than for currently married women (9 percent). Currently married women also reported higher CEB than did all women at every age, and especially at younger ages. This suggests that a substantial proportion of childbearing in Ghana takes place within marriage. About two percent of currently married women age 45-49 have not had a child. This is a rough measure of primary infertility in Ghana. Figure 3.3 Early Pregnancy Loss, 1988-1998 GDHS 1998 23 12 10 8 9 7 13 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age at Pregnancy Outcome 0 5 10 15 20 25 Percent 33 Table 3.7 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born and mean number of children ever born (CEB) and mean number of living children, according to five-year age groups, Ghana 1998 ______________________________________________________________________________________________________ Mean Mean number Number of children ever born Number number of Age __________________________________________________________ of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ______________________________________________________________________________________________________ ALL WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 88.3 10.8 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 910 0.13 0.12 39.2 32.6 20.5 5.4 2.2 0.1 0.0 0.0 0.0 0.0 0.0 100.0 900 0.99 0.89 17.6 21.8 26.1 19.0 10.5 3.2 1.6 0.3 0.0 0.0 0.0 100.0 867 2.00 1.81 6.1 10.1 17.1 20.2 20.2 13.4 8.5 3.3 0.5 0.6 0.0 100.0 653 3.36 2.95 3.2 6.2 10.1 15.4 16.6 15.9 15.7 7.8 5.5 2.1 1.4 100.0 625 4.46 3.88 1.1 4.6 7.4 10.3 13.1 14.9 14.6 13.7 9.1 6.0 5.2 100.0 473 5.42 4.61 2.5 2.9 4.3 9.2 11.3 15.2 13.6 12.8 10.1 8.4 9.7 100.0 415 5.93 4.96 28.6 14.8 13.3 10.9 9.4 7.2 6.1 3.9 2.5 1.7 1.5 100.0 4,843 2.63 2.28 ______________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 38.9 55.0 6.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.00 100.0 122 0.67 0.60 20.1 39.0 30.3 7.5 2.9 0.2 0.0 0.0 0.0 0.0 0.00 100.0 552 1.35 1.23 8.8 20.4 29.5 22.6 12.6 4.0 1.8 0.4 0.0 0.0 0.00 100.0 674 2.31 2.09 4.5 8.9 16.1 20.8 21.7 13.8 9.3 3.5 0.6 0.8 0.00 100.0 551 3.51 3.09 2.4 5.5 8.6 15.4 18.0 15.4 16.7 7.9 5.9 2.5 1.70 100.0 523 4.61 4.01 0.9 3.4 6.0 9.9 13.2 15.9 14.6 14.5 9.6 6.8 5.30 100.0 402 5.59 4.77 1.9 1.3 3.8 7.0 9.4 15.8 14.4 15.2 10.0 9.8 11.40 100.0 307 6.30 5.26 8.5 16.4 17.4 14.4 12.7 9.5 8.1 5.4 3.3 2.4 2.10 100.0 3,131 3.48 3.03 3.6 Birth Interval The interval between births provides useful information on birth spacing patterns. Studies have shown that short (less than 24 months) birth intervals are detrimental to the health of both the mother and child. Maternal health is also threatened by rapid childbearing. Table 3.8 shows the distribution of non-first births in the five years before the survey by birth intervals, according to various demographic and socio- economic variables. Thirteen percent of non-first births in the five years before the survey occurred less than 24 months after a prior birth. The median birth interval for all women is 38 months. In other words, half of non-first births to women in Ghana occur more than three years after a previous birth. The median birth interval increases with age from 36 months for births to women age 20-29 years to 41 months for births to women age 40 and older. This tendency for older women to have a longer birth interval could be attributed to a likely reduction in fecundity of women as they grow older. There is little difference in the median birth interval by birth order and sex of the child, but the median birth interval is markedly shorter if the previous child has died. Birth intervals are longer in urban than rural areas, and in the Greater Accra and Volta Regions. This could be attributed to urbanisation with its attendant employment in the formal sector and higher contraceptive prevalence. The median birth interval is also longer among mothers with secondary or higher education. 34 Table 3.8 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth and median length of birth interval, according to selected demographic and socioeconomic characteristics, Ghana 1998 _____________________________________________________________________________________________________ Median number of months Number of months since previous birth Number since ____________________________________________ of previous Characteristic 7-17 18-23 24-35 36-47 48+ Total births1 birth ______________________________________________________________________________________________________ Age of mother 20-29 30-39 40 + Birth order 2-3 4-6 7 + Sex of prior birth Male Female Survival of prior birth Dead Living Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Education No education Primary Middle/JSS Secondary+ Total 6.1 9.3 34.7 28.4 21.4 100.0 968 35.9 4.2 7.4 28.2 26.4 33.9 100.0 1,077 39.9 4.6 9.1 23.9 23.1 39.3 100.0 381 41.0 5.5 8.7 29.4 27.7 28.8 100.0 1,110 38.2 4.3 7.2 31.2 25.2 32.1 100.0 918 38.8 5.3 10.6 30.3 27.3 26.5 100.0 406 37.5 5.0 8.2 29.2 26.1 31.5 100.0 1,208 38.9 5.0 8.6 31.3 27.2 27.9 100.0 1,226 37.4 21.5 15.7 27.5 16.3 19.1 100.0 292 28.8 2.7 7.4 30.6 28.1 31.1 100.0 2,141 39.1 4.3 8.0 22.3 23.7 41.6 100.0 537 42.9 5.2 8.5 32.5 27.5 26.3 100.0 1,896 37.1 4.8 9.5 30.8 27.1 27.8 100.0 312 37.9 8.7 8.7 31.5 24.9 26.1 100.0 298 36.5 3.0 8.6 26.9 22.3 39.1 100.0 230 42.1 2.4 7.1 26.1 29.2 35.2 100.0 254 41.5 3.2 8.8 28.6 27.2 32.2 100.0 332 39.6 5.6 6.2 30.9 29.2 28.1 100.0 369 38.3 4.6 7.4 34.6 24.4 29.0 100.0 203 37.2 11.0 12.4 35.4 22.3 18.8 100.0 188 33.5 4.1 6.6 33.3 31.7 24.2 100.0 84 38.2 1.9 9.2 27.0 29.8 32.1 100.0 164 39.2 5.4 8.6 31.6 27.3 27.1 100.0 1,034 37.6 3.6 9.3 31.4 29.4 26.2 100.0 496 37.5 5.6 7.2 29.3 24.8 33.1 100.0 787 38.6 3.1 11.1 19.4 22.4 44.0 100.0 117 43.1 5.0 8.4 30.2 26.7 29.7 100.0 2,434 38.2 ____________________________________________________________________________________________________ Note: First-order births are excluded. The interval for multiple births is the number of months since the end of the preceding pregnancy that ended in a live birth. 1 Total includes 7 births to women age 15-19. 35 Table 3.9 Age at first birth Percent distribution of women 15-49 by age at first birth and median age at first birth, according to current age, Ghana 1998 ____________________________________________________________________________________________________ Women Median with Age at first birth Number age at no _____________________________________________ of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth ____________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 88.3 0.3 7.2 4.2 NA NA NA 100.0 910 a 39.2 2.0 17.9 20.7 14.8 5.5 NA 100.0 900 a 17.6 2.6 18.8 19.4 18.9 14.9 7.8 100.0 867 20.9 6.1 5.2 21.3 23.1 16.9 15.7 11.7 100.0 653 20.0 3.2 3.4 21.9 20.9 19.4 17.5 13.8 100.0 625 20.4 1.1 4.5 23.8 22.4 19.4 16.3 12.6 100.0 473 19.9 2.5 4.0 25.9 22.0 15.5 14.6 15.6 100.0 415 19.8 ____________________________________________________________________________________________________ NA = Not applicablea The medians for cohorts 15-19 and 20-24 could not be determined because half of the women had not had a birth before reaching the lowest age of the age group. 3.7 Age at First Birth Research has shown that women who have their first birth early in life tend to have more children than those who start childbearing later. A rising age at first birth is therefore an important factor contributing to the transition from high to low fertility. Table 3.9 shows the percent distribution of women age 15-49 by age at first birth, according to their current age. The median ages at first birth for women in the age groups 15-19 and 20-24 could not be calculated because less than 50 percent of women in these age groups have had a birth by the beginning of that age group. The median age at first birth for the youngest age cohort (25-29), for which a median could be estimated is 21. For all other age groups the median age at first birth is around 20, indicating that age at first birth has risen in the most recent period. A comparison of the median age at first birth for the age group 25-29 from the 1993 GDHS data (GSS and MI, 1994) confirms that the median age at first birth has risen (from 20 in 1993 to 21 in 1998). Further evidence of the longer term decline is suggested by the fall in the percentage of first births occurring before age 18, from 30 percent in the cohort age 45-49 to 20 percent in the cohort age 20-24. Table 3.10 summarises the median age at first birth for different cohorts of women by urban-rural residence, region and education. The median age at first birth is higher in urban areas than rural areas for all age groups. Women residing in the Greater Accra Region exhibit the highest median age at first birth (22.0), while residents of the Brong Ahafo (19.6) and Western (19.7) Regions have the lowest. There is a marked difference in the median age at first birth by education with highly educated women giving birth for the first time, five years later, than women with no education. 36 Table 3.10 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age and selected background characteristics, Ghana 1998 __________________________________________________________________________________ Current age Women Background ____________________________________________ age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 _________________________________________________________________________________ Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Education No education Primary Middle/JSS Secondary+ Total 22.8 20.9 20.7 20.2 20.4 21.0 20.4 19.6 20.2 19.8 19.6 20.0 20.2 19.5 19.1 18.7 21.0 19.7 21.2 18.8 20.4 19.7 20.2 20.0 24.5 21.8 21.1 21.6 20.9 22.0 20.9 19.9 21.1 20.0 19.3 20.4 20.2 20.2 20.6 19.5 18.3 20.0 20.8 19.7 19.6 19.1 19.9 19.9 20.0 19.7 19.7 19.5 18.5 19.6 20.6 19.9 20.4 20.4 19.6 20.2 20.6 21.3 21.4 21.1 21.0 21.2 20.4 19.4 20.8 21.5 23.4 20.8 19.6 19.7 19.8 20.2 19.6 19.7 20.2 19.6 20.5 20.1 19.4 20.0 21.6 19.8 20.2 19.4 19.6 20.3 a 24.6 23.9 23.3 24.2 24.9 20.9 20.0 20.4 19.9 19.8 20.3 _________________________________________________________________________________ Note: The medians for cohorts 15-19 and 20-24 could not be determined because half of the women had not had a birth before reaching the lowest age of the age group.a Medians were not calculated for this cohort because less than 50 percent of women in the age group 25-29 in this category had a birth by age 25. 3.8 Adolescent Fertility Evidence from research indicates that children born to very young mothers are at an increased risk of illness and death. Childbearing during adolescence also has adverse consequences for the health of the mother, not to mention the social constraints on young women’s ability to pursue educational and employment opportunities. In addition, young mothers may not be emotionally mature to bear the burden of childbearing and rearing. Table 3.11 shows the percentage of adolescent women (age 15-19), who were mothers or were pregnant with their first child at the time of the survey, according to selected background characteristics. Table 3.11 indicates that about 14 percent of teenagers were already mothers or pregnant with their first child, at the time of the survey. The percentage of teenagers who have begun childbearing increases with age from 2 percent among women age 15 to 32 percent among those age 19. Teenage childbearing is twice as high in the rural areas than in the urban areas. Adolescent childbearing is especially prevalent in the Eastern Region (21 percent), with more than three times as many teenagers having begun childbearing, as in the Greater Accra Region (6 percent). Women with little or no education are about seven times more likely to have begun childbearing earlier than women with some secondary education. 37 Table 3.11 Adolescent pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Ghana 1998 _______________________________________________________________ Percentage who are: Percentage _________________ who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women _______________________________________________________________ Age 15 16 17 18 19 Residence Urban Rural Region Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East Education No education Primary Middle/JSS Secondary+ Total 0.6 1.1 1.6 215 5.0 0.8 5.8 182 11.6 2.3 13.9 153 18.2 2.9 21.1 202 26.4 5.3 31.7 158 6.8 1.6 8.5 341 14.6 2.8 17.4 569 9.3 0.0 9.3 123 18.7 0.0 18.7 112 2.9 2.9 5.8 162 9.5 1.2 10.7 102 17.9 3.3 21.2 104 17.8 1.8 19.6 122 13.8 2.8 16.6 83 10.4 6.2 16.6 32 10.4 6.9 17.3 20 5.4 8.6 14.0 48 17.1 5.0 22.1 127 18.4 5.1 23.5 169 9.7 1.1 10.8 535 2.2 0.7 2.9 79 11.7 2.4 14.1 910 39 Table 4.1 Knowledge of contraceptive methods Percentage of all women and men, and currently married women and men, who know specific contraceptive methods, Ghana 1998 __________________________________________________________________ Women Men _________________ ________________ Currently Currently Contraceptive All married All married method women women men men __________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Condom Female sterilisation Male sterilisation Implants LAM Any traditional method Periodic abstinence Withdrawal Other Number of respondents Mean number of methods 92.9 93.6 94.8 96.3 92.5 93.1 94.6 96.0 78.4 82.7 72.0 80.6 49.3 55.0 40.7 50.9 77.6 83.4 71.1 81.6 42.0 45.9 45.2 52.7 86.8 86.3 92.7 93.7 65.4 69.8 62.8 72.2 26.3 28.7 33.1 38.9 21.2 24.3 16.0 20.1 18.0 21.9 11.5 16.1 69.4 73.2 69.5 79.4 59.4 61.8 54.2 63.4 54.5 59.1 59.3 69.0 3.2 4.0 1.9 3.1 4,843 3,131 1,546 816 5.8 6.2 5.6 6.4 __________________________________________________________________ LAM = Lactational amenorrhoea method CHAPTER 4 FERTILITY REGULATION This chapter includes findings on the knowledge and use of family planning, attitude towards family planning, sources of family planning methods, as well as exposure to media messages about family planning. This information is particularly useful for policy makers, programme managers, and researchers in population and family planning, and provides a means to assess the success of the Ghanaian family planning programme. The focus of this chapter is on women, however, some results from the male survey are also presented, since men play an important role in realising women’s reproductive goals. 4.1 Knowledge of Contraception Information on female and male respondents’ knowledge of contraception was collected in two ways. Respondents were first asked to mention all the methods of contraception that they had heard of spontaneously. Interviewers then described methods not mentioned spontaneously to see if respondents recognised the method. Thus knowledge of a family planning method in the 1998 GDHS is defined simply as having heard of a method. Table 4.1 shows the percent distribution of women and men by knowledge of contraceptive method. Although the table distinguishes between all and currently married women, the text emphasises currently married women only, since they have the greatest level of exposure to the risk of pregnancy. 40 Table 4.2 Couples’ knowledge of contraceptive methods Percent distribution of couples by knowledge of specific contraceptive methods, Ghana 1998 ________________________________________________________________________________ Wife Husband knows Both knows method, Number Contraceptive know method, not hus- Neither of method method not wife band know Total couples ________________________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Condom Female sterilisation Male sterilisation Implants LAM Any traditional method Periodic abstinence Withdrawal Other 90.3 4.5 2.0 3.2 100.0 573 89.4 5.2 2.2 3.2 100.0 573 70.9 8.5 12.3 8.3 100.0 573 35.5 14.5 17.2 32.8 100.0 573 70.5 10.6 11.6 7.4 100.0 573 29.8 19.7 13.0 37.5 100.0 573 81.1 10.6 2.8 5.5 100.0 573 56.4 15.7 13.3 14.7 100.0 573 17.2 21.1 13.8 47.9 100.0 573 8.2 10.6 16.3 64.9 100.0 573 8.6 6.9 13.3 71.1 100.0 573 64.9 12.1 7.6 15.3 100.0 573 46.5 14.3 13.9 25.2 100.0 573 48.2 18.5 7.5 25.8 100.0 573 0.7 2.5 4.1 92.7 100.0 573 ______________________________________________________________________________ LAM = Lactational amenorrhoea method Generally, contraceptive knowledge in Ghana is very high with 93 percent of currently married women and 96 percent of currently married men knowing at least one modern method of family planning. The condom is the most widely recognised method, with 86 percent of married women and 94 percent of married men having heard of it. This is followed closely by injectables and the pill, recognised by more than 80 percent of married women and men. About seventy percent of married women and men have heard of female sterilisation, but only 29 percent of women and 39 percent of men have heard of male sterilisation. More than one in two married respondents have heard of the IUD, while 46 percent of women and 53 percent of men have heard of vaginal methods (diaphragm, foam and jelly). A relatively smaller percentage of women and men (about 20 percent) have heard of implants or lactational amenorrhoea method (LAM). Even though traditional methods do not form part of the family planning programme, it is interesting to note that knowledge of these methods is relatively high. Seventy-three percent of married women and 79 percent of married men have heard of a traditional method. Knowledge of periodic abstinence is equally well known to women and men (about 60 percent). However, married men are much more likely to have heard of withdrawal (69 percent) than women (59 percent). Less than five percent of respondents mentioned other methods, like herbs. Knowledge of family planning methods has increased in the last 10 years, with most of the increase occurring in the five-year period between 1988 and 1993. Contraceptive knowledge among currently married women increased from 79 percent in 1988 (GSS and IRD, 1989), to 91 percent in 1993 (GSS and MI, 1994), and to 94 percent in 1998. While knowledge of modern methods rose from 77 percent to 93 percent in the 10 years between the 1988 and the 1998 GDHS, knowledge of traditional methods rose from 52 percent to 73 percent over the same period. Table 4.2 shows the distribution of couples in the 1998 GDHS sample of households by contraceptive knowledge. In general, couples’ knowledge of family planning methods is high, with 89 percent of couples knowing a modern method. However, couples’ knowledge varies by type of method. This difference is especially obvious in the case of vaginal methods, condoms and male sterilisation, where husbands are much more likely to have heard of the methods than wives. 41 Table 4.3 Knowledge of source Percentage of all women and men, and currently married women and men, who know a source, by specific methods, Ghana 1998 __________________________________________________________________ Women Men _________________ ________________ Currently Currently Contraceptive All married All married method women women men men __________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Condom Female sterilisation Male sterilisation Implants LAM Any traditional method Periodic abstinence Number of respondents 78.4 81.1 81.6 86.0 78.0 80.6 81.6 86.0 60.2 64.6 54.4 63.4 38.2 43.3 31.1 40.3 60.1 66.4 55.4 65.8 32.2 35.7 37.7 44.7 66.4 67.5 76.7 80.0 53.6 58.2 51.9 59.9 21.7 24.3 27.5 32.8 17.0 20.0 12.6 16.0 12.7 15.7 8.2 11.7 36.0 38.9 32.5 39.3 36.0 38.9 32.5 39.3 4,843 3,131 1,546 816 __________________________________________________________________ LAM = Lactational amenorrhoea method 4.2 Knowledge of Source Knowledge of a source is very crucial in enabling potential users to easily avail themselves of family planning methods. It is also a measure of the extent to which people are aware of the places where family planning services are available and are able to access these services. Table 4.3 presents information on respondents’ knowledge of a source of family planning method. Overall, about eight in ten currently married women know where to obtain a modern method of family planning. Knowledge of a source among currently married women ranges from 20 percent for implants to 68 percent for condoms. Currently married men are relatively more familiar with a source for condoms (80 percent) than any other method (between 16-66 percent). Only 16 percent of women and 12 of men know where to go to obtain advice on LAM. The question on knowledge of a source was also posed to respondents who had heard of periodic abstinence. Thirty-nine percent of women and men know where to go for advice on periodic abstinence. 4.3 Ever Use of Contraception All women interviewed in the 1998 GDHS who said they had heard of a method of contraception were further asked if they had ever used a method to avoid or delay a pregnancy. Table 4.4 presents the percentages of all women and currently married women who have ever used a method of family planning by type of method used. One in two currently married women reported ever using a contraceptive method, with 38 percent having ever used a modern method, and 31 percent having ever used a traditional method. The most popular modern method ever used is the pill (18 percent), followed closely by the condom (14 percent). A sizeable number of women also stated ever using periodic abstinence (22 percent) and withdrawal (17 percent). The wide gap between knowledge and ever use could in part be due to the fact that having heard of a method (defined as knowledge in the GDHS) does not necessarily imply the detailed familiarity with a method that may actually lead to its use. Moreover, women who are either pregnant or trying to get pregnant may not yet have the need for family planning even though they may have knowledge of it. 42 Ta bl e 4 .4 E ve r u se o f c on tra ce pt io n Pe rc en ta ge o f a ll w om en a nd o f c ur re nt ly m ar rie d w om en w ho h av e e ve r u se d a c on tra ce pt iv e m et ho d, b y m et ho d an d ag e, G ha na 1 99 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ M od er n m et ho d Tr ad iti on al m et ho d _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A ny A n y D ia ph ra gm / Fe m al e M al e tr ad i- Pe rio di c N u m be r A ny m o de rn In jec t- Fo am / st er ili - st er ili - Im - tio na l ab sti - W ith - O th er o f A ge m et ho d m et ho d Pi ll IU D ab le s Je lly Co n do m sa tio n sa tio n pl an t LA M m et ho d n en ce dr aw al m et ho ds w o m en _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A LL W O M EN _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 18 .6 12 .5 3. 6 0. 1 0. 6 1. 0 9. 1 0. 0 0. 0 0. 0 0. 5 12 .0 7. 5 8. 0 0. 4 91 0 51 .4 36 .9 12 .3 0. 5 3. 0 4. 7 22 .9 0. 0 0. 0 0. 1 3. 4 36 .0 25 .4 21 .1 1. 3 90 0 53 .3 37 .5 17 .8 1. 8 6. 7 4. 7 18 .0 0. 1 0. 0 0. 5 3. 3 35 .6 26 .7 21 .6 0. 9 86 7 54 .7 38 .7 19 .3 3. 8 8. 0 6. 0 13 .6 0. 5 0. 0 0. 2 5. 1 33 .2 25 .8 16 .5 1. 9 65 3 52 .2 41 .2 21 .3 2. 9 10 .8 8. 6 13 .3 1. 2 0. 0 0. 3 4. 5 30 .0 21 .8 15 .4 1. 5 62 5 46 .5 38 .6 19 .1 3. 2 8. 2 7. 7 9. 7 3. 4 0. 0 0. 3 4. 8 23 .4 17 .7 8. 9 1. 6 47 3 40 .4 31 .5 17 .6 3. 2 8. 0 6. 6 6. 5 3. 8 0. 3 0. 0 3. 9 21 .9 17 .9 7. 3 2. 2 41 5 44 .7 32 .9 14 .9 1. 9 5. 8 5. 1 14 .2 0. 9 0. 0 0. 2 3. 4 27 .8 20 .4 15 .0 1. 3 4, 84 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CU RR EN TL Y M A RR IE D W O M EN _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 50 .1 35 .1 13 .5 1. 0 2. 8 1. 0 20 .0 0. 0 0. 0 0. 0 3. 7 30 .1 16 .5 23 .1 2. 9 12 2 53 .3 37 .8 13 .2 0. 9 4. 1 5. 9 21 .1 0. 0 0. 0 0. 2 4. 9 36 .7 24 .2 21 .3 1. 7 55 2 52 .0 36 .5 19 .0 1. 9 7. 3 4. 9 15 .1 0. 1 0. 0 0. 2 4. 0 33 .7 24 .3 21 .7 1. 2 67 4 55 .1 38 .9 19 .6 3. 6 8. 3 5. 7 13 .3 0. 6 0. 0 0. 2 5. 5 32 .5 25 .0 16 .2 1. 8 55 1 52 .2 42 .2 20 .5 2. 8 11 .3 8. 7 13 .2 1. 4 0. 0 0. 4 5. 1 28 .7 20 .7 14 .7 1. 8 52 3 44 .3 37 .1 18 .1 3. 7 7. 9 7. 0 9. 5 3. 1 0. 0 0. 2 5. 0 23 .2 17 .3 9. 7 1. 3 40 2 41 .9 32 .9 17 .2 3. 9 9. 3 7. 0 6. 9 5. 1 0. 4 0. 0 5. 1 22 .7 18 .1 7. 2 2. 6 30 7 50 .8 37 .8 17 .8 2. 6 7. 7 6. 2 14 .2 1. 3 0. 0 0. 2 4. 8 30 .6 22 .0 16 .6 1. 7 3, 13 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LA M = L ac ta tio na l a m en or rh oe a m et ho d 43 4.4 Current Use of Contraceptive Method Table 4.5 shows the percent distribution of all women and currently married women by current contraceptive use, according to age. The percentage of currently married Ghanaian women using a family planning method at the time of the survey is 22 percent. Current use of a modern method is higher (13 percent) than use of a traditional method (9 percent). The most widely used modern method is the pill (4 percent), followed closely by injectables and condoms (3 percent each). Female sterilisation, vaginal methods, and the IUD are used by about one percent of women each, while less than one percent of women are using LAM. Seven percent of women use periodic abstinence and two percent withdrawal. Current use of contraception rises with age from 19 percent among women age 15-19, to peak at 26 percent among women age 35-39 (Table 4.5). Use falls among older women, with 16 percent of women in the age group 45-49 using a method. A similar pattern is seen in the use of a modern method, with use being highest at 18 percent among women age 35-39. Use of a traditional method peaks at 11 percent among women age 30-34. Pill use is popular among all but the oldest age group. Injectables are most popular among women age 35-39, but are generally used by all ages. Female sterilisation is more common among older women, while younger women prefer the condom. Currently married women in urban areas are nearly twice as likely to use any contraceptive method as their rural counterparts (Table 4.6 and Figure 4.1). Seventeen percent of urban women are currently using a modern method compared to 11 percent of rural women. While overall use of a contraceptive method is highest in the Greater Accra Region (32 percent), use of a modern method is highest in the Eastern Region (20 percent). In general, use is lowest in the three northern regions. As expected, education is positively related to contraceptive use, with lowest use among women with no education (13 percent), and highest use among women who have a secondary level education or higher (42 percent). The differentials in use of modern and traditional methods by education show a similar pattern, with the highest level of use among women with a secondary education. Highly educated women are 6 times more likely to use a condom than women with no education, and 5 times more likely to use periodic abstinence. In general, current use increases with the number of children. Nine percent of women with no living child use a modern method of contraception, and this number rises to 17 percent among women with four or more children. Use of the pill, injectables and female sterilisation generally rises with parity, but the reverse is true for the use of condoms. Use of traditional methods rises with parity, peaking among women with three living children, before declining among women with four or more children. 44 Ta bl e 4 .5 C ur re nt u se o f c on tra ce pt io n Pe rc en ta ge o f a ll w om en a nd cu rre nt ly m ar rie d w om en w ho ar e c ur re n tly u sin g a co nt ra ce pt iv e m et ho d, b y m et ho d an d ag e, G ha na 1 99 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ M od er n m et ho d Tr ad iti on al m et ho d _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A ny A n y D ia ph ra gm / Fe m al e M al e tr ad i- Pe rio di c N o t N u m be r A ny m o de rn In jec t- Fo am / st er ili - st er ili - Im - tio na l ab sti - W ith - O th er cu rr en tly o f A ge m et ho d m et ho d Pi ll IU D ab le s Je lly Co n do m sa tio n sa tio n pl an t LA M m et ho d n en ce dr aw al m et ho ds u sin g To ta l w o m en _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A LL W O M EN _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 8. 6 4. 8 1. 4 0. 0 0. 2 0. 3 2. 8 0. 0 0. 0 0. 0 0. 1 3. 8 2. 4 1. 3 0. 1 91 .4 10 0. 0 91 0 19 .3 10 .4 2. 7 0. 3 1. 7 0. 5 4. 5 0. 0 0. 0 0. 1 0. 7 8. 8 6. 9 1. 9 0. 1 80 .7 10 0. 0 90 0 21 .1 12 .1 4. 0 0. 3 2. 4 0. 5 3. 9 0. 1 0. 0 0. 3 0. 6 9. 0 6. 9 1. 4 0. 7 78 .9 10 0. 0 86 7 23 .5 12 .7 4. 3 1. 4 3. 0 1. 1 2. 0 0. 5 0. 0 0. 1 0. 2 10 .8 9. 2 1. 1 0. 5 76 .5 10 0. 0 65 3 23 .5 15 .4 4. 7 0. 4 4. 7 1. 7 2. 3 1. 2 0. 0 0. 3 0. 2 8. 1 5. 9 1. 6 0. 7 76 .5 10 0. 0 62 5 18 .4 12 .9 3. 4 1. 0 2. 4 1. 2 1. 2 3. 4 0. 0 0. 1 0. 2 5. 5 4. 0 1. 0 0. 5 81 .6 10 0. 0 47 3 12 .2 8. 1 0. 8 0. 6 2. 0 0. 0 0. 6 3. 8 0. 3 0. 0 0. 0 4. 2 3. 7 0. 1 0. 3 87 .8 10 0. 0 41 5 18 .0 10 .7 3. 1 0. 5 2. 2 0. 7 2. 8 0. 9 0. 0 0. 1 0. 3 7. 4 5. 7 1. 3 0. 4 82 .0 10 0. 0 4, 84 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CU RR EN TL Y M A RR IE D W O M EN _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 To ta l 19 .2 12 .6 3. 8 0. 0 1. 0 1. 0 5. 8 0. 0 0. 0 0. 0 0. 9 6. 6 3. 7 1. 9 1. 0 80 .8 10 0. 0 12 2 20 .7 11 .6 3. 0 0. 4 2. 8 0. 4 3. 6 0. 0 0. 0 0. 2 1. 1 9. 2 6. 8 2. 2 0. 1 79 .3 10 0. 0 55 2 22 .2 12 .6 4. 4 0. 4 3. 0 0. 3 3. 4 0. 1 0. 0 0. 2 0. 8 9. 6 7. 0 1. 8 0. 9 77 .8 10 0. 0 67 4 24 .8 13 .9 5. 1 1. 5 3. 0 1. 4 2. 2 0. 6 0. 0 0. 0 0. 2 10 .9 9. 2 1. 3 0. 4 75 .2 10 0. 0 55 1 26 .3 17 .5 5. 3 0. 4 5. 0 2. 1 2. 7 1. 4 0. 0 0. 3 0. 2 8. 7 6. 5 1. 4 0. 8 73 .7 10 0. 0 52 3 19 .3 13 .1 3. 5 1. 2 2. 5 1. 4 1. 4 3. 1 0. 0 0. 0 0. 0 6. 1 4. 4 1. 1 0. 6 80 .7 10 0. 0 40 2 15 .8 10 .2 0. 9 0. 5 2. 6 0. 0 0. 8 5. 1 0. 4 0. 0 0. 0 5. 6 5. 1 0. 2 0. 4 84 .2 10 0. 0 30 7 22 .0 13 .3 3. 9 0. 7 3. 1 0. 9 2. 7 1. 3 0. 0 0. 1 0. 5 8. 7 6. 6 1. 5 0. 6 78 .0 10 0. 0 3, 13 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LA M = L ac ta tio na l a m en or rh oe a m et ho d 45 Ta bl e 4 .6 C ur re nt u se o f c on tra ce pt io n b y ba ck gr ou nd ch ar ac te ris tic s: w om en Pe rc en t d ist rib ut io n of cu rre nt ly m ar rie d w om en b y co nt ra ce pt iv e m et ho d cu rre nt ly u se d, ac co rd in g to se le ct ed b ac kg ro un d ch ar ac te ris tic s, G ha na 1 99 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ M od er n m et ho d Tr ad iti on al m et ho d _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A ny A n y D ia ph ra gm / Fe m al e M al e tr ad i- Pe rio di c N o t N u m be r B ac kg ro un d A ny m o de rn In jec t- Fo am / st er ili - st er ili - Im - tio na l ab sti - W ith - O th er cu rr en tly o f ch ar ac te ris tic m et ho d m et ho d Pi ll IU D ab le s Je lly Co n do m sa tio n sa tio n pl an t LA M m et ho d n en ce dr aw al m et ho ds u sin g To ta l w o m en _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ R es id en ce U rb an R ur al R eg io n W es te rn Ce n tr al G re at er A cc ra V ol ta Ea st er n A sh an ti B ro n g A ha fo N or th er n U pp er W es t U pp er E as t Ed uc at io n N o e du ca tio n Pr im ar y M id dl e/ JS S Se co nd ar y+ N o. o f l iv in g ch ild re n 0 1 2 3 4+ To ta l 30 .4 17 .4 4. 3 1. 5 3. 8 1. 0 3. 7 2. 1 0. 0 0. 1 0. 8 13 .0 11 .0 1. 8 0. 3 69 .6 10 0. 0 97 8 18 .1 11 .4 3. 8 0. 3 2. 8 0. 9 2. 2 0. 9 0. 1 0. 1 0. 3 6. 7 4. 7 1. 3 0. 7 81 .9 10 0. 0 2, 15 3 18 .3 8. 7 3. 2 0. 0 1. 3 0. 3 2. 3 1. 0 0. 0 0. 0 0. 6 9. 6 5. 5 2. 9 1. 3 81 .7 10 0. 0 35 6 19 .3 13 .1 1. 5 0. 7 4. 4 2. 9 2. 6 0. 7 0. 0 0. 4 0. 0 6. 2 3. 6 1. 1 1. 5 80 .7 10 0. 0 33 8 32 .2 17 .4 4. 7 2. 1 3. 1 0. 5 4. 2 2. 6 0. 0 0. 3 0. 0 14 .8 11 .9 2. 6 0. 3 67 .8 10 0. 0 44 9 21 .1 12 .1 2. 6 0. 0 5. 5 1. 1 1. 5 0. 7 0. 0 0. 0 0. 8 9. 0 6. 8 1. 8 0. 4 78 .9 10 0. 0 33 4 26 .6 19 .6 8. 2 0. 6 4. 1 1. 3 4. 9 0. 5 0. 0 0. 0 0. 0 7. 0 5. 9 0. 9 0. 3 73 .4 10 0. 0 42 6 24 .6 14 .0 4. 0 0. 7 1. 7 0. 7 3. 1 2. 1 0. 2 0. 2 1. 2 10 .6 9. 2 0. 7 0. 7 75 .4 10 0. 0 49 1 24 .7 14 .8 5. 9 1. 0 2. 5 1. 5 1. 0 2. 0 0. 0 0. 0 1. 0 9. 9 7. 4 2. 5 0. 0 75 .3 10 0. 0 23 5 10 .0 5. 6 2. 0 0. 3 0. 6 0. 0 1. 0 0. 7 0. 0 0. 0 1. 0 4. 4 3. 7 0. 3 0. 3 90 .0 10 0. 0 19 6 11 .9 9. 1 2. 1 1. 0 4. 5 0. 0 0. 3 1. 0 0. 0 0. 0 0. 0 2. 8 1. 8 0. 3 0. 7 88 .1 10 0. 0 97 9. 0 7. 5 1. 5 0. 3 4. 2 0. 0 1. 2 0. 0 0. 0 0. 2 0. 0 1. 5 1. 2 0. 2 0. 0 91 .0 10 0. 0 20 9 13 .2 8. 9 2. 6 0. 5 2. 8 0. 2 1. 1 1. 1 0. 0 0. 1 0. 4 4. 3 3. 2 0. 5 0. 6 86 .8 10 0. 0 1, 10 6 20 .3 12 .9 5. 0 0. 6 2. 9 1. 0 2. 3 0. 7 0. 0 0. 0 0. 4 7. 4 4. 6 2. 0 0. 8 79 .7 10 0. 0 57 6 26 .6 16 .1 4. 8 0. 8 3. 3 1. 5 3. 5 1. 4 0. 1 0. 2 0. 5 10 .5 8. 6 1. 5 0. 4 73 .4 10 0. 0 1, 19 7 42 .3 20 .3 3. 2 1. 4 4. 3 1. 4 6. 1 2. 8 0. 0 0. 2 0. 9 22 .0 16 .8 4. 2 1. 0 57 .7 10 0. 0 25 2 16 .0 9. 0 2. 3 0. 4 0. 0 0. 4 5. 9 0. 0 0. 0 0. 0 0. 0 7. 0 5. 8 1. 1 0. 0 84 .0 10 0. 0 30 4 20 .4 11 .5 3. 2 0. 0 2. 4 0. 2 4. 0 0. 0 0. 0 0. 2 1. 4 8. 9 6. 2 2. 4 0. 3 79 .6 10 0. 0 57 6 19 .4 9. 8 4. 3 0. 4 3. 3 0. 8 0. 4 0. 4 0. 0 0. 0 0. 3 9. 6 7. 2 2. 0 0. 4 80 .6 10 0. 0 58 8 25 .6 13 .7 3. 6 1. 9 2. 0 1. 4 2. 7 1. 3 0. 0 0. 3 0. 5 11 .9 9. 6 1. 8 0. 5 74 .4 10 0. 0 51 2 24 .0 17 .0 4. 7 0. 8 4. 7 1. 3 2. 3 2. 7 0. 1 0. 1 0. 2 7. 1 5. 4 0. 7 1. 0 76 .0 10 0. 0 1, 15 0 22 .0 13 .3 3. 9 0. 7 3. 1 0. 9 2. 7 1. 3 0. 0 0. 1 0. 5 8. 7 6. 6 1. 5 0. 6 78 .0 10 0. 0 3, 13 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LA M = L ac ta tio na l a m en or rh oe a m et ho d 1 Contraceptive use among males is likely to be higher than among females, because men in a polygynous or multi- partner relationship are likely to report use with any partner. 46 Current use is much higher among men than women (Table 4.7).1 Thirty-two percent of men are currently using a method of contraception, 20 percent using a modern method, and 12 percent a traditional method. Much of the male-female difference in current use is due to a difference in condom use. Men are three times (8 percent) as likely as women (3 percent) to report current use of the condom. There is no clear pattern of variation in contraceptive use with a man’s age. Use is highest in the 35- 39 age group, and drops markedly from age 50 onwards. Men residing in the Brong Ahafo Region report the highest use of any method, with those from the Brong Ahafo and Greater Accra Regions reporting the highest use of a modern method, and those in the Brong Ahafo and Ashanti Regions reporting the highest use of a traditional method. Pill use is highest in the Brong Ahafo Region, injectables in the Volta Region, condom in the Central Region, and periodic abstinence in the Western Region. The differentials in current use reported by male respondents by urban-rural residence, education and number of living children are similar to those found for currently married women. Figure 4.1 Current Use of Family Planning Among Currently Married Women Age 15-49 30 18 18 19 32 21 27 25 25 10 12 9 13 20 27 42 RESIDENCE Urban Rural REGION Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper West Upper East EDUCATION No education Primary Middle/JSS Secondary+ 0 10 20 30 40 50 Modern methods Traditional methods GDHS 1998 Percent 47 Ta bl e 4 .7 C ur re nt u se o f c on tra ce pt io n by b ac kg ro un d ch ar ac te ris tic s: m en Pe rc en t d ist rib ut io n of cu rre nt ly m ar rie d m en b y co nt ra ce pt iv e m et ho d cu rre nt ly u se d, ac co rd in g to se le ct ed b ac kg ro un d ch ar ac te ris tic s, G ha na 1 99 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ M od er n m et ho d Tr ad iti on al m et ho d _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A ny A n y D ia ph ra gm / Fe m al e M al e tr ad i- Pe rio di c N o t N u m be r B ac kg ro un d A ny m o de rn In jec t- Fo am / st er ili - st er ili - Im - tio na l ab sti - W ith - O th er cu rr en tly o f ch ar ac te ris tic m et ho d m et ho d Pi ll IU D ab le s Je lly Co n do m sa tio n sa tio n pl an t LA M m et ho d n en ce dr aw al m et ho ds u sin g To ta l m en _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A ge 15 -1 9 20 -2 4 25 -2 9 30 -3 4 35 -3 9 40 -4 4 45 -4 9 50 -5 4 55 -5 9 R es id en ce U rb an R ur al R eg io n W es te rn Ce n tr al G re at er A cc ra V ol ta Ea st er n A sh an ti B ro n g A ha fo N or th er n U pp er W es t U pp er E as t Ed uc at io n N o e du ca tio n Pr im ar y M id dl e/ JS S Se co nd ar y+ N o. o f l iv in g ch ild re n 0 1 2 3 4+ To ta l * * * * * * * * * * * * * * * * 10 0. 0 9 29 .1 17 .9 6. 0 0. 0 0. 0 1. 9 10 .0 0. 0 0. 0 0. 0 0. 0 11 .3 6. 8 4. 4 0. 0 70 .9 10 0. 0 58 40 .3 23 .4 6. 8 1. 1 3. 3 0. 0 9. 8 0. 0 0. 0 1. 2 1. 2 16 .9 12 .6 3. 3 1. 1 59 .7 10 0. 0 10 5 27 .6 17 .3 5. 0 0. 7 2. 6 0. 0 9. 0 0. 0 0. 0 0. 0 0. 0 10 .4 6. 1 3. 6 0. 7 72 .4 10 0. 0 16 4 41 .0 26 .9 5. 9 0. 0 2. 7 0. 9 13 .1 2. 7 0. 9 0. 0 0. 8 14 .0 11 .9 1. 7 0. 5 59 .0 10 0. 0 14 1 32 .2 21 .1 4. 6 2. 5 6. 8 1. 1 5. 2 0. 9 0. 0 0. 0 0. 0 11 .1 8. 8 1. 2 1. 2 67 .8 10 0. 0 10 5 34 .7 25 .0 6. 6 1. 4 8. 2 0. 0 5. 5 3. 3 0. 0 0. 0 0. 0 9. 7 6. 6 2. 7 0. 4 65 .3 10 0. 0 88 18 .4 9. 0 1. 3 0. 0 4. 4 0. 0 2. 9 0. 4 0. 0 0. 0 0. 0 9. 4 5. 7 2. 9 0. 8 81 .6 10 0. 0 81 16 .8 9. 0 0. 0 1. 8 1. 7 0. 0 3. 6 1. 8 0. 0 0. 0 0. 0 7. 8 7. 8 0. 0 0. 0 83 .2 10 0. 0 66 42 .3 27 .0 5. 3 2. 5 4. 9 0. 5 10 .8 2. 0 0. 0 0. 5 0. 5 15 .3 12 .2 2. 5 0. 5 57 .7 10 0. 0 24 7 26 .8 16 .9 4. 9 0. 2 3. 2 0. 4 7. 0 0. 7 0. 2 0. 0 0. 2 9. 9 6. 7 2. 4 0. 7 73 .2 10 0. 0 56 9 37 .4 20 .1 6. 7 0. 0 2. 9 1. 0 9. 5 0. 0 0. 0 0. 0 0. 0 17 .3 13 .4 2. 9 1. 0 62 .6 10 0. 0 11 7 32 .6 24 .2 3. 2 1. 8 1. 6 1. 6 12 .7 3. 4 0. 0 0. 0 0. 0 8. 4 5. 0 3. 4 0. 0 67 .4 10 0. 0 76 39 .8 26 .2 6. 8 3. 9 4. 9 0. 0 8. 7 1. 9 0. 0 0. 0 0. 0 13 .6 11 .7 1. 9 0. 0 60 .2 10 0. 0 12 5 30 .8 17 .5 0. 0 0. 0 8. 8 0. 0 8. 8 0. 0 0. 0 0. 0 0. 0 13 .3 8. 8 4. 6 0. 0 69 .2 10 0. 0 84 29 .9 22 .2 10 .1 0. 0 2. 1 0. 0 8. 9 0. 0 1. 0 0. 0 0. 0 7. 7 4. 7 3. 0 0. 0 70 .1 10 0. 0 11 6 28 .8 14 .2 0. 0 0. 0 2. 2 0. 0 7. 5 1. 1 0. 0 1. 1 2. 1 14 .6 11 .5 2. 1 1. 1 71 .2 10 0. 0 10 9 41 .1 26 .8 12 .5 1. 8 5. 3 1. 8 3. 6 1. 8 0. 0 0. 0 0. 0 14 .3 8. 9 3. 6 1. 8 58 .9 10 0. 0 65 20 .3 12 .2 0. 0 0. 0 1. 3 0. 0 9. 5 1. 4 0. 0 0. 0 0. 0 8. 2 5. 4 0. 0 2. 8 79 .7 10 0. 0 46 (18 .9) (13 .7) (4. 0) (0. 0) (4. 1) (0. 0) (2. 8) (2. 8) (0. 0) (0. 0) (0. 0) (5. 2) (3. 9) (0. 0) (1. 4) (81 .1 ) 10 0. 0 25 11 .7 11 .7 2. 9 0. 0 4. 9 0. 0 2. 9 1. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 88 .3 10 0. 0 53 11 .8 7. 7 3. 0 0. 7 1. 7 0. 0 1. 7 0. 6 0. 0 0. 0 0. 0 4. 1 1. 6 0. 7 1. 8 88 .2 10 0. 0 17 0 26 .5 17 .8 5. 7 0. 0 0. 9 0. 0 10 .8 0. 4 0. 0 0. 0 0. 0 8. 7 5. 0 3. 7 0. 0 73 .5 10 0. 0 93 36 .1 23 .6 6. 0 1. 2 5. 5 0. 6 9. 1 0. 9 0. 3 0. 0 0. 0 12 .5 9. 6 2. 3 0. 5 63 .9 10 0. 0 40 6 44 .9 25 .6 4. 3 0. 8 3. 2 0. 8 11 .2 2. 8 0. 0 0. 8 1. 6 19 .3 15 .1 4. 1 0. 0 55 .1 10 0. 0 14 7 25 .4 18 .1 3. 8 0. 0 0. 0 0. 0 14 .3 0. 0 0. 0 0. 0 0. 0 7. 3 4. 9 2. 4 0. 0 74 .6 10 0. 0 92 35 .7 19 .1 4. 1 0. 9 3. 2 0. 8 8. 6 0. 0 0. 0 0. 9 0. 8 16 .5 13 .0 3. 5 0. 0 64 .3 10 0. 0 14 0 30 .0 19 .3 8. 7 0. 0 2. 8 0. 0 7. 7 0. 0 0. 0 0. 0 0. 0 10 .7 8. 6 1. 9 0. 3 70 .0 10 0. 0 13 6 38 .2 24 .0 3. 0 3. 1 1. 6 0. 0 12 .2 2. 0 1. 0 0. 0 1. 0 14 .3 8. 4 4. 9 1. 0 61 .8 10 0. 0 11 7 29 .7 19 .8 5. 0 0. 8 6. 1 0. 7 5. 1 2. 1 0. 0 0. 0 0. 0 9. 9 7. 4 1. 4 1. 1 70 .3 10 0. 0 33 2 31 .5 20 .0 5. 0 0. 9 3. 7 0. 4 8. 2 1. 1 0. 1 0. 1 0. 3 11 .5 8. 4 2. 5 0. 6 68 .5 10 0. 0 81 6 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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