Ghana - Demographic and Health Survey - 2015

Publication date: 2015

Ghana 2014 G hana 2014 D em ographic and H ealth Survey Demographic and Health Survey Ghana Demographic and Health Survey 2014 Ghana Statistical Service Accra, Ghana Ghana Health Service Accra, Ghana The DHS Program ICF International Rockville, Maryland, USA October 2015 International Labour Organization This report summarises the findings of the 2014 Ghana Demographic and Health Survey (2014 GDHS), implemented by the Ghana Statistical Service (GSS), the Ghana Health Service (GHS), and the National Public Health Reference Laboratory (NPHRL) of the GHS. Financial support for the survey was provided by the United States Agency for International Development (USAID), the Global Fund to fight AIDS, Tuberculosis, and Malaria through the Ghana AIDS Commission (GAC) and the National Malaria Control Programme (NMCP), the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the International Labour Organization (ILO), the Danish International Development Agency (DANIDA), and the Government of Ghana. ICF International provided technical assistance through The DHS Program, a USAID-funded project offering support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2014 GDHS may be obtained from the Ghana Statistical Service, Head Office, P.O. Box GP 1098, Accra, Ghana; Telephone: 233-302-682-661/233-302-663-578; Fax: 233-302-664-301; E-mail: info@statsghana.gov.gh. Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Suggested citation: Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF International. 2015. Ghana Demographic and Health Survey 2014. Rockville, Maryland, USA: GSS, GHS, and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xvii ACRONYMS . xix MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxi MAP OF GHANA . xxii 1 INTRODUCTION . 1 1.1 Geography, History, and Economy . 1 1.1.1 Geography . 1 1.1.2 History . 1 1.1.3 Economy . 2 1.2 Demographic Profile . 2 1.3 Population Policy and Reproductive Health Programmes . 3 1.4 Objectives and Organisation of the Survey . 5 1.5 Sample Design . 5 1.6 Questionnaires . 6 1.7 Blood Pressure Measurement, Anthropometry, Anaemia Testing, and HIV Testing . 7 1.8 Pretest . 9 1.9 Training of Field Staff . 9 1.10 Fieldwork . 10 1.11 Data Processing . 10 1.12 Response Rates . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Household Characteristics . 11 2.1.1 Water and Sanitation . 12 2.1.2 Housing Characteristics . 14 2.1.3 Household Possessions . 16 2.2 Socioeconomic Status Index . 17 2.3 Hand Washing . 18 2.4 Household Population by Age and Sex . 19 2.5 Household Composition . 21 2.6 Birth Registration . 22 2.7 Children’s Living Arrangements, Orphanhood, and School Attendance . 23 2.8 Education of Household Population . 25 2.8.1 Educational Attainment of Household Population . 25 2.8.2 School Attendance Ratios . 28 3 CHARACTERISTICS OF RESPONDENTS . 31 3.1 Characteristics of Survey Respondents . 31 3.2 Educational Attainment by Background Characteristics . 33 3.3 School Attendance . 35 3.4 Literacy . 37 3.5 Access to Mass Media . 39 3.6 Employment . 41 3.6.1 Employment Status . 41 3.6.2 Occupation . 44 3.6.3 Earnings, Employers, and Continuity of Employment . 47 4 MARRIAGE AND SEXUAL ACTIVITY . 49 4.1 Current Marital Status . 49 4.2 Polygyny . 50 4.3 Age at First Marriage . 52 4.4 Median Age at First Marriage . 53 iv • Contents 4.5 Age at First Sexual Intercourse . 54 4.6 Median Age at First Sexual Intercourse . 55 4.7 Recent Sexual Activity . 56 5 FERTILITY . 59 5.1 Current Fertility . 60 5.2 Fertility Differentials . 61 5.3 Fertility Trends . 62 5.4 Children Ever Born and Living . 64 5.5 Birth Intervals . 65 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . 66 5.7 Menopause . 68 5.8 Age at First Birth . 68 5.9 Teenage Pregnancy and Motherhood . 69 6 FERTILITY PREFERENCES . 71 6.1 Desire for More Children . 71 6.2 Desire to Limit Childbearing by Background Characteristics. 72 6.3 Ideal Family Size . 74 6.4 Fertility Planning . 76 6.5 Wanted Fertility Rates . 77 7 FAMILY PLANNING . 79 7.1 Knowledge of Contraceptive Methods . 80 7.2 Current Use of Contraception . 82 7.3 Current Use of Contraception by Background Characteristics . 84 7.4 Trends in Current Use of Family Planning . 86 7.5 Timing of Sterilisation . 87 7.6 Source of Modern Contraception . 87 7.7 Brands of Pills and Condoms Used . 88 7.8 Informed Choice . 88 7.9 Contraceptive Discontinuation Rates . 89 7.10 Reasons for Discontinuation of Contraceptive Use . 90 7.11 Knowledge of Fertile Period . 91 7.12 Need and Demand for Family Planning Services . 91 7.13 Future Use of Contraception . 93 7.14 Exposure to Family Planning Messages . 94 7.15 Contact of Nonusers with Family Planning Providers . 95 7.16 Attitudes towards Family Planning Among Men . 96 8 INFANT AND CHILD MORTALITY . 99 8.1 Assessment of Data Quality . 100 8.2 Levels and Trends in Infant and Child Mortality . 101 8.2.1 Childhood Mortality Trends 1988-2014 . 102 8.2.2 Recent Trends 2008-2014 . 103 8.3 Socioeconomic Differentials in Childhood Mortality . 103 8.4 Demographic Differentials in Mortality . 104 8.5 Perinatal Mortality . 105 8.6 High-risk Fertility Behaviour . 107 9 MATERNAL HEALTH . 109 9.1 Antenatal Care . 109 9.1.1 Antenatal Care Coverage . 109 9.1.2 Number and Timing of Antenatal Care Visits . 110 9.1.3 Components of Antenatal Care . 111 9.1.4 Tetanus Immunisation . 113 9.2 Delivery Care . 114 9.2.1 Place of Delivery . 114 9.2.2 Assistance at Delivery . 115 9.3 Trends in Maternal Care . 117 9.4 Postnatal Care for the Mother . 118 9.4.1 Timing of First Postnatal Checkup for the Mother . 118 9.4.2 Type of Provider of First Postnatal Checkup for the Mother . 119 Contents • v 9.5 Postnatal Care for the Newborn . 120 9.5.1 Type of Provider of First Postnatal Checkup for the Newborn . 121 9.6 Problems in Accessing Health Care . 122 10 CHILD HEALTH AND EARLY DEVELOPMENT . 125 10.1 Child’s Size and Weight at Birth . 126 10.2 Vaccination Coverage . 127 10.3 Trends in Vaccination Coverage . 132 10.4 Acute Respiratory Infection . 133 10.5 Fever . 135 10.6 Diarrhoeal Disease . 136 10.6.1 Prevalence and Treatment of Diarrhoea. 137 10.6.2 Feeding Practices . 139 10.7 Knowledge of ORS Packets . 141 10.8 Stool Disposal . 142 10.9 Childhood Early Learning and Development . 143 10.9.1 Support for Learning . 144 10.9.2 Reading, Book Ownership, and Textbook and Reading Materials . 145 10.9.3 Language for Education . 148 10.9.4 Travel to School . 150 11 NUTRITION OF CHILDREN AND WOMEN . 153 11.1 Nutritional Status of Children . 154 11.1.1 Measurement of Nutritional Status among Young Children . 154 11.1.2 Data Collection . 155 11.1.3 Levels of Child Malnutrition . 155 11.1.4 Trends in Children’s Nutritional Status . 157 11.2 Breastfeeding and Complementary Feeding . 158 11.2.1 Initiation of Breastfeeding . 158 11.3 Breastfeeding Status by Age . 160 11.4 Duration of Breastfeeding . 162 11.5 Types of Complementary Foods . 163 11.6 Infant and Young Child Feeding (IYCF) Practices . 164 11.7 Anaemia in Children . 167 11.8 Micronutrient Intake among Children . 169 11.9 Adult Nutritional Status . 172 11.9.1 Nutritional Status of Women . 172 11.9.2 Nutritional Status of Men . 175 11.10 Prevalence of Anaemia in Women . 176 11.11 Micronutrient Intake among Mothers . 178 12 MALARIA . 181 12.1 Ownership of Mosquito Nets . 181 12.2 Access to an Insecticide-Treated Net . 184 12.3 Use of Mosquito Nets . 185 12.3.1 Use of Mosquito Nets by Persons in the Household . 185 12 3.2 Use of Existing Mosquito Nets . 187 12.3.3 Use of Mosquito Nets by Children under Age 5 . 188 12.3.4 Use of Mosquito Nets by Pregnant Women . 189 12.3.5 Trends in Use of Mosquito Nets by Children under Age 5 and Pregnant Women . 191 12.3.6 Source and Cost of Nets. 191 12.3.7 Disposal of Nets . 192 12.4 Indoor Residual Spraying . 194 12.5 Use of Intermittent Preventive Treatment of Malaria during Pregnancy . 195 12.6 Prevalence, Diagnosis, and Prompt Treatment of Children with Fever . 197 12.7 Prevalence of Low Haemoglobin in Children . 199 12.8 Prevalence of Malaria in Children . 200 12.9 Exposure to Messages on Malaria . 201 12.9.1 Exposure to Specific Messages on Malaria . 203 vi • Contents 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 205 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods. 206 13.1.1 Knowledge of AIDS . 206 13.1.2 Knowledge of HIV Prevention Methods . 208 13.1.3 Comprehensive Knowledge about HIV/AIDS . 209 13.2 Knowledge about Mother-to-Child Transmission . 212 13.3 Attitudes towards People Living with HIV/AIDS . 214 13.4 Attitudes towards Negotiating Safer Sexual Relations with Husbands . 216 13.5 Attitudes towards Condom Education for Young People . 218 13.6 Higher-risk Sex . 219 13.7 Point Prevalence and Cumulative Prevalence of Concurrent Sexual Partners . 221 13.8 Paid Sex . 223 13.9 Coverage of HIV Testing Services. 224 13.10 HIV Testing during Pregnancy . 226 13.11 Male Circumcision . 228 13.12 Self-reporting of Sexually Transmitted Infections . 229 13.13 Injections . 230 13.14 HIV/AIDS-Related Knowledge and Behaviour among Young People . 232 13.15 Age at First Sexual Intercourse among Young People . 233 13.16 Premarital Sex . 235 13.17 Multiple Sexual Partners among Youth . 236 13.18 Age Mixing in Sexual Relationships . 238 13.19 Recent HIV Test among the Youth . 239 14 HIV PREVALENCE . 241 14.1 Coverage Rates for HIV Testing . 242 14.2 HIV Prevalence . 245 14.2.1 HIV Prevalence by Age and Sex . 245 14.2.2 HIV Prevalence by Socio-economic Characteristics . 246 14.2.3 HIV Prevalence by Other Socio-demographic and Health Characteristics . 248 14.2.4 HIV Prevalence by Sexual Risk Behaviour . 249 14.3 HIV Prevalence among Young People . 251 14.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 253 14.5 HIV Prevalence among Couples . 254 15 ADULT HEALTH AND LIFESTYLE . 257 15.1 Blood Pressure . 258 15.1.1 History and Treatment of High Blood Pressure . 258 15.1.2 Coverage Rates for Blood Pressure Measurement . 260 15.1.3 Prevalence of High Blood Pressure . 261 15.2 Consumption of Fruits and Vegetables . 264 15.3 Household Use of Salty Foods . 265 15.4 Knowledge of Iodised Salt and Its Perceived Benefits . 266 15.5 Knowledge and Attitudes on Tuberculosis . 268 15.6 Tobacco Use . 270 15.7 Health Insurance . 272 15.7.1 Health Insurance Coverage . 272 15.7.2 Health Insurance Payment . 275 15.7.3 Possession of a Valid N/DHIS Card . 277 15.7.4 Out-of-Pocket Payments . 278 15.7.5 Need for Services Not Covered Under N/DHIS . 279 15.8 Perceived Quality of Services and Client Satisfaction . 280 15.9 Treatment Seeking and Perceived Quality of Care . 284 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 289 16.1 Employment and Form of Earnings . 290 16.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s and Their Husbands’ Earnings . 291 16.3 Control over Husbands’ Earnings . 292 16.4 Women’s and Men’s Ownership of Selected Assets . 295 16.5 Women’s Participation in Decision-making . 297 16.6 Attitudes towards Wife Beating . 300 Contents • vii 16.7 Women’s Empowerment Indicators . 303 16.8 Current Use of Contraception by Women’s Status . 303 16.9 Ideal Family Size and Unmet Need by Women’s Status . 304 16.10 Reproductive Health Care and Women’s Empowerment . 305 16.11 Infant and Child Mortality and Women’s Empowerment . 306 16.12 Entitlement to and Use of Maternity Leave . 307 16.13 Length of Maternity Leave. 309 16.14 Bridewealth Negotiation . 311 REFERENCES . 313 APPENDIX A SAMPLE DESIGN . 317 A.1 Introduction . 317 A.2 Sampling Frame . 317 A.3 Sample Design and Selection . 318 A.4 Sample Probabilities and Sample Weights . 320 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 327 APPENDIX C DATA QUALITY TABLES . 343 APPENDIX D PARTICIPANTS IN THE 2014 GHANA DEMOGRAPHIC AND HEALTH SURVEY . 349 APPENDIX E QUESTIONNAIRES . 355 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators . 3 Table 1.2 Results of the household and individual interviews . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1 Household drinking water . 13 Table 2.2 Household sanitation facilities . 14 Table 2.3 Household characteristics . 15 Table 2.4 Household possessions . 17 Table 2.5 Wealth quintiles . 18 Table 2.6 Hand washing . 19 Table 2.7 Household population by age, sex, and residence . 20 Table 2.8 Household composition . 21 Table 2.9 Birth registration of children under age 5 . 22 Table 2.10 Children’s living arrangements and orphanhood . 23 Table 2.11 School attendance by survivorship of parents . 25 Table 2.12.1 Educational attainment of the female household population . 26 Table 2.12.2 Educational attainment of the male household population . 27 Table 2.13 School attendance ratios . 29 Figure 2.1 Population pyramid . 20 Figure 2.2 Children under age 18 living away from home: Place or person with whom they currently live . 24 Figure 2.3 Age-specific attendance rates of the de-facto population 5 to 24 years . 30 3 CHARACTERISTICS OF RESPONDENTS . 31 Table 3.1 Background characteristics of respondents . 32 Table 3.2.1 Educational attainment: Women . 34 Table 3.2.2 Educational attainment: Men . 35 Table 3.3.1 School attendance: Women 15-24 . 36 Table 3.3.2 School attendance: Men 15-24 . 37 Table 3.4.1 Literacy: Women . 38 Table 3.4.2 Literacy: Men . 39 Table 3.5.1 Exposure to mass media: Women . 40 Table 3.5.2 Exposure to mass media: Men . 41 Table 3.6.1 Employment status: Women . 43 Table 3.6.2 Employment status: Men . 44 Table 3.7.1 Occupation: Women . 45 Table 3.7.2 Occupation: Men . 46 Table 3.8 Type of employment: Women . 47 Figure 3.1 Women’s employment status in the past 12 months . 42 4 MARRIAGE AND SEXUAL ACTIVITY . 49 Table 4.1 Current marital status . 50 Table 4.2.1 Number of women’s co-wives . 51 Table 4.2.2 Number of men’s wives . 52 Table 4.3 Age at first marriage . 53 Table 4.4 Median age at first marriage by background characteristics . 54 Table 4.5 Age at first sexual intercourse . 55 x • Tables and Figures Table 4.6 Median age at first sexual intercourse by background characteristics . 56 Table 4.7.1 Recent sexual activity: Women . 57 Table 4.7.2 Recent sexual activity: Men . 58 5 FERTILITY . 59 Table 5.1 Current fertility . 60 Table 5.2 Fertility by background characteristics. 62 Table 5.3.1 Trends in age-specific fertility rates . 63 Table 5.3.2 Trends in age-specific and total fertility rates . 63 Table 5.4 Children ever born and living . 64 Table 5.5 Birth intervals . 66 Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility . 67 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 68 Table 5.8 Menopause . 68 Table 5.9 Age at first birth . 69 Table 5.10 Median age at first birth . 69 Table 5.11 Teenage pregnancy and motherhood . 70 Figure 5.1 Total fertility rates, selected Sub-Saharan African countries . 61 Figure 5.2 Trends in age-specific fertility rates . 63 6 FERTILITY PREFERENCES . 71 Table 6.1 Fertility preferences by number of living children . 72 Table 6.2.1 Desire to limit childbearing: Women . 73 Table 6.2.2 Desire to limit childbearing: Men . 74 Table 6.3 Ideal number of children by number of living children . 75 Table 6.4 Mean ideal number of children . 76 Table 6.5 Fertility planning status . 77 Table 6.6 Wanted fertility rates . 78 7 FAMILY PLANNING . 79 Table 7.1 Knowledge of contraceptive methods . 80 Table 7.2 Knowledge of contraceptive methods by background characteristics . 81 Table 7.3 Current use of contraception by age . 83 Table 7.4.1 Current use of contraception by background characteristics . 85 Table 7.4.2 Trends in the current use of contraception . 86 Table 7.5 Source of modern contraception methods . 88 Table 7.6 Informed choice . 89 Table 7.7 Twelve-month contraceptive discontinuation rates . 90 Table 7.8 Reasons for discontinuation . 90 Table 7.9 Knowledge of fertile period . 91 Table 7.10 Need and demand for family planning among currently married women . 92 Table 7.11 Future use of contraception . 94 Table 7.12 Exposure to family planning messages . 95 Table 7.13 Contact of nonusers with family planning providers . 96 Figure 7.1 Trends in current use of contraceptive methods, Ghana 1988-2014 . 87 Figure 7.2 Trends in unmet need and percentage of demand satisfied with modern methods, Ghana 1993-2014 . 93 Tables and Figures • xi 8 INFANT AND CHILD MORTALITY . 99 Table 8.1 Early childhood mortality rates . 102 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 104 Table 8.3 Early childhood mortality rates by demographic characteristics . 105 Table 8.4 Perinatal mortality . 106 Table 8.5 High-risk fertility behaviour . 107 Figure 8.1 Mortality trends, Ghana 1988-2014 . 103 9 MATERNAL HEALTH . 109 Table 9.1 Antenatal care . 110 Table 9.2 Number of antenatal care visits and timing of first visit. 111 Table 9.3 Components of antenatal care . 112 Table 9.4 Tetanus toxoid injections . 113 Table 9.5 Place of delivery . 115 Table 9.6 Assistance during delivery . 116 Table 9.7 Timing of first postnatal checkup for the mother . 119 Table 9.8 Type of provider of first postnatal checkup for the mother . 120 Table 9.9 Timing of first postnatal checkup for the newborn . 121 Table 9.10 Type of provider of first postnatal checkup for the newborn . 122 Table 9.11 Problems in accessing health care . 123 Figure 9.1 Mother’s duration of stay in the health facility after giving birth . 117 Figure 9.2 Trends in maternal health care, 1988-2014 . 118 10 CHILD HEALTH AND EARLY DEVELOPMENT . 125 Table 10.1 Child’s size and weight at birth . 127 Table 10.2.1 Vaccinations by source of information: Children age 12-23 months . 129 Table 10.2.2 Vaccinations by source of information: Children 24-35 months . 129 Table 10.3.1 Vaccinations by background characteristics: Children 12-23 months . 130 Table 10.3.2 Vaccinations by background characteristics: Children 24-35 months . 131 Table 10.4 Vaccinations in first year of life . 132 Table 10.5 Prevalence and treatment of symptoms of ARI . 134 Table 10.6 Prevalence and treatment of fever . 136 Table 10.7 Prevalence of diarrhoea . 137 Table 10.8 Diarrhoea treatment . 139 Table 10.9 Feeding practices during diarrhoea . 141 Table 10.10 Knowledge of ORS packets . 142 Table 10.11 Disposal of children’s stools . 143 Table 10.12 Activities that promote learning . 145 Table 10.13 Reading and book ownership . 147 Table 10.14 Textbooks and reading materials . 148 Table 10.15 Language for education . 149 Table 10.16 Travel to school . 151 Figure 10.1 Trends in basic vaccination coverage among children 12-23 months, Ghana 1988-2014 . 133 11 NUTRITION OF CHILDREN AND WOMEN . 153 Table 11.1 Nutritional status of children . 156 Table 11.2 Initial breastfeeding . 159 Table 11.3 Breastfeeding status by age . 161 Table 11.4 Median duration of breastfeeding . 163 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 164 Table 11.6 Infant and young child feeding (IYCF) practices . 166 Table 11.7 Prevalence of anaemia in children . 168 xii • Tables and Figures Table 11.8 Micronutrient intake among children . 171 Table 11.9 Presence of iodised salt in household . 172 Table 11.10.1 Nutritional status of women . 174 Table 11.10.2 Nutritional status of men . 176 Table 11.11 Prevalence of anaemia in women . 177 Table 11.12 Micronutrient intake among mothers . 180 Figure 11.1 Nutritional status of children by age . 157 Figure 11.2 Trends in nutritional status of children under age 5, Ghana 2003-2014 . 158 Figure 11.3 Infant feeding practices by age . 161 Figure 11.4 IYCF indicators on breastfeeding status . 162 Figure 11.5 IYCF indicators on minimum acceptable diet . 167 Figure 11.6 Trends in anaemia status among children age 6-59 months, Ghana 2003 2014 . 169 Figure 11.7 Trends in nutritional status among women age 15-49, Ghana 2003-2014 . 175 Figure 11.8 Trends in anaemia status among women age 15-49, Ghana 2003-2014 . 178 12 MALARIA . 181 Table 12.1 Household possession of mosquito nets . 183 Table 12.2 Access to an insecticide-treated net (ITN) . 184 Table 12.3 Use of mosquito nets by persons in the household . 186 Table 12.4 Use of existing ITNs . 187 Table 12.5 Use of mosquito nets by children . 189 Table 12.6 Use of mosquito nets by pregnant women . 190 Table 12.7 Source and cost of nets . 192 Table 12.8 Household disposal of mosquito nets . 193 Table 12.9 Mosquito net disposal . 193 Table 12.10 Indoor residual spraying against mosquitoes . 195 Table 12.11 Use of intermittent preventive treatment (IPTp) by women during pregnancy . 196 Table 12.12 Prevalence, diagnosis, and prompt treatment of children with fever . 198 Table 12.13 Source of advice or treatment for children with fever . 199 Table 12.14 Haemoglobin <8.0 g/dl in children . 200 Table 12.15 Prevalence of malaria in children . 201 Table 12.16 Exposure to messages on malaria by media source . 202 Table 12.17 Exposure to specific messages on malaria . 203 Figure 12.1 Percentage of the de facto population with access to an ITN in the household . 185 Figure 12.2 Ownership of, access to, and use of ITNs . 187 Figure 12.3 Trends in ITN use . 191 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 205 Table 13.1 Knowledge of AIDS . 207 Table 13.2 Knowledge of HIV prevention methods . 209 Table 13.3.1 Comprehensive knowledge about AIDS: Women . 211 Table 13.3.2 Comprehensive knowledge about AIDS: Men . 212 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV. 213 Table 13.5.1 Accepting attitudes towards those living with HIV/AIDS: Women . 215 Table 13.5.2 Accepting attitudes towards those living with HIV/AIDS: Men . 216 Table 13.6 Attitudes towards negotiating safer sexual relations with husband . 217 Table 13.7 Adult support of education about condom use to prevent AIDS . 218 Table 13.8.1 Multiple sexual partners: Women . 220 Table 13.8.2 Multiple sexual partners: Men . 221 Table 13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 222 Table 13.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 223 Table 13.11.1 Coverage of prior HIV testing: Women . 225 Table 13.11.2 Coverage of prior HIV testing: Men . 226 Table 13.12 Pregnant women counselled and tested for HIV . 227 Tables and Figures • xiii Table 13.13 Male circumcision . 228 Table 13.14 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 229 Table 13.15 Prevalence of medical injections . 231 Table 13.16 Comprehensive knowledge about AIDS and of a source of condoms among youth . 233 Table 13.17 Age at first sexual intercourse among young people . 234 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 236 Table 13.19.1 Multiple sexual partners in the past 12 months among young people: Women . 237 Table 13.19.2 Multiple sexual partners in the past 12 months among young people: Men. 237 Table 13.20 Age-mixing in sexual relationships among women age 15-19 . 238 Table 13.21 Recent HIV tests among young people . 239 Figure 13.1 Women and men seeking treatment for STIs . 230 Figure 13.2 Trends in age of first sexual intercourse . 235 14 HIV PREVALENCE . 241 Table 14.1 Coverage of HIV testing by residence and region . 243 Table 14.2 Coverage of HIV testing by selected background characteristics . 244 Table 14.3 HIV prevalence by age . 245 Table 14.4 HIV prevalence by socio-economic characteristics . 247 Table 14.5 HIV prevalence by demographic characteristics . 248 Table 14.6 HIV prevalence by sexual behaviour . 250 Table 14.7 HIV prevalence among young people by background characteristics . 252 Table 14.8 HIV prevalence among young people by sexual behaviour . 253 Table 14.9 HIV prevalence by other characteristics . 253 Table 14.10 Prior HIV testing according to current HIV status . 254 Table 14.11 HIV prevalence among couples. 255 Figure 14.1 HIV prevalence among all adults age 15-49 by sex, Ghana 2003 and 2014 . 246 15 ADULT HEALTH AND LIFESTYLE . 257 Table 15.1 History of hypertension . 259 Table 15.2 History of hypertension and actions taken to lower blood pressure . 260 Table 15.3 Coverage of blood pressure measurement among women and men . 260 Table 15.4.1 Blood pressure status: Women . 262 Table 15.4.2 Blood pressure status: Men . 263 Table 15.5 Consumption of fruit and vegetables . 265 Table 15.6 Household use of salty foods . 266 Table 15.7 Knowledge of iodised salt and perceived benefits of using iodised salt . 267 Table 15.8 Knowledge and attitude concerning tuberculosis . 269 Table 15.9.1 Use of tobacco: Women . 271 Table 15.9.2 Use of tobacco: Men . 272 Table 15.10.1 Health insurance coverage: Women . 273 Table 15.10.2 Health insurance coverage: Men . 274 Table 15.11 Registration with N/DHIS . 275 Table 15.12.1 Payment for N/DHIS coverage: Women . 276 Table 15.12.2 Payment for N/DHIS coverage: Men . 277 Table 15.13 Possession of a valid N/DHIS card . 278 Table 15.14 Out-of-pocket payment for medicines and services by respondents covered by N/DHIS . 279 Table 15.15 Need for health services not covered by N/DHIS . 280 Table 15.16 N/DHIS card holders’ perceived quality of services received . 281 Table 15.17 Client satisfaction among respondents covered by N/DHIS . 283 Table 15.18 Treatment seeking behaviour among all respondents . 284 Table 15.19 Type of health services received among all respondents . 285 xiv • Tables and Figures Table 15.20 Awareness of health services for children and pregnant women . 286 Table 15.21 Satisfaction with health services among all respondents . 287 Figure 15.1 Awareness of high blood pressure and treatment status among women and men age 15-49 with high blood pressure . 264 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 289 Table 16.1 Employment and cash earnings of currently married women and men . 290 Table 16.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 292 Table 16.2.2 Control over men’s cash earnings . 294 Table 16.3 Women’s control over their own earnings and over those of their husbands . 295 Table 16.4.1 Ownership of assets: Women . 296 Table 16.4.2 Ownership of assets: Men . 297 Table 16.5 Participation in decision making . 298 Table 16.6.1 Women’s participation in decision making by background characteristics . 298 Table 16.6.2 Men’s participation in decision making by background characteristics . 300 Table 16.7.1 Attitude towards wife beating: Women . 301 Table 16.7.2 Attitude towards wife beating: Men . 302 Table 16.8 Indicators of women’s empowerment . 303 Table 16.9 Current use of contraception by women’s empowerment . 304 Table 16.10 Ideal number of children and unmet need for family planning by women’s empowerment . 305 Table 16.11 Reproductive health care by women’s empowerment . 306 Table 16.12 Early childhood mortality rates by women’s status . 307 Table 16.13 Entitlement to maternity leave . 308 Table 16.14 Maternity leave . 309 Table 16.15 Median number of weeks women do not work before and after birth . 310 Table 16.16 Bridewealth negotiation . 311 Figure 16.1 Number of decisions in which currently married women participate . 299 APPENDIX A SAMPLE DESIGN . 317 Table A.1 Households . 318 Table A.2 Enumeration areas and enumeration area size . 318 Table A.3 Sample allocation of clusters and households . 319 Table A.4 Sample allocation of completed interviews with women and men. 319 Table A.5 Sample implementation: Women . 321 Table A.6 Sample implementation: Men . 322 Table A.7 Coverage of HIV testing by social and demographic characteristics: Women . 323 Table A.8 Coverage of HIV testing by social and demographic characteristics: Men . 324 Table A.9 Coverage of HIV testing by sexual behaviour characteristics: Women . 325 Table A.10 Coverage of HIV testing by sexual behaviour characteristics: Men . 326 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 327 Table B.1 List of variables for sampling errors, Ghana DHS 2014 . 329 Table B.2 Sampling errors for the national sample, Ghana 2014 . 330 Table B.3 Sampling errors for the urban sample, Ghana 2014 . 331 Table B.4 Sampling errors for the rural sample, Ghana 2014 . 332 Table B.5 Sampling errors for the Western region sample, Ghana 2014 . 333 Table B.6 Sampling errors for the Central region sample, Ghana 2014 . 334 Table B.7 Sampling errors for the Greater Accra region sample, Ghana 2014 . 335 Table B.8 Sampling errors for the Volta region sample, Ghana 2014 . 336 Table B.9 Sampling errors for the Eastern region sample, Ghana 2014 . 337 Table B.10 Sampling errors for the Ashanti region sample, Ghana 2014 . 338 Table B.11 Sampling errors for the Brong Ahafo region sample, Ghana 2014 . 339 Table B.12 Sampling errors for the Northern region sample, Ghana 2014 . 340 Tables and Figures • xv Table B.13 Sampling errors for the Upper East region sample, Ghana 2014 . 341 Table B.14 Sampling errors for the Upper West region sample, Ghana 2014 . 342 APPENDIX C DATA QUALITY TABLES . 343 Table C.1 Household age distribution . 343 Table C.2.1 Age distribution of eligible and interviewed women . 344 Table C.2.2 Age distribution of eligible and interviewed men . 344 Table C.3 Completeness of reporting . 345 Table C.4 Births by calendar years . 345 Table C.5 Reporting of age at death in days . 346 Table C.6 Reporting of age at death in months . 346 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 347 Foreword • xvii FOREWORD his report presents findings from the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey of 9,396 women age 15-49 and 4,388 men age 15-59 from 11,835 interviewed households. The primary purpose of the GDHS was to generate recent and reliable information on fertility, family planning, infant and child mortality, maternal and child health, and nutrition. In addition, the survey collected information on malaria treatment, prevention, and prevalence among children age 6-59 months; blood pressure among adults; anaemia among women and children; and HIV prevalence among adults. This information is essential for making informed policy decisions and for planning, monitoring, and evaluating programmes related to health in general, and reproductive health in particular, at both the national and regional levels. The 2014 GDHS is the sixth in a series of population and health surveys conducted in Ghana as part of the global Demographic and Health Surveys (DHS) Program. The survey was implemented by the Ghana Statistical Service (GSS), the Ghana Health Service (GHS), and the National Public Health Reference Laboratory (NPHRL) of the GHS. Financial support for the survey was provided by the United States Agency for International Development (USAID), the Global Fund through the Ghana AIDS Commission (GAC) and the National Malaria Control Programme (NMCP), the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the International Labour Organization (ILO), the Danish International Development Agency (DANIDA), and the Government of Ghana. ICF International provided technical assistance through The DHS Program, a USAID-funded project offering support and technical assistance in the implementation of population and health surveys in countries worldwide. Dr. Philomena Efua Nyarko Government Statistician Ghana Statistical Service T Acronyms • xix ACRONYMS ACT artemisinin-based combination therapy AIDS acquired immunodeficiency syndrome ANC antenatal care ARI acute respiratory infection ASFR age-specific fertility rate BCG Bacille Calmette-Guerin BMI body mass index BOG Bank of Ghana CAFE computer assisted field editing CBR crude birth rate CDC Centers for Disease Control and Prevention CDD Control of Diarrhoeal Diseases CEDAW Convention on the Elimination of All Forms of Discrimination against Women CHPS community-based health planning and services CSPro Census and Survey Processing System CPR contraceptive prevalence rate DANIDA Danish International Development Agency DBS dried blood spot DFID Department for International Development DOTS directly observed treatment, short-course EA enumeration area ELISA enzyme-linked immunosorbent assay EQA external quality assurance GAR gross attendance ratio GAC Ghana AIDS Commission GDHS Ghana Demographic and Health Survey GDP gross domestic product GETFUND Ghana Education Trust Fund GFR general fertility rate GHS Ghana Health Service GPI gender party index GPS Global Positioning System GSS Ghana Statistical Office HCT HIV counselling and testing HepB hepatitis B HIV human immunodeficiency virus IFSS Internet File Streaming System ILO International Labour Organization IMCI integrated management of childhood illnesses IPTp intermittent preventive treatment IRS indoor residual spraying ITN insecticide-treated net xx • Acronyms IUD intrauterine device IYCF Infant and Young Child Feeding LAM lactational amenorrhoea method LEAP livelihood empowerment against poverty LPG liquid petroleum gas LLIN long-lasting insecticidal net MDG Millenium Development Goal MoH Ministry of Health MWRWH Ministry of Water Resource Works and Housing NACP National AIDS/STI Control Programme NAR net attendance ratio NDPC National Development Planning Commission NGO nongovernmental organisation NHIS National Health Insurance Scheme NMCP National Malaria Control Programme NMIMR Noguchi Memorial Institute for Medical Research NPHRL National Public Health and Reference Laboratory ORS oral rehydration salt ORT oral rehydration therapy PAHO Pan American Health Organization PHC population and housing census PLHIV people living with HIV/AIDS PMI President’s Malaria Initiative PMTCT prevention of mother-to-child transmission RDT rapid diagnostic test RHF recommended home fluid RTI reproductive tract infection SHS secondhand smoke STI sexually transmitted infection TB tuberculosis TFR total fertility rate UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD vitamin A deficiency WASH water, sanitation and hygiene WHO World Health Organization Millennium Development Goal Indicators • xxi MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Ghana 2014 Sex Total Indicator Male Female 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age 5 10.6 11.6 11.0 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 70.8 70.5 70.6 2.3 Literacy rate of 15 to 24-year-olds2 89.3a 80.9 85.1b 3. Promote gender equality and empower women 3.1 Ratio of girls to boys in primary, secondary, and tertiary education 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 1.0 3.1c Ratio of girls to boys in tertiary education3 na na 1.0 4. Reduce child mortality 4.1 Under-5 mortality rate4 78 62 60 4.2 Infant mortality rate4 52 43 41 4.3 Proportion of 1-year-old children immunized against one dose of measles 88.2 90.3 89.3 5. Improve maternal health 5.2 Percentage of births attended by skilled health personnel5 na na 73.7 5.3 Contraceptive prevalence rate6 na 26.7 na 5.4 Adolescent birth rate7 na 76.3 na 5.5a Antenatal care coverage: at least one visit8 na 97.0 na 5.5b Antenatal care coverage: four or more visits9 na 87.3 na 5.6 Unmet need for family planning na 29.9 na 6. Combat HIV/AIDS, malaria, and other diseases 6.1 HIV prevalence among the population age 15-24 0.2 1.5 0.8 6.2 Condom use at last high-risk sex10 39.3 19.2 29.3 6.3 Percentage of the population age 15-24 with comprehensive correct knowledge of HIV/AIDS11 27.2 19.9 23.6 6.4 Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 0.97 0.92 0.94 6.7 Percentage of children under 5 sleeping under insecticide-treated bed nets 47.5 45.6 46.6 6.8 Percentage of children under 5 with fever who are treated with appropriate antimalarial drugs12 46.8 50.6 48.5 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source13 57.0 71.4 64.2 7.9 Percentage of population with access to improved sanitation14 20.5 9.6 15.0 na = Not applicable 1 The ratio is based on reported attendance, not enrollment, in primary education among primary school age children (6-11 years). The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, Net enrollment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrollment, among 6-11-year-olds for primary, 12-17-year-olds for secondary, and 18-24-year- olds for tertiary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the five-year period preceding the survey. 5 Among births in the five years preceding the survey 6 Percentage of currently married women age 15-49 using any method of contraception 7 Equivalent to the age-specific fertility rate for women age 15-19 for the three years preceding the survey, expressed in terms of births per 1,000 women age 15-19 8 With a skilled provider 9 With any health care provider 10 High-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. Expressed as a percentage of men and women age 15- 24 who had higher-risk sex in the past 12 months. 11 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 12 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and who received any antimalarial drug 13 Percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, protected spring, or rainwater collection. 14 Percentage of de jure population whose household has a flush toilet, ventilated improved pit latrine, pit latrine with a slab, or composting toilet and does not share its facility with other households a Restricted to men in a subsample of households selected for the male interview b The total calculated as the simple arithmetic mean of the percentages in the columns for male and females xxii • Map of Ghana Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geography he Republic of Ghana is centrally located on the West African coast. It has a total land area of 238,537 square kilometres, and it is bordered by three French-speaking countries: Togo on the east, Burkina Faso on the north and northwest, and Côte d’Ivoire on the west. The Gulf of Guinea lies to the south and stretches across the 560-kilometre coastline. Ghana is a lowland country except for a range of highlands on the eastern border. The highest elevation is Mt. Afadjato, 884 metres above sea level, found in the Akuapem-Togo ranges, west of the Volta River. Ghana can be divided into three ecological zones: the low, sandy coastal plains, with several rivers and streams; the middle and western parts of the country, characterised by a heavy canopy of semi- deciduous rainforests, with many streams and rivers; and a northern savannah, which is drained by the Black and White Volta Rivers. The Volta Lake, created by the hydroelectric dam in the East, is one of the largest artificial lakes in the world. Ghana has a tropical climate with temperatures and rainfall patterns that vary according to distance from the coast and elevation. The eastern coastal area is comparatively dry, the southwestern corner is hot and humid, and the north of the country is hot and dry. The average annual temperature is about 26ºC (79ºF). There are two distinct rainy seasons in the southern and middle parts of the country, from April to June and September to November. The North is, however, characterised by one rainfall season that begins in May, peaks in August, and lasts until September. Annual rainfall ranges from about 1,015 millimetres (40 inches) in the North to about 2,030 millimetres (80 inches) in the Southwest. The harmattan, a dry dusty desert wind, blows from the northeast and covers much of the country between December and March, lowering the humidity and visibility, and also creates very warm days and cool nights in the North. In the South, the effects of the harmattan are felt mainly in January. 1.1.2 History Ghana gained independence from British colonial rule on 6 March 1957, and became a republic in the British Commonwealth of Nations on 1 July 1960 with Accra as its administrative and political capital. Ghana operates a multi-party democracy with an executive president who is elected for a term of four years with a maximum of two terms. There is a parliament elected every four years, an independent judiciary, and a vibrant media. There are 10 administrative regions in Ghana: Western, Central, Greater Accra, Volta, Eastern, Ashanti, Brong Ahafo, Northern, Upper East, and Upper West. Ghana’s population was estimated at 27 million in 2014 (GSS 2013a). The Ashanti, Eastern, and Greater Accra regions together constitute about 50 percent of the country’s population. Upper East is the least populated region, accounting for 2 percent of the total population of Ghana. The regions are subdivided into 216 districts to ensure equitable resource allocation and efficient, effective administration at the local level (GSS 2013b). The Ghanaian population is made up of several ethnic groups, with the Akans constituting the largest group (48 percent), followed by the Mole-Dagbani (17 percent), Ewe (14 percent), Ga-Dangme (7 percent), and others (GSS 2013b). T 2 • Introduction 1.1.3 Economy The structure of the Ghanaian economy has seen minimal changes over the past two decades. The agriculture sector, previously the largest contributor to the Ghanaian economy, has been overtaken by the service and industry sectors. By 2014, the service sector was the fastest growing sector of the economy, contributing 52 percent of the gross domestic product (GDP), followed by the industry sector, at 27 percent, and the agriculture sector, at 22 percent. In 2014, the service sector recorded its highest growth, of 6 percent, followed by the agricultural sector with 5 percent growth, and the industry sector with 1 percent growth (GSS 2015). Overall, the 2014 real annual GDP grew by 4 percent compared with 7 percent growth recorded in 2013 (GSS 2015). About 45 percent of the economically active population are engaged in agriculture, and 41 percent provide services. A high proportion of the employed population of Ghana works in the informal sector, the majority being self-employed (GSS 2014). The leading export commodities of Ghana are cocoa, gold, and timber. Recently, the economy has diversified to the export of non-traditional commodities such as pineapples, bananas, yams, and cashew nuts. The tourism industry contributes substantially to the country's economy, as a key driver of economic growth. The industry is currently the third largest foreign exchange earner after merchandise exports and remittances from abroad and has become one of the most important and fastest growing sectors of the Ghanaian economy (BOG 2007). Over the past decade, the government of Ghana has embarked on various economic and poverty- reduction programmes designed to improve the living conditions of its citizenry. The Livelihood Empowerment Against Poverty (LEAP) programme was introduced in 2007 and, in 2008, the poor began to receive cash support on a monthly basis. Many changes have occurred in the education sector over the past 15 years. Pre-school education has officially been incorporated into the basic education as a part of primary and junior high school. All primary schools are required to have nurseries or kindergartens. In the 2005-2006 academic year, the government absorbed school fees for all pupils enrolled in basic public schools, resulting in free education (Darko et al. 2009). During the same period, a school feeding programme was introduced on a pilot basis and has since been extended to all basic schools. While the programme aims at improving the nutritional status of school pupils, a secondary effect has been to increase enrolment. At the secondary level, the senior high school was introduced in the 2007-2008 academic year, expanding the system from three to four years, but this policy was reversed in 2009. The introduction of the Ghana Education Trust Fund (GETFUND), a public trust set up by an Act of Parliament in the year 2000, has brought many improvements to the education system. The fund provides educational infrastructure such as buildings to support the country’s tertiary institutions and, as a result, has improved teaching and learning within these institutions. 1.2 DEMOGRAPHIC PROFILE Sources of demographic information about the Ghanaian population include censuses, surveys, and administrative data. Population censuses provide more comprehensive demographic information than other sources. Ghana has completed five censuses since gaining independence in 1957. The first one was conducted in 1960 and reported a population of 6.7 million. The 1970 census recorded 8.6 million people, and the 1984 census, 12.3 million. In 2000, the Population and Housing Census (PHC) recorded 18.9 million, while in the 2010 PHC, 24.7 million were recorded. The average annual growth rate between 2000 and 2010 was 2.5 percent. The growth rates over individual periods were 2.4 percent, 2.6 percent, 2.7 Introduction • 3 percent, and 25 percent during 1960-1970, 1970-1984, 1984-2000, and 2000-2010, respectively (Table 1.1). The population density has increased over the years from 29 persons per square kilometre (persons/km2) in 1960 to 103 persons/km2 in 2010. The proportion of the population living in urban areas has more than doubled in the last five decades, expanding from 23 percent in 1960 to 51 percent in 2010. The sex ratio of 102.2 males per 100 females recorded in 1960 has declined to 95.2 males per 100 females in 2010. The proportion of the population under age 15 has also decreased from 45 percent in 1960 to 38 percent in 2010 (Table 1.1), while the proportion of the population age 65 years and older increased from 3 percent to 5 percent over the same period (data not shown separately). Over the last five decades, life expectancy at birth has increased from 38 years to 60 years among males and from 43 years to 63 years among females (GSS 1979, 1985, 2002, and 2013b). Table 1.1 Basic demographic indicators Indicators Pop census 1960 Pop census 1970 Pop census 1984 Pop & housing census 2000 Pop & housing census 2010 Population (millions) 6.7 8.6 12.3 18.9 24.7 Annual growth rate (percent) na 2.4 (1960-1970) 2.6 (1970-1984) 2.7 (1984-2000) 2.5 (2000-2010) Density (population/km2) 29 36 52 79 103 Percent urban 23 29 32 44 51 Sex Ratio 102.2 98.5 97.3 97.9 95.2 Population under 15 years 45 48 46 42 40 Life expectancy (years) Male 38 45 50 55 60 Female 43 48 54 60 63 na= Not applicable Sources: Ghana Statistical Service (GSS), 1979, 1985, 2002, and 2013b Population and housing censuses are resource intensive, expensive to implement, and generally take place at 10-year intervals. Sample surveys are, therefore, important for informing demographic profiles during inter-censal periods. They are conducted to collect a wide range of data to complement the census data. Sample surveys are cheaper and can be implemented more frequently and at regular intervals. The Ghana Demographic and Health Survey (GDHS), which is a household survey, is an example of a sample survey data collection tool. Another important but often neglected data source in Ghana is the administrative data. These data are generated as a by-product of events and processes, and they provide relatively up-to-date information to fill gaps in both censuses and surveys. Vital registration systems (birth and death registration), health systems (immunisations), and education data (enrolment) are examples of administrative data. 1.3 POPULATION POLICY AND REPRODUCTIVE HEALTH PROGRAMMES The National Population Policy of Ghana was formulated in 1969 in recognition of the simultaneous high growth of population and fertility. The policy was revised in 1994 because of its modest impact after 25 years of implementation. The revision took into account emerging issues such as HIV/AIDS, population and the environment, and concerns about the elderly and children. It developed new strategies that would ensure the achievement of its goals and objectives. The revision of the population policy also entailed concerted effort to systematically integrate population variables in all areas of national development and programme planning (NPC 1994). 4 • Introduction Some selected targets of the revised population policy included the following: • Reduce the total fertility rate (TFR) from 5.5 in 1993 to 5.0 by 2000, 4.0 by 2010, and 3.0 by 2020 • Achieve a contraceptive prevalence rate (CPR) with modern methods of 15 percent by the year 2000, 28 percent by 2010, and 50 percent by the year 2020 • Reduce the population growth rate from about 3 percent per annum to 1.5 percent per annum by the year 2020 • Increase life expectancy to age 70 years by the year 2020 (NPC 1994) The attainment of these population targets is recognised as an integral component of the national strategy to accelerate economic development, eradicate poverty, and enhance the quality of life of all Ghanaians. In collaboration with the United Nations Population Fund (UNFPA), the United States Agency for International Development (USAID), the World Bank, and other development partners, Ghana has implemented several projects aimed at reducing reproductive health problems among its population. Support from these agencies has targeted policy coordination, implementation, and service delivery. The government is committed to improving access and equity of access to essential health care services. The priority areas identified include HIV/AIDS and other sexually transmitted infections (STIs), malaria, tuberculosis, guinea worm disease, poliomyelitis, reproductive health, maternal and child health, accidents and emergencies, noncommunicable diseases, oral health and eye care, and specialised services. Emphasis is also being placed on regenerative health and preventive as well as community-based health care services. This has necessitated the introduction of the Community-based Health Planning and Services (CHPS) programme in which trained nurses are stationed in selected communities to provide health care services to members of the communities. In response to the HIV/AIDS epidemic, the government of Ghana set up the National AIDS Commission to oversee the implementation of HIV/AIDS programmes using a multi-sectoral approach and to ensure that HIV/AIDS prevention education, treatment, care, and support reach every corner of the country. The Ghana Health Service (GHS) also set up the National AIDS Control Programme (NACP) to offer HIV/AIDS prevention and education services. The combined efforts of all stakeholders ensured the implementation of the Ghana HIV/AIDS Strategic Framework: 2001-2005 (World Bank 2003). These collaborative efforts have had a positive impact. In 2013, only 1.3 percent of Ghanaian adults were HIV positive (GHS 2014). The Roll Back Malaria, tuberculosis (TB-DOTS), and integrated management of childhood illnesses (IMCI) are also priority areas under the country’s health care system. Other health interventions instituted as part of the government’s efforts to make health care accessible and affordable to all include the introduction of the National Health Insurance Scheme (NHIS) and a free maternal care programme (United Nations 2008). Sustainable accessibility and availability of improved water and sanitation are essential to the health of a population. Therefore, extensive efforts are being made in Ghana to ensure universal access to safe drinking water and improved sanitation facilities by the year 2025 (MWRWH 2009). The Ghana WASH Project, under the auspices of the Ministry of Local Government and Rural Development, is a USAID-funded initiative. The goal of the project is to improve water and sanitation facilities and to increase hygiene education among rural and peri-urban communities to prevent the spread of diseases like diarrhoea, dysentery, cholera, and, recently, Ebola. The Ghana WASH Project is supported by a number of Introduction • 5 agencies, including Relief International, the Adventist Development Relief Agency, and Winrock International. 1.4 OBJECTIVES AND ORGANISATION OF THE SURVEY The primary objective of the 2014 GDHS was to generate recent reliable information on fertility, family planning, infant and child mortality, maternal and child health, and nutrition. In addition, the survey collected specialised data on malaria treatment, prevention, and prevalence among children age 6-59 months; blood pressure among adults; anaemia among women and children; and HIV prevalence among adults. This information is essential for making informed policy decisions and for planning, monitoring, and evaluating programmes related to health in general, and reproductive health in particular, at both the national and regional levels. Analysis of data collected in the 2014 GDHS provides updated estimates of basic demographic and health indicators covered in the earlier rounds of the 1988, 1993, 1998, 2003, and 2008 surveys. The GDHS will assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of Ghana’s population. The 2014 GDHS also provides comparable data for long-term trend analysis in Ghana, since the surveys were implemented by the same organisation, using similar data collection procedures. Furthermore, the survey adds to the international database on demographic and health–related information for research purposes. The survey was implemented by the Ghana Statistical Service (GSS), the Ghana Health Service (GHS), and the National Public Health Reference Laboratory (NPHRL) of the GHS. The Noguchi Memorial Institute for Medical Research (NMIMR) performed the external quality assurance testing for the malaria and HIV testing component of the 2014 Ghana DHS survey. Financial support for the survey was provided by the United States Agency for International Development (USAID), the Global Fund through the Ghana AIDS Commission (GAC) and the National Malaria Control Programme (NMCP), the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the International Labour Organization (ILO), the Danish International Development Agency (DANIDA), and the Government of Ghana. ICF International provided technical assistance through The DHS Program, a USAID-funded project offering support and technical assistance in the implementation of population and health surveys in countries worldwide. In addition to the main survey, a follow up study on family planning was conducted by a different team on a subsample of households selected for the GDHS survey. The main goal of this study was to better understand the underlying factors behind observed variations in unmet need and to strengthen assessments of the demand for family planning. The research team re-interviewed a subsample of the selected GDHS original female respondents in 13 clusters who consented to be re-interviewed. Women age 15-44 who were not currently using family planning or who reported not wanting their current pregnancy or their most recent live birth were eligible for the follow-up survey. Additionally, a randomly selected 10 percent of current female users of family planning age 15-44 in those clusters also were eligible for the study. Results of the follow up study on unmet need for family planning are not discussed in this report and will be published in a separate report. 1.5 SAMPLE DESIGN The sampling frame used for the 2014 GDHS is an updated frame from the 2010 Ghana Population and Housing Census provided by the Ghana Statistical Service (GSS 2013b). The sampling frame excluded nomadic and institutional populations such as persons in hotels, barracks, and prisons. The 2014 GDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as for urban and rural areas and each of Ghana’s 10 administrative regions. The first stage involved selecting sample points (clusters) consisting of enumeration areas (EAs) 6 • Introduction delineated for the 2010 PHC. A total of 427 clusters were selected, 216 in urban areas and 211 in rural areas. The second stage involved the systematic sampling of households. A household listing operation was undertaken in all the selected EAs in January-March 2014, and households to be included in the survey were randomly selected from the list. About 30 households were selected from each cluster to constitute the total sample size of 12,831 households. Because of the approximately equal sample sizes in each region, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed and have their blood pressure measured. In half of the households, all men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. In addition, in the subsample of households selected for the male survey: • blood pressure measurements were performed among eligible men who consented to being tested; • children age 6-59 months were tested for anaemia and malaria with the parent’s or guardian’s consent; • eligible women who consented were tested for anaemia; • blood samples were collected for laboratory testing of HIV from eligible women and men who consented; and • height and weight information was collected from eligible women, men, and children age 0- 59 months. 1.6 QUESTIONNAIRES Three questionnaires were used for the 2014 GDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires, which were based on standard Demographic and Health Survey (DHS) questionnaires, were adapted to reflect the population and health issues relevant to Ghana. Comments on the questionnaires were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. The definitive questionnaires were first prepared in English; they were then translated into the major local languages, namely Akan, Ga, and Ewe. The Household Questionnaire was used to list all the members of and visitors to the selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women and men who were eligible for individual interviews. The Household Questionnaire also included questions on child education as well as the characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various durable goods. The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics: Introduction • 7 • Background characteristics (age, education, media exposure, etc.) • Birth history and child mortality • Residence of children under age 18 not living with their parents • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Women’s work and husbands’ background characteristics • Women’s empowerment indicators, maternity leave, and bridewealth • Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs) • Knowledge, attitudes, and behaviour related to other health issues (e.g., smoking, tuberculosis, and blood pressure) In half of the selected households, the Man’s Questionnaire was administered to all men age 15-59. The Man’s Questionnaire collected much of the same information found in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. 1.7 BLOOD PRESSURE MEASUREMENT, ANTHROPOMETRY, ANAEMIA TESTING, AND HIV TESTING In half of the households selected for the male survey, the 2014 GDHS incorporated several biomarkers: blood pressure measurement, anthropometry, anaemia testing, and HIV testing. The survey protocol, including biomarker collection, was reviewed and approved by the Ghana Health Service Ethical Review Committee and the Institutional Review Board of ICF International. Blood pressure. During the individual interview, three blood pressure measurements were taken from consenting women age 15-49 in all the selected households and from consenting men age 15-59 in the subsample of households selected for the male survey (half of the households). Blood pressure was measured using the LIFE SOURCE® UA-767 Plus blood pressure monitor: a digital oscillometric blood pressure measuring device with automatic upper-arm inflation and automatic pressure release. Measurements were taken at intervals of 10 minutes or more. The average of the second and third measurements was used to classify the respondent with respect to hypertension, according to internationally recommended categories (WHO 1999). The results, as well as information about the symptoms of high blood pressure and ways in which it can be prevented, were provided to the respondent via a blood pressure reporting form. Anthropometry. In the subsample of households selected for the male survey, height and weight measurements were recorded for children age 0-59 months, women age 15-49, and men age 15-59. Anaemia testing. Blood specimens for anaemia testing were collected in half of the selected households (the subsample selected for the male survey) from women age 15-49 who voluntarily consented to be tested and from all children age 6-59 months for whom consent was obtained from their parents or the adult responsible for the children. Blood samples were drawn from a drop of blood taken 8 • Introduction from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Haemoglobin analysis was carried out on-site using a battery-operated portable HemoCue analyser. All households in which anthropometry and/or anaemia testing was conducted were given an Anaemia and Height and Weight Brochure containing information on height and weight measurements of all children measured, as well as information on causes and prevention of anaemia. The haemoglobin test results for all children tested in the household were entered into the Malaria and Anaemia Brochure and given to the parent or responsible adult. Finally, an anaemia referral form was given to facilitate immediate treatment at a nearby health facility of children with a haemoglobin level less than 7.0 g/dl, of nonpregnant women with a haemoglobin level less than 7.0 g/dl, and of pregnant women with a haemoglobin level less than 9.0 g/dl. Malaria testing. In half of the selected households, children age 6-59 months were also tested for malaria in the field using SDBioline Malaria Ag P.f/Pan, a rapid diagnostic test (RDT). This high- sensitivity and high-specificity test detects malaria antigens from capillary blood samples. The children’s RDT results were recorded in the Malaria and Anaemia Brochure and given to the parent or responsible adult. In accordance with the Ghanaian national treatment guidelines, children who tested positive for malaria by the RDT and did not exhibit symptoms of severe malaria were provided with ACT (excluding children who were on ACT treatment at the time of the survey or who had taken ACT in the previous two weeks prior to the testing). Children showing signs or symptoms of severe malaria were given a malaria referral form to seek immediate treatment at a nearby health facility. In addition, blood was collected on glass slides from the same children who were tested with RDT and sent to the National Public Health Reference Laboratory (NPHRL) in Accra for malaria microscopy through reading of thick-smear slides. As mentioned above, the Noguchi Memorial Institute for Medical Research (NMIMR) performed the external quality assurance testing (EQA) for the malaria testing component of the 2014 Ghana DHS survey. HIV testing. Health technicians collected finger-prick blood specimens to test for HIV in women age 15-49 and men age 15-59 in the subsample of households selected for the male survey who consented to be tested. The protocol for blood specimen collection and analysis was based on the anonymous linked protocol developed for The DHS Program. This protocol allows for merging of HIV test results with the sociodemographic data collected in the individual questionnaires after removal of all information that could potentially identify an individual. Health technicians explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If a respondent consented to HIV testing, five blood spots from the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. A duplicate label was attached to the Biomarker Section of the Household Questionnaire. A third copy of the same barcode was affixed to a dried blood spot transmittal sheet to track the blood samples from the field to the laboratory. Respondents were asked whether they would consent to having the laboratory store their blood sample for future unspecified testing. If respondents did not consent to additional testing using their sample, it was indicated on the Biomarker Section of the Household Questionnaire that they refused additional tests using their specimen, and the words no additional testing were written on the filter paper card. Each respondent, whether he or she provided consent or not, was given an informational brochure on HIV and a list of nearby sites providing HIV counselling and testing (HCT) services. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected from the field and transported to NPHRL. Once they arrived at the central laboratory, each blood sample was logged into the CSPro HIV Test Tracking System database, given a laboratory number, and stored at -20˚C until tested. Introduction • 9 The HIV testing protocol stipulated that blood could be tested only after questionnaire data collection had been completed, data had been verified and cleaned, and all unique identifiers other than the anonymous barcode number had been removed from the data file. The testing algorithm calls for testing all samples on the first assay test, the Vironostika® HIV Ag/Ab (Biomérieux) enzyme-linked immunoassay (ELISA). A negative result is recorded as negative. All positives are subjected to a second ELISA, the Enzygnost® HIV Integral II assay (Siemens). Positive samples on the second test are recorded as positive. If the first and second tests are discordant, the two ELISAs are repeated in parallel. If the results remain discordant, a third confirmatory blot assay, the Inno- Lia HIV I/II Score (Innogenetics, Ghent, Belgium), is used. The final result is recorded as positive if the blot assay confirms it to be positive and negative if the blot assay confirms it to be negative. If the blot assay results are indeterminate, the sample is recorded as indeterminate. External quality assurance testing was done by the Noguchi Memorial Institute for Medical Research. After HIV testing has been completed, the HIV test results for the 2014 GDHS were entered into a spreadsheet with a barcode as the unique identifier. The barcode was used to link the HIV test results with the data from the individual interviews. Data from the HIV results were then linked to demographic and health data. 1.8 PRETEST Ten women and five men participated in the pretest training and field practice of the GDHS survey protocol and instruments over a three-week period, 9-28 June, 2014. Most participants had participated in previous GDHS surveys. During the first week of training, seven health technicians (one woman and six men) hired through the National Public Health and Reference Laboratory in Accra, were trained together with the interviewers on general interviewing techniques and how to conduct interviews using the Household Questionnaire. The biomarker portion of the training was conducted from 16-21 June, 2014. The pretest participants were later used as field supervisors or editors, or as field coordinators to facilitate the data collection during the main fieldwork. Six trainers assigned by the GSS conducted the training with support from ICF International. The participants actively discussed the questionnaires and made suggestions to modify all versions. Field practice took place over four days in both rural and urban locations. Interviewers and health technicians were divided into five teams (two female interviewers, one male interviewer, and one health technician). During the pretest field practice, a total of 88 households, 77 women, and 34 men, were interviewed in English, Akan, Ewe, and Ga. Following field practice, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.9 TRAINING OF FIELD STAFF Training of the field staff took place over four weeks (4-30 August 2014) with 139 field data collectors (67 women and 72 men) and 55 health technicians (26 women and 29 men). Training was conducted at the Winneba Windy Lodge Hotel in the Central Region about 65 kilometres from Accra. During the first week, all trainees were instructed in standard DHS procedures, including general interviewing techniques, conducting interviews at the household level, and measuring blood pressures. During the second week, health technicians began separate biomarker training while the other field staff (data collectors) continued to train on the Woman’s and the Man’s questionnaires, including a detailed review of each question and mock interviews between participants in the classroom. To provide the health technicians with practical experience measuring anthropometry among children, representatives from UNICEF and GHS organised a standardisation exercise with the health technicians. Measurements from health technicians were compared to a reference measure, which helped health technicians correct and improve on their measurement techniques whenever applicable. 10 • Introduction All trainees were also given an overview of the 2014 GDHS biomarker collection protocol that summarised eligibility for each biomarker, appropriate procedures for obtaining informed consent, and sample transportation logistics. In addition, nine data entry personnel (seven women and two men) attended the first two weeks of questionnaire training, so that they would be familiar with the survey instruments at a later stage when they received and entered data from the completed questionnaires. During the final week, ICF staff trained field editors in the computer assisted field editing (CAFE) system. Field supervisors were trained in the collection of global positioning system (GPS) data using the Garmin eTrex10 model. Practice interviews with real respondents took place over a course of three days (24-26 August 2014) in areas outside the 2014 GDHS sample points. Participants were evaluated through homework, in-class exercises, quizzes, and observations made during field practice. After training, they were assigned to 25 teams composed of one supervisor, one field editor, two female interviewers, one male interviewer, and two health technicians. Fourteen interviewers and five health technicians were selected as reserve staff. 1.10 FIELDWORK Data collection was carried out by the 25 field teams from early September to mid-December 2014. Senior staff members from the Ghana Statistical Service and the Ghana Health Service coordinated and monitored the fieldwork. Paper questionnaires were used to conduct the interviews. After the interviews, field editors entered the questionnaire data into laptops, using passwords to protect the files. Electronic data files were transferred to the central office every few days via the secured Internet File Streaming System (IFSS). Fieldwork monitoring was carried out by staff of GSS, GHS, and two survey technical specialists from The DHS Program. Data collection took 3.5 months. 1.11 DATA PROCESSING The data processing operation included 100 percent verification (also called second data entry) and secondary editing, which involved resolution of computer-identified inconsistencies. The data processing activities at the central office were led by one key GSS officer who took part in the main fieldwork training. Data processing was accomplished using CSPro software. Data entry and editing were initiated in September 2014 and completed in February 2015. 1.12 RESPONSE RATES Table 1.2 shows response rates for the 2014 GDHS. A total of 12,831 households were selected for the sample, of which 12,010 were occupied. Of the occupied households, 11,835 were successfully interviewed, yielding a response rate of 99 percent, the same as the 2008 GDHS household response rate (GSS, GHS, and ICF Macro 2009). In the interviewed households, 9,656 eligible women were identified for individual interviews; interviews were completed with 9,396 women, yielding a response rate of 97 percent. In the subsample of households selected for the male survey, 4,609 eligible men were identified and 4,388 were successfully interviewed, yielding a response rate of 95 percent. The lower response rate for men was likely due to their more frequent and longer absences from the household. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Ghana 2014 Residence Total Result Urban Rural Household interviews Households selected 6,492 6,339 12,831 Households occupied 6,070 5,940 12,010 Households interviewed 5,939 5,896 11,835 Household response rate1 97.8 99.3 98.5 Interviews with women age 15-49 Number of eligible women 4,753 4,903 9,656 Number of eligible women interviewed 4,602 4,794 9,396 Eligible women response rate2 96.8 97.8 97.3 Interviews with men age 15-59 Number of eligible men 2,189 2,420 4,609 Number of eligible men interviewed 2,050 2,338 4,388 Eligible men response rate2 93.7 96.6 95.2 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter provides an overview of demographic and socioeconomic characteristics of the household population, including information on housing facilities and characteristics, household assets, wealth status, and education. These data serve as a basis for understanding the socioeconomic status of households. The chapter also presents information on birth registration, children’s living arrangements and orphanhood, and children’s educational attainment, helping to provide an understanding of the general social environment in which children live. In the 2014 GDHS, a household is defined as a person or group of related and unrelated persons who usually live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as the head of the household, and who have common cooking and eating arrangements. Information was collected from all usual members of a selected household (de jure population) as well as persons who had stayed in the selected household the night before the interview (de facto population). The difference between these two populations is very small, so all tables in this report refer to the de facto population unless otherwise specified to maintain comparability with other DHS reports. 2.1 HOUSEHOLD CHARACTERISTICS Access to basic utilities, sources of drinking water, and water treatment practices; access to sanitation facilities, housing structure; crowdedness of dwelling spaces; and type of fuel used for cooking are physical characteristics of a household that are used to assess the general well-being and socioeconomic status of household members. Millennium Development Goal 7 (MDG 7), which focuses on environmental sustainability, is measured according to the percentage of the population using solid fuels, those with sustainable access to an improved water source, and the proportion with access to improved sanitation. This section provides information from the 2014 GDHS on household drinking water, household sanitation facilities, hand-washing practices, housing characteristics, and availability of basic amenities and utilities. T Key Findings: • Six in 10 households in Ghana have access to an improved source of drinking water, including a piped source within the dwelling, yard, or plot; a public tap, standpipe, tube well, or borehole; a hand pump, protected well, or protected spring; and rainwater. Three in 10 households use bottled or sachet water. • Only 14 percent of households have an improved toilet facility that is not shared with other households. • Seventy-eight percent of households have electricity. • More than 7 in 10 of residents in Northern and Upper East regions and 6 in 10 residents in Upper West region are in the lowest wealth quintile. • Forty-two percent of the population in Ghana is under age 15. • Thirty-four percent of households are headed by women. • Seventy-one percent of children under 5 had their births registered. • Among households in which the place for hand washing was observed, 37 percent of households have no water, soap, or other cleansing agent for hand washing • Twenty-six percent of females and 18 percent of males age 6 and older have no education. 12 • Housing Characteristics and Household Population 2.1.1 Water and Sanitation The basic determinants of better health, such as access to safe water and sanitation, are still a basic problem in Ghana. Limited access to safe drinking water and sanitation facilities and poor hygiene are associated with skin diseases, acute respiratory infections (ARIs), and diarrhoeal diseases, the leading preventable diseases. The source of drinking water is important because potentially fatal diseases, such as diarrhoeal diseases, guinea worm, typhoid, cholera, schistosomiasis, trachoma, and dysentery, are water- related diseases. Table 2.1 shows the percent distribution of the households and the de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to background characteristics. The source of drinking water is an indicator of its suitability for drinking. Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Even if the water is obtained from an improved source, it may be contaminated during transport or storage if fetched from a source not immediately accessible to the household. Six in ten households in Ghana (60 percent) obtain drinking water from an improved source, including a piped source within the dwelling, yard, or plot; a public tap, standpipe, tube well, or borehole; a hand pump, protected well, or protected spring; and rainwater. An additional 30 percent of households use bottled or sachet water.1 Ten percent of households still rely on unimproved sources. The most common source of drinking water in urban areas is sachet water (43 percent), followed by public tap or standpipe (23 percent). In rural households, the most common source for drinking water is tube well or borehole (41 percent), followed by public tap or standpipe (19 percent). The most notable change in access to drinking water sources between 2008 and 2014 is the increase in the proportion of households using sachet water from 8 percent to 29 percent in the past six years. On the other hand, the proportion of households that use drinking water from public tap/standpipe or tube well/borehole has decreased from 57 percent in the 2008 GDHS to 44 percent in the 2014 GDHS, most likely due to switching to sachet water in the latter survey. Fifteen percent of households have water on their premises, a decline from 23 percent reported in the 2008 GDHS. This is mostly due to the decline in the percentage of households in urban areas with water on their premises, from 42 percent in 2008 to 22 percent in 2014. However, there is a substantial increase in the proportion of urban households that spend less than 30 minutes to obtain water, from 51 percent in 2008 to 71 percent in 2014. Overall, 70 percent of households in 2014 spend less than 30 minutes to obtain their drinking water, with no major differences between urban and rural households. Fifteen percent of households spend 30 minutes or longer to obtain their drinking water, 25 percent in rural areas compared with only 7 percent in urban areas. The majority of households (93 percent) do not treat their drinking water, with similar proportions by residence. Boiling the water and straining it through cloth are the most common drinking water treatment methods (2 percent each). One percent of households are engaged in harmful practice of using camphor balls or naphthalene to purify their drinking water. Camphor or naphthalene are toxic and should not be used to treat drinking water. Overall, only 4 percent of households using an appropriate water treatment method. Over half of the households store their drinking water in a plastic container or a bucket (55 percent), 29 percent in a bottle or a sachet, 11 percent in a pot or earthenware vessel, and 6 percent in a metal container (data not shown). 1 The WHO-UNICEF Joint Monitoring Program for Water Supply and Sanitation (JMP) classifies bottled/sachet water used for drinking according to the source of water that households use for cooking and handwashing (secondary source). Where information about the secondary water source is not collected, JMP does not currently categorise bottled/sachet water as an improved drinking water source (WHO and UNICEF 2014). Since the 2014 Ghana DHS did not collect information on the secondary water source, the quality of bottled/sachet water is not known. However, to ensure consistency with the 2008 GDHS findings and in accordance with the The DHS Program tabulation plan, which categorises bottled/sachet water as improved, an additional category is included in Table 2.1 to show the percentage of households/population using “improved source, including bottled/sachet water”. Housing Characteristics and Household Population • 13 Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Ghana 2014 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source, excluding bottled/sachet water 52.6 69.0 60.1 57.0 71.4 64.2 Improved source, including bottled//sachet water1 97.0 80.9 89.8 96.0 79.6 87.7 Piped into dwelling 7.9 0.6 4.6 8.4 0.5 4.4 Piped to yard/plot 8.2 1.3 5.1 8.5 1.2 4.8 Public tap/standpipe 22.5 19.1 21.0 24.5 18.2 21.4 Tube well/borehole 8.1 41.3 23.1 9.1 44.7 27.0 Protected dug well 5.2 5.5 5.4 6.1 6.0 6.0 Protected spring 0.2 0.4 0.3 0.1 0.3 0.2 Rainwater 0.4 0.8 0.6 0.3 0.5 0.4 Bottled water 1.3 0.2 0.8 1.0 0.1 0.6 Sachet water 43.1 11.8 29.0 38.0 8.0 22.8 Nonimproved source 3.0 19.0 10.2 4.0 20.4 12.3 Unprotected dug well 1.0 3.8 2.3 1.4 4.0 2.7 Unprotected spring 0.3 0.9 0.6 0.4 1.1 0.7 Tanker truck/cart with small tank 0.5 0.1 0.3 0.4 0.1 0.3 Surface water 1.2 14.2 7.1 1.7 15.3 8.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 21.7 6.1 14.7 22.9 5.6 14.2 Less than 30 minutes 70.9 68.6 69.9 69.0 65.0 67.0 30 minutes or longer 6.9 25.0 15.1 7.7 29.0 18.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 1.9 1.5 1.7 2.0 1.5 1.7 Bleach/chlorine/alum added 0.6 0.6 0.6 0.7 0.6 0.6 Strained through cloth 1.1 2.4 1.7 1.5 2.8 2.2 Ceramic, sand, composite, or other filter 1.4 0.1 0.8 1.0 0.1 0.6 Let stand and settle 0.8 0.9 0.9 1.0 1.0 1.0 Camphor/Naphthalene 0.9 0.8 0.9 1.0 1.0 1.0 Purification tablets 1.8 0.3 1.1 1.6 0.3 0.9 Other 0.2 0.1 0.1 0.2 0.1 0.1 No treatment 92.8 93.9 93.3 92.4 93.6 93.0 Percentage using an appropriate treatment method3 5.7 2.5 4.2 5.3 2.5 3.8 Number 6,503 5,332 11,835 20,432 20,791 41,223 Note: Totals may not add up to 100 percent because households with missing information are not shown separately. 1 Since the 2014 Ghana DHS did not collect information on the secondary source of water, the quality of bottled/sachet water is not known. However, to ensure consistency with the 2008 GDHS findings and in accordance with the The DHS Program tabulation plan, which categorises bottled/sachet water as improved, an additional category is included to show the percentage of households/population using “improved source, including bottled/sachet water”. 2 Respondents may report multiple treatment methods, so the sum of treatments may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, filtering, solar disinfection, and purification tablets. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates waste from human contact (WHO and UNICEF 2014). The types of facilities considered improved are toilets that flush or pour flush into a piped sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrines; and pit latrines with a slab (Table 2.2). Table 2.2 shows that only 14 percent of households in Ghana use improved toilet facilities that are not shared with other households, and 61 percent use facilities that would be considered improved if they were not shared. Twice as many households in urban as in rural areas have improved toilet facilities that are not shared (18 percent versus 9 percent). More than one in four (26 percent) of households use a nonimproved toilet facility, 14 percent in urban areas and 41 percent in rural areas. Seventeen percent of households in Ghana have no toilet facility and still use the bush or open field for defecation. As expected, rural households are much more likely to have no toilet facilities than urban households (29 percent versus 7 percent). 14 • Housing Characteristics and Household Population Table 2.2 further indicates that 4 in 10 households have a toilet facility in their dwelling, yard, or plot, 51 percent in urban areas compared with 27 percent in rural areas. About one-third of households (32 percent) take less than 30 minutes to reach a toilet facility, and 1 in 10 (11 percent) take more than 30 minutes to reach a toilet facility. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Ghana 2014 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 17.8 8.5 13.6 20.5 9.6 15.0 Flush/pour flush to piped sewer system 6.5 0.5 3.8 6.8 0.6 3.7 Flush/pour flush to septic tank 7.6 1.0 4.6 8.4 0.9 4.6 Flush/pour flush to pit latrine 0.4 0.2 0.3 0.5 0.2 0.3 Ventilated improved pit (VIP) latrine 2.5 3.2 2.8 3.5 3.6 3.6 Pit latrine with slab 0.9 3.6 2.1 1.3 4.4 2.8 Shared facility1 68.5 50.7 60.5 65.0 44.5 54.7 Flush/pour flush to piped sewer system 7.0 0.5 4.0 6.1 0.4 3.2 Flush/pour flush to septic tank 14.6 2.0 8.9 12.6 1.6 7.0 Flush/pour flush to pit latrine 4.7 0.8 3.0 4.3 0.7 2.5 Ventilated improved pit (VIP) latrine 34.3 26.9 30.9 33.7 22.9 28.3 Pit latrine with slab 8.0 20.6 13.6 8.3 18.9 13.7 Nonimproved facility 13.7 40.8 25.9 14.4 45.9 30.3 Flush/pour flush not to sewer/septic tank/pit latrine 1.3 0.0 0.7 1.3 0.0 0.6 Pit latrine without slab/open pit 4.8 11.4 7.7 4.7 11.5 8.1 Bucket 0.3 0.2 0.3 0.3 0.1 0.2 Hanging toilet/hanging latrine 0.1 0.3 0.2 0.2 0.3 0.3 No facility/bush/field 7.1 28.8 16.9 7.9 34.0 21.0 Time to reach facility No facility/bush/field 7.1 28.8 16.9 7.9 34.0 21.0 In own dwelling/yard/ plot 51.3 26.5 40.1 51.5 24.3 37.8 Less than 30 minutes 30.3 35.1 32.4 29.4 32.7 31.1 More than 30 minutes 11.2 9.6 10.5 11.0 9.0 10.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,503 5,332 11,835 20,432 20,791 41,223 Note: Totals may not add up to 100 percent because households with missing information are not shown separately. 1 Facilities that would be considered improved if they were not shared by two or more households. 2.1.2 Housing Characteristics Housing characteristics and household assets can be used as a measure of the socioeconomic status of household members. Cooking practices and cooking fuels also affect the health of family members and the environment. For example, the use of biomass fuels exposes household members to indoor pollution, which has a direct bearing on their health and surroundings. Table 2.3 presents information on the availability of electricity, type of flooring material, number of rooms for sleeping, type of fuel used for cooking, and place where cooking is done. Overall, 78 percent of households in Ghana have access to electricity, 91 percent in urban areas and 63 percent in rural areas. This shows a marked improvement since the 2008 GDHS, when 61 percent of households had access to electricity; the sharpest increase has occurred in rural areas (from 38 percent to 63 percent). This increase is partially attributed to the rural electrification programmes implemented by successive governments in recent years. Among flooring materials, cement is the most common (63 percent), with rural households being more likely than urban households to have cement flooring (70 percent versus 57 percent). Other common flooring materials include linoleum or rubber carpet (12 percent) and woolen or synthetic carpets (11 percent). Housing Characteristics and Household Population • 15 Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Ghana 2014 Residence Total Housing characteristic Urban Rural Electricity Yes 90.8 63.0 78.3 No 9.2 37.0 21.7 Total 100.0 100.0 100.0 Flooring material Earth, sand 1.2 10.3 5.3 Dung 0.0 1.4 0.7 Wood planks 0.6 0.0 0.3 Parquet, polished wood 0.4 0.1 0.3 Ceramic/marble/porcelain tiles/terrazo 13.2 1.9 8.1 Cement 57.1 70.1 63.0 Woolen carpets/synthetic carpet 15.1 5.5 10.8 Linoleum/rubber carpet 12.3 10.7 11.6 Total 100.0 100.0 100.0 Rooms used for sleeping One 65.0 57.1 61.4 Two 23.6 26.1 24.7 Three or more 11.4 16.7 13.7 Total 100.0 100.0 100.0 Place for cooking In the house 47.7 20.0 35.2 In a separate building 15.7 33.5 23.7 Outdoors 31.3 43.3 36.7 No food cooked in household 5.3 3.2 4.3 Total 100.0 100.0 100.0 Cooking fuel Electricity 2.2 0.2 1.3 LPG/natural gas/biogas 36.8 9.1 24.3 Kerosene 0.2 0.0 0.1 Charcoal 42.1 20.7 32.5 Wood 13.4 65.9 37.0 Straw/shrubs/grass 0.1 0.7 0.4 Agricultural crop 0.0 0.1 0.1 No food cooked in household 5.3 3.2 4.3 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 55.6 87.5 70.0 Oil used for cooking Red palm oil 38.7 57.6 47.2 Yellow palm oil 1.7 1.1 1.4 Frytol/fortified vegetable oil 43.9 19.4 32.9 Other vegetable oil 8.5 4.3 6.6 Shea butter 1.5 13.6 6.9 Other 0.4 0.8 0.6 No food cooked in household 5.3 3.2 4.3 Total 100.0 100.0 100.0 Frequency of smoking in the home Daily 8.0 11.0 9.3 Weekly 1.8 1.7 1.7 Monthly 0.5 0.5 0.5 Less than monthly 0.4 0.5 0.4 Never 89.4 86.3 88.0 Total 100.0 100.0 100.0 Number 6,503 5,332 11,835 Note: Totals may not add up to 100 percent because households with missing information are not shown separately. LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung The number of rooms used for sleeping indicates the extent of crowding in households. Overcrowding increases the risk of contracting infectious diseases such as acute respiratory infections and skin diseases, which particularly affect children and the elderly population. Six in 10 households (61 percent) report using one room for sleeping, one in four (25 percent) use two rooms for sleeping, and 14 16 • Housing Characteristics and Household Population percent use three or more rooms. The proportion of households that uses one room for sleeping is higher in urban than in rural areas (65 percent versus 57 percent). The presence and extent of indoor pollution depend on cooking practices, places used for cooking, and types of fuel used. According to the 2014 GDHS, 35 percent of households cook inside the house, 37 percent cook outdoors, and 24 percent cook in a separate building. The percentage of households that cook inside the dwelling is substantially higher in urban than in rural areas (48 percent versus 20 percent). By contrast, 34 percent and 43 percent of rural households cook in a separate building or outdoors, as compared with 16 percent and 31 percent, respectively, of urban households. Table 2.3 also presents information on fuel and oil used for cooking by the Ghanaian households. Wood (37 percent), charcoal (33 percent), and liquid petroleum gas (LPG), natural gas, or biogas (24 percent) are the most commonly used cooking fuels. Urban households are much more likely than rural households to use LPG, natural gas, or biogas (37 percent versus 9 percent) or charcoal (42 percent versus 21 percent). On the other hand, a notably higher proportion of rural households use wood for cooking compared with urban households (66 percent versus 13 percent). Overall, 70 percent of households use solid fuel for cooking, i.e., charcoal, wood, straw, shrubs, grass and agricultural crops, and animal dung, a decline from 83 percent reported in the 2008 GDHS. Red palm oil is the most commonly used cooking oil (47 percent), with a substantially higher percentage of rural households using it when compared with urban households (58 percent versus 39 percent). One-third of households use Frytol or fortified vegetable oil for cooking. Urban households are more than twice as likely as rural households to use Frytol or fortified vegetable oil (44 percent compared with 19 percent). Other vegetable oil and shear butter are each used by 7 percent of households. A major concern for the government of Ghana is the effect of secondhand smoke, especially on the vulnerable groups, such as pregnant women, infants, and young children. The 2014 GDHS collected information on the frequency of smoking in the home in order to assess exposure of household members to secondhand smoking. Data show that 9 percent of households are exposed daily to secondhand smoke, with rural households being slightly more likely to be exposed than urban households (11 percent compared with 8 percent). 2.1.3 Household Possessions Possession of durable consumer goods is another useful indicator of household socioeconomic status. The possession and use of household durable goods have multiple effects and implications. For instance, having access to a radio or television exposes household members to updated daily news events, information, and educational materials. Similarly, a refrigerator prolongs food storage and keeps food fresh and hygienic. A means of transportation allows greater access to services away from the local area and enhances social and economic activities. The 2014 GDHS collected information on possession of durable assets, means of transportation, and ownership of agricultural land and farm animals. Table 2.4 shows that radios (69 percent), color televisions (62 percent), and mobile telephones (85 percent) are common durable goods owned by households in Ghana. Refrigerators are owned by 35 percent of households. Ownership of each of these household items is higher in urban than in rural areas. Possession of color televisions, mobile phones, and refrigerators has increased since the 2008 GDHS survey, while possession of radios has decreased slightly. It is noteworthy that there has been an especially sharp increase in mobile phone ownership in Ghana, from 57 percent in 2008 to 85 percent in 2014, especially in rural households where mobile phone ownership has more than doubled (from 37 percent to 76 percent). In addition, 42 percent of households own a video deck or DVD/VCD and 16 percent have a sewing machine. Computers and access to the internet was reported each by 14 percent of households (data not shown). Housing Characteristics and Household Population • 17 Looking at means of transport, bicycles continue to be common, with 23 percent of households owning a bicycle, 17 percent in urban areas and 31 percent in rural areas. Ownership of a motorcycle is more common in rural areas (11 percent) than in urban areas (7 percent), while ownership of a car or truck is more common in urban than in rural areas (13 percent compared with 4 percent). Ghana is predominantly an agricultural economy, with a large proportion of the population engaged in this sector. The 2014 GDHS data indicate that 39 percent of households own agricultural land, with rural households notably more likely to own land (59 percent) than urban households (22 percent). Thirty-six percent of households in the country possess farm animals, 55 percent in rural areas as compared with 20 percent in urban areas. Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Ghana 2014 Residence Total Possession Urban Rural Household effects Radio 72.5 63.9 68.6 Color television 77.7 42.2 61.7 Mobile telephone 92.3 76.2 85.1 Non-mobile telephone 3.0 0.3 1.8 Refrigerator 50.5 16.4 35.1 Means of transport Bicycle 17.4 30.7 23.4 Animal drawn cart 0.7 1.4 1.0 Motorcycle/scooter 6.9 11.1 8.8 Car/truck 13.2 4.4 9.2 Boat with a motor 0.3 0.4 0.4 Ownership of agricultural land 21.9 58.7 38.5 Ownership of farm animals1 19.7 54.7 35.5 Number 6,503 5,332 11,835 1 Cattle, milk cows, bulls, horses, donkeys, mules, goats, pigs, rabbits, grasscutters, sheep, chickens, or other poultry 2.2 SOCIOECONOMIC STATUS INDEX The wealth index has been used in many DHS reports to measure inequalities in household characteristics, in the use of health and other services, and in health outcomes. It is an indicator of wealth that is consistent with expenditure and income measurement among households. The index was constructed from household asset data using principal components analysis. These assets or consumer items consist of a television, bicycle, or car, as well as dwelling characteristics, such as a source of drinking water, sanitation facilities, and type of flooring material. In its current form, which takes better account of urban-rural differences in scores and indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. Categorical variables to be used are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators. The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. This three-step procedure permits greater adaptability of the wealth index in both urban and rural areas. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are obtained by assigning the household score to each de jure household member, ranking each person in the population by his or her score, and then dividing the ranking into five equal categories, each 18 • Housing Characteristics and Household Population comprising 20 percent of the population. The 2014 GDHS provides an opportunity to examine the distribution of Ghana’s population by household wealth status. Table 2.5 presents distributions across the five wealth quintiles by residence and region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed according to geographic area. A large majority of the urban population (71 percent) is in the highest two wealth quintiles, while a much lower proportion of rural residents (10 percent) falls in this category. The majority of rural residents are in the lowest and the second wealth quintiles (36 percent and 33 percent, respectively). By contrast, only 4 percent and 7 percent, respectively, of urban residents fall in the lowest two quintiles. By region, data show that Greater Accra is the richest region, with 52 percent of the population in the highest wealth quintile, compared with only 2 percent each of the population in the Northern and Upper East regions. More than 7 in 10 of the population in the Northern and Upper East regions (72 percent and 79 percent, respectively) and 6 in 10 of the population in the Upper West region (60 percent) is in the lowest wealth quintile. Table 2.5 also presents information on the Gini coefficient, which indicates the level of concentration of wealth (0 being an equal distribution and 1 a totally unequal distribution). This ratio is expressed as a proportion between 0 and 1. Wealth inequality, as measured by the Gini coefficient, is higher in rural (0.25) than in urban areas (0.10). Inequality in wealth is highest in Upper West and lowest in Greater Accra (Gini coefficients of 0.33 and 0.14, respectively). Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Ghana 2014 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 4.0 7.0 18.2 31.5 39.2 100.0 20,432 0.10 Rural 35.7 32.7 21.8 8.7 1.1 100.0 20,791 0.25 Region Western 6.0 23.3 29.4 25.3 16.1 100.0 4,144 0.24 Central 4.7 30.2 32.1 19.3 13.7 100.0 3,986 0.31 Greater Accra 2.6 3.7 11.4 30.1 52.2 100.0 7,583 0.14 Volta 21.7 33.3 28.2 12.8 4.1 100.0 3,444 0.25 Eastern 12.6 29.5 27.7 17.9 12.4 100.0 3,987 0.27 Ashanti 6.5 18.0 19.5 28.9 27.1 100.0 7,567 0.24 Brong Ahafo 25.2 30.9 22.8 13.9 7.2 100.0 3,531 0.31 Northern 71.6 15.3 7.7 3.5 2.0 100.0 4,081 0.30 Upper East 78.5 9.4 6.1 4.4 1.7 100.0 1,750 0.26 Upper West 60.2 19.9 9.3 7.7 3.0 100.0 1,149 0.33 Total 20.0 20.0 20.0 20.0 20.0 100.0 41,223 0.21 2.3 HAND WASHING Hand washing is one of the most efficient ways to stop germs from spreading and protect people from contracting communicable diseases. The practice is promoted by the Ghanaian government, various institutions, and nongovernmental organisations. There is an ongoing campaign in communities at schools and households to boost awareness of the importance of having designated places for hand washing with running water and soap. Table 2.6 provides information on designated places for hand washing in households and the use of water and cleansing agents for washing hands according to place of residence, region, and wealth quintile. In the 2014 GDHS, interviewers were asked to observe the place where household members usually washed their hands. They also observed the regularity of water supply and whether households had Housing Characteristics and Household Population • 19 cleansing agents near the place of hand washing. Such observations were made in 53 percent of households selected for the survey. Among the observed households, 39 percent had soap and water at the place where household members washed their hands, 19 percent had water only, 4 percent had soap but no water, and less than 1 percent had water and other cleansing agents (such as ash, mud, or sand), or only cleaning agents other than soap. Thirty-seven percent of households did not have water, soap, or other cleansing agents. In general, although the hand washing place was observed, most likely these households did not have a fixed, designated place for hand washing. Forty-six percent of the households in urban areas had soap and water, compared with 29 percent of rural households. At the regional level, more than half of households in Greater Accra (51 percent) had soap and water, compared with less than one in five (18 percent) households in Upper West. Presence of soap and water increases steadily with wealth, from 20 percent of the poorest households to 64 percent of the richest households. Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Ghana 2014 Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Background characteristic Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Total Residence Urban 58.0 6,503 46.2 0.2 17.5 3.9 0.2 32.0 100.0 3,770 Rural 47.8 5,332 29.0 0.5 21.1 4.6 0.4 44.5 100.0 2,548 Region Western 58.3 1,298 45.5 0.5 17.2 4.4 0.0 32.4 100.0 757 Central 43.0 1,180 39.4 0.0 17.6 10.7 0.0 32.3 100.0 507 Greater Accra 64.7 2,457 50.6 0.0 16.3 4.0 0.1 29.1 100.0 1,591 Volta 79.7 1,015 32.2 0.4 18.3 2.1 0.9 46.1 100.0 809 Eastern 50.9 1,255 20.7 0.3 7.3 5.3 0.8 65.5 100.0 639 Ashanti 47.9 2,216 45.2 0.7 29.2 0.7 0.3 23.9 100.0 1,062 Brong Ahafo 45.7 1,028 21.6 0.6 17.1 3.0 0.0 57.7 100.0 469 Northern 31.1 742 38.1 0.0 14.8 14.3 0.0 32.8 100.0 230 Upper East 27.1 378 40.6 0.3 29.6 2.1 0.0 27.4 100.0 102 Upper West 57.6 265 18.3 0.0 46.0 3.2 0.0 32.5 100.0 153 Wealth quintile Lowest 39.2 1,600 19.5 0.0 23.3 6.0 0.1 51.1 100.0 627 Second 48.5 2,211 21.5 0.3 20.5 4.7 0.6 52.4 100.0 1,072 Middle 50.9 2,647 26.8 0.4 18.9 4.2 0.3 49.5 100.0 1,347 Fourth 51.9 2,686 40.0 0.4 20.2 3.9 0.2 35.3 100.0 1,395 Highest 69.8 2,690 64.4 0.2 15.8 3.5 0.2 15.9 100.0 1,877 Total 53.4 11,835 39.2 0.3 19.0 4.2 0.3 37.0 100.0 6,318 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud or sand 3 Includes households with soap only as well as those with soap and another cleansing agent 2.4 HOUSEHOLD POPULATION BY AGE AND SEX Table 2.7 shows the distribution of the de facto household population by age and sex according to urban and rural residence. The 2014 GDHS enumerated a total of 40,337 persons (21,035 females and 19,302 males). More than 4 in 10 of the population in Ghana (42 percent) is under age 15 (Figure 2.1), similar to 41 percent reported in the 2008 GDHS. The data show that 14 percent of the population are under age 5, a slight increase from 13 percent in 2008. Persons age 65 and older account for about 5 percent of the total population, the same as in 2008. 20 • Housing Characteristics and Household Population There is a slightly higher proportion of children under 5 in rural than in urban areas (15 percent versus 13 percent). The concentration of the population is high in the 5-9 and 10-14 age groups (14 percent and 13 percent, respectively), potentially creating pressure for schooling and adolescent care. The overall sex ratio (the number of males for every 100 females) is 92, slightly higher than the sex ratio of 91 reported in the 2008 GDHS. Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Ghana 2014 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 15.0 11.8 13.3 16.6 14.4 15.4 15.8 13.1 14.4 5-9 12.8 11.9 12.3 15.8 14.7 15.3 14.4 13.3 13.8 10-14 13.2 12.0 12.5 14.7 13.2 14.0 14.0 12.6 13.3 15-19 8.8 7.7 8.2 9.9 8.1 9.0 9.4 7.9 8.6 20-24 8.0 8.3 8.1 6.2 7.3 6.8 7.1 7.8 7.4 25-29 7.7 8.9 8.3 5.4 6.5 6.0 6.5 7.7 7.1 30-34 7.1 7.5 7.3 4.9 5.7 5.3 5.9 6.6 6.3 35-39 6.4 6.7 6.6 4.5 5.6 5.1 5.4 6.2 5.8 40-44 4.9 5.3 5.1 4.6 4.8 4.7 4.8 5.0 4.9 45-49 4.1 4.2 4.1 3.8 4.0 3.9 3.9 4.1 4.0 50-54 3.2 4.6 3.9 3.4 4.9 4.2 3.3 4.7 4.0 55-59 2.6 2.9 2.8 2.5 2.9 2.7 2.5 2.9 2.7 60-64 2.5 2.6 2.5 2.8 2.4 2.6 2.6 2.5 2.5 65-69 1.2 1.8 1.5 1.8 1.7 1.8 1.5 1.7 1.6 70-74 1.0 1.6 1.3 1.3 1.5 1.4 1.2 1.5 1.4 75-79 0.7 1.0 0.8 0.9 1.1 1.0 0.8 1.0 0.9 80+ 0.9 1.4 1.2 0.9 1.4 1.2 0.9 1.4 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 9,360 10,546 19,905 9,942 10,490 20,432 19,302 21,035 40,337 Figure 2.1 Population pyramid 8 6 4 2 0 2 4 6 8 <5 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 + Percent Age Male Female GDHS 2014 8 6 4 2 Housing Characteristics and Household Population • 21 2.5 HOUSEHOLD COMPOSITION Information on household composition is critical for understanding family size, household headship, and orphanhood and for implementing meaningful population-based policies and programmes. Household composition is also a determinant of health status and wellbeing. Table 2.8 presents information on household composition in Ghana. Almost twice as many households are headed by men as by women (66 percent versus 34 percent), a pattern observed both in urban and in rural areas. The average household size in 2014 is 3.5 persons, compared with 3.7 in 2008. The household size is somewhat larger in rural areas (mean size of 3.9 persons) when compared with urban areas (mean size of 3.1 persons). Single-person households are more common in urban areas (29 percent) than in rural areas (22 percent), perhaps due to the influx of unmarried young individuals migrating to urban areas in search of employment or to further their education. Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18 years of age, according to residence, Ghana 2014 Residence Total Characteristic Urban Rural Household headship Male 62.9 70.2 66.2 Female 37.1 29.8 33.8 Total 100.0 100.0 100.0 Number of usual members 0 0.3 0.3 0.3 1 29.2 21.6 25.8 2 17.1 13.9 15.6 3 15.4 13.6 14.6 4 13.8 13.1 13.5 5 10.2 13.6 11.7 6 7.0 9.5 8.1 7 3.5 6.3 4.8 8 1.6 3.2 2.3 9+ 1.8 4.9 3.2 Total 100.0 100.0 100.0 Mean size of households 3.1 3.9 3.5 Percentage of households with orphans and foster children under 18 years of age Foster children1 15.5 16.6 16.0 Double orphans 1.0 1.0 1.0 Single orphans2 5.9 7.7 6.7 Foster and/or orphan children 18.4 20.5 19.4 Number of households 6,503 5,332 11,835 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent. The 2014 GDHS also collected information on the presence of foster children and orphans in households. Foster children are children under age 18 living in households with neither their mother nor their father present; orphans are children with one (single orphans) or both parents (double orphans) dead. Foster children and orphans are of concern because they may be at greater risk of neglect, maltreatment or exploitation with their mothers or fathers not present to assist them. Sixteen percent of all households in Ghana have foster children, 16 percent in urban households and 17 percent in rural households. Single orphans are present in 7 percent of the households, whereas double orphans are present in 1 percent of households. 22 • Housing Characteristics and Household Population Overall, 19 percent of households have foster and/or orphan children, a decrease from 22 percent in the 2008 GDHS. 2.6 BIRTH REGISTRATION Although Ghana has a legal and administrative structure stipulating official registration of births according to standard procedures, only 6 out of 10 births are registered annually. The practice of formally registering births is not widely adhered to in the country, even though the registration system was implemented over 100 years ago. Despite the existence of compulsory nationwide registration laws in the country, registration centres are highly inadequate and poorly equipped, especially in the rural areas, due to a number of reasons, the predominant one being inadequate financial resources (UNICEF 2013). The Births and Deaths Registry Act 301 of 1965 requires the issuance of a birth certificate immediately after birth, free of charge. Until mid-2003, the legal period for free birth registration of infants was within 21 days of birth. However, since mid-2013, the period has been extended to 12 months, in order to encourage early registration of all births by parents or caretakers (Government of Ghana 1965). Birth registration information was solicited for all children age 0-4 years. Table 2.9 presents the percentage of the de jure population under age 5 whose births are registered with the civil authorities, according to background characteristics. About 7 in 10 children under age 5 (71 percent) have their births registered: 56 percent are registered and have a birth certificate, while 15 percent are registered but do not have a birth certificate. Children under age 2 (66 percent) are less likely to be registered than children age 2-4 (74 percent). Although not legally required, the registration of older children may be primarily due to the practice of asking for a child’s birth certificate for school admission. Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Ghana 2014 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have a birth certificate Percentage registered Age <2 49.1 16.8 65.9 2,335 2-4 60.3 13.2 73.5 3,483 Sex Male 55.9 14.9 70.8 3,067 Female 55.7 14.4 70.1 2,752 Residence Urban 68.3 10.7 79.0 2,678 Rural 45.2 18.0 63.2 3,141 Region Western 55.6 6.3 61.9 590 Central 51.2 30.1 81.3 613 Greater Accra 72.4 6.9 79.3 918 Volta 42.0 7.4 49.5 468 Eastern 55.3 9.0 64.3 560 Ashanti 68.5 13.0 81.5 1,041 Brong Ahafo 40.5 16.2 56.7 519 Northern 44.4 23.9 68.3 720 Upper East 50.1 21.3 71.3 237 Upper West 47.6 27.7 75.3 153 Wealth quintile Lowest 37.8 20.4 58.1 1,314 Second 43.4 17.5 60.9 1,216 Middle 54.9 13.9 68.8 1,152 Fourth 69.3 11.7 81.1 1,095 Highest 79.9 8.1 88.0 1,042 Total 55.8 14.7 70.5 5,819 Housing Characteristics and Household Population • 23 Children in urban areas (79 percent) are notably more likely to be registered than those in rural areas (63 percent). At the regional level, only half of births in Volta are registered, as compared with more than 8 in 10 births registered in the Central and Ashanti regions (81 percent and 82 percent, respectively). Birth registration increases with wealth, from 58 percent among children in the poorest households to 88 percent among children in the richest households. 2.7 CHILDREN’S LIVING ARRANGEMENTS, ORPHANHOOD, AND SCHOOL ATTENDANCE The 2014 GDHS collected information on living arrangements of children and orphanhood. Living arrangements should be monitored together with the proportion of foster and orphan children because of their significant effects on the comprehensive development of children. Table 2.10 shows the percent distribution of children under age 18 by their living arrangements and survivorship of parents. Of the 19,074 children under age 18 reported in the 2014 GDHS, 55 percent live with both parents, 21 percent live with their mother only, although their father is alive, 4 percent live with their father only, although their mother is alive, and 13 percent live with neither of their natural or biological parents, although both parents are alive. Table 2.10 Children’s living arrangements and orphanhood Percent distribution of de jure children under 18 years of age by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Ghana 2014 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biological parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing infor- mation on father/ mother Age 0-4 65.5 24.5 1.9 1.5 0.2 5.6 0.3 0.2 0.2 0.1 100.0 6.3 2.8 5,819 <2 71.3 25.9 1.4 0.3 0.1 0.8 0.2 0.0 0.1 0.0 100.0 1.0 1.7 2,335 2-4 61.7 23.5 2.2 2.3 0.3 8.9 0.3 0.3 0.3 0.2 100.0 9.9 3.5 3,483 5-9 56.0 19.7 3.2 3.9 0.7 13.8 0.9 1.0 0.6 0.2 100.0 16.3 6.4 5,641 10-14 47.3 19.5 5.0 5.4 1.1 16.8 1.2 2.1 1.4 0.2 100.0 21.5 10.8 5,421 15-17 42.2 19.4 7.5 5.6 1.8 16.8 1.9 2.7 1.6 0.6 100.0 22.9 15.5 2,193 Sex Male 56.4 20.9 3.8 4.3 0.9 10.9 0.7 1.2 0.7 0.2 100.0 13.5 7.4 9,734 Female 53.3 21.2 3.8 3.3 0.6 14.2 1.0 1.3 1.0 0.2 100.0 17.5 7.7 9,340 Residence Urban 48.8 24.5 3.8 3.9 0.5 14.7 1.1 1.4 1.0 0.2 100.0 18.2 7.8 8,736 Rural 60.0 18.1 3.8 3.7 1.0 10.6 0.7 1.2 0.7 0.2 100.0 13.2 7.4 10,338 Region Western 51.7 23.7 3.8 3.2 0.4 13.2 0.8 1.7 1.1 0.4 100.0 16.7 7.8 1,850 Central 46.9 28.7 4.6 4.0 1.0 12.0 0.8 0.7 1.2 0.2 100.0 14.7 8.3 1,942 Greater Accra 52.3 23.3 2.8 4.0 0.5 13.3 1.0 1.3 1.1 0.4 100.0 16.7 6.7 3,032 Volta 49.7 22.0 3.7 5.3 0.7 15.0 1.1 2.0 0.5 0.1 100.0 18.6 8.0 1,602 Eastern 45.1 26.0 3.8 3.9 0.9 16.5 1.3 1.2 1.1 0.3 100.0 20.0 8.2 1,840 Ashanti 52.8 25.6 3.4 3.1 0.2 12.5 0.8 1.0 0.6 0.0 100.0 14.8 6.0 3,547 Brong Ahafo 53.6 21.2 2.4 3.6 0.8 14.4 1.4 1.7 0.6 0.2 100.0 18.2 7.0 1,677 Northern 77.8 4.6 4.4 3.6 1.8 6.3 0.5 0.8 0.2 0.0 100.0 7.8 7.7 2,158 Upper East 64.6 7.7 8.4 4.8 1.6 9.3 0.4 1.7 1.4 0.1 100.0 12.8 13.5 855 Upper West 67.2 9.4 3.6 3.6 1.7 11.7 0.4 1.2 1.1 0.2 100.0 14.4 8.0 572 Wealth quintile Lowest 69.4 8.5 4.5 4.1 1.4 9.6 0.6 1.1 0.6 0.2 100.0 11.8 8.2 4,435 Second 52.1 24.6 3.6 3.3 0.8 12.6 1.1 1.3 0.6 0.0 100.0 15.6 7.4 4,102 Middle 43.6 30.3 4.5 3.7 0.7 13.7 1.4 1.2 0.8 0.2 100.0 17.1 8.6 3,816 Fourth 49.9 23.4 4.1 3.7 0.6 14.3 0.6 1.4 1.7 0.4 100.0 17.9 8.4 3,534 Highest 57.2 20.3 1.9 4.4 0.2 13.2 0.9 1.2 0.5 0.2 100.0 15.8 4.7 3,187 Total <15 56.5 21.3 3.3 3.6 0.7 12.0 0.8 1.1 0.7 0.1 100.0 14.5 6.5 16,881 Total <18 54.9 21.1 3.8 3.8 0.8 12.5 0.9 1.3 0.8 0.2 100.0 15.5 7.6 19,074 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent. 24 • Housing Characteristics and Household Population Table 2.10 also provides information on the extent of orphanhood, that is, the proportion of children who have lost one or both parents. Less than 1 percent of children under age 18 have both parents dead and 8 percent have one or both parents dead. The percentage of children living with both biological parents decreases with increasing age of the child. This may be due to children moving to a relative’s house to pursue further education or seek work. Children in rural areas are more likely than those in urban areas to live with both parents (60 percent versus 49 percent). The Northern region (78 percent) has the highest proportion of children living with both parents and the Eastern region has the lowest proportion (45 percent). By wealth status, the proportion of children under age 18 living with both parents shows a U- shaped pattern with increasing wealth quintile. The highest proportions are among children in the lowest and highest wealth quintiles (69 percent and 57 percent, respectively) and the lowest proportion is in the middle wealth quintile (44 percent). In the 2014 GDHS, eligible women were asked if they had any sons or daughters to whom they had given birth, who were still alive, but who did not live with their mother at the time of the survey. For each identified child under age 18 who did not live with the mother, the respondent was asked where and with whom the children lived at the time of the interview. The findings are shown in Figure 2.2. The majority of female and male children under age 18 who did not live with their mother at home at the time of the survey were living with relatives (90 percent). Six percent of females and 5 percent of males were living in boarding schools, and 4 percent and 3 percent, respectively, were living with family or friends. Figure 2.2 Children under age 18 living away from home: Place or person with whom they currently live Children orphaned or vulnerable by death or acute illness of one or both parents may or may not go to school. Often, these children are compelled to work to pay their school fees or eventually drop out to assist in family businesses. The 2014 GDHS collected information on school attendance of children age 10-14 by parental survival. The findings are presented in Table 2.11. Seventy-six percent of children age 10-14 whose both parents are deceased are attending school, an increase from 67 percent in 2008. Among children age 10-14 whose parents are both alive and who live with at least one parent, 81 percent are attending school, compared with 88 percent in 2008. The overall ratio of school attendance of children whose parents are dead to those whose parents are living (when the child resides with at least one parent) is 0.94. Further breakdown by background characteristics is not possible due to the small number of orphans (95 unweighted cases). Relatives 90% Family/friends 4% Care home/ disability home <1% Boarding school 6% Other <1% Females Relatives 90% Family/friends 3% Care home/ disability home 1% Boarding school 5% Other 1% Males Housing Characteristics and Household Population • 25 Table 2.11 School attendance by survivorship of parents For de jure children age 10-14 , the percentage attending school by parental survival and the ratio of the percentage attending, by parental survival, according to background characteristics, Ghana 2014 Percentage attending school by survivorship of parents Background characteristic Both parents deceased Number Both parents alive and living with at least one parent Number Ratio1 Sex Male (78.2) 30 81.0 2,101 0.97 Female 74.5 45 81.3 1,816 0.92 Residence Urban (71.0) 43 83.1 1,745 0.85 Rural 82.6 32 79.6 2,173 1.04 Region Western * 10 93.8 366 0.61 Central * 7 51.9 363 1.23 Greater Accra * 14 82.1 620 1.22 Volta * 5 89.6 310 0.83 Eastern * 13 84.2 331 1.12 Ashanti * 10 80.0 828 0.87 Brong Ahafo * 8 88.9 345 0.60 Northern * 1 79.9 471 1.25 Upper East * 6 81.8 162 0.74 Upper West * 3 85.4 121 1.00 Wealth quintile Lowest (79.2) 11 78.4 965 1.01 Second * 12 74.7 852 1.00 Middle * 16 84.0 746 0.74 Fourth * 30 85.0 709 1.01 Highest * 7 86.3 645 0.75 Total 76.0 75 81.1 3,918 0.94 Note: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent 2.8 EDUCATION OF HOUSEHOLD POPULATION Studies have shown that education is one of the major socioeconomic factors to influence a person’s behaviour and attitude. In general, the higher the level of education of a woman, the more knowledgeable she is about the use of health facilities, family planning methods, and the health of her children. Education in Ghana has undergone several changes in recent years (see Chapter 1). Pre-school education has been incorporated into basic education, and all primary schools are required to have nurseries or kindergartens. The basic education is free and compulsory, with the goal of providing educational attainment for all. The Ghana Education Trust Fund (GETFUND), set up in 2000, has resulted in major improvements in the educational infrastructure to support the country’s tertiary institutions. The current educational system is based on a three-tier system: six years of primary education, followed by three years of junior high school (JHS), formerly called junior secondary school (JSS), and a further three years at the senior high school (SHS) level. At the secondary level, in the 2007/2008 academic year, the three-year Senior Secondary School (SSS) system was changed to the four-year Senior High School, but this policy was reversed in 2009. 2.8.1 Educational Attainment of Household Population Tables 2.12.1 and 2.12.2 show the percent distribution of the de facto female and male household population age 6 and older by level of education and background characteristics. 26 • Housing Characteristics and Household Population Table 2.12.1 shows that 26 percent of the female household population has never been to school, a decline from 31 percent in 2008. Among females age 6 and older, 27 percent have some primary education, 5 percent have completed primary school only, 39 percent have some secondary education or have completed secondary school, and 4 percent have more than a secondary school education. The data show that the proportion of females with no education is higher in the older ages, suggesting some improvement in education over the years. This may be due to the impact of the Free Compulsory Universal Basic Education (FCUBE) programme, which was introduced in 1996. Educational attainment varies by place of residence. Urban females are more likely to be educated than their rural counterparts. For instance, 18 percent of urban females have no education, compared with 35 percent of rural females. The proportion of urban females with some secondary education or higher (54 percent) is notably higher than that of their rural counterparts (30 percent). Table 2.12.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Ghana 2014 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years completed Age 6-9 40.0 59.8 0.1 0.2 0.0 0.0 100.0 2,296 0.0 10-14 4.8 68.5 8.1 18.6 0.0 0.0 100.0 2,646 3.6 15-19 4.6 16.2 8.1 64.9 6.0 0.2 100.0 1,661 7.1 20-24 12.2 9.0 5.3 40.1 26.0 7.3 100.0 1,637 8.5 25-29 17.2 9.9 4.0 38.1 16.4 14.4 100.0 1,622 8.4 30-34 21.6 12.2 5.3 42.8 9.9 8.1 100.0 1,387 8.1 35-39 24.5 13.6 4.4 43.2 9.2 5.0 100.0 1,300 7.8 40-44 32.5 14.9 6.0 41.5 2.3 2.8 100.0 1,056 5.4 45-49 35.6 14.1 5.2 41.4 0.6 3.2 100.0 859 5.0 50-54 42.1 12.6 4.8 36.0 1.3 3.2 100.0 990 3.9 55-59 40.7 13.1 3.9 38.1 0.2 4.1 100.0 608 3.7 60-64 49.0 10.9 2.3 34.0 0.0 3.8 100.0 517 0.6 65+ 73.4 7.5 1.4 14.7 0.3 2.7 100.0 1,197 0.0 Residence Urban 17.9 23.6 4.3 38.5 9.3 6.4 100.0 9,063 6.5 Rural 34.9 29.8 5.2 25.8 2.9 1.3 100.0 8,715 2.3 Region Western 21.1 26.7 4.9 38.3 6.4 2.6 100.0 1,850 5.4 Central 23.9 26.2 6.4 33.8 6.3 3.3 100.0 1,766 5.0 Greater Accra 14.4 23.7 3.9 38.0 10.5 9.6 100.0 3,321 7.3 Volta 28.3 29.5 5.2 30.2 4.4 2.4 100.0 1,480 3.6 Eastern 20.6 27.2 7.0 36.5 5.4 3.3 100.0 1,725 5.3 Ashanti 18.5 26.8 4.7 39.9 6.6 3.5 100.0 3,340 5.8 Brong Ahafo 31.3 28.0 4.8 29.4 4.6 2.0 100.0 1,506 3.3 Northern 58.9 25.4 1.9 10.5 2.3 1.0 100.0 1,569 0.0 Upper East 44.8 32.0 5.2 13.7 3.0 1.3 100.0 731 0.6 Upper West 53.3 27.8 3.2 11.6 1.8 2.2 100.0 490 0.0 Wealth quintile Lowest 52.1 31.1 3.7 12.2 0.8 0.1 100.0 3,277 0.0 Second 36.1 31.5 5.7 25.2 1.4 0.2 100.0 3,548 2.1 Middle 23.3 28.3 6.2 36.6 4.5 1.1 100.0 3,716 4.7 Fourth 14.5 24.8 4.8 43.0 9.1 3.8 100.0 3,717 6.7 Highest 7.8 17.7 3.2 42.2 14.7 14.4 100.0 3,520 8.7 Total 26.2 26.6 4.7 32.3 6.2 3.9 100.0 17,778 4.4 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Findings show that females in the northern half of the country are disadvantaged. The percentage of females who have never been to school is high in Northern (59 percent), followed by Upper West (53 percent) and Upper East (45 percent), as compared with only 14 percent of females in Greater Accra. On the other hand, 20 percent of females in Greater Accra have completed secondary education or higher, compared with 4 percent or less each in the Northern, Upper East, and Upper West regions. Housing Characteristics and Household Population • 27 The proportion of female household members who have never attended school decreases sharply with increasing wealth, from 52 percent in the lowest quintile to 8 percent in the highest quintile. Overall, the median number of completed years of schooling among females age 6 and older is 4.4. Table 2.12.2 shows that 18 percent of males have never been to school, a decline from 22 percent in 2008. Thirty-one percent of males have had some primary education or have completed primary education, 44 percent have had some secondary or have completed secondary education, and 8 percent have more than a secondary education. Similar to females, the proportion of males with no education is higher in the older ages. Twenty- five percent of males in rural areas have no education, compared with 10 percent in urban areas. There is a marked urban-rural differential in secondary and higher education: 23 percent of males in urban areas have completed secondary or higher education, compared with 9 percent in rural areas. Across the regions, the pattern for males is similar to that observed for females. Higher proportions of males in the three northern regions (Northern, 44 percent; Upper West, 41 percent; and Upper East, 32 percent) have never been to school, compared with 20 percent or less of males in other regions. The percentage of males with no education is strongly associated with wealth; those in the lowest quintile are the most likely to have no education (38 percent), compared with only 5 percent of males in the richest households. The median number of completed years of schooling among the male household population age 6 and older is 5.9. Table 2.12.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Ghana 2014 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years completed Age 6-9 43.6 56.2 0.0 0.2 0.0 0.0 100.0 2,292 0.0 10-14 4.9 70.1 8.9 16.0 0.0 0.0 100.0 2,700 3.6 15-19 3.2 18.0 8.0 63.9 6.0 0.9 100.0 1,814 7.1 20-24 6.1 8.5 3.9 40.9 32.0 8.6 100.0 1,366 9.0 25-29 11.0 8.7 3.3 33.6 22.6 20.7 100.0 1,255 8.9 30-34 12.0 8.4 4.3 41.1 16.0 18.2 100.0 1,143 8.6 35-39 14.2 8.5 3.6 44.2 15.8 13.8 100.0 1,047 8.5 40-44 15.4 8.0 3.9 54.9 7.2 10.6 100.0 920 8.9 45-49 19.6 7.6 3.6 55.6 3.3 10.3 100.0 754 9.2 50-54 21.1 10.1 1.7 53.8 1.6 11.7 100.0 643 9.2 55-59 25.8 7.7 2.9 49.0 2.4 12.1 100.0 486 9.2 60-64 28.2 5.3 3.5 48.8 2.1 12.3 100.0 511 9.1 65+ 43.7 8.3 1.1 37.4 1.2 8.2 100.0 837 3.0 Residence Urban 10.3 23.2 3.6 39.5 11.9 11.5 100.0 7,763 8.2 Rural 24.5 30.5 5.1 31.3 4.9 3.7 100.0 8,008 4.1 Region Western 13.0 25.3 4.8 40.3 10.4 6.2 100.0 1,580 7.2 Central 15.3 26.7 5.5 37.8 7.3 7.3 100.0 1,456 6.4 Greater Accra 7.7 23.1 3.4 38.8 14.0 12.9 100.0 3,025 8.3 Volta 15.8 30.7 4.6 37.6 5.7 5.6 100.0 1,347 5.6 Eastern 13.4 27.6 5.2 40.2 6.9 6.7 100.0 1,537 6.4 Ashanti 11.7 24.1 5.1 42.4 8.5 8.1 100.0 2,792 7.8 Brong Ahafo 19.6 29.4 4.1 35.2 6.9 4.9 100.0 1,344 5.2 Northern 44.3 28.9 2.4 16.0 3.8 4.6 100.0 1,555 0.5 Upper East 31.6 38.8 5.3 16.3 3.9 3.9 100.0 678 2.1 Upper West 41.3 30.3 2.7 16.4 4.2 5.1 100.0 458 1.0 Wealth quintile Lowest 37.7 34.9 4.0 20.3 2.2 0.8 100.0 3,252 1.4 Second 22.0 31.9 6.7 34.0 3.8 1.6 100.0 3,104 4.4 Middle 14.4 28.1 5.1 40.2 8.0 4.2 100.0 3,034 6.2 Fourth 8.7 23.1 3.8 45.0 11.6 7.7 100.0 3,081 8.2 Highest 4.5 16.8 2.2 38.0 15.8 22.6 100.0 3,301 9.5 Total 17.5 26.9 4.3 35.4 8.3 7.5 100.0 15,771 5.9 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 28 • Housing Characteristics and Household Population 2.8.2 School Attendance Ratios The 2014 GDHS collected information on school attendance for the population age 3-24 that allows the calculation of net attendance ratios (NARs) and gross attendance ratios (GARs). The NAR for primary school is the percentage of the primary-school-age (6-11 years) population that is attending primary school. The NAR for secondary school is the measure of the secondary-school-age (12-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR however, measures participation at each level of schooling among persons age 6-25. The GAR is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older, because they may have started school late, may have repeated one or more grades in school, or may have dropped out of school and later returned, or may be younger than the official age range for that level. Table 2.13 presents data on the NAR and GAR for the de facto household population by level of schooling and sex, according to place of residence, region, and wealth quintile. Seventy percent of children age 6-11 who should be attending primary school are currently doing so, a slight decrease from 74 percent in 2008. The GAR at the primary school level is 99 percent. The distribution shows that both the NAR and the GAR are much lower at the secondary school level: 39 percent of students age 12-17 who should be attending secondary school are in school (NAR), a slight decrease from 42 percent in 2008. The GAR for secondary school is 50 percent. The results show no differences in the primary or secondary school NARs between males and females, indicating no notable gender gap in school attendance for the Ghanaian school-age population who should be attending school at a given level. However, the GAR at the secondary school level is slightly higher for males than for females (53 percent versus 47 percent). The NAR at both the primary and secondary levels are lower in rural than in urban areas. For instance, the NAR at the primary school level is 66 percent in rural areas compared with 74 percent in urban areas. Similarly, the NAR at the secondary school level is 32 percent in rural areas, compared with 46 percent in urban areas. Regional differences are also pronounced. The primary school NAR is lowest in the Upper West region (64 percent) and the secondary school NAR is lowest in the Northern, Upper East, and Upper West regions (30 percent each). The GAR at the secondary school level is also higher in urban areas. However, there is almost no urban-rural difference in the GAR at the primary school level. The GAR at the primary school level is highest in the Upper East region, indicating higher overage or underage attendance than in other regions. The lowest GAR at the secondary level is in Central region (31 percent) and the highest is in Volta (58 percent). There is a strong relationship between household economic status and school attendance at both the primary and secondary levels and among both males and females. For example, the primary school NAR increases from 61-64 percent among students from households in the lowest two wealth quintiles to 81 percent among students from the richest households. Similarly, the NAR for secondary school rises from 25 percent among students in the lowest wealth quintile to 50-54 percent among those in the top two wealth quintiles. Table 2.13 also shows the Gender Parity Index (GPI), which represents the ratio of the NAR and GAR for females to the NAR and GAR for males. It is a more precise indicator of gender differences in the schooling system. A GPI less than 1 indicates that a smaller proportion of females than males attend school. In Ghana, the GPI is 1.00 for primary school attendance and 1.01 for secondary school attendance, indicating no gender gaps. There are no notable differences in the primary school GPI for NAR by background characteristics. At the secondary school level, the widest gender gap in attendance is in Northern region (GPI of 0.88) and among the richest households (GPI of 0.84). The indexes for GAR at the primary and secondary levels are slightly less than 1 (0.98 for primary school and 0.89 for secondary Housing Characteristics and Household Population • 29 school), indicating some gender gap, especially at the secondary school level. The gender gap in attendance has remained unchanged over the last six years at the primary and secondary levels. Table 2.13 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Ghana 2014 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 74.5 74.3 74.4 1.00 98.4 99.0 98.7 1.01 Rural 65.8 65.8 65.8 1.00 101.2 97.7 99.5 0.97 Region Western 77.4 80.6 78.9 1.04 103.0 115.8 109.2 1.12 Central 45.8 46.3 46.1 1.01 69.0 58.4 63.4 0.85 Greater Accra 74.7 74.8 74.7 1.00 91.5 96.8 94.1 1.06 Volta 73.4 73.6 73.5 1.00 117.3 105.8 111.7 0.90 Eastern 70.5 65.2 68.0 0.92 107.0 96.4 101.9 0.90 Ashanti 74.2 73.5 73.8 0.99 101.3 101.6 101.5 1.00 Brong Ahafo 70.5 68.2 69.4 0.97 103.9 104.4 104.2 1.00 Northern 66.1 70.3 68.1 1.06 103.5 103.9 103.7 1.00 Upper East 70.0 76.5 73.1 1.09 111.0 115.5 113.2 1.04 Upper West 65.0 63.9 64.4 0.98 111.9 100.2 105.9 0.90 Wealth quintile Lowest 62.5 64.8 63.6 1.04 102.5 102.7 102.6 1.00 Second 63.4 58.1 60.8 0.92 97.6 88.1 92.9 0.90 Middle 70.0 71.5 70.8 1.02 100.7 99.2 100.0 0.99 Fourth 78.4 76.8 77.5 0.98 103.6 97.5 100.3 0.94 Highest 79.9 82.0 80.9 1.03 94.3 106.7 100.1 1.13 Total 69.6 69.6 69.6 1.00 99.9 98.3 99.1 0.98 SECONDARY SCHOOL Residence Urban 45.5 45.5 45.5 1.00 61.0 54.8 57.8 0.90 Rural 32.5 32.0 32.3 0.99 45.9 39.5 42.8 0.86 Region Western 48.5 46.2 47.2 0.95 67.2 57.9 61.9 0.86 Central 23.2 24.6 23.8 1.06 32.6 29.7 31.3 0.91 Greater Accra 47.1 44.5 45.7 0.94 62.1 50.5 56.2 0.81 Volta 40.6 41.8 41.2 1.03 59.6 55.3 57.7 0.93 Eastern 39.4 38.0 38.7 0.96 46.1 47.4 46.7 1.03 Ashanti 42.0 42.8 42.4 1.02 52.3 49.7 51.0 0.95 Brong Ahafo 38.5 36.0 37.2 0.94 61.0 45.3 52.8 0.74 Northern 31.8 27.8 30.0 0.88 48.3 34.2 41.9 0.71 Upper East 26.3 34.5 30.4 1.31 44.0 47.6 45.8 1.08 Upper West 27.7 33.4 30.4 1.21 45.6 40.8 43.3 0.89 Wealth quintile Lowest 24.9 25.0 25.0 1.00 41.5 32.7 37.5 0.79 Second 30.8 28.7 29.8 0.93 42.5 35.2 39.1 0.83 Middle 40.9 37.8 39.3 0.93 54.8 47.9 51.3 0.87 Fourth 46.3 53.8 50.3 1.16 63.1 62.2 62.6 0.99 Highest 58.8 49.5 53.9 0.84 71.2 58.8 64.7 0.83 Total 38.4 38.6 38.5 1.01 52.7 47.0 49.9 0.89 1 The NAR for primary school is the percentage of the primary-school age (6-11 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (12-17 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary- school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. 30 • Housing Characteristics and Household Population Figure 2.3 shows that attendance rates increase up to ages 9-11 for both males and females, with some fluctuations for females, then they drop gradually. Figure 2.3 Age-specific attendance rates of the de-facto population 5 to 24 years 0 10 20 30 40 50 60 70 80 90 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age (years) Male Female GDHS 2014 Characteristics of Respondents • 31 CHARACTERISTICS OF RESPONDENTS 3 he purpose of this chapter is to create a demographic and socioeconomic profile of individual female and male respondents in the 2014 Ghana Demographic and Health Survey (GDHS). This information helps in the interpretation of findings presented later in the report and provides an indication of the representativeness of the survey. The chapter first describes basic background characteristics, including age, religion, ethnicity, marital status, residence, and wealth status. It then provides more detailed information on education, literacy, media exposure, and employment. Throughout this report, numbers in the tables reflect weighted numbers. Percentages based on 25 to 49 unweighted cases are shown in parentheses, and percentages based on fewer than 25 unweighted cases are suppressed and replaced with an asterisk, to caution readers when interpreting data that a percentage based on fewer than 50 cases may not be statistically reliable.1 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 shows the weighted and unweighted numbers and the weighted percent distributions of women and men age 15-49 who were interviewed in the 2014 GDHS, by background characteristics. More than half of the respondents age 15-49 (52 percent of women and 53 percent of men) are under age 30, reflecting the young age structure of the population. The vast majority of respondents are Christian. More than 4 in 10 women (41 percent) and 3 in 10 men (32 percent) are Pentecostal/Charismatic, and 39 percent 1 Parentheses are used if early childhood mortality rates are based on 250 to 499 children exposed to the risk of mortality in any of the component rates; early childhood mortality rates are suppressed if they are based on fewer than 250 children exposed to the risk of mortality in any of the component rates. T Key Findings: • More than half of women and men age 15-49 (54 percent and 53 percent, respectively) live in urban areas, an increase from 49 percent and 46 percent, reported in the 2008 GDHS. • Nineteen percent of women and 9 percent of men age 15-49 have never attended school; more are in school now than in 2008 when 21 percent and 13 percent did not attend. • The median age of enrolment in primary school among women and men age 15-24 is 6.5 years. • Large percentages of women and men age 15-24 who stopped going to school (38 percent and 39 percent, respectively) indicated they had no money to cover the education costs. • Sixty-seven percent of women and 82 percent of men age 15-49 are literate, an increase from the 2008 literacy levels of 63 percent and 77 percent, respectively. • Men are more likely to have access to the media than women; 13 percent of men are exposed to all three media at least once a week compared with only 5 percent of women. • Thirty-one percent of women and 14 percent of men age 15-49 are not exposed to any media. • Overall, 26 percent of employed women in the agricultural sector are not paid at all, mainly because they are employed by a family member. On the other hand, 14 percent of women who are employed in the nonagricultural sector are not paid for their work. 32 • Characteristics of Respondents of women and 42 percent of men are Catholic, Anglican, Methodist, Presbyterian, or other Christian. Fifteen percent of women and 18 percent of men are Muslim. Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Ghana 2014 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 17.3 1,625 1,756 22.1 855 889 20-24 17.2 1,613 1,571 15.2 588 620 25-29 17.1 1,604 1,564 15.2 589 577 30-34 14.6 1,372 1,343 14.3 552 497 35-39 13.8 1,295 1,260 12.2 473 472 40-44 11.0 1,030 1,032 11.8 456 442 45-49 9.1 857 870 9.2 355 358 Religion Catholic 10.0 944 1,341 10.7 416 538 Anglican/Methodist/Presbyterian 14.0 1,312 1,132 13.0 504 425 Pentecostal/Charismatic 41.1 3,859 3,457 31.5 1,217 1,025 Other Christian 15.1 1,416 1,239 18.0 695 614 Muslim 15.2 1,423 1,726 17.6 680 823 Traditional/Spiritualist 2.0 188 226 3.3 128 210 No religion 2.7 251 273 5.9 227 218 Other 0.0 2 1 0.0 1 2 Missing 0.0 1 1 0.0 0 0 Ethnic group Akan 50.1 4,705 3,876 49.2 1,905 1,557 Ga/Dangme 7.7 728 519 8.3 323 228 Ewe 13.5 1,266 1,118 13.3 514 450 Guan 2.3 216 256 2.1 79 102 Mole-Dagbani 14.8 1,388 2,270 14.7 568 932 Grusi 2.9 271 415 2.6 101 176 Gurma 5.8 545 658 5.8 226 266 Mande 0.9 85 110 1.2 47 55 Other 2.0 191 173 2.7 106 89 Missing 0.0 1 1 0.0 0 0 Marital status Never married 32.9 3,094 3,041 47.8 1,851 1,854 Married 42.2 3,968 4,243 38.3 1,480 1,527 Living together 14.4 1,353 1,213 9.5 366 309 Divorced/separated 7.7 728 630 4.1 159 146 Widowed 2.7 253 269 0.3 13 19 Residence Urban 53.8 5,051 4,602 53.0 2,050 1,826 Rural 46.2 4,345 4,794 47.0 1,819 2,029 Region Western 11.0 1,038 1,027 11.6 447 447 Central 10.0 937 941 9.8 380 363 Greater Accra 20.2 1,898 999 21.5 831 422 Volta 7.7 720 795 7.6 295 312 Eastern 9.3 878 907 9.4 362 377 Ashanti 19.1 1,798 1,040 17.6 680 390 Brong Ahafo 8.2 769 1,005 8.3 320 422 Northern 8.4 786 1,042 8.2 316 431 Upper East 3.8 358 914 3.8 146 382 Upper West 2.3 215 726 2.3 91 309 Education No education 19.1 1,792 2,281 9.4 362 502 Primary 17.8 1,672 1,747 14.0 543 636 Middle/JSS/JHS 41.1 3,862 3,528 42.0 1,626 1,512 Secondary+ 22.0 2,070 1,840 34.5 1,336 1,205 Wealth quintile Lowest 16.1 1,511 2,335 16.5 639 990 Second 17.4 1,636 1,759 16.8 648 717 Middle 20.6 1,938 1,902 19.9 770 735 Fourth 22.5 2,117 1,771 21.9 848 726 Highest 23.3 2,194 1,629 24.9 963 687 Total 15-49 100.0 9,396 9,396 100.0 3,869 3,855 50-59 na na na na 519 533 Total 15-59 na na na na 4,388 4,388 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents • 33 As expected, the Akans form the largest ethnic group, with about half of respondents belonging to this group, followed by the Mole-Dagbanis, which account for 15 percent each of women and men, and the Ewes, which account for 14 percent of women and 13 percent of men. One-third of women (33 percent) and nearly half of men (48 percent) have never been married. Women are more likely to be married or living together with a partner (i.e., in union) than men (57 percent versus 48 percent). More women than men are also divorced or separated (8 percent versus 4 percent) or widowed (3 percent versus less than 1 percent). More than half of women (54 percent) and men (53 percent) live in urban areas, an increase from 49 percent and 46 percent, respectively, in the 2008 GDHS. By region, the largest proportion of women and men reside in Greater Accra (20 percent and 22 percent, respectively), and the smallest proportion reside in the Upper West region (2 percent each). In general, most men and women in Ghana have some formal education. However, 19 percent of women and 9 percent of men have never attended school, a decrease from the figures of 21 percent and 13 percent, respectively, reported in the 2008 GDHS survey. Men tend to be more educated than women: 35 percent of men have a secondary or higher education, as compared with 22 percent of women. 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Education provides people with the knowledge and skills that can lead to better employment opportunities and a better quality of life. Education level is closely associated with the health of women and children as well as reproductive health behaviours of women and men. Tables 3.2.1 and 3.2.2 show the distribution of women and men by highest level of schooling attended or completed and the median number of years of schooling, according to background characteristics. Table 3.2.1 shows that 19 percent of women age 15-49 have never been to school, 13 percent have some primary education, 5 percent have completed primary school, 46 percent have some secondary education, 11 percent have completed secondary school, and 6 percent have attained more than a secondary education. Older women age 40-49 (32-36 percent), those who reside in rural areas (29 percent), women who live in Northern region (66 percent), and those in the poorest wealth quintile (52 percent) are most likely to have no education. The urban-rural and wealth quintile differences in education are more pronounced at the secondary and higher levels. For example, women in urban areas are more than twice as likely as those in rural areas to have completed secondary education (16 percent versus 6 percent). Similarly, 22 percent of women in the highest wealth quintile have completed secondary education, compared with just 2 percent of women in the lowest wealth quintile. Nationally, women have completed a median of 7.8 years of schooling. Looking at age, women in the 20-24 age group have the highest median years of schooling (8.5 years) while those age 45-49 have the lowest number of median years of schooling (4.9 years). Urban women have completed a median of 8.5 years of schooling compared with 5.7 years among rural women. Median number of years completed is highest among women from Greater Accra (8.7 years) and lowest among women in the Northern region (0.0 years). There is a notable difference in median number of schooling years by wealth quintile; it is 9.6 years among women in the highest wealth quintile versus 0.0 years among those in the lowest quintile. 34 • Characteristics of Respondents Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Ghana 2014 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 8.1 12.0 6.4 53.8 15.7 4.0 100.0 7.9 3,238 15-19 4.3 14.5 8.1 67.0 6.1 0.1 100.0 7.2 1,625 20-24 11.9 9.5 4.6 40.6 25.4 8.0 100.0 8.5 1,613 25-29 17.2 10.2 3.8 39.0 15.4 14.3 100.0 8.3 1,604 30-34 21.3 12.6 5.2 43.4 9.5 7.9 100.0 8.1 1,372 35-39 25.4 12.9 4.3 42.6 9.4 5.5 100.0 7.8 1,295 40-44 31.6 15.8 5.7 41.9 2.1 2.9 100.0 5.4 1,030 45-49 35.7 14.5 4.5 41.7 0.3 3.3 100.0 4.9 857 Residence Urban 11.0 9.9 4.0 49.8 15.7 9.7 100.0 8.5 5,051 Rural 28.5 15.7 6.7 41.1 5.5 2.5 100.0 5.7 4,345 Region Western 14.2 14.1 5.8 51.3 11.0 3.6 100.0 8.1 1,038 Central 15.1 10.6 7.3 50.0 10.6 6.3 100.0 8.0 937 Greater Accra 8.3 10.5 3.7 46.3 17.5 13.7 100.0 8.7 1,898 Volta 19.1 16.2 6.0 46.0 8.4 4.2 100.0 7.0 720 Eastern 10.4 13.5 8.1 52.4 10.3 5.4 100.0 8.0 878 Ashanti 10.8 11.3 4.2 56.4 11.5 5.8 100.0 8.4 1,798 Brong Ahafo 20.5 16.4 6.1 45.2 8.5 3.2 100.0 6.5 769 Northern 65.8 8.6 2.6 17.0 4.4 1.7 100.0 0.0 786 Upper East 40.0 19.7 7.4 24.8 5.9 2.3 100.0 2.9 358 Upper West 48.7 15.4 4.6 23.1 3.6 4.6 100.0 1.0 215 Wealth quintile Lowest 51.7 16.9 5.7 24.0 1.6 0.1 100.0 0.0 1,511 Second 27.4 20.0 7.4 42.0 3.0 0.3 100.0 5.3 1,636 Middle 15.0 14.7 7.8 52.4 8.0 2.1 100.0 7.3 1,938 Fourth 9.0 9.1 4.2 56.4 15.6 5.7 100.0 8.5 2,117 Highest 3.8 5.5 2.0 47.6 21.5 19.5 100.0 9.6 2,194 Total 19.1 12.6 5.2 45.8 11.0 6.3 100.0 7.8 9,396 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Similar patterns in educational attainment are observed among men (Table 3.2.2). Nationally, 9 percent of men age 15-49 have no education, 10 percent have some primary education, 4 percent have completed primary education, 50 percent have some secondary education, 15 percent have completed secondary education, and 12 percent have completed secondary or higher schooling. Men age 45-49 are most likely to have no education (17 percent), while the youngest men age 15- 19 are the least likely to have no education (3 percent). Urban residents have higher levels of educational attainment than their rural counterparts; only 4 percent of urban men have no education, compared with 15 percent of rural men. By contrast, 16 percent of men in urban areas have more than a secondary education, compared with 6 percent of rural men. The percentage with no education is highest among men in the Northern region (47 percent) and lowest among men in the Eastern region (2 percent). Thirty-two percent of men in the lowest wealth quintile have no schooling compared with less than 1 percent of men in the highest quintile. On the other hand, 29 percent of men in the highest wealth quintile have more than a secondary education compared with less than 1 percent of men in the lowest quintile. At the national level, men age 15-49 have completed a median of 8.5 years of schooling. Men age 20-24 (12.2 years) and men in urban areas (9.1 years) have the highest median number of school years when compared with other age groups and with rural residents. The median number of completed years of schooling ranges from 9.5 years in Greater Accra to 2.7 years in Northern. Median years of schooling increases from 5.0 years among the poorest men to 13.3 years among the wealthiest men. Survey results show that men have more education than women above the primary level. For example, twice as many men as women have completed more than a secondary education (12 percent compared with 6 percent). Characteristics of Respondents • 35 Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Ghana 2014 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 3.2 11.6 4.8 59.0 17.3 4.1 100.0 8.1 1,443 15-19 2.5 14.6 6.4 70.5 5.5 0.4 100.0 7.3 855 20-24 4.3 7.3 2.4 42.4 34.4 9.3 100.0 12.2 588 25-29 10.7 9.5 2.7 34.1 20.2 22.8 100.0 8.8 589 30-34 10.3 9.2 5.2 40.8 16.3 18.0 100.0 8.6 552 35-39 13.6 8.6 3.3 45.8 14.2 14.5 100.0 8.5 473 40-44 15.7 9.2 4.5 52.7 9.4 8.5 100.0 8.8 456 45-49 16.8 7.5 2.7 55.6 3.7 13.7 100.0 9.2 355 Residence Urban 4.1 6.8 2.1 51.5 19.2 16.4 100.0 9.1 2,050 Rural 15.3 13.4 6.4 48.3 10.3 6.2 100.0 7.6 1,819 Region Western 5.1 11.9 2.6 55.6 16.5 8.3 100.0 8.6 447 Central 5.1 7.2 5.3 56.8 11.6 14.0 100.0 8.5 380 Greater Accra 2.9 7.9 2.0 47.3 21.4 18.4 100.0 9.5 831 Volta 4.7 17.1 5.6 54.6 9.8 8.1 100.0 8.1 295 Eastern 1.8 12.6 5.1 56.6 15.1 8.7 100.0 8.5 362 Ashanti 4.6 4.7 4.2 57.8 16.1 12.5 100.0 8.8 680 Brong Ahafo 10.1 11.5 4.5 53.8 13.4 6.7 100.0 8.3 320 Northern 47.4 8.7 3.4 24.5 8.0 7.9 100.0 2.7 316 Upper East 23.5 22.0 11.8 28.3 9.5 4.9 100.0 5.4 146 Upper West 30.7 14.6 4.7 27.9 11.5 10.7 100.0 5.8 91 Wealth quintile Lowest 31.9 18.2 7.1 37.3 4.8 0.7 100.0 5.0 639 Second 10.9 17.0 8.8 51.2 9.7 2.5 100.0 7.1 648 Middle 6.8 12.1 3.8 56.8 13.9 6.6 100.0 8.3 770 Fourth 3.9 5.7 2.4 58.1 18.5 11.5 100.0 8.9 848 Highest 0.3 1.7 0.8 44.9 23.3 29.0 100.0 13.3 963 Total 15-49 9.4 9.9 4.1 50.0 15.0 11.6 100.0 8.5 3,869 50-59 20.6 7.2 1.9 55.5 1.4 13.4 100.0 9.3 519 Total 15-59 10.7 9.6 3.8 50.6 13.4 11.8 100.0 8.6 4,388 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 3.3 SCHOOL ATTENDANCE In the 2014 Ghana DHS all respondent age 15-24 who ever attended school were asked at what age the respondent age 24 or younger started primary school and whether the respondent age 24 or younger is currently attending school at any level. If the respondent is currently not attending school, she or he was asked why the respondent is not currently attending any school. Table 3.3.1 and Table 3.3.2 show the median age of enrollment in primary school among women and men age 15-24, respectively, who ever attended school, and percent distribution of respondents age 15- 24 who ever attended school and who are not currently attending school, by reason for stopping school, according to background characteristics. The median age for enrolment in primary school among women age 15-24 is 6.5 years. The median age for enrolment is slightly lower for women in urban than in rural areas (6.2 years versus 6.9 years). Young women in Upper East (8.1 years) and Upper West (8.0 years) and those in the lowest wealth quintile (7.9 years) have the highest median age for enrolment in primary school when compared with other sub groups. Respondents age 15-24 who had attended school but were not attending school at the time of the survey were asked why they stopped going. About 4 in 10 women age 15-24 (38 percent) indicated they had no money to cover the education costs. Other reasons for quitting include having completed the 36 • Characteristics of Respondents desired level of education (13 percent), waiting for approved admission (11 percent), having family reasons or getting married (9 percent), having bad grades (7 percent), having no desire to continue education (6 percent), having to work (5 percent), becoming pregnant and health reasons (2 percent each), and moving or changing residence (1 percent). The percentage of women age 15-24 who reported they stopped going to school because they had no money to cover the education costs is highest among rural residents (40 percent), those living in Eastern region (45 percent), and among young women in the middle wealth quintile (44 percent). Table 3.3.1 School attendance: Women 15-24 Median age of enrolment in primary school among women age 15-24 who ever attended school, and percent distribution of women age 15-24 who ever attended school and who are not currently attending school, by reason for stopping school, according to background characteristics, Ghana, 2014 Women 15-24 who ever attended school Reason for stopping school among women 15-24 who ever attended school and who are currently not attending school: Total Number of women Background characteristic Median age of enrolment in primary school Number of women Had to work Moved No money to cover costs Had bad grades Health reasons Family reasons/ got married Completed desired level of education No desire to continue Waiting for approved admission Became pregnant Other Residence Urban 6.2 1,582 5.3 1.4 36.1 7.8 1.8 6.1 15.4 5.0 13.8 1.4 5.7 100.0 1,089 Rural 6.9 1,395 3.9 0.8 39.7 6.1 1.7 12.3 9.8 7.8 7.6 1.5 8.9 100.0 846 Region Western 6.6 368 2.8 0.0 30.5 8.5 2.1 16.2 19.0 5.5 5.2 0.3 9.9 100.0 257 Central 6.9 298 10.0 1.6 39.2 7.3 1.9 8.3 11.1 5.9 5.9 1.1 7.8 100.0 208 Greater Accra 5.9 547 5.4 1.9 35.5 3.5 0.8 6.5 21.7 5.0 14.6 0.0 5.0 100.0 386 Volta 6.7 227 0.3 2.8 41.7 2.7 3.0 9.3 3.7 4.6 15.2 3.8 12.8 100.0 148 Eastern 6.8 307 4.7 1.3 44.9 5.0 1.3 4.0 16.0 9.6 4.6 3.6 4.9 100.0 205 Ashanti 6.2 592 6.3 0.0 42.1 10.3 2.0 5.2 7.8 3.4 14.8 0.0 8.0 100.0 395 Brong Ahafo 6.5 273 1.7 1.5 31.8 5.5 1.4 10.2 10.7 15.0 10.4 6.9 5.0 100.0 170 Northern 7.6 166 1.4 0.0 38.5 12.7 4.2 19.0 1.6 7.7 11.4 0.5 2.9 100.0 75 Upper East 8.1 127 4.0 2.8 29.5 14.6 1.4 25.2 2.4 4.1 11.5 0.0 4.4 100.0 57 Upper West 8.0 72 0.0 1.4 43.5 8.4 0.6 4.9 7.4 9.1 17.1 1.0 6.5 100.0 34 Wealth quintile Lowest 7.9 430 2.6 1.1 36.7 7.9 3.7 15.5 5.1 10.9 7.5 1.3 7.8 100.0 224 Second 6.9 564 3.6 1.6 41.4 5.1 1.4 11.5 5.7 7.1 8.5 4.8 9.4 100.0 364 Middle 6.7 675 4.4 1.5 44.3 5.1 2.4 8.1 8.6 8.3 7.7 1.4 8.1 100.0 475 Fourth 6.1 695 5.4 1.0 37.9 9.5 1.1 6.7 15.5 3.7 11.0 0.3 7.9 100.0 489 Highest 5.9 612 6.3 0.5 26.8 7.4 0.9 6.9 26.0 3.9 19.1 0.0 2.2 100.0 382 Total 15-24 6.5 2,977 4.7 1.1 37.8 7.0 1.8 9.0 12.8 6.3 10.9 1.5 7.1 100.0 1,935 Table 3.3.2 shows that the median age of enrolment in primary school is the same among men as it is among women age 15-24 (6.5 years). Rural residents (7.0 years), those living in Volta (8.3 years), and young men in the lowest wealth quintile (7.7 years) have the highest median age of enrollment in primary school. As with women, almost four in ten men (39 percent) not attending school at the time of the survey indicated lack of money to cover costs as the main reason for stopping. Other reasons included having completed the desired level of education (18 percent), having to work (12 percent), waiting for approved admission (11 percent), no desire to continue education (8 percent), bad grades (3 percent), and moving or changing place of residence, health reasons, family reasons, or getting married (1 percent each). Young men who reside in rural areas (43 percent), those who live in Volta (66 percent), and men who belong to the second wealth quintile (52 percent) are the most likely to report that they stopped going to school because of lack of money to cover costs. Characteristics of Respondents • 37 Table 3.3.2 School attendance: Men 15-24 Median age of enrolment in primary school among men age 15-24 who ever attended school, and percent distribution of men age 15-24 who ever attended school and who are not currently attending school, by reason for stopping school, according to background characteristics, Ghana, 2014 Men 15-24 who ever attended school Reason for stopping school among men 15-24 who ever attended school and who are currently not attending school: Total Number of men Background characteristic Median age of enrolment in primary school Number of men Had to work Moved No money to cover costs Had bad grades Health reasons Family reasons/ got married Completed desired level of education No desire to continue Waiting for approved admission Other Residence Urban 6.2 722 12.6 0.9 36.2 2.8 0.3 1.1 20.7 5.9 12.0 7.6 100.0 429 Rural 7.0 675 11.6 0.2 43.0 2.4 1.5 1.9 14.1 10.1 8.9 6.5 100.0 344 Region Western 6.3 167 9.1 2.3 39.7 1.5 2.3 2.5 21.8 11.1 8.9 0.9 100.0 97 Central 6.4 131 21.0 0.0 29.8 2.9 0.0 2.9 20.8 3.0 6.1 13.5 100.0 73 Greater Accra 6.2 268 15.2 0.9 29.9 1.7 0.0 0.0 28.3 4.7 10.1 9.1 100.0 177 Volta 8.3 115 9.8 1.5 66.3 0.0 2.8 1.8 4.1 5.3 7.4 1.1 100.0 49 Eastern 6.2 158 14.6 0.0 52.4 3.6 1.6 1.0 11.1 4.2 8.5 2.9 100.0 93 Ashanti 6.2 250 10.9 0.0 39.9 2.5 0.0 1.9 14.2 7.0 10.2 13.4 100.0 155 Brong Ahafo 7.3 123 4.9 0.0 46.0 5.3 0.8 0.0 10.9 12.5 16.7 2.9 100.0 63 Northern 7.3 87 (2.6) (0.0) (24.6) (3.6) (0.0) (5.7) (11.8) (18.9) (32.7) (0.0) 100.0 30 Upper East 6.9 62 2.9 0.0 32.0 5.4 2.6 0.0 13.3 29.3 9.4 5.2 100.0 23 Upper West 7.2 37 (25.9) (0.0) (19.9) (5.6) (0.0) (0.0) (24.6) (8.2) (7.1) (8.6) 100.0 12 Wealth quintile Lowest 7.7 259 8.9 0.7 34.0 4.2 1.0 3.9 8.8 12.4 13.3 12.6 100.0 105 Second 7.0 269 7.3 0.0 51.8 1.7 1.7 0.5 11.6 10.6 9.9 4.8 100.0 140 Middle 6.7 292 14.1 0.0 45.2 2.0 1.6 1.0 14.7 10.9 6.2 4.3 100.0 176 Fourth 6.0 326 11.3 1.8 42.5 4.1 0.0 0.8 18.8 5.1 7.5 8.1 100.0 210 Highest 5.9 251 18.2 0.0 18.2 1.0 0.0 2.0 32.6 1.6 19.3 7.1 100.0 142 Total 15-24 6.5 1,397 12.2 0.6 39.2 2.6 0.8 1.4 17.8 7.8 10.6 7.1 100.0 773 Note: Figures in parentheses are based on 25-49 unweighted cases. 3.4 LITERACY The ability to read and write is an important personal asset that empowers women and men by increasing opportunities in life. Knowing the distribution of the literate population of a country can help programme managers—especially those concerned with health and family planning—reach their targeted audiences with their messages. The 2014 GDHS assessed literacy by asking respondents to read a simple sentence in the local language (or in English). Respondents were scored on whether they could not read at all, or read part or all of the sentence shown to them. Only women and men who had never attended school and those who had primary or middle/JSS/JHS education were asked to read the sentence in the language they were most familiar with. Respondents with a secondary or higher education were assumed to be literate. Persons who were blind or visually impaired were excluded. Results are shown in Table 3.4.1 for women and in 3.4.2 for men. Table 3.4.1 indicates that two-thirds of women in Ghana (67 percent) are literate, an increase from 63 percent in the 2008 GDHS. Literacy is much higher among the youngest women age 15-19 (85 percent), and it decreases steadily with age to 47 percent among the oldest women age 45-49, suggesting more education opportunities for the younger generation. Literacy varies by place of residence; 78 percent of women in urban areas are literate, compared with 54 percent of rural women. Regional differences with regard to literacy are notable; literacy is highest among women in the Greater Accra region (81 percent) and lowest among women in the Northern region (27 percent). By wealth, literacy ranges from 32 percent among women in the lowest wealth quintile to 91 percent among women in the highest quintile, reaffirming a positive association between economic status and literacy. 38 • Characteristics of Respondents Table 3.4.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Ghana 2014 Secondary school or higher No schooling or primary school Total Percent- age literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Age 15-24 73.6 4.3 3.1 19.0 0.0 100.0 80.9 3,238 15-19 73.1 6.8 5.0 14.9 0.1 100.0 84.9 1,625 20-24 74.0 1.8 1.1 23.1 0.0 100.0 76.9 1,613 25-29 68.7 1.1 1.2 29.0 0.0 100.0 71.0 1,604 30-34 60.8 0.6 1.1 37.4 0.0 100.0 62.6 1,372 35-39 57.4 0.8 1.4 40.3 0.0 100.0 59.7 1,295 40-44 46.9 1.2 1.5 50.3 0.0 100.0 49.6 1,030 45-49 45.2 1.2 0.9 52.4 0.3 100.0 47.3 857 Residence Urban 75.2 1.7 1.5 21.5 0.1 100.0 78.4 5,051 Rural 49.1 2.5 2.4 45.9 0.0 100.0 54.0 4,345 Region Western 65.9 1.6 2.8 29.7 0.0 100.0 70.3 1,038 Central 67.0 2.5 1.6 29.0 0.0 100.0 71.0 937 Greater Accra 77.5 1.8 1.5 19.0 0.1 100.0 80.8 1,898 Volta 58.7 4.3 1.9 34.9 0.2 100.0 64.9 720 Eastern 68.0 2.4 0.9 28.7 0.0 100.0 71.3 878 Ashanti 73.8 1.7 1.1 23.5 0.0 100.0 76.5 1,798 Brong Ahafo 57.0 2.4 1.1 39.4 0.1 100.0 60.5 769 Northern 23.1 1.1 3.3 72.4 0.2 100.0 27.4 786 Upper East 32.9 3.2 5.7 58.2 0.0 100.0 41.8 358 Upper West 31.3 1.9 3.6 63.2 0.0 100.0 36.8 215 Wealth quintile Lowest 25.8 2.9 2.9 68.3 0.0 100.0 31.6 1,511 Second 45.3 2.5 2.5 49.5 0.2 100.0 50.3 1,636 Middle 62.5 2.3 2.1 33.1 0.0 100.0 66.9 1,938 Fourth 77.7 1.9 1.4 18.9 0.1 100.0 81.0 2,117 Highest 88.7 1.4 0.9 8.9 0.0 100.0 91.0 2,194 Total 63.1 2.1 1.9 32.8 0.1 100.0 67.1 9,396 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Table 3.4.2 shows that men have a higher literacy level than women (82 percent versus 67 percent). This is an increase from the 2008 GDHS, which reported a literacy level of 77 percent among men. Similar to women, literacy among men is highest for the 15-24 age group (89 percent). Seventy-two percent of rural men are literate, as compared with 91 percent of urban men. There are variations across regions. Greater Accra has the highest proportion of literate men (92 percent), while Northern has the lowest proportion (45 percent). Literacy increases steadily with wealth from 52 percent among the poorest men to 99 percent among men in the highest wealth quintile. Characteristics of Respondents • 39 Table 3.4.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Ghana 2014 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Age 15-24 80.4 4.4 4.6 10.7 0.0 100.0 89.3 1,443 15-19 76.5 6.5 6.8 10.3 0.0 100.0 89.7 855 20-24 86.1 1.3 1.4 11.3 0.0 100.0 88.7 588 25-29 77.1 0.6 2.2 19.9 0.0 100.0 80.0 589 30-34 75.2 0.5 2.9 21.4 0.0 100.0 78.6 552 35-39 74.5 0.9 2.8 21.9 0.0 100.0 78.1 473 40-44 70.6 1.9 3.6 23.5 0.4 100.0 76.1 456 45-49 73.0 1.5 1.6 23.7 0.2 100.0 76.0 355 Residence Urban 87.1 1.4 2.7 8.8 0.0 100.0 91.2 2,050 Rural 64.8 3.2 4.1 27.7 0.1 100.0 72.1 1,819 Region Western 80.4 1.4 5.2 12.6 0.4 100.0 87.0 447 Central 82.4 2.3 1.3 14.0 0.0 100.0 86.0 380 Greater Accra 87.2 1.2 3.9 7.7 0.0 100.0 92.3 831 Volta 72.5 5.4 5.1 16.8 0.0 100.0 83.0 295 Eastern 80.4 3.5 3.1 12.9 0.0 100.0 87.1 362 Ashanti 86.5 1.0 2.6 9.9 0.0 100.0 90.1 680 Brong Ahafo 73.9 2.7 1.3 21.8 0.2 100.0 77.9 320 Northern 40.4 2.0 2.5 55.0 0.0 100.0 45.0 316 Upper East 42.7 5.4 5.7 46.2 0.0 100.0 53.8 146 Upper West 50.1 4.7 6.0 39.2 0.0 100.0 60.8 91 Wealth quintile Lowest 42.8 4.8 4.6 47.9 0.0 100.0 52.1 639 Second 63.3 4.9 4.6 27.0 0.1 100.0 72.8 648 Middle 77.3 1.8 4.5 16.2 0.3 100.0 83.5 770 Fourth 88.1 0.8 3.0 8.1 0.0 100.0 91.9 848 Highest 97.2 0.5 1.2 1.0 0.0 100.0 99.0 963 Total 15-49 76.6 2.3 3.4 17.7 0.1 100.0 82.2 3,869 50-59 70.3 1.3 2.0 26.3 0.0 100.0 73.7 519 Total 15-59 75.8 2.2 3.2 18.7 0.1 100.0 81.2 4,388 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.5 ACCESS TO MASS MEDIA In the 2014 GDHS, exposure to media was assessed by asking respondents whether they listened to the radio, watched television, or read a newspaper or magazine at least once a week. Programme managers and planners use this information to determine which media may be most effective for disseminating health-related information to targeted audiences. Tables 3.5.1 and 3.5.2 show exposure to specific media on a weekly basis, by background characteristics, for women and men. The data show that 52 percent of women and 78 percent of men age 15-49 listen to the radio at least once a week, and 51 percent of women and 66 percent of men watch television at least once a week. Exposure to print media is much less common; 9 percent of women and 17 percent of men reported reading a newspaper or magazine at least once a week. Overall media exposure is higher among men than women; 13 percent of men are exposed to all three media at least once a week, as compared with 5 percent of women. Thirty-one percent of women and 14 percent of men age 15-49 are not exposed to any media source. There is a wide gap in exposure to mass media by place of residence. For example, the proportion of newspaper readers is notably higher among urban women and men (12 percent and 26 percent, respectively) than among their rural counterparts (4 percent and 8 percent, respectively). Women and men residing in the Greater Accra region are most likely to be exposed to all three media on a weekly basis (11 percent and 24 percent, respectively). 40 • Characteristics of Respondents Media exposure is highly related to the educational level as well as economic status of respondents. While 17 percent of women and 28 percent of men with a secondary or higher education access all three specific media at least once a week, 1 percent or less of those with no education or with primary education do so. Likewise, 12 percent of women and 31 percent of men in the highest wealth quintile access all three media at least once a week compared with less than 1 percent of women and 2 percent of men in the lowest quintile. The reason for the lower level of exposure to media among poor respondents may be that they are less likely to own a radio or television and, therefore, less likely to be consistently exposed to these media sources. Table 3.5.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Ghana 2014 Background characteristic Reads a newspaper or magazine at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 11.2 48.9 46.6 5.8 33.1 1,625 20-24 10.9 56.7 52.2 6.7 26.5 1,613 25-29 10.5 56.5 56.3 6.4 26.2 1,604 30-34 7.5 51.4 54.7 5.1 30.8 1,372 35-39 7.2 48.8 52.5 3.0 30.9 1,295 40-44 5.1 44.8 53.1 3.2 35.9 1,030 45-49 4.7 41.9 49.9 2.7 37.4 857 Residence Urban 12.4 65.7 57.1 7.8 21.9 5,051 Rural 4.4 33.5 46.6 1.7 41.3 4,345 Region Western 9.9 47.5 50.3 3.9 31.0 1,038 Central 8.7 47.6 54.0 4.0 29.6 937 Greater Accra 18.2 72.4 59.0 11.1 16.5 1,898 Volta 7.9 44.4 48.7 5.7 38.2 720 Eastern 10.1 49.9 53.3 6.3 29.7 878 Ashanti 3.8 52.7 53.1 2.4 31.7 1,798 Brong Ahafo 5.4 40.2 51.0 3.1 37.2 769 Northern 2.0 32.9 36.8 1.2 48.6 786 Upper East 2.3 26.2 52.4 1.3 39.3 358 Upper West 3.1 43.8 55.3 1.5 33.1 215 Education No education 0.0 30.2 41.3 0.0 47.5 1,792 Primary 1.1 42.3 45.2 0.5 38.2 1,672 Middle/JSS/JHS 6.2 53.1 54.2 3.0 29.1 3,862 Secondary+ 26.9 71.2 63.7 16.6 13.7 2,070 Wealth quintile Lowest 1.0 15.5 38.8 0.3 54.6 1,511 Second 3.0 33.8 48.1 1.4 40.2 1,636 Middle 5.5 49.6 48.1 2.9 33.0 1,938 Fourth 10.4 66.5 58.4 5.4 19.2 2,117 Highest 19.3 73.8 62.3 12.3 16.8 2,194 Total 8.7 50.8 52.2 5.0 30.8 9,396 Characteristics of Respondents • 41 Table 3.5.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Ghana 2014 Background characteristic Reads a newspaper or magazine at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 13.7 61.6 66.7 9.4 18.7 855 20-24 20.0 67.2 82.2 14.0 10.3 588 25-29 18.5 68.7 76.6 15.1 14.4 589 30-34 18.4 71.5 82.9 14.8 10.8 552 35-39 16.8 66.7 84.7 14.2 10.7 473 40-44 15.4 61.4 78.4 11.4 13.0 456 45-49 18.6 62.0 79.1 15.6 15.0 355 Residence Urban 25.6 79.3 79.7 21.4 10.8 2,050 Rural 7.5 50.1 75.2 3.9 16.9 1,819 Region Western 12.8 69.4 83.1 8.6 5.4 447 Central 17.6 48.3 52.5 8.3 30.5 380 Greater Accra 27.8 86.8 87.1 23.7 5.1 831 Volta 8.7 63.0 78.5 6.3 12.5 295 Eastern 17.9 63.8 81.1 12.0 7.4 362 Ashanti 21.3 76.4 85.8 18.2 10.7 680 Brong Ahafo 11.2 51.3 83.5 8.8 13.2 320 Northern 3.4 36.4 58.2 3.1 32.6 316 Upper East 11.4 50.1 69.2 8.7 19.9 146 Upper West 8.3 34.6 50.1 4.8 38.6 91 Education No education 0.0 30.8 62.1 0.0 29.8 362 Primary 2.2 51.4 68.2 0.8 21.3 543 Middle/JSS/JHS 11.8 68.0 78.8 8.2 12.0 1,626 Secondary+ 34.2 77.8 84.2 27.7 8.1 1,336 Wealth quintile Lowest 5.1 26.8 64.3 2.1 27.5 639 Second 5.2 49.6 74.5 2.6 16.2 648 Middle 9.8 69.1 79.2 6.1 12.9 770 Fourth 19.3 80.4 79.8 15.3 10.8 848 Highest 37.0 86.1 85.2 31.3 5.9 963 Total 15-49 17.1 65.6 77.6 13.1 13.6 3,869 50-59 20.0 55.4 83.8 16.8 11.4 519 Total 15-59 17.4 64.4 78.3 13.6 13.4 4,388 3.6 EMPLOYMENT 3.6.1 Employment Status The 2014 GDHS asked respondents a number of questions regarding their employment status, including whether they were working during the seven days preceding the survey and, if not, whether they had worked in the 12 months before the survey. The results for women and men are presented in Tables 3.6.1 and 3.6.2, respectively. At the time of the survey, 73 percent of women were currently employed, and 3 percent were not currently employed but had worked sometime during the past 12 months (Figure 3.1). 42 • Characteristics of Respondents Figure 3.1 Women’s employment status in the past 12 months Table 3.6.1 shows that the proportion of women currently employed increases from 33 percent in the 15-19 age group to more than 90 percent for those age 40-44 and 45-49 (91 percent and 93 percent, respectively). Never-married women are less likely to be currently employed (50 percent) compared with currently or previously married women (85 percent and 88 percent, respectively). Current employment increases with the number of living children from 51 percent of women with no children to 89 percent among those with five or more children. There are no notable variations in women’s current employment by place of residence. Across regions, women in Ashanti are most likely to be currently employed (77 percent), while women in Eastern and Upper East regions are least likely to be currently employed (66 percent each). Current employment among women decreases steadily with their level of education from 86 percent of women with no education to 66 percent of those with a secondary or higher education. There are no pronounced differences in women’s current employment by wealth status. Currently employed 73% Not currently employed but worked in past 12 months 3% Not employed in the 12 months preceding the survey 23% GDHS 2014 Characteristics of Respondents • 43 Table 3.6.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Ghana 2014 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 32.6 2.8 64.5 100.0 1,625 20-24 60.8 4.8 34.4 100.0 1,613 25-29 81.8 3.4 14.8 100.0 1,604 30-34 86.0 2.6 11.4 100.0 1,372 35-39 89.3 3.9 6.9 100.0 1,295 40-44 92.7 1.8 5.4 100.0 1,030 45-49 91.3 2.0 6.7 100.0 857 Marital status Never married 49.6 4.0 46.4 100.0 3,094 Married or living together 84.5 2.8 12.7 100.0 5,321 Divorced/separated/widowed 88.0 2.8 9.2 100.0 981 Number of living children 0 51.1 3.9 45.0 100.0 2,994 1-2 78.0 3.3 18.7 100.0 2,843 3-4 88.2 2.4 9.4 100.0 2,119 5+ 89.0 2.4 8.5 100.0 1,440 Residence Urban 73.0 3.7 23.3 100.0 5,051 Rural 73.9 2.6 23.5 100.0 4,345 Region Western 72.7 0.3 27.0 100.0 1,038 Central 74.5 3.0 22.5 100.0 937 Greater Accra 76.0 4.7 19.3 100.0 1,898 Volta 67.8 1.7 30.4 100.0 720 Eastern 65.7 4.6 29.5 100.0 878 Ashanti 76.8 3.8 19.3 100.0 1,798 Brong Ahafo 74.6 2.9 22.6 100.0 769 Northern 76.0 2.2 21.8 100.0 786 Upper East 65.7 3.6 30.6 100.0 358 Upper West 70.0 1.5 28.6 100.0 215 Education No education 86.1 2.6 11.3 100.0 1,792 Primary 75.5 2.3 22.2 100.0 1,672 Middle/JSS/JHS 70.6 3.0 26.4 100.0 3,862 Secondary+ 65.8 4.8 29.4 100.0 2,070 Wealth quintile Lowest 75.4 2.1 22.5 100.0 1,511 Second 72.2 2.8 24.9 100.0 1,636 Middle 73.0 2.9 24.0 100.0 1,938 Fourth 73.2 3.3 23.5 100.0 2,117 Highest 73.4 4.3 22.3 100.0 2,194 Total 73.4 3.2 23.4 100.0 9,396 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Table 3.6.2 shows that the proportion of men age 15-49 who are currently employed (82 percent) is higher than the proportion of women (73 percent). The percentage of currently employed men is lowest in the 15-19 age group (45 percent). Similar to women, never-married men (64 percent) and those with no living children (66 percent) are much less likely to be currently employed than ever-married men (96-99 percent) and men with living children (98-100 percent). Men living in rural areas (86 percent) are more likely to be currently employed than men in urban areas (79 percent). Current employment among men ranges from 76 percent among residents of Upper West to 88 percent among men living in Brong Ahafo and Northern (88 percent each). Men with no education (99 percent) and those in the lowest wealth quintile (86 percent) are more likely to be currently employed when compared with the other subgroups. Twenty-three percent of women and 15 percent of men were not employed during the 12 months preceding the survey. 44 • Characteristics of Respondents Table 3.6.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Ghana 2014 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 45.1 4.4 50.4 100.0 855 20-24 74.7 5.3 20.0 100.0 588 25-29 92.1 3.2 4.7 100.0 589 30-34 98.6 0.8 0.6 100.0 552 35-39 99.5 0.2 0.3 100.0 473 40-44 98.8 0.7 0.5 100.0 456 45-49 98.7 0.0 1.3 100.0 355 Marital status Never married 64.4 4.7 30.9 100.0 1,851 Married or living together 99.0 0.3 0.7 100.0 1,846 Divorced/separated/widowed 95.8 2.2 2.0 100.0 172 Number of living children 0 66.1 4.4 29.4 100.0 1,944 1-2 98.2 0.9 0.9 100.0 839 3-4 98.6 0.3 1.0 100.0 649 5+ 99.6 0.0 0.4 100.0 437 Residence Urban 79.1 2.8 18.1 100.0 2,050 Rural 85.9 2.2 11.9 100.0 1,819 Region Western 85.9 3.4 10.7 100.0 447 Central 79.3 2.6 18.1 100.0 380 Greater Accra 81.1 2.5 16.5 100.0 831 Volta 80.9 3.6 15.2 100.0 295 Eastern 76.8 1.8 21.4 100.0 362 Ashanti 82.2 2.1 15.7 100.0 680 Brong Ahafo 87.6 2.8 9.6 100.0 320 Northern 88.0 0.7 11.3 100.0 316 Upper East 82.6 3.3 14.1 100.0 146 Upper West 76.0 4.0 20.0 100.0 91 Education No education 99.3 0.4 0.3 100.0 362 Primary 82.5 2.9 14.5 100.0 543 Middle/JSS/JHS 80.1 2.0 17.9 100.0 1,626 Secondary+ 80.3 3.5 16.2 100.0 1,336 Wealth quintile Lowest 85.6 2.0 12.4 100.0 639 Second 83.3 2.7 13.9 100.0 648 Middle 83.9 3.1 13.0 100.0 770 Fourth 78.8 2.4 18.8 100.0 848 Highest 81.2 2.3 16.5 100.0 963 Total 15-49 82.3 2.5 15.2 100.0 3,869 50-59 97.7 0.3 2.1 100.0 519 Total 15-59 84.1 2.2 13.7 100.0 4,388 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 3.6.2 Occupation Respondents who were currently employed or who had worked in the 12 months preceding the survey were asked to state their occupation. The results presented in Tables 3.7.1 and 3.7.2 show the percent distribution of currently employed women and men by occupation, and background characteristics. The type of occupation varies greatly by gender. The leading occupation among women is sales and services, which employs more than half of women (51 percent). Other occupations in which women are engaged include agriculture (24 percent), skilled manual labour (14 percent), professional, technical, or managerial work (7 percent), and unskilled manual labour and clerical positions (2 percent each). Characteristics of Respondents • 45 Among men, on the other hand, agriculture is the leading occupation, with 35 percent of men engaged in this occupation. Twenty percent of men report doing skilled manual labour, 15 percent are engaged in unskilled manual labour, 14 percent do professional, technical, or managerial work or work in sales and services, and only 2 percent do clerical work. The percentage of women and men age 15-49 who work in agriculture has decreased since the 2008 GDHS survey, dropping from 30 percent to 24 percent for women and from 41 percent to 35 percent for men. The relationship between occupation and age varies. One notable finding is that the proportion of young women and men engaged in agriculture is relatively high among youth age 15-19 (28 percent for women and 53 percent for men); then it decreases somewhat, before it increases again for the older respondents age 40-49. Table 3.7.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Ghana 2014 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Total Number of women Age 15-19 2.2 0.3 53.4 13.6 2.8 27.7 100.0 576 20-24 9.7 3.0 50.6 15.2 2.4 18.9 100.0 1,057 25-29 13.3 2.7 47.8 15.8 2.2 17.9 100.0 1,366 30-34 7.3 1.7 52.0 15.1 2.0 21.6 100.0 1,215 35-39 5.7 0.8 52.6 13.8 1.8 24.8 100.0 1,206 40-44 3.5 0.8 51.6 12.3 1.8 29.9 100.0 973 45-49 4.6 0.8 46.8 9.0 2.1 36.8 100.0 800 Marital status Never married 13.1 3.9 50.7 16.1 3.0 13.0 100.0 1,657 Married or living together 5.9 1.0 48.7 13.1 1.4 29.5 100.0 4,647 Divorced/separated/widowed 3.7 0.3 60.0 13.4 4.0 18.3 100.0 891 Number of living children 0 14.4 4.5 50.6 14.8 2.8 12.8 100.0 1,647 1-2 8.5 1.4 55.7 16.0 1.9 16.2 100.0 2,311 3-4 4.0 0.5 53.1 12.8 2.3 27.1 100.0 1,920 5+ 1.2 0.0 37.9 10.5 1.3 49.0 100.0 1,317 Residence Urban 10.2 2.5 64.0 14.9 2.4 5.7 100.0 3,871 Rural 3.9 0.5 34.9 12.6 1.8 46.1 100.0 3,323 Region Western 6.3 1.7 54.5 14.5 1.8 21.1 100.0 758 Central 7.6 1.0 53.6 16.0 2.0 19.6 100.0 726 Greater Accra 11.7 3.1 66.1 12.7 4.2 2.2 100.0 1,531 Volta 7.2 0.4 38.3 19.4 0.9 33.5 100.0 501 Eastern 7.9 0.6 60.6 8.7 1.2 20.8 100.0 618 Ashanti 7.3 2.3 54.8 14.6 2.2 18.5 100.0 1,449 Brong Ahafo 4.6 1.0 36.2 14.7 0.5 43.0 100.0 595 Northern 2.0 0.3 22.8 10.3 0.3 64.2 100.0 615 Upper East 3.0 0.5 35.3 13.6 3.6 44.1 100.0 248 Upper West 4.3 0.4 13.2 19.4 1.5 59.4 100.0 153 Education No education 0.6 0.0 30.6 11.9 1.7 55.1 100.0 1,589 Primary 0.9 0.0 51.9 14.8 2.8 29.4 100.0 1,301 Middle/JSS/JHS 1.5 0.4 62.2 17.9 2.1 15.8 100.0 2,843 Secondary+ 31.7 7.1 48.4 7.4 2.0 3.0 100.0 1,462 Wealth quintile Lowest 0.4 0.1 17.9 11.2 1.2 69.3 100.0 1,171 Second 1.0 0.3 32.8 13.4 1.8 50.5 100.0 1,228 Middle 3.9 0.4 56.2 17.6 3.2 18.5 100.0 1,471 Fourth 8.7 2.1 69.3 14.8 2.2 2.5 100.0 1,621 Highest 18.3 4.1 63.1 12.0 2.0 0.4 100.0 1,703 Total 7.3 1.6 50.6 13.9 2.1 24.3 100.0 7,195 Note: Totals may not add up to 100 percent because women with missing information are not shown separately. 46 • Characteristics of Respondents Place of residence has a significant effect on type of occupation. As expected, a high proportion of respondents in rural areas, 46 percent of employed women and 61 percent of employed men—are engaged in agricultural work. Urban women (64 percent) are more likely to be engaged in sales and services, while urban men are more likely to be engaged in skilled manual labour (28 percent). Rural regions such as Northern have a high proportion of women and men who work in agriculture (64 percent and 75 percent, respectively). Urban regions, such as Greater Accra, by contrast, have a high proportion of women and men who work in sales and service (66 percent of women and 24 percent of men), and who do professional, technical or managerial work (12 percent of women and 22 percent of men). About one-fifth of women in Volta and Upper West regions (19 percent each) and more than one-quarter of men living in Greater Accra, Volta and Ashanti regions (26-27 percent) are engaged in skilled manual labor. Table 3.7.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Ghana 2014 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 4.2 0.9 14.6 15.3 11.9 53.0 0.2 100.0 423 20-24 11.2 3.1 17.1 21.6 16.9 29.9 0.2 100.0 471 25-29 20.2 2.2 11.1 22.8 15.2 27.7 0.7 100.0 561 30-34 17.6 2.6 15.1 23.2 14.6 26.8 0.1 100.0 549 35-39 16.9 1.8 12.3 20.1 16.8 30.5 1.6 100.0 472 40-44 11.6 0.9 13.0 18.3 15.5 40.6 0.1 100.0 454 45-49 14.6 2.6 14.5 19.6 9.3 39.0 0.4 100.0 350 Marital status Never married 15.3 2.8 16.7 19.4 12.9 32.4 0.4 100.0 1,278 Married or living together 13.1 1.6 12.0 21.5 14.9 36.3 0.6 100.0 1,833 Divorced/separated/widowed 16.4 0.9 13.1 14.9 23.3 31.4 0.0 100.0 169 Number of living children 0 15.6 2.7 16.3 20.1 12.9 31.9 0.3 100.0 1,371 1-2 18.0 1.8 12.9 22.7 18.0 26.1 0.6 100.0 831 3-4 9.9 1.5 14.0 21.1 17.2 35.4 0.9 100.0 643 5+ 8.6 0.9 8.1 15.4 9.3 57.5 0.2 100.0 435 Residence Urban 20.6 2.8 20.5 28.4 17.6 9.5 0.6 100.0 1,679 Rural 7.4 1.2 7.0 12.0 11.3 60.8 0.4 100.0 1,601 Region Western 8.7 2.2 15.6 18.3 19.7 35.3 0.3 100.0 399 Central 18.4 2.7 13.9 17.9 15.7 31.1 0.2 100.0 311 Greater Accra 21.8 3.0 23.9 25.8 19.7 5.3 0.6 100.0 694 Volta 9.9 0.2 4.9 27.0 9.7 45.9 2.3 100.0 249 Eastern 16.5 2.6 9.7 18.8 15.1 36.1 1.2 100.0 285 Ashanti 15.9 2.5 16.5 27.2 16.1 21.9 0.0 100.0 573 Brong Ahafo 8.4 1.2 6.7 16.1 9.6 58.0 0.0 100.0 289 Northern 7.6 0.8 5.3 6.4 4.4 75.3 0.2 100.0 280 Upper East 4.7 0.0 9.9 9.1 7.5 68.9 0.0 100.0 125 Upper West 9.7 0.2 4.0 10.5 6.0 68.9 0.7 100.0 73 Education No education 1.5 0.0 7.2 6.0 8.6 76.7 0.0 100.0 361 Primary 2.8 0.3 6.4 17.0 14.2 59.2 0.0 100.0 464 Middle/JSS/JHS 3.8 0.8 14.9 28.5 18.7 32.8 0.5 100.0 1,335 Secondary+ 35.4 4.8 17.9 16.7 11.6 12.7 0.9 100.0 1,119 Wealth quintile Lowest 0.7 0.0 2.8 5.0 3.4 88.1 0.0 100.0 559 Second 5.1 0.5 5.3 12.5 8.5 67.9 0.3 100.0 557 Middle 9.5 2.1 12.8 24.1 19.9 31.3 0.5 100.0 670 Fourth 14.9 2.7 19.9 32.7 23.1 5.9 0.8 100.0 689 Highest 33.0 3.9 23.4 22.9 14.8 1.4 0.7 100.0 804 Total 15-49 14.2 2.0 13.9 20.4 14.6 34.5 0.5 100.0 3,280 50-59 12.3 2.4 7.5 14.3 13.0 50.6 0.0 100.0 509 Total 15-59 13.9 2.1 13.0 19.6 14.3 36.7 0.4 100.0 3,788 The percentage of respondents who work in agriculture decreases notably with increasing level of education and wealth. For example, 55 percent of women with no education work in agriculture compared with just 3 percent of those with a secondary or higher education. Furthermore, less than 1 percent of the wealthiest women work in agriculture compared with 69 percent of women in the lowest wealth quintile. Characteristics of Respondents • 47 As expected, the opposite patterns are observed for professional, technical, or managerial work. The percentage of respondents who work in these fields is highest among those with a secondary or higher education and among the wealthiest respondents. The same pattern is also observed among men who work in sales in services. 3.6.3 Earnings, Employers, and Continuity of Employment Table 3.8 shows the percent distribution of women age 15-49 employed in the 12 months preceding the survey by the type of earnings and employer, and continuity of employment, according to type of employment (agricultural or nonagricultural occupations). Overall, 26 percent of employed women in the agricultural sector are not paid at all while 31 percent are paid in cash and in-kind. Women are more likely to be paid in cash if they are employed in the nonagricultural sector; 71 percent of women employed in the nonagricultural sector receive cash earnings, compared with 32 percent of women in the agriculture sector. Fourteen percent of women who work in the nonagricultural sector are not paid, and 13 percent are paid in cash and in-kind. The large majority of women employed in the agricultural and nonagricultural sector are self- employed (70 percent and 66 percent, respectively). Twenty-seven percent of women working in agriculture are employed by family members (27 percent), as compared with only 9 percent of women working in the nonagricultural sector. The opposite pattern is observed for employment by nonfamily members; more than one in four women in the nonagricultural sector is employed by a nonfamily member (26 percent), compared with 4 percent of women who work in the agricultural sector. Sixty-two percent of women who work in agriculture are employed throughout the year, compared with 88 percent of those who do nonagricultural work. Women are more likely to do seasonal work if they work in the agricultural sector than if they work in the nonagricultural sector (35 percent versus 8 percent). Table 3.8 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Ghana 2014 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 32.2 71.4 61.9 Cash and in-kind 31.0 12.7 17.1 In-kind only 11.2 2.3 4.4 Not paid 25.7 13.7 16.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 26.5 8.5 12.9 Employed by nonfamily member 3.9 25.8 20.5 Self-employed 69.6 65.6 66.6 Total 100.0 100.0 100.0 Continuity of employment All year 62.4 87.8 81.7 Seasonal 35.0 8.4 14.9 Occasional 2.5 3.7 3.5 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 1,751 5,429 7,195 Note: Total includes women with missing information on type of employment who are not shown separately. Marriage and Sexual Activity • 49 MARRIAGE AND SEXUAL ACTIVITY 4 his chapter discusses the principal factors other than contraception that affect women’s chances of becoming pregnant. These factors include marriage and sexual activity. Marriage signals the onset of exposure to the risk of pregnancy for most women, and thus it is an important fertility indicator. In the context of the 2014 GDHS, marriage also includes living with partners in consensual but informal unions. In addition, this chapter includes information on more direct measures of the beginning of exposure to pregnancy and level of exposure, for example age at first sexual intercourse and frequency of recent sexual intercourse. 4.1 CURRENT MARITAL STATUS Table 4.1 shows current marital status by age and sex. Fifty-seven percent of women and 48 percent of men age 15-49 are currently in a union; 42 percent and 38 percent, respectively, are married and 14 percent and 10 percent, respectively, are living together with a partner. A higher proportion of men (48 percent) than women (33 percent) have never been married. In combination, the percentage who are divorced, separated, or widowed is almost three times as high among women as among men (11 percent and 4 percent, respectively). The proportion of women and men who have never been married decreases sharply with age, from more than 9 in 10 respondents age 15-19 to 1 percent of women and 4-5 percent of men in the 40-49 age group. By contrast, the proportion of currently married women increases rapidly from 2 percent among women age 15-19 to 19 percent among those age 20-24 and peaks at 65 percent among women age 35-44. Among men, the percentage currently married also increases sharply with age, from less than 1 percent in the youngest age group to 5 percent among those age 20-24 and a high of 79-80 percent among men age 40-49. T Key Findings: • Median age at first marriage increased somewhat between the 2008 and 2014 GDHS surveys, from 19.8 to 20.7 years among women age 25-49 and from 25.9 years to 26.4 years among men age 30-59. • The proportion of women married by age 15 ranges from 2 percent among women age 15-19 to 11 percent among women age 45-49. • Ghanaian men marry later than women. • The proportion of currently married women and men in polygynous unions is on the decline. Over the last six years, it has decreased from 18 percent to 16 percent among women and from 9 percent to 7 percent among men age 15-49. • The median age at first sexual intercourse among respondents age 25-49 is lower among women (18.4 years) than among men (19.8 years). • Overall, 44 percent of never-married men have never had sexual intercourse, as compared with 38 percent of never-married women. • Eleven percent women and 5 percent men age 25-49 had their first sex by age 15, and 44 percent of women and 27 percent of men had their first intercourse by age 18. • Forty-three percent of women and 46 percent of men age 15-49 were sexually active during the four weeks preceding the survey. 50 • Marriage and Sexual Activity The proportion of respondents who are divorced, separated, or widowed tends to increase with age among both women and men. Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Ghana 2014 Marital status Total Percentage of respondents currently in union Number of respondents Age Never married Married Living together Divorced Separated Widowed WOMEN 15-19 92.8 2.3 4.1 0.1 0.7 0.0 100.0 6.4 1,625 20-24 57.9 19.4 18.2 0.7 3.7 0.1 100.0 37.6 1,613 25-29 27.1 45.9 20.3 1.5 3.9 1.3 100.0 66.2 1,604 30-34 9.9 61.3 17.3 3

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